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350314 results in Medicine

Page 15 of 17516

  • Anticoagulation with warfarin for paediatric cardiac indications: a retrospective study

  • Stephen T. O’Brien, Sophie Duignan, Kathleen Crumlish, Jacqueline O’Donoghue, Orla Franklin, Colin J. McMahon
  • Journal:
    Cardiology in the Young , First View
    Published online by Cambridge University Press:
    15 November 2024, pp. 1-6
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  • Warfarin is used as anticoagulation for children for a wide range of cardiac indications but carries the disadvantage of requiring international normalised ratio monitoring and dose adjustment. Management of warfarin therapy is challenging due to its narrow therapeutic window and is further complicated in children by dietary changes, frequent illnesses, and developing systems of metabolism and haemostasis.

    A retrospective review was performed of patients’ medical records to assess the indication for warfarin use, percentage of international normalised ratio values in target range (%ITR), and frequency of phlebotomy.

    Twenty-six patients were identified. The most common indication for warfarin use was in patients post-total cavo-pulmonary connection (n = 19, 73%). We demonstrated a variability in duration of warfarin therapy following total cavo-pulmonary connection (median of 11.1 months). Nineteen (73%) patients had used the CoaguChek machine for home measurement of international normalised ratio. The median frequency of phlebotomy for all indications was once every 10 days, and the median %ITR was 55.4 % (29.7–86.4%). Of note, the percentage under target range in the patients with mechanical mitral (n = 2) and aortic valves (n = 1) was found to be 23% and 33%, respectively.

    These data demonstrate a high frequency of international normalised ratio values outside of the target range as seen in previous studies of warfarin in children. This necessitates frequent phlebotomy and dose changes, which can have a significant effect on the quality of life of these patients and their families highlighting the need to focus on quality improvement in the area of anticoagulation in paediatric cardiac patients.

  • The prefrontal cortex, but not the medial temporal lobe, is associated with episodic memory in middle-aged persons with HIV

  • Laura M. Campbell, Christine Fennema-Notestine, Erin E. Sundermann, Averi Barrett, Mark W. Bondi, Ronald J. Ellis, Donald Franklin, Benjamin Gelman, Paul E. Gilbert, Igor Grant, Robert K. Heaton, David J. Moore, Susan Morgello, Scott Letendre, Payal B. Patel, Scott Roesch, Raeanne C. Moore
  • Journal:
    Journal of the International Neuropsychological Society , First View
    Published online by Cambridge University Press:
    15 November 2024, pp. 1-11
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  • Objective:

    Identifying persons with HIV (PWH) at increased risk for Alzheimer’s disease (AD) is complicated because memory deficits are common in HIV-associated neurocognitive disorders (HAND) and a defining feature of amnestic mild cognitive impairment (aMCI; a precursor to AD). Recognition memory deficits may be useful in differentiating these etiologies. Therefore, neuroimaging correlates of different memory deficits (i.e., recall, recognition) and their longitudinal trajectories in PWH were examined.

    Design:

    We examined 92 PWH from the CHARTER Program, ages 45–68, without severe comorbid conditions, who received baseline structural MRI and baseline and longitudinal neuropsychological testing. Linear and logistic regression examined neuroanatomical correlates (i.e., cortical thickness and volumes of regions associated with HAND and/or AD) of memory performance at baseline and multilevel modeling examined neuroanatomical correlates of memory decline (average follow-up = 6.5 years).

    Results:

    At baseline, thinner pars opercularis cortex was associated with impaired recognition (p = 0.012; p = 0.060 after correcting for multiple comparisons). Worse delayed recall was associated with thinner pars opercularis (p = 0.001) and thinner rostral middle frontal cortex (p = 0.006) cross sectionally even after correcting for multiple comparisons. Delayed recall and recognition were not associated with medial temporal lobe (MTL), basal ganglia, or other prefrontal structures. Recognition impairment was variable over time, and there was little decline in delayed recall. Baseline MTL and prefrontal structures were not associated with delayed recall.

