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World Journal of Methodology Sep 2023Compensated liver cirrhosis (CLC) is defined as cirrhosis with one or more decompensating events, such as ascites, variceal haemorrhage, or hepatic encephalopathy.... (Review)
Review
Compensated liver cirrhosis (CLC) is defined as cirrhosis with one or more decompensating events, such as ascites, variceal haemorrhage, or hepatic encephalopathy. Patients with CLC are largely asymptomatic with preserved hepatic function. The transition from CLC to decompensated cirrhosis occurs as a result of a complex interaction between multiple predisposing and precipitating factors. The first decompensation event in CLC patients is considered a significant turning point in the progression of cirrhosis, as it signals a drastic decline in median survival rates from 10-12 years to only 1-2 years. Furthermore, early cirrhosis has the potential to regress as liver fibrosis is a dynamic condition. With the advent of effective non-invasive tools for detecting hepatic fibrosis, more and more patients with CLC are currently being recognised. This offers clinicians a unique opportunity to properly manage such patients in order to achieve cirrhosis regression or, at the very least, prevent its progression. There are numerous emerging approaches for preventing or delaying decompensation in CLC patients. A growing body of evidence indicates that treating the underlying cause can lead to cirrhosis regression, and the use of non-selective beta-blockers can prevent decompensation by lowering portal hypertension. Additionally, addressing various cofactors (such as obesity, diabetes, dyslipidaemia, and alcoholism) and precipitating factors (such as infection, viral hepatitis, and hepatotoxic drugs) that have a detrimental impact on the natural course of cirrhosis may benefit patients with CLC. However, high-quality data must be generated through well-designed and adequately powered randomised clinical trials to validate these disease-modifying techniques for CLC patients. This article discussed the natural history of CLC, risk factors for its progression, and therapeutic approaches that could alter the trajectory of CLC evolution and improve outcomes.
PubMed: 37771878
DOI: 10.5662/wjm.v13.i4.179 -
Sante Publique (Vandoeuvre-les-Nancy,... 2021Prevention is one of the main priorities for the « Santé de Défense 2019-2022 » strategy. In the current climate where the application of...
INTRODUCTION
Prevention is one of the main priorities for the « Santé de Défense 2019-2022 » strategy. In the current climate where the application of preventive measures is a daily challenge, it is necessary, in conjunction with the target cohort, to develop and agree occupational health policies.
OBJECTIVE
Having analyzed several papers outlining techniques to generate a co-developed strategy, we created a participation-based process which could be applied to the crew of a French Navy vessel. The main objective was for the crew to implement the health strategies as outlined in a co-developed policy.
RESULTS
The study highlighted precipitating factors of health within the target group (lack of empathetic management, family separation, workplace stress) for which potential solutions were discussed.
CONCLUSION
This paper puts forward solutions to remedy the problems encountered in creating a co-developed strategy, as well as pathways for the implementation of participative processes.
Topics: Cohort Studies; Government Agencies; Health Policy; Humans; Occupational Health; Occupational Stress
PubMed: 34553869
DOI: 10.3917/spub.212.0245 -
International Journal of Surgery Case... Oct 2021Cecal volvulus is a rare clinical condition. It is characterized by axial twist of caecum, terminal ileum and the ascendant right colon around their mesenteric pedicles....
INTRODUCTION AND IMPORTANCE
Cecal volvulus is a rare clinical condition. It is characterized by axial twist of caecum, terminal ileum and the ascendant right colon around their mesenteric pedicles. The main pathophysiologic mechanism is cecal hyper mobility associated to precipitating factor such as colonic tumor, abdominal mass or pregnancy. Cecal volvulus during pregnancy was reported, but it remains exceptional during postpartum period.
CLINICAL PRESENTATION
We report a case of cecal volvulus occurring in 37-year-old woman ten days after cesarean section delivery. She presented an acute abdominal pain associated to vomiting and nausea. X ray imaging and abdominal CT showed a large colonic obstruction, the caecum was dilated and located in the left hypochondrium. An open surgery was performed showing twisted bowels involving the caecum, the ileocecal junction and the right colon. There were necrotic areas on the colonic wall. Right hemicolectomy was performed with end to side ileo-colostomy. The evolution was marked by a serious septic shock causing patient's death.
CLINICAL DISCUSSION
Cecal volvulus is a rare condition. Its suggested mechanism associates cecal hyper mobility to a precipitating factor. Increased uterine volume may explain cecal volvulus during pregnancy. In post-partum period, it may be explained by rapid uterine size variation. Cecal volvulus diagnosis is challenging. In fact, its symptoms can be confused with post operative ileus after cesarean section delivery. Delayed management leads to worst prognosis.
