Clinicians Research Articles

Clinical and Pathologic Factors Matter in Decision Making for Breast Cancer Care

Clinicians caring for patients with early-stage breast cancer long relied on clinical and pathologic factors to estimate an individual's risk for

Findings in physical examination of the external genitalia in pediatric age − different is not always pathological - Part II (female)

Introduction: Findings in the physical examination of the external genitalia in children are often a source of concern for parents and caregivers, not only for the emotional significance that people unconsciously attribute to these structures (partly due to their reproductive function), but also for the physical and psychological impact in the child. Due to the child’s close monitoring and periodic surveillance, the family physician has a key role in the identification and initial guidance of these cases. Objectives: To review the evidence about main variations and anomalies of the external male genitalia in pediatric age regarding diagnosis and clinical approach in primary health care. Results: In most cases, anomalies in the external male genitalia represent variants of normal and/or do not significantly affect function, thus only requiring clinical surveillance and no intervention. However, some cases − as epispadias, hypospadias, and urethral duplication − require surgical intervention and early action is crucial for the success of implemented measures. Conclusion: Physical examination is a key aspect of child assessment. Although changes in physical examination of the external male genitalia mostly represent normality variants, clinicians should be able to recognize pathological changes and properly refer those cases without overloading health services or causing unnecessary anxiety to children and caregivers.

Progress in application of near-infrared fluorescence imaging in the diagnosis and treatment of oral cancer.

The preliminary screening of oral cancer mostly depends on the experience of clinicians, The surgical margin of tumor is mostly based on physical examination and preoperative imaging examination. It lacks real-time and objective intraoperative evaluation methods. Indocyanine green (ICG), as a safe and pollution-free organic fluorescent pigments, combined with near-infrared fluorescence imaging can be applied in the screening of early oral cancer, the determination of tumor resection margins, sentinel lymph node biopsy, cervical lymph node dissection, targeted chemotherapy, and other aspects. Near-infrared fluorescence imaging may become a key link in the early diagnosis and accurate treatment for oral cancer in the future.

Dr. Jack Taunton, Trailblazer and Mentor

This article highlights the important contributions that Dr. Jack Taunton has made to the field of Sport and Exercise Medicine during his long and illustrious career. He has been a mentor to many young clinicians and has been a pioneer in shaping the Sport and Exercise Medicine landscape in Canada and internationally. His energy and passion to grow this field have influenced many young clinicians and he has set a high bar that will be hard to match.

Cutaneous Leuckocytoclastic Vasculitis Revealing Acute Brucellosis: A Case Report

The clinical presentations of human brucellosis are very polymorphic, representing a real challenge for clinicians. Among the unusual manifestations of this infection, vasculitis is particularly uncommon with only few sporadic cases in the world literature. We report an original observation of isolated cutaneous leuckocytoclastic vasculitis revealing acute brucellosis in a 44-year-old Tunisian man who was admitted for a rash with fever that had been evolving for two days. Somatic examination noted fever at 38°C, red-purple infiltrated and tender petechial lesions on feet, legs, and hands, small periungual necrotic lesions, and subungual splinter hemorrhages. The basic biological tests showed a biological inflammatory syndrome with an erythrocyte sedimentation rate of 82mmH1 and a C-reactive protein at 62mg/l. The skin biopsy concluded in leukocytoclastic vasculitis, without signs of malignancy and with a negative direct immunofluorescence. The specific etiological assessment of this vasculitis was negative. Wright's serology was positive at 1/1,280 confirming the diagnosis of acute septicemic brucellosis with brucellian vasculitis. The patient was treated with the combination: Doxycycline 200mg/d and Rifampicin 600mg/d with a rapidly favorable evolution. Healthcare professionals should be aware of the possibility of brucellosis in front of any unproven vasculitis, especially in endemic countries. This better knowledge will make it possible to avoid diagnostic delay and improve the prognosis of this infection.

Left Atrial Thrombus Mimicking Myxoma Secondary to Rebound Hypercoagulable State

Novel oral anticoagulants (NOACs) have made the use of anticoagulation in patients with atrial fibrillation (AFib) much more convenient and predictable. It is a very common practice to hold anticoagulation either in anticipation of surgical procedures (to prevent excessive bleeding) or in case of acute bleeding episodes. This abrupt withdrawal of anticoagulation tilts the balance in favor of pro-thrombotic state in the body. We present a case of a 60-year-old man with past medical history of AFib who abruptly discontinued his apixaban (Eliquis). This patient presented to emergency room with the complaint of weakness and numbness of left arm and left half of the face. Stroke code was activated, and patient received tissue plasminogen activator (t-PA). This resulted in significant improvement of symptoms within hours of receiving treatment. Later during the same day, patient developed numbness and tingling of fingers of left hand. On physical exam, left hand was cold to touch and radial pulse was absent. Arterial duplex revealed occluded ulnar and radial arteries. Vascular surgery performed embolectomy to establish blood flow in the radial and ulnar arteries. Transthoracic echocardiogram revealed large left atrial mass attached to the atrial septum. Most likely t-PA infusion in the setting of atrial mass led to distal showering of emboli resulting in stenosis of radial and ulnar arteries. The left atrial mass was most likely thrombus as patient had cardiac imaging including transthoracic echocardiogram and computed tomography of heart prior to these events which did not reveal any mass in left atrium. In short, as clinicians we should be aware of the hypercoagulability associated with withdrawal of anticoagulation. In addition, we should be wary of the challenges associated with differentiating cardiac masses of different etiology. J Med Cases. 2021;12(6):243-247 doi: https://doi.org/10.14740/jmc3656

