Annie B Friedrich
Every day around the country, patients are discharged from hospitals without difficulty, as the interests of the hospital and the patient tend to align: both the hospital and the patient want the patient to leave and go to a setting that will promote the patient's continued recovery. In some cases, however, this usually routine process does not go quite as smoothly. Patients may not want to leave the hospital, or they may insist on an unsafe discharge plan. In other cases, there may simply be no good place for the patient to go...
August 4, 2020: Theoretical Medicine and Bioethics
Nagasubramanyam Vempalli, Sireesha Reddy Konda, Nidhi Kaeley, Bharat B Bhardwaj, Subodh Kumar
Diaphragmatic hernia (DH) is a common condition following blunt trauma to upper abdomen and is also a commonly missed diagnosis. Its early anticipation in post-traumatic setting is very important to avoid any further life-threatening sequelae. X-ray chest with a nasogastric tube is a simpler way to diagnose this condition. CT scan is a gold standard tool to confirm diagnosis. Due to wide availability of ultrasound (US) in emergency room (ER), this tool will decide the correct way of further evaluation avoiding unnecessary delays in management...
May 2020: Journal of Family Medicine and Primary Care
Krithiga Ramachandran, Reshu Agarwal, Chhagan Bihari, Vikram Bhatia, Ekta Gupta
We report a case of 55-year-old female with chief complaints of fever and deranged liver function tests, diagnosed as autoimmune hepatitis (AIH) and under immunosuppressive therapy for two years. Following the failure in clinical improvement, she was started on anti-tubercular therapy (ATT). While investigating the underlying etiology, virological markers for Hepatitis A to E were found to be negative with plasma Epstein-Barr virus (EBV) viral load of 5 log10 copies/ml. Additional investigation of the liver biopsy showed Hodgkin's lymphoma (HL)...
May 2020: Journal of Family Medicine and Primary Care
Juan Francisco Sánchez-Ortega, Jesús Aguas-Valiente, Patricia Sota-Ochoa, Juan Calatayud-Pérez
Background: Glioblastoma with primitive neuronal components (GB/PNC) is an extremely rare type of glioblastoma characterized by presenting histological and cytogenetic features of both entities. The mixed nature of these tumors limits the imaging diagnosis and supposes a therapeutic dilemma. Case Description: We present the case of a 77-year-old female with a GB/PNC who is treated with surgery and adjuvant radiochemotherapy according to the STUPP protocol, where an abnormal uptake of 5-aminolevulinic acid (5-ALA) is evident during surgery in probable relation to the mixed nature of GB/PNC...
2020: Surgical Neurology International
Carl-Joar Karlsson, Julie Rowlett
In numerous contexts, individuals may decide whether they take actions to mitigate the spread of disease, or not. Mitigating the spread of disease requires an individual to change their routine behaviours to benefit others, resulting in a 'disease dilemma' similar to the seminal prisoner's dilemma. In the classical prisoner's dilemma, evolutionary game dynamics predict that all individuals evolve to 'defect.' We have discovered that when the rate of cooperation within a population is directly linked to the rate of spread of the disease, cooperation evolves under certain conditions...
August 4, 2020: Scientific Reports
Sohil Khan, Michael R Gionfriddo, Nicolas Cortes-Penfield, Girish Thunga, Muhammad Rashid
INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide and has contributed to over 650,000 deaths. This review synthesizes the literature on COVID-19 pharmacotherapy to inform practice and policymaking. AREAS COVERED: The authors systematically review the published literature on COVID-19 therapeutics, grouping candidate treatments into repurposed, adjunct, and experimental agents...
August 4, 2020: Expert Opinion on Pharmacotherapy
Donghwi Park, Min Cheol Chang
The health insurance system in Korea is well-established and provides benefits for the entire national population. In Korea, when patients are treated at a hospital, the hospital receives a partial payment for the treatment from the patient, and the remaining amount is provided by the health insurance service. The Health Insurance Review and Assessment Service (HIRA) assesses whether the treatment was appropriate. If HIRA deems the treatment appropriate, the doctor can receive payment from the health insurance service...
July 2020: Journal of Preventive Medicine and Public Health
Péter Rajna
Background - Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose - To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods - Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation...
July 30, 2020: Ideggyógyászati Szemle
S Metselaar, M V van Schaik, A C Molewijk, G A M Widdershoven
Dealing with euthanasia requests can be a complex matter for a doctor. How to determine whether the due diligence criteria of the Dutch Euthanasia Act are met in cases that are not straightforward? We argue that moral case deliberation (MCD), methodically structured reflective discussions on concrete moral dilemmas, can provide support in dealing with complex euthanasia requests. In this article, we discuss a case that was talked about during a MCD (in particular the CURA method, where CURA stands for 'concentrating, postponing, reflecting and action') by a group of GPs and nurses who met in the context of a network for ambulatory palliative care...
