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Foot and Ankle Clinics Jun 2023Lateral ankle ligament sprains and syndesmotic injuries are two different entities. However, they may be combined under the same spectrum depending on the arch of... (Review)
Review
Lateral ankle ligament sprains and syndesmotic injuries are two different entities. However, they may be combined under the same spectrum depending on the arch of violence during the injury. Currently, the clinical examination has a limited value in the differential diagnosis between an acute anterior talofibular ligament rupture and a syndesmotic high ankle sprain. However, its use is indispensable for raising a high index of suspicion for detecting these injuries. Based on the mechanism of injury, clinical examination plays an essential role in guiding further imaging and early diagnosis of low/high ankle instability.
Topics: Humans; Ankle; Lateral Ligament, Ankle; Ankle Joint; Physical Examination; Sprains and Strains; Joint Instability; Ankle Injuries
PubMed: 37137620
DOI: 10.1016/j.fcl.2022.12.004 -
The International Journal of... Jun 2020Drawing on Winnicott's renowned concept of regression to dependence, the author elaborates on both the creative potential and limitations of this notion, examining some...
Drawing on Winnicott's renowned concept of regression to dependence, the author elaborates on both the creative potential and limitations of this notion, examining some theoretical and clinical contributions from his own psychoanalytic practice with neurotic and psychotic children. First, the author questions and discusses the theoretical difficulties that arise in the conception of regression to dependence. In particular, he analyses the matter of psychic temporality and passivity. Second, the author considers how analysts can receive and foster the regression to dependence, and examines the use of limited physical contact in the treatment of severely disturbed children.
Topics: Child; Dependency, Psychological; Female; Humans; Male; Psychoanalytic Interpretation; Psychoanalytic Theory; Regression, Psychology
PubMed: 33945701
DOI: 10.1080/00207578.2020.1754836 -
The Medical Clinics of North America Sep 2010The dizzy patient often presents a challenge to the physician. The history is the most important component of the evaluation of the dizzy patient and often allows the... (Review)
Review
The dizzy patient often presents a challenge to the physician. The history is the most important component of the evaluation of the dizzy patient and often allows the cause of the dizziness to be categorized as peripheral or central. Peripheral causes include benign paroxysmal positional vertigo, Meniere's disease, and vestibular neuritis. Central causes include migraine-associated dizziness, postconcussion syndromes, cerebrovascular disease, and multiple sclerosis. Treatment depends on the cause of the dizziness and may include dietary modifications, diuretics, vestibular suppressants, vestibular rehabilitation, or surgical intervention.
Topics: Dizziness; Humans; Magnetic Resonance Imaging; Physical Examination; Tomography, X-Ray Computed; Vertigo
PubMed: 20736108
DOI: 10.1016/j.mcna.2010.05.011 -
Advances in Pediatrics Aug 2023Sudden cardiac death is defined as an abrupt, unexpected death of cardiovascular cause with loss of consciousness within 1 hour of onset of symptoms. In an effort to... (Review)
Review
Sudden cardiac death is defined as an abrupt, unexpected death of cardiovascular cause with loss of consciousness within 1 hour of onset of symptoms. In an effort to prevent these events, clinicians need to recognize symptoms to identify at risk patients. There is often an overlap in symptoms of chest pain, palpitations, and syncope. The workup depends on the characteristics of these symptoms. The history and physical examination often provide adequate information, but additional testing and referral to pediatric cardiology are sometimes indicated.
Topics: Humans; Child; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Syncope; Chest Pain; Physical Examination
PubMed: 37422295
DOI: 10.1016/j.yapd.2023.04.003 -
Biomedical Engineering Online May 2022Falls among older adults have become a global concern. While previous studies have established associations between autonomic function indicator; heart rate variability...
BACKGROUND
Falls among older adults have become a global concern. While previous studies have established associations between autonomic function indicator; heart rate variability (HRV) and blood pressure variability (BPV) with fall recurrence, as well as physical inactivity and psychological disorders as risk factors for falls, the influence of physical activity and psychological status on autonomic dysfunction observed among older fallers has not been adequately investigated. The aim of this study was to evaluate the relationship between psychological disorder and physical performance on the autonomic nervous system (ANS) in older fallers. We hypothesised that older fallers have poorer autonomic function, greater dependency on others and were associated with psychological disorders. Furthermore, we hypothesised that both physical performance and psychological status can contribute to the worsening of the autonomic function among the elderly.
METHODS
In this cross-sectional survey, adults aged ≥ 60 years were recruited. Continuous non-invasive BP was monitored over 5 min of supine and 3 min of standing. Psychological status was assessed in terms of depression, anxiety, stress, and concern about falling, while functional status was measured using time-up-and-go, functional reach, handgrip and Lawton's Instrumental Activities of Daily Life (IADL) scale.
RESULTS
A total of 62 participants were recruited consisting of 37 fallers and 25 non-fallers. Multivariate analysis revealed that Lawton IADL was independently associated with systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) during both supine (SBPV: r = 0.080, p = 0.025; DBPV: r = 0.064, p = 0.046) and standing (SBPV: r = 0.112, p = 0.008; DBPV: r = 0.105, p = 0.011), while anxiety score was independently associated with SBPV and DBPV during standing (SBPV: r = 0.112, p = 0.009; DBPV: r = 0.105, p = 0.011) as compared to the other parameters.