    Conclusions:

    Episodic memory was associated with prefrontal structures, and MTL and prefrontal structures did not predict memory decline. There was relative stability in memory over time. Findings suggest that episodic memory is more related to frontal structures, rather than encroaching AD pathology, in middle-aged PWH. Additional research should clarify if recognition is useful clinically to differentiate aMCI and HAND.

  • A new blood parasite of the accentor birds: description, molecular characterization, phylogenetic relationships and distribution

  • Gediminas Valkiūnas, Tatjana A. Iezhova, Mélanie Duc, Jenny C. Dunn, Staffan Bensch
  • Journal:
    Parasitology , First View
    Published online by Cambridge University Press:
    15 November 2024, pp. 1-11
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  • Haemoproteus bobricklefsi sp. nov. (Haemosporida, Haemoproteidae) was found in the dunnock Prunella modularis and represents the first blood parasite described in accentor birds of the Prunellidae. The description is based on the morphology of blood stages and includes information about a barcoding segment of the mitochondrial cytochrome b gene (lineage hDUNNO01) and the full mitochondrial genome, which can be used for identification and diagnosis of this infection. The new parasite can be readily distinguished from described species of haemoproteids parasitizing passeriform birds due to markedly variable position of nuclei in advanced and fully grown macrogametocytes. Illustrations of blood stages of the new species are given, and phylogenetic analyses based on partial mitochondrial cytochrome b gene sequences and the full mitochondrial genome identified the closely related lineages. DNA haplotype networks showed that transmission occurs in Europe and North America. This parasite was found in the dunnock in Europe and several species of the Passerellidae in North America. It is probably of Holarctic distribution, with the highest reported prevalence in the UK. The parasite distribution seems to be geographically patchy, with preference for areas of relatively cool climates. Phylogenetic analysis suggests that H. bobricklefsi sp. nov. belongs to the Parahaemoproteus subgenus and is probably transmitted by biting midges belonging to Culicoides (Ceratopogonidae). The available data on molecular occurrence indicate that this pathogen is prone to abortive development, so worth attention in regard of consequences for bird health.

  • Seasonal infestation patterns of ticks on Hokkaido sika deer (Cervus nippon yesoensis)

  • Kotaro Shimizu, Michito Shimozuru, Masami Yamanaka, Genta Ito, Ryo Nakao, Toshio Tsubota
  • Journal:
    Parasitology , First View
    Published online by Cambridge University Press:
    15 November 2024, pp. 1-9
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  • Ticks prefer specific feeding sites on a host that are influenced by host–tick and tick–tick interactions. This study focused on the spatiotemporal distribution of ticks in Hokkaido sika deer, an important tick host in Hokkaido, Japan. Tick sampling was performed on the sika deer in the Shiretoko National Park between June and October 2022. Ticks were collected from 9 different body parts of the deer to compare their attachment site preferences. Interspecific and intraspecific relationships among ticks were examined using co-occurrence analysis. The collected ticks were nymphal and adult stages of 4 species: Ixodes ovatus, Ixodes persulcatus, Haemaphysalis japonica and Haemaphysalis megaspinosa. Seasonal variations in tick burden were observed, with I. persulcatus and I. ovatus peaking in June and declining towards October; H. japonica showing low numbers in July and August and increasing from September; and H. megaspinosa appearing from September onwards with little variation. Attachment site preferences varied among species, with a significant preference for the pinna in I. ovatus and I. persulcatus. Haemaphysalis japonica was mainly found on the body and legs between June and August, and shifted to the pinna from September. Haemaphysalis megaspinosa showed a general preference for areas other than the legs. Co-occurrence analysis revealed positive, negative and random co-occurrence patterns among the tick species. Ticks of the same genus and species exhibited positive co-occurrence patterns; I. ovatus showed negative co-occurrence patterns with Haemaphysalis spp. This study revealed the unique attachment site preferences and distinct seasonal distributions of tick species in the Hokkaido sika deer.