June 18, 2020: Nederlands Tijdschrift Voor Geneeskunde
S P C Groen
BACKGROUND: The accumulation of health problems as grounds for euthanasia often poses a challenge for physicians. The distinction between the accumulation of health problems and a 'completed life' is sometimes hard to make. Suffering is subjective and the question is if and to what extent pronounced anticipatory suffering and detachment should be considered in the request for euthanasia. CASE: A very old lady, who sets great store by propriety, requests euthanasia because she feels she will no longer be able to live an independent life...
June 18, 2020: Nederlands Tijdschrift Voor Geneeskunde
Sarah Rosanel, Joshua Fogel
No abstract text is available yet for this article.
August 2020: Southern Medical Journal
Frank R Noyes
The altered knee joint function and symptomatic state in younger patients after meniscectomy and progressive tibiofemoral arthritis remain an important unsolved treatment dilemma. Meniscal allograft transplantation has evolved as an acceptable treatment because there are few (if any) other options. The procedure is effective in most patients, who experience a decrease in tibiofemoral pain and improved knee function, even allowing a return to light recreational activities. However, biological remodeling of the implant occurs over time, with replacement of the complex circumferential and radial fibers with disorganized collagen tissues and altered cellular and proteoglycan components that affects load bearing and negates chondroprotective function...
August 2020: Arthroscopy
B Casolla, C Cordonnier
Antithrombotic therapy is a cornerstone for secondary prevention of ischaemic events, cerebral and extra-cerebral. A number of clinical questions remain unanswered concerning the impact of antithrombotic drugs on the risk of first-ever and recurrent macro or micro cerebral haemorrhages, raising the clinical dilemma on the risk/benefit balance of giving antiplatelets and anticoagulants in patients with potential high risk of brain bleeds. High field magnetic resonance imaging (MRI) blood-weighted sequences, including susceptibility weighted imaging (SWI), have expanded the spectrum of these clinical questions, because of their increasing sensitivity in detecting radiological markers of small vessel disease...
July 31, 2020: Revue Neurologique
Karin J Kuhn, Jeffrey M Cloutier, Robert D Boutin, Robert Steffner, Geoffrey Riley
Radiologists serve an important role in the diagnosis and staging of soft tissue tumors, often through participation in multidisciplinary tumor board teams. While an important function of the radiologist is to review pertinent imaging and assist in the differential diagnosis, a critical role is to ensure that there is concordance between the imaging and the pathologic diagnosis. This requires a basic understanding of the pathology of soft tissue tumors, particularly in the case of diagnostic dilemmas or incongruent imaging and histologic features...
August 2, 2020: Skeletal Radiology
Hiromu Ito, Jun Tanimoto
[This corrects the article DOI: 10.1098/rsos.181085.].
June 2020: Royal Society Open Science
Lars Mehlum, Christian Schmahl, Ann Berens, Stephan Doering, Joost Hutsebaut, Andres Kaera, Ueli Kramer, Paul Anthony Moran, Babette Renneberg, Joaquim Soler Ribaudi, Sebastian Simonsen, Michaela Swales, Svenja Taubner, Ester di Giacomo
Background: Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice...
2020: Borderline Personality Disorder and Emotion Dysregulation
Jaya Naidu, Pritha Bhattacharya, Joyce P Mendonsa, Manju M, Kirthana Satish
Aim: The following case report discusses the diagnostic dilemma presented by and the multidisciplinary management of a patient with chronic atypical facial pain of psychogenic origin. Background: Though oral health care professionals are primarily concerned with the treatment of somatic disorders of the orofacial region, there remains a particularly challenging need to identify, diagnose and treat various psychological and psychosomatic symptoms. Case description: This case report describes the management of a 13-year-old male patient with the chief complaint of pain and discoloration of the skin over the right side of the face for the last 5 months, who also demonstrated symptoms of chronic anxiety and social withdrawal...
March 2020: International Journal of Clinical Pediatric Dentistry
Gabor Bagameri, John M Stulak
No abstract text is available yet for this article.
July 11, 2020: Journal of Thoracic and Cardiovascular Surgery
Matteo Prencipe, Tommaso Perossini, Giampaolo Brancoli, Mario Perossini
PURPOSE: Visual electrophysiological testing continues to generate interest among glaucoma experts because of its potential help in clarifying disease pathophysiology and promoting early detection of glaucomatous damage. The photopic negative response (PhNR) is a slow negative component of the full-field electroretinogram that has been shown to provide specific information about retinal ganglion cells (RGCs) activity. The purpose of this article is to review the literature to explore the currently available measurement methods and the utility of PhNR in glaucoma diagnostic process...
July 31, 2020: International Ophthalmology
Dorothy Smok, Kenneth M Prager
Bioethical conflicts in pregnancy are distinguished from those in other areas of medicine due to competing interests between mother and fetus because of their shared biology. Historically, prior to the advent of fetal therapy and advances in medical technology, the maternal-fetal complex was considered to be a single entity. With advances in medicine, treatment options can now be directed at both the mother and the fetus, and a duality has evolved in the maternal-fetal unit. Thus at some point during pregnancy, two individuals rather than just one are the responsibility of the physician...
2020: Handbook of Clinical Neurology
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