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Evaluation of the Selection associated with Medico-Magic Information on Four Herbaceous Varieties inside Benin.
Background Diabetes impairs the body's ability to produce or respond to the hormone insulin resulting in abnormal metabolism of carbohydrates and elevated glucose levels in the body. Because of these factors, diabetes can cause several complications that include heart disease, stroke, hypertension, eye complications, kidney disease, skin complications, vascular disease, nerve damage, and foot problems. Diabetes education allows patients to explore effective interventions into living their life with diabetes and incorporate the necessary changes to improve their lifestyle. Objective To educate patients diagnosed with diabetes or followed up for diabetes management by other departments with regard to their own responsibility in maintaining preventive foot self-care. Methods Ten patients completed a validated educational foot care knowledge assessment pretest to determine their existing knowledge about their own foot care after a thorough foot assessment. Preventive diabetic foot self-care education was conducted through a lecture, visual aids, and a return demonstration. Patients then took a posttest questionnaire with the same content as the pretest to determine their uptake of the educational content. Results Correct toenail cutting was the most identified educational need. It was a limitation in the pretest (30%), and it remained the lowest-scoring item on the posttest (70%). Walking barefoot was thought to be safe by 60% of participants pretest, but with remedial education, all participants identified this as a dangerous activity posttest. Participants also understood the high importance of having corns and calluses looked after by a health professional. Conclusions Effective communication with patients by healthcare providers who can mold educational content to identified patient needs by teaching much needed skills is a key driver in rendering safe, quality healthcare education interventions.General purpose To provide information about infection with cutaneous larva migrans (CLM). Target audience This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. Learning objectives/outcomes After participating in this educational activity, the participant will1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM. Abstract Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.Background Exercise-based cardiac rehabilitation is safe and effective for adults with chronic heart failure (CHF), yet services are greatly underutilized. However, tai chi is a popular and safe form of exercise among older adults with chronic health conditions. Objective A systematic review and meta-analysis was conducted to examine the benefits of tai chi exercise among persons with CHF. Methods An electronic literature search of 10 databases (Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Embase, OpenGrey, PsycARTICLES, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science) was conducted from January 1, 2004, to August 1, 2019. Clinical trials that examined tai chi exercise, were published in English or German languages, and conducted among participants with CHF were included. Comprehensive Meta-Analysis version 2.0 software (Biostat, Inc) was used to calculate effect sizes (ie, Hedges g) and 95% confidence intervals using random effects models. Results A total of 6 studies met the inclusion criteria, enrolling 229 participants (mean age, 68 years; 28% women; mean ejection fraction = 37%). At least 3 studies reported outcomes for exercise capacity (n = 5 studies), quality of life (n = 5 studies), depression (n = 4 studies), and b-type natriuretic peptide (n = 4 studies), allowing for meta-analysis. Compared with controls, tai chi participants had significantly better exercise capacity (g = 0.353; P = .026, I = 32.72%), improved quality of life (g = 0.617; P = .000, I = 0%), with less depression (g = 0.627; P = .000, I = 0%), and decreased b-type natriuretic peptide expression (g = 0.333; P = .016, I = 0%). Conclusion Tai chi can be easily integrated into existing cardiac rehabilitation programs. Further research is needed with rigorous study designs and larger samples before widespread recommendations can be made.Objective The study aimed to investigate the effect of dry needling (DN) into trigger points of the sternocleidomastoid muscle in migraine headache patients. Design Forty subjects with a migraine headache, originating from myofacial trigger points into the sternocleidomastoid (SCM) muscle (20 subjects in DN group and 20 subjects in control group) volunteered to participate in this study. The subjects in the treatment group received three sessions of dry needling in the myofascial trigger point region. Headache frequency, headache intensity, headache duration, drug consumption, muscle thickness, pressure pain threshold (PPT), and cervical range of motion were assessed before, immediately after intervention, and at one-month follow-up period. Also, this article was extracted from Iranian Register of Clinical Trials number IRCT20171219037956N1. Results The experimental group showed significant reduction in the headache parameters immediately after the intervention and at one month's follow-up, as compared to the control group. The PPT of SCM muscle, cervical range of motion, and muscle thickness significantly increased in the DN group in comparison to the control group (p less then 0.001). Conclusion