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COVID-19 Findings on Chest CT
Chest CT can play an important role in evaluating patients with COVID-19 and detecting alternative diagnoses or complications. Common CT findings of COVID-19 include ground-glass opacities, vascular enlargement, bilateral lung involvement especially in the lower lobes, and a posterior predominance. CT may show normal findings early in infection but often demonstrates progressive abnormalities from ground-glass opacities to consolidation over the course of illness. Complications seen on CT include acute respiratory distress syndrome, pulmonary embolism, superimposed pneumonia, heart failure, and pericardial effusions.
Dyspepsia endoscopy guideline
This document provides guidelines from the American Society for Gastrointestinal Endoscopy on the role of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those exhibiting alarm features should undergo endoscopic evaluation, while those under 50 without alarm features can be initially treated with noninvasive H. pylori testing and treatment if positive or a short course of PPIs. For patients who do not respond to or have recurring symptoms after these initial approaches, endoscopy is recommended to exclude structural diseases. The guidelines aim to optimize the use of endoscopy for diagnosing conditions like peptic ulcer disease or malignancy while avoiding unnecessary endoscopies.
Avascular necrosis
Avascular necrosis, also known as osteonecrosis or bone infarction, is the death of bone tissue due to a lack of blood supply. It most commonly affects the femoral head. There are many potential causes including trauma, alcohol use, steroid use, and idiopathic cases. Diagnosis is made through imaging like x-rays, CT scans, MRIs, and bone scans. Treatment depends on the stage of necrosis and other factors, and may include observation, core decompression, vascularized bone grafts, partial or total hip replacement, or hip resurfacing. Staging is important for determining treatment and can range from pre-symptomatic changes visible only on MRI to complete femoral head destruction indistinguishable from osteo
Shoulder injury
This document summarizes various shoulder injuries including sprains, dislocations, tendinitis, fractures, and nerve injuries. It describes the mechanisms of injury, signs and symptoms, special tests used for diagnosis, and recommends referring patients to an orthopedist. Key details are provided for sternoclavicular joint sprains, acromioclavicular joint sprains, glenohumeral dislocations, rotator cuff injuries, bicep tendon injuries, clavicle and scapula fractures, and thoracic outlet syndrome.
Tokyo guidelines for cholangitis and cholecystitis
The document presents the Tokyo Guidelines for the management of acute cholangitis and cholecystitis. It was created by an international working group to address the lack of standardized diagnostic criteria and treatment guidelines for biliary infections. The working group conducted an extensive literature review, found little high-level evidence, and thus developed the guidelines through international consensus meetings. The Tokyo Guidelines provide evidence-based diagnostic criteria, severity assessments, and management recommendations for acute cholangitis and cholecystitis. They aim to establish international standards for evaluating and treating biliary infections.
Recommended
COVID-19 Findings on Chest CT
Chest CT can play an important role in evaluating patients with COVID-19 and detecting alternative diagnoses or complications. Common CT findings of COVID-19 include ground-glass opacities, vascular enlargement, bilateral lung involvement especially in the lower lobes, and a posterior predominance. CT may show normal findings early in infection but often demonstrates progressive abnormalities from ground-glass opacities to consolidation over the course of illness. Complications seen on CT include acute respiratory distress syndrome, pulmonary embolism, superimposed pneumonia, heart failure, and pericardial effusions.
Dyspepsia endoscopy guideline
This document provides guidelines from the American Society for Gastrointestinal Endoscopy on the role of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those exhibiting alarm features should undergo endoscopic evaluation, while those under 50 without alarm features can be initially treated with noninvasive H. pylori testing and treatment if positive or a short course of PPIs. For patients who do not respond to or have recurring symptoms after these initial approaches, endoscopy is recommended to exclude structural diseases. The guidelines aim to optimize the use of endoscopy for diagnosing conditions like peptic ulcer disease or malignancy while avoiding unnecessary endoscopies.
Avascular necrosis
Avascular necrosis, also known as osteonecrosis or bone infarction, is the death of bone tissue due to a lack of blood supply. It most commonly affects the femoral head. There are many potential causes including trauma, alcohol use, steroid use, and idiopathic cases. Diagnosis is made through imaging like x-rays, CT scans, MRIs, and bone scans. Treatment depends on the stage of necrosis and other factors, and may include observation, core decompression, vascularized bone grafts, partial or total hip replacement, or hip resurfacing. Staging is important for determining treatment and can range from pre-symptomatic changes visible only on MRI to complete femoral head destruction indistinguishable from osteo
Shoulder injury
This document summarizes various shoulder injuries including sprains, dislocations, tendinitis, fractures, and nerve injuries. It describes the mechanisms of injury, signs and symptoms, special tests used for diagnosis, and recommends referring patients to an orthopedist. Key details are provided for sternoclavicular joint sprains, acromioclavicular joint sprains, glenohumeral dislocations, rotator cuff injuries, bicep tendon injuries, clavicle and scapula fractures, and thoracic outlet syndrome.
