Notes

U.Utes. Anatomical counselors' ideas associated with in-patient innate guidance: An invaluable style with regard to medically intricate patients.
Frailty is associated with further walking impairment in patients with PAD.Chronic leg ulcers are a common condition among adults, causing pain and social distress. Population aging has contributed to the amplification of the disease with increased cardiovascular diseases such as myocardial infarction, stroke, limb ischemia, cancers, chronic respiratory diseases, and diabetes. The aim of this study was to evaluate the influence of the Mediterranean Diet (MD) and hydration on the healing rate of the ulcers. A group of 35 patients (M/F 16/19, mean age 78 ± 10 years) with venous, arterial, or mixed ulcers was subjected to a Food Frequency Questionnaire (FFQ) and a Hydration Habits Questionnaire (HHQ). Clinical and anthropometric data were collected. A one-year follow-up was conducted. Complete ulcer healing was observed in 26% of the patients, of whom 67% had a habit of high hydration (more than 1 liter /day), regardless of adherence to the MD. In our study population, about half showed a low adherence to the MD. A moderate-high adherence to the MD showed an increase of arterial ulcer healing compared to subjects with a low adherence to the MD, however, only when associated to a consumption of more than 1 liter of water daily. In conclusion, dietary assessments could help identify patients who are likely to benefit from nutritional interventions for improving overall health and wound healing. The habit of high hydration, namely more than 1 liter daily, can influence the wound healing rate.The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79-9.5) cm2 for group I, 0.54 (0.47-1.16) cm2 for group II and 26.76 (17.25-41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.
To explore how patients with intermittent claudication experiences participating in a community-based cardiovascular rehabilitation program and the various components of the rehabilitation program.

Intermittent claudication is a condition associated with progressive atherosclerosis that affects daily life. Most patients with intermittent claudication do not exercise even though exercise is essential in the treatment of this condition. Rehabilitation is reported to be effective in alleviating symptoms, increasing walking distance, reducing cardiovascular events, and improving quality of life. Patients' perspectives are important when designing such programs, however, this aspect has not previously been investigated.

A qualitative study.

Patients with intermittent claudication (n=10) participating in a rehabilitation program were interviewed in two focus groups. Pragmatic philosophy inspired the approach. Data were analyzed using qualitative thematic analysis, and emerging themes were discussed accordinograms targeted patients with intermittent claudication in a community setting.
The qualitative results can be used to guide development of existing cardiac rehabilitation programs targeted patients with intermittent claudication in a community setting.
Coronavirus-2019 (COVID-19) is a global health crisis. Although pregnant women are a vulnerable population during the infectious pandemics, extremely rare cases of pregnant women infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are described in Taiwan. We share our experience to manage a pregnant women with COVID-19 in the third trimester and subsequent delivery at term.

A 43-year-old woman presented with sore throat, cough and rhinorrhea was diagnosed as laboratory-confirmed SARS-CoV-2 infection at the 35 gestational weeks (GW). During the hospitalization, the disease progressed with a need of oxygen supplement and prednisolone therapy. She was discharged uneventfully at 37GW. Finally, she delivered a female baby with Apgar score of 8-9 points at 38GW by cesarean section due to the deformity of pelvic cavity resulted from previous surgery for pelvic bone tumor. Both mother and her offspring (without SARS-CoV-2 infection) were discharged uneventfully.

Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.
Our report adds the growing body of experience toward management of pregnant women with SARS-CoV-2 infection. Decision making of timing and method of delivery is regarding to individualized condition and hospital setting.
A real-Taiwan experience to deal with near-term pregnant woman infected by severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus disease 2019, COVID-19) is extremely limited. We described the first case in Taiwan.

A 30-year-old woman, primigravida had a laboratory-confirmed COVID-19 infection at 36 gestational weeks (GW). She was asymptomatic. Ten days later, she was hospitalized and receive a selective cesarean section with a term baby weighted 3142gm (Apgar score 8 and 9at 1st and 5th minute, respectively) at 38GW. No evidence of in utero and direct transmission was found and newborn was free of COVID-19.

