Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of ...suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes.
Key points
1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance.
2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis.
3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.
A 2001 survey found that most healthcare professionals considered intensive care unit (ICU) delirium as a serious problem, but only 16% used a validated delirium screening tool. Our objective was to ...assess beliefs and practices regarding ICU delirium and sedation management.
Between October 2006 and May 2007, a survey was distributed to ICU practitioners in 41 North American hospitals, seven international critical care meetings and courses, and the American Thoracic Society e-mail database.
A convenience sample of 1384 healthcare professionals including 970 physicians, 322 nurses, 23 respiratory care practitioners, 26 pharmacists, 18 nurse practitioners and physicians' assistants, and 25 others.
A majority 59% (766 of 1300) estimated that more than one in four adult mechanically ventilated patients experience delirium. More than half 59% (774 of 1302) screen for delirium, with 33% of those respondents (258 of 774) using a specific screening tool. A majority of respondents use a sedation protocol, but 29% (396 of 1355) still do not. A majority (76%, 990 of 1309) has a written policy on spontaneous awakening trials (SATs), but the minority of respondents (44%, 446 of 1019) practice spontaneous awakening trials on more than half of ICU days.
Delirium is considered a serious problem by a majority of healthcare professionals, and the percent of practitioners using a specific screening tool has increased since the last published survey data. Although most respondents have adopted specific sedation protocols and have an approved approach to stopping sedation daily, few report even modest compliance with daily cessation of sedation.
Abstract
Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality ...score, originally developed in the United Kingdom, for a Canadian population, and to examine its performance over time. We conducted an external validation study within a registry of COVID-19 positive hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4, 2020 and June 13, 2021. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. The study included 959 individuals, of whom 224 (23.4%) died in-hospital. Median age was 72 years and 524 individuals (55%) were male. The AUC of the 4C score was 0.77, 95% confidence interval 0.79–0.87. Overall mortality rates across the pre-defined risk groups were 0% (Low), 8.0% (Intermediate), 27.2% (High), and 54.2% (Very High). Wave 1, 2 and 3 values of the AUC were 0.81 (0.76, 0.86), 0.74 (0.69, 0.80), and 0.76 (0.69, 0.83) respectively. The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian hospitals and can be used to prioritize care and resources for patients at greatest risk of death.
Feto maternal outcome in pregnancy with fever Prajapati, Dipika D; Patel, Shlok V; Panchal, Nirali P ...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology,
06/2024, Letnik:
13, Številka:
6
Journal Article
Odprti dostop
Background: Infection in pregnancy is a common clinical problem worldwide. The risk to the mother and the fetus is significantly increased in pregnancy complicated by fever. Effect of fever depends ...on the extent and duration of temperature elevation, socioeconomic status and nutritional status of mother, pre-existing co-morbidity, timing of exposure in pregnancy and several other factors. So, here we have carried out study on symptomatic antenatal patients to determine the fetomaternal outcome of various infections during pregnancy. Methods: This prospective observational study is done to determine fetomaternal outcome of 80 antenatal patients admitted during antepartum period with fever with infectious etiology at the department of obstetrics and gynecology, At SMT. SCL hospital, between 1st April 2023 to 30th September 2023, who were either delivered or aborted. Results: Out of 80 cases of fever in pregnancy, most common cause of fever was urinary tract infection (UTI) (31.3%) followed by upper respiratory infection (25%). fever was associated with antenatal complication such as abortion (13.8%), preterm delivery (23.7%), PROM, PPROM and etc. fetal outcome were preterm birth (23.7%), low birth weight (40%), neonatal mortality (2.5%). Conclusions: Infection during pregnancy is a commonly encountered feature that results in an extensive array of both maternal and fetal complications. The most common cause of fever was UTI. So, all women coming for first antenatal check-up should be investigated for the presence of asymptomatic genitourinary infection. early diagnosis and treatment of them adequately with the antimicrobials decreasing the associated neonatal and maternal morbidities. Keywords: Fever, Preterm, UTI
Background: Iron deficiency anemia (IDA) is described as decrease in the hemoglobin and/or the amount of red blood cells in the blood due to iron insufficiency in the body. The aim of the study was ...to measure the efficacy and tolerability of iron sucrose in iron deficiency anemia in pregnant women. Methods: This was the prospective study of 50 pregnant women with iron deficiency anemia (Hb-5 g/dl to 8 g/dl) between 20-34 weeks of gestation, who were given intravenous iron sucrose as per their requirements and follow up measurement of Hb was done. Results: Mean rise in Hb was seen by 2.2 g/dl. Minor side effects were seen in 6 out of 50 participants. Conclusions: Parenteral iron sucrose therapy can be used effectively and safely in pregnant women with iron deficiency anemia Keywords: Iron deficiency anemia in pregnancy, Parenteral iron therapy, Intravenous iron sucrose in pregnancy
Abstract Objective To predict biliary stent occlusion on computed tomography (CT) from the loss of pneumobilia. Methods A total of 66 patients with common bile duct stents with pneumobilia after ...initial stent placement had a follow-up CT and diagnostic endoscopic retrograde cholangiopancreatography (ERCP). Two readers evaluated all CT exams for pneumobilia. Resolution or decrease of pneumobilia on CT was compared with ERCP findings. Results Sensitivity and specificity was 60–64% and 95% with a positive predictive value of 97% and a negative predictive value of 49–51%. Conclusion Resolution or reduction of pneumobilia after stent placement is specific (95%) and is moderately accurate (70–73%) for predicting biliary stent occlusion.
