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Dental and also Gum Care in the Plan Employing a Lightweight Tooth Unit in Hospitalized Specific Wants Patients: The Experience of the German Child fluid warmers Medical center.
Acne vulgaris is common among adolescents in our country. The identification of various modifiable factors related to acne generates opportunities to tailor and focus prevention efforts and better management and treatment planning in relevant high-risk groups. © 2020 Wiley Periodicals LLC.Rates of thrombosis and bleeding episodes are both increased in patients with advanced chronic kidney disease (CKD). The pathogenic mechanisms of thrombosis in these patients include platelet activation, increased formation of platelet-leukocyte conjugates, and platelet-derived microparticles, as well as effects of uremic toxins on platelets. On the other side of the coin, platelet hyporeactivity mediated by uremic toxins and anemia contributes to the increased bleeding risk in advanced CKD. Platelets also contribute to the inflammatory environment, thus increasing the risk of cardiovascular diseases in these patients. This review provides insights into the altered platelet function in advanced stages of CKD and their relationship with risks of thrombosis and bleeding. Particularly, the effect of dialysis on platelets will be discussed. Furthermore, therapeutic options with respect to thrombotic disorders as well as bleeding in patients with CKD are reviewed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.The impact of thrombocytopenia varies widely depending on the underlying pathophysiology driving it. The biggest challenge in managing thrombocytopenia in pregnancy is accurately identifying the responsible pathophysiology-a task made difficult given the tremendous overlap in clinical and laboratory abnormalities associated with different thrombocytopenia processes. The most common etiologies of thrombocytopenia in pregnancy range from physiology deemed benign to those that are life-threatening to the mother and fetus. Even in cases in which the responsible etiology is deemed benign, such as gestational thrombocytopenia, there are still implications for the management of labor and delivery, a time where hemostatic challenges may prove life-threatening. In most institutions, a minimum platelet count will be mandated for epidural anesthesia to be deemed a safe option. The causes of thrombocytopenia can also include diagnoses that are pregnancy-specific (such as preeclampsia or gestational thrombocytopenia), potentially triggered by pregnancy (such as thrombotic thrombocytopenic purpura), or unrelated to or predating the pregnancy (such as liver disease, infections, or immune thrombocytopenia purpura). It is imperative that the source of thrombocytopenia is identified accurately and expeditiously, as intervention can range from observation alone to urgent fetal delivery. In this review, the approach to diagnosis and the pathophysiological mechanisms of the most common etiologies of thrombocytopenia in pregnancy and associated management issues are presented. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.This is a review of the evidence for the use of different platelet count thresholds prior to invasive procedures and surgery. This review will focus on three procedures that are common in patients with thrombocytopenia-central venous catheter insertion, liver biopsy, and lumbar punctures and epidural catheters-as well as highlighting the lack of evidence for more major surgery. Tunneled or untunneled central venous catheters are low-risk procedures and can be safely performed without any intervention when the platelet count is 20 × 109/L or above. Evidence for their safety is more limited below this threshold, but as bleeding is easily treated, interventions should focus on treating any bleeding that occurs rather than preventative strategies. The available evidence for neuraxial anesthesia is based on very low-quality evidence from observational studies. Based on this evidence, the risk of an epidural hematoma is less than 0.19% (upper limit of 95% confidence interval) for pregnant women undergoing an epidural anesthetic when the platelet count is between 70 and 99 × 109/L. NVP-BGT226 cell line No randomized trials have been performed in children, nor have any randomized trials been performed in major or emergency surgeries. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and potentially lethal disease characterized by fragmentary hemolysis, moderate-to-severe thrombocytopenia, end-organ dysfunction, and severely reduced ADAMTS13 levels ( less then 10%). Survival in iTTP has improved significantly since the introduction of plasma exchange as standard therapy combined with immune suppression to address the underlying pathophysiology. A host of challenges remain including prompt recognition of the disease, treatment of the end-organ effects of the disease, improving the early mortality rate, significantly reducing the relapse rate as well as addressing refractory disease. Discussed in this narrative review of iTTP are the recent measures aimed at addressing these issues, including improvements in clinical prediction models, postremission maintenance approaches with early retreatment as well as the development of novel therapies. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.in English, German EINLEITUNG  Der kontrastverstärkte Ultraschall wird in immer mehr medizinischen Bereichen eingesetzt, darunter auch in der Thoraxmedizin. Diese Technik ist jedoch noch relativ neu und wird in aktuellen Richtlinien und Empfehlungen nur sporadisch erwähnt. Ziel dieser systematischen Übersichtsarbeit ist es, einen Literaturüberblick zu geben und die aktuellen klinischen Anwendungen des kontrastverstärkten Thorax-Ultraschalls (CETUS) kritisch zu bewerten. MATERIAL UND METHODEN  Es wurde eine systematische Literaturrecherche unter Verwendung der wichtigsten elektronischen Datenbanken in Übereinstimmung mit den PRISMA-Richtlinien durchgeführt. Eingeschlossen wurden Studien mit dem primären Schwerpunkt auf CETUS bei Erkrankungen des Thorax im Vergleich zum Standard-Referenztest. Das QUADAS-2-Tool wurde angewandt, um die Qualität der Studien zu beurteilen. ERGEBNISSE  Die Suche ergab 43 Artikel, davon 1 randomisierte kontrollierte Studie, 6 nichtrandomisierte kontrollierte Studien, 16 nichtrandomisierte nichtkontrollierte Studien, 5 Fallserien, 10 Einzelfallberichte und 5 Tierstudien.
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