It is still uncertain whether timing or mode of delivery is appropriate in SARS-CoV-2 infected pregnant woman in near term, but we suggested that a selective delivery time at 38GW or later, regardless of which mode of delivery is finally decided, can be considered.
It is still uncertain whether timing or mode of delivery is appropriate in SARS-CoV-2 infected pregnant woman in near term, but we suggested that a selective delivery time at 38 GW or later, regardless of which mode of delivery is finally decided, can be considered.
Recurrent cervical cancer is hard to treat when occurring in a previous radiated area and unresectable or distant metastasis. We present three such cases who achieved complete remission (CR) after chemoradiotherapy and pembrolizumab.

Case 1 was diagnosed with cervical adenocarcinoma, stage IVB. She obtained CR after concurrent chemoradiotherapy (CCRT) and post-CCRT adjuvant chemotherapy and bevacizumab. Recurrence at previous irradiated sacral bone was controlled with pembrolizumab and CCRT using proton therapy (PT). Case 2 was diagnosed with stage IVB squamous cell carcinoma. First recurrence occurred at inguinal lymph node (LN). Secondary recurrence occurred at paraaortic LN ten years later. PT with chemotherapy and pembrolizumab achieved CR. Case 3 had a small cell carcinoma (stage IVB) with bone metastasis. She had CR to CCRT with etoposide-cisplatin. Liver metastasis was salvaged with CCRT and pembrolizumab.

CCRT with pembrolizumab is potentially curative for recurrent cervical cancer conventionally amenable for palliation.
CCRT with pembrolizumab is potentially curative for recurrent cervical cancer conventionally amenable for palliation.
Obesity has a negative impact on in-vitro fertilization (IVF) outcomes, and obese women who plan IVF treatments are often encouraged to pursue weight reduction. Bariatric surgery is an effective strategy for the treatment of morbidly obese women. The current case report is to investigate the impact of bariatric surgery on IVF outcome in a morbidly obese woman with subfertility.

A 37-year-old, morbidly obese woman with subfertility was indicated for IVF treatment. Due to her high body mass index (47.9kg/m
), she was advised to lose weight; initial failure at conservative measures of weight loss prompted her to undergo bariatric surgery, combined with post-operative lifestyle change, prior to receiving IVF treatment. The woman successfully conceived at the second cycle and delivered twins by cesarean section smoothly at 36+3/7 weeks of gestation. Both twins have normal development up to two years of age.

Weight reduction mediated by bariatric surgery in subfertile and morbidly obese women can be considered before IVF treatment.
Weight reduction mediated by bariatric surgery in subfertile and morbidly obese women can be considered before IVF treatment.
The risks of ovarian hyperstimulation syndrome (OHSS) involve high estrogen (E
) levels. We report two breast cancer patients with polycystic ovarian syndrome who underwent fertility preservation and had severe OHSS; their E
levels were lowered using aromatase inhibitors (AI).

A 36-year-old woman underwent controlled ovarian stimulation (COS) with AI and cryopreserved 10 blastocysts. She was hospitalized with OHSS (E
=139.1pg/mL). She improved with infusion alone. A 31-year-old woman underwent COS with AI and cryopreserved 8 blastocysts. She was hospitalized for OHSS (E
429pg/mL). Her vascular endothelial growth factor (VEGF) levels were high (62pg/mL) at 8 days after the procedure. She needed hospitalization for 9 days. The planned adjuvant therapy was delayed for a week in both cases.

Elevated VEGF levels should be considered as a risk factor of OHSS even if E
levels are low with AI treatment.
Elevated VEGF levels should be considered as a risk factor of OHSS even if E2 levels are low with AI treatment.
Bowel perforation during pregnancy is a rare but life-threatening situation, and the management remained uncertain. We presented a case in our hospital and reviewed literatures to provide a guidance to deal with this challenging situation.

A case at gestational age 26 weeks and 4 days, who had bowel perforation over previous ileo-colonic anastomosis site. The fetus was delivered via cesarean section after 1 week of operation and both were discharged without major complication at 35 days after delivery. selleck compound We searched Pubmed and reviewed 15 English literatures and make a discussion.

A simultaneous cesarean section could be considered if the gestational age was large enough to avoid the comorbidity of preterm birth or the maternal risk of sepsis outweigh the risk of preterm birth. Otherwise, tocolysis should be used in an attempt to delay delivery until the antenatal corticosteroids have worked.
A simultaneous cesarean section could be considered if the gestational age was large enough to avoid the comorbidity of preterm birth or the maternal risk of sepsis outweigh the risk of preterm birth.
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