Background
The objective of this study was to find out the effect, course of disease and management of the COVID-19 infection in pregnant women and compare it with non-pregnant population.
Method
...This is a retrospective study done at Sardar Vallabhbhai Patel Institute of Medical Science and Research (SVPIMSR), Smt. NHL MMC, Ahmedabad, from April 1, 2020, to September 30, 2020
.
All COVID-19-positive patients were divided into two groups: group A was comprised of pregnant/postpartum and group B of non-pregnant patients.
Result
A total of 709 women (Group A-205, Group B-504) were included in the study, In group A 90% of patients were asymptomatic, while in group B 48% asymptomatic patients. Group A had 5.9% and group B had 13.1% patients having comorbidities. In group A, smaller number of patients had raised inflammatory markers as compared to group B. Only 4% patients of group A showed significant changes on chest X-ray as compared to 16% in group B. Only 2.9% patients of group A required intensive care unit admission as compared to 10.31% patients of group B. Mean hospital stay of group A was 10.6 days, and that of group B was 12.1 days.
Conclusion
In pregnancy, due to the physiological alterations in cardiovascular, respiratory and immune system, the pregnant women are vulnerable to infections. Although pregnancy is immunocompromised state, the severity of Coivd-19 disease is milder as compared to non-pregnant COVID-19-positive patients.
Background: Meconium staining amniotic fluid is associated with lots of adverse outcome and has long been considered to be a bad predictor of fetal outcome. This prospective observational study was ...undertaken to find out immediate fetal outcome in meconium-stained liquor.Methods: The design of the study was prospective. This study was conducted from July 2021 to December 2021.The study included women with meconium-stained amniotic fluid in labor with gestational age >37 completed weeks.Results: Total 100 cases were enrolled. Majority of the patients (74%) were in the age group of 21-30 years with the mean age being 24.6±2.4 years. Fetal distress occurred in 30% of babies, more in association with thick meconium (15%). Caesarean deliveries were 70%. Apgar scores between 0-3 was seen in 17% babies and 1% at fifth minute, between 4-6 in 21% babies and between 7-10 in 62% babies at first minute of birth. Admission in neonatal ward was 32% with perinatal mortality of 6%.Conclusions: Meconium-stained amniotic fluid was associated with higher rate of caesarean delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission and mortality. It is more commonly associated with pregnancy induced hypertension (PIH), post-datism, oligohydramnios and gestational diabetes mellitus.
•Immune checkpoint inhibitors can be safely administered to patients with dermatomyositis.•Immunosuppressants did not impact the efficacy of treatment with an immune check point inhibitor.•Patients ...with autoimmune disorders who require immune check point inhibitors should be monitored by a rheumatologist.
Existing trials have not evaluated the feasibility of oral or nasal feeding tube (FT) placement in the critically ill thrombocytopenic oncology population. Thrombocytopenia (TCP) may be considered a ...contraindication to FT placement due to the potential risk of bleeding complications.
Medical intensive care unit (ICU) adult oncology patients with attempted nasal or oral FT placement were evaluated in a 52-bed ICU at a comprehensive cancer center. End points were compared between patients with and without TCP (platelet count <150,000/μL). Primary outcomes of overt and clinically important bleeding (gastrointestinal and point of entry) were evaluated within 72 hours of FT placement.
Fifty-nine patients were enrolled (TCP, n = 42; no TCP, n = 17; baseline platelet count, 41 ± 48 vs 249 ± 85 × 10(3)/μL, P < .001). Patients with TCP were more likely to have a hematologic malignancy and lower baseline hemoglobin and platelet count (P < .01). More patients with TCP received blood products 24 hours prior to FT placement (86% vs 12%, P < .01). There was no difference in overt (7.1% vs 0%, P = .55) or clinically important (2.4% vs 5.9%, P = .5) bleeding complications within 72 hours of attempted FT placement among patients with TCP versus those without.
Critically ill oncology patients with TCP do not appear to be at a higher risk for bleeding complications after FT placement compared with those without TCP, which may be related to blood product transfusion within 24 hours prior to FT placement.
PDF