CONCLUSION
Cecal volvulus during post-partum period is a rare condition, it may be serious in case of delayed diagnosis.
PubMed: 34607265
DOI: 10.1016/j.ijscr.2021.106461 -
Injury Nov 2023Tendon injury accounts for 30% of musculoskeletal diseases and often leads to disability, pain, healthcare cost, and lost productivity. Following injury to tendon,... (Review)
Review
Tendon injury accounts for 30% of musculoskeletal diseases and often leads to disability, pain, healthcare cost, and lost productivity. Following injury to tendon, tendon healing proceeds via three overlapping healing processes. However, due to the structural defects of the tendon itself, the tendon healing process is characterized by the formation of excessive fibrotic scar tissue, and injured tendons rarely return to native tendons, which can easily contribute to tendon reinjury. Moreover, the resulting fibrous scar is considered to be a precipitating factor for subsequent degenerative tendinopathy. Despite this, therapies are almost limited because underlying molecular mechanisms during tendon healing are still unknown. Transforming Growth Factor-β1 (TGF-β1) is known as one of most potent profibrogenic factors during tendon healing process. However, blockage TGF-β1 fails to effectively enhance tendon healing. A detailed understanding of real abilities of TGF-β1 involved in tendon healing can bring promising perspectives for therapeutic value that improve the tendon healing process. Thus, in this review, we describe recent efforts to identify and characterize the roles and mechanisms of TGF-β1 involved at each stage of the tendon healing and highlight potential roles of TGF-β1 leading to the fibrotic response to tendon injury.
Topics: Humans; Transforming Growth Factor beta1; Cicatrix; Tendons; Wound Healing; Tendon Injuries; Fibrosis
PubMed: 37738787
DOI: 10.1016/j.injury.2023.111052 -
Brain and Behavior Dec 2021Migraine is a main form of headache, it is also a chronic and complex neuroinflammatory disease; it is characterized by recurrent severe headaches, usually affecting one...
BACKGROUND
Migraine is a main form of headache, it is also a chronic and complex neuroinflammatory disease; it is characterized by recurrent severe headaches, usually affecting one side of the head, and often accompanied by nausea and blurred vision. In susceptible individuals, irritants can trigger migraine attacks, which can be considered as triggers or accelerators.
OBJECTIVE
To describe the precipitating factors, clinical presentation, and treatment of migraine headache in Sudanese patients.
METHODS
This is a descriptive hospital-based prospective study covering 130 patients during the study period from January 2016 to December 2018. At the National Centre for Neurological Science, Khartoum, participants were Sudanese patients with migraine headache after exclusion of other causes of headache. Data was collected using structured questionnaire entered and analyzed using SPSS version 22.0, p value < .05 is considered significant.
RESULTS
The study covered 130 study participants most of them were females (80%), within 26-35 years of age (56.9%) and a considerable proportion of them were housewives (40%). The majority of the study participants had headache without aura in 81.5% and headache with aura in 18.5% (mainly visual type 87.5%). Photophobia and nausea were the main associated symptoms in 51.5% and 50%, respectively. Acetaminophen was the main prescribed treatment in 46.1%, beta blockers was the main prophylaxis in 29.2%. Environmental triggers were the prevalent predisposing factors (43.8%) followed by fasting, lack of sleep, and exertion (24.6% for each).
CONCLUSION
Environmental conditions were the commonest triggering factors of migraine headache, while Acetaminophen was the most common drug used for relieving migraine in this population.
Topics: Epilepsy; Female; Headache; Humans; Migraine Disorders; Prospective Studies; Sudan
PubMed: 34775687
DOI: 10.1002/brb3.2429 -
Acta Clinica Croatica Apr 2023The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender...
The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender and severity of diabetic ketoacidosis. Medical records from January 1, 2017 until December 31, 2019 were reviewed and patients diagnosed with diabetic ketoacidosis were selected. The study included 52 patients, median age 34 (interquartile range 21-56) years. There was no statistically significant difference between male and female gender. The severity of diabetic ketoacidosis was moderate in the majority of cases (65.4%; p=0.005). The most common precipitating factor was infection (61.7%). In patients with moderate diabetic ketoacidosis, respiratory infections were more common, while gastrointestinal infections were more common in severe diabetic ketoacidosis (33% and 25%, respectively; p=0.03). Nausea (median age 32 years; p=0.004) and vomiting (median age 31 years; p=0.01) were more common in younger age groups, while altered mental status was more common in the older age group (median age 61 years; p=0.001). Infection was the most common precipitating factor. The most common symptoms in younger age groups were nausea and vomiting, and altered mental status in the older age group.
