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Clinical Medicine (London, England) Aug 2015Radiotherapy is an effective treatment modality and an essential tool in the management of cancer. As the incidence of malignant disease rises it is inevitable that... (Review)
Review
Radiotherapy is an effective treatment modality and an essential tool in the management of cancer. As the incidence of malignant disease rises it is inevitable that physicians will increasingly encounter patients who have presented acutely and require radiotherapy or with a complication from irradiation. This paper explores the basic principles of radiotherapy tailored to the perspective of the acute medical physician and how to manage acute complications. We also discuss the role of radiotherapy in the acutely ill patient and define the need for radiotherapy pathways to ensure that patients receive treatment in a timely manner.
Topics: Humans; Neoplasms; Palliative Care; Time Factors
PubMed: 26407392
DOI: 10.7861/clinmedicine.15-4-382 -
Heliyon Mar 2023Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use... (Review)
Review
Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common, potentially deadly neurological immune related adverse events. When feeling acutely ill, patients will often seek care not from their oncologist but from their family physician, clinics, emergency, and urgent care sites, or other available providers. Thus, while assessing acutely ill cancer patients who are experiencing neurological symptoms, non-oncologists should be prepared to recognize, diagnose, and treat neurological immune related adverse events in addition to more familiar conditions. This narrative review is designed to update acute care clinicians on current knowledge and to present a symptom-based framework for evaluating and treating neurological immune related adverse events based on the leading immunotoxicity organizations' latest recommendations.
PubMed: 36851967
DOI: 10.1016/j.heliyon.2023.e13725 -
Singapore Medical Journal Mar 2016The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic... (Review)
Review
The acutely obstructed airway is a medical emergency that can potentially result in serious morbidity and mortality. Apart from the latest advancements in anaesthetic techniques, equipment and drugs, publications relevant to our topic, including the United Kingdom's 4th National Audit Project on major airway complications in 2011 and the updated American Society of Anesthesiologists' difficult airway algorithm of 2013, have recently been published. The former contained many reports of adverse events associated with the management of acute airway obstruction. By analysing the data and concepts from these two publications, this review article provides an update on management techniques for the acutely obstructed airway. We discuss the principles and factors relevant to the decision-making process in formulating a logical management plan.
Topics: Acute Disease; Airway Management; Airway Obstruction; Anesthesia; Anesthetics; Humans
PubMed: 26996162
DOI: 10.11622/smedj.2016050 -
Korean Journal of Anesthesiology Dec 2017Hyperglycemia is commonly observed in critical illness. A landmark large randomized controlled trial (RCT) reported that the incidence of hyperglycemia (blood glucose... (Review)
Review
Hyperglycemia is commonly observed in critical illness. A landmark large randomized controlled trial (RCT) reported that the incidence of hyperglycemia (blood glucose concentration > 108 mg/dl) was as high as 97.2% in critically ill patients. During the past two decades, a number of RCTs and several meta-analyses and network meta-analyses have been conducted to determine the optimal target for acute glycemic control. The results of those studies suggest that serum glucose concentration would be better to be maintained between 144 and 180 mg/dl. Although there have been studies showing an association of hypoglycemia with worsened clinical outcomes, a causal link has yet to be confirmed. Nonetheless, some researchers are of the view that the data suggest even mild hypoglycemia should be avoided in critically ill patients. Since acutely ill patients who receive insulin infusion are at a higher risk of hypoglycemia, a reliable devices for measuring blood glucose concentrations, such as an arterial blood gas analyzer, should be used frequently. Acute glycemic control in patients with premorbid hyperglycemia is a novel issue. Available literature suggests that blood glucose concentrations considered to be desirable and/or safe in non-diabetic critically ill patients might not be desirable in patients with diabetes. Moreover, the optimal target for acute blood glucose control may be higher in critically ill patients with premorbid hyperglycemia. Further study is required to assess optimal blood glucose control in acutely ill patients with premorbid hyperglycemia.
PubMed: 29225740
DOI: 10.4097/kjae.2017.70.6.591 -
Scandinavian Journal of Trauma,... Apr 2014Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with... (Review)
Review
Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition. In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a "minimal handling approach" is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.
Topics: Acute Disease; Bronchiolitis; Disease Management; Humans; Infant
PubMed: 24694087
DOI: 10.1186/1757-7241-22-23 -
Nutrients May 2023The beneficial impact of dietary fiber on the prevention and management of several chronic conditions associated with aging, including diabetes, neurodegenerative,... (Review)
Review
The beneficial impact of dietary fiber on the prevention and management of several chronic conditions associated with aging, including diabetes, neurodegenerative, cardiovascular diseases, and cancer, is well-known. High fiber intake has been associated with reduced inflammatory mediators counteracting the low-grade chronic inflammation typical of older age. In addition, dietary fiber improves postprandial glucose response and insulin resistance. In contrast, during acute diseases, its effects on insulin resistance and modulation of immune response are unclear. The aim of this narrative is to summarize the evidence for the potential impact of dietary fiber on inflammation and insulin resistance in older adults, with a particular focus on those acutely ill. Available evidence suggests that dietary fiber has the potential to counteract acute inflammation and to improve metabolic health. In addition, modulation of gut microbiota composition may contribute to improved immune function, particularly in the setting of aging-associated dysbiosis. This phenomenon has relevant implications in those acutely ill, in whom dysbiosis can be exacerbated. Our review leads to the conclusion that dietary interventions based on fiber manipulation could exploit its beneficial effects on inflammation and insulin resistance, if conducted from a precision nutrition perspective. This could also be true for the acutely ill patient, even though strong evidence is lacking.