The application of dry needling technique caused an improvement in symptoms of migraine patients. Therefore, this technique may be prescribed for treating migraine patients with myofacial trigger points in the sternocleidomastoid muscle.In the management of scaphoid fractures, nonunion is an important complication that can lead to carpal instability and early-onset arthritis. Various techniques have been described to treat scaphoid nonunions, yet a clear consensus on the superiority of one method is not yet established. The use of compression staple fixation has been described in the literature and may be a viable alternative to other fixation techniques. Volar Nitinol staple fixation avoids damage to the trapezium during retrograde fixation with a screw. It also avoids damage to the proximal dorsal cartilage, which occurs during anterograde screw fixation. Because of its shape and position on the volar aspect of the scaphoid, staple fixation provides compression, prevents graft extrusion, and avoids taking up space in the medullary canal of the scaphoid. Moreover, it may be technically easier than screw fixation. Despite these advantages, this technique has not been widely adopted. We describe the technique for utilizing Nitinol compression staples and bone grafting in the treatment of scaphoid nonunion.We describe an evolution of the senior author's technique in the repair or reconstruction of foveal triangular fibrocartilage complex tears. This technique uses a transulnar styloid approach, which gives superior access to the fovea, without disruption of secondary stabilizers. A free palmaris longus graft is used to stabilize and augment the triangular fibrocartilage complex with an interosseous anchor through an ulnar tunnel.Introduction Acute care surgery (ACS) was initiated two decades ago to address timeliness and quality in emergency general surgery. We hypothesized that ACS has improved the management of acute appendicitis and biliary disease. Methods A comprehensive systematic review and meta-analysis of outcome studies for emergent appendectomy and cholecystectomy from 1966 to 2017, comparing studies prior to and following ACS implementation. Results Of 1704 studies, 27 were selected for analysis (appendicitis = 16, biliary pathology= 7, both = 4). Following ACS introduction, the complication rate was significantly reduced in both appendectomy and cholecystectomy (Risk ratios = 0.70; 95% CI 0.57 to 0.85; I 9.2% and RR= 0.62; 95% CI 0.41 to 0.94; I 63.5%) respectively. There was a significant reduction in the time from arrival in emergency until admission and from admission to operation (-1.37 hours 95% CI -1.93 to -0.80 and -2.51 hours 95% CI -4.44 to -0.58) in the appendectomy cohort. Time to operation was shorter in the cholecystectomy group (-6.46 hours; 95% CI -9.54 to -3.4). Length of hospital stay was reduced in both groups (appendectomy = -0.9 day, cholecystectomy = -1.09 day). There was a reduction in overall cost in cholecystectomy group (-$854.37 USD; 95% CI -1554.1 to -154.05). No statistical significance was detected for wound infection, abscess, conversion of laparoscopy to open, rate of negative appendectomy, after-hours, readmission and cost. Conclusion The implementation of ACS models in general surgery emergency care has significantly improved system and patient outcomes for appendicitis and biliarypathology. Level of evidence Systematic review and meta-analysis of a retrospective study. Level III.Direct Oral Anticoagulants (DOACs) are widely used among patients requiring anticoagulant therapy. These drugs are associated with a lower risk of bleeding than vitamin K antagonists (VKA). However, the outcomes of elderly trauma patients receiving DOACs are not well known. Methods We reviewed data from trauma patients at our Level I trauma center (University of Pittsburgh Medical Center, Presbyterian Hospital) seen from January 2011 to July 2018. We identified trauma patients taking DOACs or VKA and compared these cohorts using 11 propensity score matching based on patient characteristics, antiplatelet use, comorbidities, and laboratory values. The primary outcome was in-hospital mortality. Secondary outcomes included the proportion of patients discharged to SNF (Skilled nursing facility)/ rehabilitation facility discharge or to home, and transfusion volume. Results Of 32,272 trauma patients screened, 530 were taking DOACs and 1702 were taking VKA. We matched 668 patients in a 11 ratio (DOACs group 334 vs. VKA group 334). selleckchem The DOACs group had similar mortality (4.8% vs. 1.6%, odds ratio (OR) 3.0, 95% confidence interval (CI) 0.31-28.8, p=0.31) among patients less than 65 years-old, but mortality differed (3.0% vs. 6.6%, OR 0.41, 95%CI 0.17-0.99, p=0.048) among patients over 65 years-old. The proportion of patients discharged to SNF/rehabilitation facility (50.0% vs. 50.6%, OR 0.98, 95%CI 0.72-1.32, p=0.88) and to home (40.4% vs. 38.6%, OR 1.08, 95%CI 0.79-1.47, p=0.64) were similar. Patients in the DOACs group received fewer fresh frozen plasma (p=0.032) but packed red blood cells (p=0.86) and prothrombin complex concentrate (p=0.48) were similar. Conclusions In this matched cohort of anticoagulated trauma patients, DOACs were associated with the decreased in-hospital mortality and decreased administration of fresh frozen plasma compared to VKA among trauma patients 65 years of age or greater taking anticoagulant therapy. Level of evidence Therapeutic study, level III.
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