Topics: Humans; Male; Female; Aged; Young Adult; Adult; Middle Aged; Diabetic Ketoacidosis; Diabetes Mellitus, Type 1; Precipitating Factors; Vomiting; Nausea
PubMed: 38304369
DOI: 10.20471/acc.2023.62.01.08 -
Clinical Implant Dentistry and Related... Aug 2023Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis... (Review)
Review
BACKGROUND
Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis is a site-specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri-implant disorders.
PURPOSE
The purpose of the present review is to shed light on the significance of local and systemic factors on peri-implant diseases, making special emphasis on the associations with peri-implantitis.
METHODS
The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri-implant diseases.
RESULTS
Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri-implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri-implant diseases. Robust data points toward the strong link between residual sub-mucosal cement and peri-implant diseases, while limited data suggests the impact of residual sub-mucosal floss and peri-implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri-implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri-implant diseases.
CONCLUSION
Local predisposing/precipitating factors and systemic drivers may increase the risk of peri-implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically-driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.
Topics: Humans; Peri-Implantitis; Dental Implants; Precipitating Factors; Disease Susceptibility; Smoking; Risk Factors
PubMed: 36533411
DOI: 10.1111/cid.13155 -
World Journal of Hepatology Apr 2022Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated... (Review)
Review
Hepatic encephalopathy (HE) is a reversible syndrome of impaired brain function and represents one of the many complications of portal hypertension and decompensated liver disease. Although ammonia is clearly implicated in the pathogenesis of HE, the pathogenesis of HE is multifactorial with numerous mechanisms that results in functional impairment of neuronal cells. The initial management of HE focuses on supportive care and stabilization which includes providing appropriate nutritional support. Thereafter, focus should be on identifying and treating the precipitating factors. There are many therapeutic agents available for the management of HE, most of which are directed towards lowering the gut nitrogen load and thus the serum ammonia level. This review aims to provide an update on the conventional and emerging treatment options for HE.
PubMed: 35646276
DOI: 10.4254/wjh.v14.i4.670 -
Anasthesiologie, Intensivmedizin,... Sep 2023Postoperative delirium (POD) is a complex disorder with significant implications for health and well-being. Over the last few years, there has been a significant...
Postoperative delirium (POD) is a complex disorder with significant implications for health and well-being. Over the last few years, there has been a significant increase in awareness of the pathophysiological processes, the different clinical forms and the prevention of POD. It is known that POD develops when anaesthetic- and surgery-related precipitating factors coincide with the patient's predisposing vulnerability. Consequently, assessing the preoperative physical, cognitive, psychological, social and resilience capabilities of patients scheduled for surgery is critical to assessing overall risk and determining optimal preoperative, intraoperative and postoperative management, particularly as pharmacological treatment options remain limited. For treatment, non-pharmacological measures remain in the foreground, pharmacological therapy is only used for severe symptoms, and should be symptom-oriented and low-dosed. There is no drug that is suitable for delirium treatment alone.
Topics: Humans; Emergence Delirium; Physical Examination
PubMed: 37725992
DOI: 10.1055/a-2065-3780 -
Annals of Palliative Medicine Nov 2019Delirium is a syndrome characterized by acute onset of changes in awareness and cognition, which fluctuate in severity during the episode. Altered mental status (AMS)... (Review)
Review
Delirium is a syndrome characterized by acute onset of changes in awareness and cognition, which fluctuate in severity during the episode. Altered mental status (AMS) and delirium have a high incidence rate among patients with cancer and this increases dramatically towards the end of life. Delirium is multifactorial, as cancer patients have an array of predisposing and precipitating factors: metabolic disturbances, structural lesions, in addition to medications and infection. The complex nature of delirium in cancer patients and the high variability of its presentation make its diagnosis and management challenging and frequently missed. Management of delirium requires identifying and correcting the precipitating cause if feasible. Diagnosis of delirium requires a high index of suspicion, and a systematic assessment to confirm the diagnosis and identify the possible cause. This includes detailed history and comprehensive physical examination together with the use of diagnostic tools, for example: Confusion Assessment Method (CAM) tool. Given the considerable distress cancer patients suffer from, clinicians must assure safety of patients with delirium and safety of the medical team caring for the patient. Family members should be provided with counseling and support.
Topics: Delirium; Female; Humans; Male; Neoplasms; Prognosis
PubMed: 31735040
DOI: 10.21037/apm.2019.09.14