Topics: Humans; Aged; Insulin Resistance; Dysbiosis; Inflammation; Dietary Fiber; Glucose
PubMed: 37242248
DOI: 10.3390/nu15102365 -
Medicine and Science in Sports and... Jan 2020Previous studies report memory and functional connectivity of memory systems improve acutely after a single aerobic exercise session or with training, suggesting that... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Previous studies report memory and functional connectivity of memory systems improve acutely after a single aerobic exercise session or with training, suggesting that the acute effects of aerobic exercise may reflect initial changes that adapt over time. In this trial, for the first time, we test the proof-of-concept of whether the acute and training effects of aerobic exercise on working memory and brain network connectivity are related in the same participants.
METHODS
Cognitively normal older participants (N = 34) were enrolled in a randomized clinical trial (NCT02453178). Participants completed fMRI resting state and a face working memory N-back task acutely after light- and moderate-intensity exercises and after a 12-wk aerobic training intervention.
RESULTS
Functional connectivity did not change more after moderate-intensity training compared with light-intensity training. However, both training groups showed similar changes in cardiorespiratory fitness (CRF) (maximal exercise oxygen uptake, V˙O2peak), limiting group-level comparisons. Acute effects of moderate-intensity aerobic exercise on connections primarily in the default network predicted training enhancements in the same connections. Working memory also improved acutely, especially after moderate-intensity, and greater acute improvements predicted greater working memory improvement with training. Exercise effects on functional connectivity of right lateralized frontoparietal connections were related to both acute and training gains in working memory.
CONCLUSIONS
Our data support the concept of acute aerobic exercise effects on functional brain systems and performance as an activity-evoked biomarker for exercise training benefits in the same outcomes. These findings may lead to new insights and methods for improving memory outcomes with aerobic exercise training.
Topics: Aged; Aged, 80 and over; Brain; Cardiorespiratory Fitness; Cognition; Exercise; Female; Humans; Magnetic Resonance Imaging; Male; Memory, Short-Term; Middle Aged; Physical Conditioning, Human; Proof of Concept Study
PubMed: 31385912
DOI: 10.1249/MSS.0000000000002115 -
The Journal of Physiology May 2011Reactive oxygen and nitrogen species (ROS/RNS) are important for skeletal muscle function under both physiological and pathological conditions. ROS/RNS induce long-term... (Review)
Review
Reactive oxygen and nitrogen species (ROS/RNS) are important for skeletal muscle function under both physiological and pathological conditions. ROS/RNS induce long-term and acute effects and the latter are the focus of the present review. Upon repeated muscle activation both oxygen and nitrogen free radicals likely increase and acutely affect contractile function. Although fluorescent indicators often detect only modest increases in ROS during repeated activation, there are numerous studies showing that manipulations of ROS can affect muscle fatigue development and recovery. Exposure of intact muscle fibres to the oxidant hydrogen peroxide (H(2)O(2)) affects mainly the myofibrillar function, where an initial increase in Ca(2+) sensitivity is followed by a decrease. Experiments on skinned fibres show that these effects can be attributed to H(2)O(2) interacting with glutathione and myoglobin, respectively. The primary RNS, nitric oxide (NO()), may also acutely affect myofibrillar function and decrease the Ca(2+) sensitivity. H(2)O(2) can oxidize the sarcoplasmic reticulum Ca(2+) release channels. This oxidation has a large stimulatory effect on Ca(2+)-induced Ca(2+) release of isolated channels, whereas it has little or no effect on the physiological, action potential-induced Ca(2+) release in skinned and intact muscle fibres. Thus, acute effects of ROS/RNS on muscle function are likely to be mediated by changes in myofibrillar Ca(2+) sensitivity, which can contribute to the development of muscle fatigue or alternatively help counter it.
Topics: Action Potentials; Animals; Excitation Contraction Coupling; Humans; Muscle Contraction; Muscle Fatigue; Muscle Strength; Muscle, Skeletal; Oxidation-Reduction; Oxidative Stress; Reactive Nitrogen Species; Reactive Oxygen Species; Sarcoplasmic Reticulum; Time Factors
PubMed: 21041533
DOI: 10.1113/jphysiol.2010.199059 -
Cureus Dec 2023Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic...
Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.
PubMed: 38288181
DOI: 10.7759/cureus.51337