Tokyo guidelines for cholangitis and cholecystitis
The document presents the Tokyo Guidelines for the management of acute cholangitis and cholecystitis. It was created by an international working group to address the lack of standardized diagnostic criteria and treatment guidelines for biliary infections. The working group conducted an extensive literature review, found little high-level evidence, and thus developed the guidelines through international consensus meetings. The Tokyo Guidelines provide evidence-based diagnostic criteria, severity assessments, and management recommendations for acute cholangitis and cholecystitis. They aim to establish international standards for evaluating and treating biliary infections.
The role of ercp in diseases of the biliary tract and pancreas
This document provides guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) on the role of endoscopic retrograde cholangiopancreatography (ERCP) in diseases of the biliary tract and pancreas. It was developed using an evidence-based methodology including a literature review. The guidelines are intended to apply to all physicians performing GI endoscopy. ERCP is described as useful for diagnosing and treating conditions like gallstones, biliary strictures, pancreatic disease, and leaks or injuries to the biliary tract. Outcomes of ERCP for various conditions are discussed along with appropriate patient selection and techniques.
Role of endoscopy in dyspepsia
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Role of endoscopy in choledocholithiasis
This document provides guidelines for the role of endoscopy in evaluating suspected choledocholithiasis (gallstones in the common bile duct). It recommends a risk-stratified approach based on initial evaluation. For low risk patients, only cholecystectomy is needed. For intermediate risk, additional imaging like EUS, MRCP or preoperative ERCP is recommended to further evaluate need for ductal stone removal. For high risk, preoperative ERCP or operative cholangiography is recommended due to frequent need for therapy. Non-endoscopic options like CT, MRCP, IOC and laparoscopic ultrasound are also discussed. The guidelines are meant to help endoscopists provide care while considering individual clinical factors.
Pneumonia in children
This clinical guideline provides recommendations for diagnosing and treating pneumonia in children. Pneumonia is common in children under 2 years old and can be caused by bacteria, viruses, or mixed infections depending on the child's age. Clinical features like fever, cough, difficulty breathing, and fast breathing should prompt consideration of pneumonia. Chest x-rays are not needed for most cases but can help in complicated cases. Most children can be treated with oral antibiotics at home, while those with more severe symptoms require hospital admission and intravenous antibiotics. Complications like lung abscesses may occur and require longer treatment and follow up to ensure full recovery. Recurrent pneumonia may indicate underlying conditions that require further investigation.
Febrile neutropenia in children
This document provides guidelines for treating fever and neutropenia in children with cancer. It defines low-risk and high-risk patients based on their condition and symptoms. For low-risk patients, initial treatment with ceftazidime is recommended, while high-risk patients should receive ceftazidime and vancomycin. Treatment is modified based on blood culture results and patient stability. Persistent fever may warrant adding antifungal drugs or investigating non-bacterial causes.
Diseases of the rectum and anal canal in Thai
Rectal procidentia, or rectal prolapse, is the full-thickness circumferential intussusception of the rectum through the anal verge. It can be incomplete involving just the mucosa, or complete involving the full rectal wall. Complete prolapse is classified as first degree if the prolapse remains outside the anus, second degree if it reduces spontaneously on lying down, or third degree if it requires manual reduction. Predisposing factors include constipation, pelvic floor weakness, rectocele, and increased intra-abdominal pressure. Treatment options include pelvic floor repair, rectopexy to elevate the rectum, and resection of redundant sigmoid colon.