An Ounce of Prevention
  • Evidence-Based Prevention for Counseling and Psychology
  • Edited by Sally M. Hage
  • Published online:
    14 November 2024
    Print publication:
    28 November 2024
  • The boundaries of psychology are expanding as growing numbers of psychological scientists, educators, and clinicians take a preventive approach to social and mental health challenges. Offering a broad introduction to prevention in psychology, this book provides readers with the tools, resources, and knowledge to develop and implement evidence-based prevention programs. Each chapter features key points, a list of helpful resources for creating successful intervention programs, and culturally informed case examples from across the lifespan, including childhood, school, college, family, adult, and community settings. An important resource for students, researchers, and practitioners in counseling, clinical, health, and educational psychology, social justice and diversity, social work, and public health.

Neuroprognostication in Critical Care
  • Edited by David M. Greer, Neha S. Dangayach
  • Published online:
    14 November 2024
    Print publication:
    21 November 2024
  • Neuroprognostication in patients with primary neurological diagnoses as well as in critically ill patients with concomitant neurological diagnoses is increasingly complex. With advances in critical care, the focus of the field is progressively moving from survivorship to improving patients' quality of life. This evidence-based resource provides an in-depth analysis of different aspects of prognostication in neurologically critically ill patients, covering how to gather the correct data and synthesize this information at the bedside. Delving into disease specific prognostication such as traumatic brain injury, acute ischemic stroke and delirium, guidance is provided for choosing management strategies based on overall perception of prognostication and shared decision making. Other topics covered include religious and legal issues, palliative care, chronic critical illness and new frontiers including machine learning and biomarkers usage. An online version of the book with expandable figures can be accessed on Cambridge Core, via the code printed inside the cover.

A Clinician's Brief Guide to the Coroner's Court and Inquests
  • Edited by Gabrielle Pendlebury, Derek Tracy
  • Published online:
    14 November 2024
    Print publication:
    21 November 2024
  • The sudden and unexpected death of a patient can be emotionally complex and overwhelming for clinicians. This book will equip medical and other healthcare professionals with the necessary information and skills to fulfil their requirements in the coroner's court confidently and competently and understand their organisation's responsibilities. Practical and straightforward, this book aims to make the unfamiliar territory of the coroner's court transparent, enabling clinicians to negotiate all eventualities. It will provide clinicians with the confidence to turn what can feel like an adversarial situation into an opportunity to engage with an important part of the healthcare system, preventing future deaths and providing understanding to relatives. It also explores the underlying necessity of complying with requirements and suggests ways to cope with the emotional impact. With chapters covering expert witnesses, legal perspectives and managing outcomes, this book is essential for any healthcare professional called to an inquest.

A Practical Guide to Portable Pupillometry
  • Merlin D. Larson
  • Published online:
    14 November 2024
    Print publication:
    21 November 2024
  • The applications and advantages of portable pupillometry for a wide variety of healthcare providers are becoming increasingly evident, with frequent pupil evaluation becoming the protocol throughout critical care and emergency departments. Authored by a world leading expert, this practical, user-friendly book brings together all the research on portable pupillometry and explains the meaning of the various parameters that new portable pupillometers provide. Starting with the anatomy and physiology of the pupil, the book moves on to discuss pharmacological effects, unusual pupillary syndromes, measurement and size of the pupil, pupillary reflex dilation and pupillary unrest. Additional chapters focus on traumatic brain injury, cardiac arrest, intensive care, opioid effect, acute pain and anisocoria and provide valuable clinical examples and case reports. Also featuring an extensive bibliography for further reading, this book is essential reading for all healthcare professionals using the pupil to evaluate drug effects and ischemic/traumatic insults to the brain.

The Complete Guide to Core Surgical Training Interviews
  • Oliver Skan, Kiran Saini
  • Published online:
    14 November 2024
    Print publication:
    21 November 2024
  • Written by the candidates who ranked first and second nationally in the 2023 Core Surgical Training (CST) application process, this book is a definitive guide to success in the CST interview. This book takes candidates through the CST interview process, covering all of the clinical, ethical, and leadership components that an applicant can expect to be tested on. Over 55 clinical and ethics-based cases and hundreds of interview questions are used as part of a spiral curriculum that covers common stations and helps to build a replicable approach to each station. It also covers important aspects of communication and presentation skills. The authors share their tips and tricks for scoring highly, helping candidates to maximise their chances and stand out in a highly competitive field. This book will be an invaluable resource for foundation-year doctors and international medical graduates preparing to apply for CST.