CONCLUSION
Our findings suggest that fallers had poorer ANS, greater dependence in IADLs, and were more anxious. IADL dependency and anxiety were the most predictive of autonomic dysfunction, and can be used in practice to identify poor autonomic function for the prevention of falls and cardiovascular diseases among older adults.
Topics: Aged; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cross-Sectional Studies; Hand Strength; Humans; Physical Functional Performance
PubMed: 35513815
DOI: 10.1186/s12938-022-00996-7 -
Health and Quality of Life Outcomes May 2011The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU...
BACKGROUND
The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors.
METHODS
We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score.
RESULTS
One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life.
CONCLUSIONS
In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Cognition; Comorbidity; Critical Care; Critical Illness; Dependency, Psychological; Female; Follow-Up Studies; Forecasting; Health Status; Humans; Intensive Care Units; Length of Stay; Male; Prospective Studies; Quality of Life; Risk Factors; Survivors
PubMed: 21575208
DOI: 10.1186/1477-7525-9-35 -
Nutrition, Metabolism, and... Dec 2023The assessment of muscle mass using technology-based methods is less commonly performed when applying the Global Leadership Initiative on Malnutrition (GLIM) criteria...
Anthropometric measures and physical examination could be used to assess phenotypic GLIM (Global leadership initiative on malnutrition) criteria in heart failure patients.
BACKGROUND AND AIMS
The assessment of muscle mass using technology-based methods is less commonly performed when applying the Global Leadership Initiative on Malnutrition (GLIM) criteria due to the lack of skilled clinical nutrition practitioners and/or equipment. Based on the predictive validity of poor health outcomes and feasibility in clinical practice, this study aimed to analyze whether the measurement of calf circumference (CC), mid-upper arm circumference (MAC), and the physical examination could be used as substitutes for muscle mass assessment, as well as handgrip strength (HGS) used as a substitution when applying the GLIM criteria in hospitalized HF patients.
METHODS AND RESULTS
From June 2022 to January 2023, a single-center prospective study including 216 patients was performed. Additionally, covariates were identified by a directed acyclic graph. The multivariate logistic regression analysis was also used to analyze and compare the association between poor health outcomes and malnutrition (based on 5 types of GLIM criteria). Cohen-kappa coefficient and TELOS-feasibility score were calculated. The prevalence of malnutrition ranged from 35.2% to 42.6%, depending on the tool used. After adjusting for covariates, malnutrition assessed using CC, MAC, or physical examination within the GLIM criteria was independently associated with poor clinical outcomes (90-day HF-related readmission or all-cause mortality and prolonged hospital stay) but not with HGS.
CONCLUSION
CC, MAC and results from physical examination but not HGS may serve as a substitutive metric of muscle mass contained in the GLIM criteria to diagnose malnutrition and predict poor clinical outcomes among HF patients.
REGISTRATION NUMBER
This study was registered at Chinese Clinical Trial Registry. (ChiCTR2200057876) on 20 Mar. 2022.
Topics: Humans; Hand Strength; Leadership; Prospective Studies; Heart Failure; Physical Examination; Malnutrition; Nutrition Assessment; Nutritional Status
PubMed: 37788948
DOI: 10.1016/j.numecd.2023.07.034 -
The American Journal of Physiology Jun 1960
Topics: Blood Viscosity; Humans; Physical Examination; Radius; Viscosity
PubMed: 14400362
DOI: 10.1152/ajplegacy.1960.198.6.1193 -
PloS One 2023Circadian rhythms (CR) regulate daily cycles in behavior, physiology and molecular processes. CRs are endogenous and vary across individuals. Seasonal changes can...
INTRODUCTION
Circadian rhythms (CR) regulate daily cycles in behavior, physiology and molecular processes. CRs are endogenous and vary across individuals. Seasonal changes can influence CR. Accordingly, rhythms with different characteristics (amplitude, phase) are depicted during the summer months, as compared to winter. Increasing evidence points to an influence of circadian regulation on physical performance. Here, we aim to obtain a comprehensive circadian gene expression profile for physically active individuals, which can potentially be used for the identification of optimal time intervals for physical exercise.
METHODS AND ANALYSIS
To explore these different aspects, we propose a study where we will carry out a molecular analysis of CR by measuring the expression of specific clock and clock-controlled genes, based on a non-invasive approach using RNA extracted from saliva in physically active, healthy participants. We will collect data across two seasons and use computational algorithms to integrate the molecular data with hormonal data (cortisol and melatonin), and generate a profile of CR in healthy individuals of different sex and age groups. Finally, we will use computational tools to predict optimal time intervals for physical performance based on the above-described data, thereby retrieving valuable data on the circadian clock as a key factor for health maintenance and optimization.
Topics: Humans; Circadian Clocks; Prospective Studies; Circadian Rhythm; Melatonin; Physical Examination
PubMed: 37874792
DOI: 10.1371/journal.pone.0293226 -
Health Reports Feb 2007
Topics: Adolescent; Adult; Aged; Canada; Child; Dependency, Psychological; Fatigue Syndrome, Chronic; Female; Fibromyalgia; Humans; Male; Mental Health; Middle Aged; Multiple Chemical Sensitivity; Quality of Life; Somatoform Disorders
PubMed: 17441443
DOI: No ID Found