NEJM Cholecystitis
The document discusses acute calculous cholecystitis, a complication of gallstones where the gallbladder becomes inflamed. It provides details on the pathogenesis, symptoms, diagnosis and treatment strategies. Regarding treatment strategies, it indicates that early laparoscopic cholecystectomy within 1 week of symptoms starting is considered the best treatment for most patients based on randomized trials showing shorter hospital stays compared to delayed surgery 2-3 months later. However, it notes the risk of bile duct injuries may be higher for early surgery on an inflamed gallbladder based on large registry studies, though randomized trials were too small to definitively assess this risk. It concludes that while early laparoscopy is usually best, open surgery or postponing surgery may
Children with recurrent chest infection
The document discusses the assessment of children with recurrent chest infections. It can be a difficult diagnostic challenge to determine if a child has a simple cause like viral infections or asthma, or a more serious underlying issue like cystic fibrosis, immunodeficiency, or congenital abnormalities. A detailed history, physical exam, and selective investigations are needed to distinguish between self-limiting issues and serious progressive lung disease. Recurrent respiratory infections are common in childhood but the aim is to identify those with severe or long-term lung pathology.
Approach to the child with recurrent infections
The document discusses primary immunodeficiencies (PIDs) in children, which are genetic defects that result in recurrent or unusual infections. It notes that PIDs should be considered when standard causes of infection have been ruled out in a child. The summary provides:
1) PIDs can present in infancy with a predominance in males, but many are not diagnosed until later in life. They occur in about 1 in 2,000 live births.
2) Accurate prevalence in South Africa is unknown, but international rates are likely similar, though some deficiencies may be more common.
3) Diagnosis of PIDs is often delayed, despite awareness of HIV. Late diagnosis can be tragic as effective
Acute cholecystitis and acute cholangitis
This document provides guidelines for the diagnosis and treatment of acute cholangitis and cholecystitis. It discusses the typical presentations and risk factors for each condition. For acute cholangitis, Charcot's triad is the classic diagnostic criteria. Severity is classified into mild, moderate, and severe based on organ dysfunction. Initial treatment involves antibiotics and drainage of the bile ducts. For acute cholecystitis, Murphy's sign and ultrasound findings help with diagnosis. Severity is also classified into three grades. Treatment ranges from laparoscopic cholecystectomy within 3 days for mild cases to drainage followed by delayed surgery for more severe cases. Risk factors for common bile duct stones are also outlined.
Acute cholangitis note
The document outlines the diagnostic criteria and severity assessment criteria for acute cholangitis according to the Tokyo Guidelines. For a suspected diagnosis of acute cholangitis, a patient must present with two or more clinical manifestations including fever, jaundice, abdominal pain, or a history of biliary disease. A definite diagnosis requires meeting the criteria for a suspected diagnosis along with laboratory evidence of inflammation and imaging findings of biliary dilatation or evidence of an underlying etiology. Acute cholangitis is classified as mild, moderate, or severe based on the presence of organ dysfunction and response to initial medical treatment including antibiotics and supportive care.
Travel Clinic Cardiff: Health Advice for International Travelers
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The role of ercp in diseases of the biliary tract and pancreas
This document provides guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) on the role of endoscopic retrograde cholangiopancreatography (ERCP) in diseases of the biliary tract and pancreas. It was developed using an evidence-based methodology including a literature review. The guidelines are intended to apply to all physicians performing GI endoscopy. ERCP is described as useful for diagnosing and treating conditions like gallstones, biliary strictures, pancreatic disease, and leaks or injuries to the biliary tract. Outcomes of ERCP for various conditions are discussed along with appropriate patient selection and techniques.
Role of endoscopy in dyspepsia
This guideline discusses the appropriate use of endoscopy in evaluating patients with dyspepsia. It recommends that patients over 50 years old or those with alarm features should undergo endoscopy due to their higher risk of structural diseases like cancer or peptic ulcers. Younger patients without alarm features may initially receive noninvasive testing for H. pylori infection and be treated if positive, or try acid suppression therapy. If these approaches do not resolve symptoms, endoscopy is recommended to check for structural causes. The guideline aims to help clinicians determine which dyspepsia patients most need endoscopy versus other initial treatment strategies.
Role of endoscopy in choledocholithiasis
This document provides guidelines for the role of endoscopy in evaluating suspected choledocholithiasis (gallstones in the common bile duct). It recommends a risk-stratified approach based on initial evaluation. For low risk patients, only cholecystectomy is needed. For intermediate risk, additional imaging like EUS, MRCP or preoperative ERCP is recommended to further evaluate need for ductal stone removal. For high risk, preoperative ERCP or operative cholangiography is recommended due to frequent need for therapy. Non-endoscopic options like CT, MRCP, IOC and laparoscopic ultrasound are also discussed. The guidelines are meant to help endoscopists provide care while considering individual clinical factors.