How Appropriate Are Screening Mammogram Recommendations Made by Breast Centers

Breast cancer screening recommendations issued by breast centers have considerable capacity to influence women and clinicians. Is this guidance

Clinician Wellness—Self-Care for Staying Healthy: The Critical Need to Prioritize Calm in Our Lives

Clinician Wellness—Self-Care for Staying Healthy: The Critical Need to Prioritize Calm in Our Lives

Standard of periodontal examination and evaluation during oral diagnosis and treatment

Report of the fourth national oral health survey showed that the prevalence of gingivitis and periodontitis stayed at a high level in Chinese population and the periodontitis was the most common cause of tooth loss in Chinese adults. Therefore, the examination of periodontal health status, disease condition and risk assessment are particularly important. The Society of Periodontology of the Chinese Stomatological Association organized experts of related disciplines to formulate the standard of basic periodontal examination and evaluation during oral diagnosis and treatment, aiming to emphasize the necessity and importance of periodontal health and to improve dental clinicians' abilities in understanding, diagnosis and treatment planning of periodontal disease. As a national and professional standard, it will play an important and practically significant role in conservation of natural teeth and improvement of people's oral health in China.

Use of the CTC Count in Treatment Decisions for Metastatic Breast Cancer

The circulating tumor cell (CTC) count has long been recognized as a prognostic factor in metastatic breast cancer. Clinicians face a clinical dilemma

Oral Antibiotics for Outpatient Diverticulitis

For oral antibiotic management of diverticulitis in outpatients, clinicians traditionally have used either metronidazole plus a quinolone or

ACSM Clinician Profile.

ACSM Clinician Profile.

Women Also Do Well with Ablation of Atrial Fibrillation

Many clinicians believe — primarily based on data from observational registries — that women have more complications with ablation of atrial

Thirty years of IJNS - A Clinician's View.

Thirty years of IJNS - A Clinician's View.

Sensorimotor synchronisation and non-verbal behaviours in Alzheimer's disease: the influence of social and musical contexts.

Given the limited efficacy of pharmacological treatments, the use of musical intervention as a non-drug treatment for patients with Alzheimer's disease is strongly recommended. Musical interventions appear to improve the socio-emotional and cognitive functioning of these patients, and benefits increase when patients' motor skills are engaged. Our study evaluates the factors that may influence patients' socio-emotional and motor engagement during musical activities and measures their sensorimotor synchronisation (SMS) abilities. Participants were asked to tap in time to a metronomic or musical rhythm, in the presence of a musician who performed the task with them. The musician's presence was either physical (live condition) or virtual (video condition). Two tempos were tested: a slow tempo (inter-onset interval of 800 ms) and a fast tempo (inter-onset interval of 667 ms). The results showed that patients spontaneously produced more rhythmic movements in response to the music than to the metronome. However, the consistency and accuracy of sensorimotor synchronisation was better with the metronome than with the music and was also better when the musician was present through the video rather than in person. These effects were modulated by the tempo of the auditory sequences. These results confirm the importance of the musical context and social interactions on these different performances. By simultaneously evaluating the sensorimotor synchronisation of the hands, spontaneous motor behaviours, and socio-emotional behaviours using quantitative and controlled measurements, this study validates a multimodal approach to evaluating patients' engagement in a musical task. These initial results provide promising prospects in terms of application while providing clinicians and researchers with a rigorous methodology for understanding the factors that are at the origin of the therapeutic benefits of musical activities on the behaviour and well-being of patients and their caregivers.

Consensus of Chinese stomatological multidisciplinary experts on maintaining periodontal health (First edition)

Periodontal disease is the main cause of tooth loss in adults, and it is also one of the major factors affecting oral and general health. In the process of diagnosing and treating the oral diseases, many subspecialties of stomatology will involve in the maintenance of periodontal tissue health. The Chinese Stomatological Association organized a number of experts in related disciplines to thrash out the present expert consensus in order to enhance the awareness of dental clinicians to maintain the health of periodontal tissues and to standardize the procedures of diagnosis and treatment. The clinicians' abilities in prevention and treatment of oral diseases will be hopefully elevated if the clinicians, especially in such disciplines as prosthodontics, orthodontics, oral implantology, operative dentistry and endodontics, can early recognize and identify the periodontal disease and the damage degree of periodontal tissues, adopt the appropriate intervention measures and predict the prognosis scientifically.

Association Between Frailty and Postoperative Mortality

Frailty — a vulnerability to adverse healthcare outcomes that often is age-related — should be considered when clinicians weigh benefits and harms of

Novel Immunotherapy for BCG-Unresponsive Bladder Cancer

For patients and clinicians, bacille Calmette-Guerin (BCG)–unresponsive bladder cancer remains a major therapeutic dilemma. While the

Improved Exercise Capacity with Inhaled Treprostinil

Pulmonary vasodilator therapy has transformed pulmonary arterial hypertension from a uniformly fatal disease to a chronically managed one. Clinicians

臨床医に英語論文は必要か？

臨床医に英語論文は必要か？