  • Case 39 - “I Hate That Guy … I Can’t Get Any Sleep!”

  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book:
    Clinical Case Studies in Long-Term Care Psychiatry
    Published online:
    31 October 2024
    Print publication:
    14 November 2024, pp 197-201

  • Summary

    Sleep-related complaints are quite common in the long-term care setting. It is estimated that 40-70% of older adults have some type of chronic sleep-related complaint. Up to 50% of these go undiagnosed. Older adults are known to have increased wakefulness at night, increased number of sleep arousals, and increased sleep latency. Older adults are known to have decreased total sleep time, slow wave sleep, REM sleep, and sleep efficiency. Some common sleep-wake cycle disturbances seen in older adults include primary insomnia, delayed sleep phase syndrome, advanced sleep phase syndrome, irregular sleep-wake rhythm, non-24-hour sleep-wake disorder, sleep state misperception, hypersomnia, and narcolepsy. Good nonpharmacologic principles beneficial to sleep quality are often safer and more effective than pharmacologic therapies. These include good sleep hygeine practices, sleep restriction, increased physical activity, limiting daytime naps, and daytime bright light exposure.

  • Case 28 - “My Whole Life Is in There!”

  • from Section 4 - Anxiety and Related Disorders
  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book:
    Clinical Case Studies in Long-Term Care Psychiatry
    Published online:
    31 October 2024
    Print publication:
    14 November 2024, pp 135-139

  • Summary

    Hoarding disorder is now considered one of the obsessive-compulsive and related disorders. It is thought to affect about 6% of those over the age of 70. Symptoms of hoarding disorder are thought to begin in young adulthood and increase in severity with age. Sufferers are likely to be diagnosed late in the course of their disease due to prominent lack of insight, shame, and social stigma. Complications of hoarding disorder include food contamination, malnutrition, medication mismanagement, falls, and eviction from the home. The best treatment outcomes have been shown with cognitive rehabilitation and exposure/sorting therapy. This treatment can be limited by availability of appropriately trained professionals and lack of insight by patients.

  • Case 20 - “I Am Staying Here Illegally”

  • Matthew Gibfried, Saint Louis University School of Medicine, Missouri, George T. Grossberg, Saint Louis University School of Medicine, Missouri
  • Book:
    Clinical Case Studies in Long-Term Care Psychiatry
    Published online:
    31 October 2024
    Print publication:
    14 November 2024, pp 98-102

  • Summary

    Those with depression with psychosis meet the criteria for diagnosis of depression but also experience psychotic symptoms. When individuals with major depressive disorder (MDD) experience delusions, hallucinations, or catatonic symptoms, it is referred to as MDD with psychotic psychosis, also known as psychotic depression. The nature of the psychosis in those with depression is usually mood-congruent somatic, pessimistic, or guilt-related delusions. It is crucial for healthcare providers to diagnose psychotic depression early due to its high risk of suicide and poor response to antidepressant treatment alone. Additional antipsychotic medication is typically necessary, in addition to the antidepressant, for an effective response. Electroconvulsive therapy is more commonly used in those with severe depression with suicidality, catatonia, and those with psychotic depression. Studies have shown a response rate of 70-90% with electroconvulsive therapy in those with severe depression.

  • Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

  • Cecilia E. Jakobsson, Natalie E. Johnson, Brenda Ochuku, Rosine Baseke, Evelyn Wong, Christine W. Musyimi, David M. Ndetei, Katherine E. Venturo-Conerly
  • Journal:
    Cambridge Prisms: Global Mental Health / Volume 11 / 2024
    Published online by Cambridge University Press:
    14 November 2024, e109
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  • Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need.

    We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators.

    The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence.

    Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Page 15 of 17516