Pneumonia in children
This clinical guideline provides recommendations for diagnosing and treating pneumonia in children. Pneumonia is common in children under 2 years old and can be caused by bacteria, viruses, or mixed infections depending on the child's age. Clinical features like fever, cough, difficulty breathing, and fast breathing should prompt consideration of pneumonia. Chest x-rays are not needed for most cases but can help in complicated cases. Most children can be treated with oral antibiotics at home, while those with more severe symptoms require hospital admission and intravenous antibiotics. Complications like lung abscesses may occur and require longer treatment and follow up to ensure full recovery. Recurrent pneumonia may indicate underlying conditions that require further investigation.
Febrile neutropenia in children
This document provides guidelines for treating fever and neutropenia in children with cancer. It defines low-risk and high-risk patients based on their condition and symptoms. For low-risk patients, initial treatment with ceftazidime is recommended, while high-risk patients should receive ceftazidime and vancomycin. Treatment is modified based on blood culture results and patient stability. Persistent fever may warrant adding antifungal drugs or investigating non-bacterial causes.
Diseases of the rectum and anal canal in Thai
Rectal procidentia, or rectal prolapse, is the full-thickness circumferential intussusception of the rectum through the anal verge. It can be incomplete involving just the mucosa, or complete involving the full rectal wall. Complete prolapse is classified as first degree if the prolapse remains outside the anus, second degree if it reduces spontaneously on lying down, or third degree if it requires manual reduction. Predisposing factors include constipation, pelvic floor weakness, rectocele, and increased intra-abdominal pressure. Treatment options include pelvic floor repair, rectopexy to elevate the rectum, and resection of redundant sigmoid colon.
NEJM Cholecystitis
The document discusses acute calculous cholecystitis, a complication of gallstones where the gallbladder becomes inflamed. It provides details on the pathogenesis, symptoms, diagnosis and treatment strategies. Regarding treatment strategies, it indicates that early laparoscopic cholecystectomy within 1 week of symptoms starting is considered the best treatment for most patients based on randomized trials showing shorter hospital stays compared to delayed surgery 2-3 months later. However, it notes the risk of bile duct injuries may be higher for early surgery on an inflamed gallbladder based on large registry studies, though randomized trials were too small to definitively assess this risk. It concludes that while early laparoscopy is usually best, open surgery or postponing surgery may
Children with recurrent chest infection
The document discusses the assessment of children with recurrent chest infections. It can be a difficult diagnostic challenge to determine if a child has a simple cause like viral infections or asthma, or a more serious underlying issue like cystic fibrosis, immunodeficiency, or congenital abnormalities. A detailed history, physical exam, and selective investigations are needed to distinguish between self-limiting issues and serious progressive lung disease. Recurrent respiratory infections are common in childhood but the aim is to identify those with severe or long-term lung pathology.
Approach to the child with recurrent infections
The document discusses primary immunodeficiencies (PIDs) in children, which are genetic defects that result in recurrent or unusual infections. It notes that PIDs should be considered when standard causes of infection have been ruled out in a child. The summary provides:
1) PIDs can present in infancy with a predominance in males, but many are not diagnosed until later in life. They occur in about 1 in 2,000 live births.
2) Accurate prevalence in South Africa is unknown, but international rates are likely similar, though some deficiencies may be more common.
3) Diagnosis of PIDs is often delayed, despite awareness of HIV. Late diagnosis can be tragic as effective
Acute cholecystitis and acute cholangitis
This document provides guidelines for the diagnosis and treatment of acute cholangitis and cholecystitis. It discusses the typical presentations and risk factors for each condition. For acute cholangitis, Charcot's triad is the classic diagnostic criteria. Severity is classified into mild, moderate, and severe based on organ dysfunction. Initial treatment involves antibiotics and drainage of the bile ducts. For acute cholecystitis, Murphy's sign and ultrasound findings help with diagnosis. Severity is also classified into three grades. Treatment ranges from laparoscopic cholecystectomy within 3 days for mild cases to drainage followed by delayed surgery for more severe cases. Risk factors for common bile duct stones are also outlined.
Acute cholangitis note
The document outlines the diagnostic criteria and severity assessment criteria for acute cholangitis according to the Tokyo Guidelines. For a suspected diagnosis of acute cholangitis, a patient must present with two or more clinical manifestations including fever, jaundice, abdominal pain, or a history of biliary disease. A definite diagnosis requires meeting the criteria for a suspected diagnosis along with laboratory evidence of inflammation and imaging findings of biliary dilatation or evidence of an underlying etiology. Acute cholangitis is classified as mild, moderate, or severe based on the presence of organ dysfunction and response to initial medical treatment including antibiotics and supportive care.
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
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