Common Condition In Adults Research Articles

Orthotic Devices for the Foot and Ankle.

Millions of Americans wear ankle-foot orthotic devices for protection, pain relief, and deformity correction. Inquiries about off-the-shelf and custom devices are a common reason for evaluation with a foot and ankle surgeon or general orthopaedic surgeon. Despite limited high-quality evidence for their use, these devices can have a notable clinical impact on physical function. An up-to-date understanding of orthotic device options and their appropriate use in managing musculoskeletal pathologies applies to all orthopaedic providers. This review aims to categorize orthosis types and provide specific device recommendations for common adult conditions such as flatfoot, cavovarus foot, and ankle instability. Collaboration with a certified orthotist can help patients achieve functional and recreational goals with the use of appropriately designed and applied orthoses.

Individualized homoeopathic treatment of chronic arterial foot ulcer: A case report

Chronic lower leg ulceration is a fairly common adult condition that causes pain and social distress. The condition affects 1% of adults and 3.6% of those over 65. Leg ulcers are painful and have a negative impact on the quality of life of patients. Arterial pathologies can cause arterial ulcers, but the one important cause is arterial obstruction. Atherosclerotic obstruction usually occurs in the iliac, femoropopliteal, and the distal branches (Peroneal and tibial arteries).The case was diagnosed using an arterial doppler of the right lower limb, which revealed an arterial block above the right common femoral artery at the aortic bifurcation, resulting in an ulcer.Vascular leg ulcers, venous ulcers, and diabetic ulcers were all ruled out as possibilities in this case. Silicea 0/1 to Silicea 0/4, 16 doses of each potency, twice a day, were given to the patient as constitutional homoeopathic medicine. The foot ulcer was completely healed after a one-month follow-up. This case study suggests homoeopathic treatment as a promising complementary or alternative therapy, emphasising the significance of repertorisation in individualised homoeopathic prescription

Adverse Prognostic Impact of Even Mild or Moderate Tricuspid Regurgitation: Insights from the National Echocardiography Database of Australia

The prevalence and prognostic impact of tricuspid regurgitation (TR) remain incompletely characterized. The distribution of TR severity was analyzed in 439,558 adults (mean age, 62.1±17.8years; 51.5% men) being investigated for heart disease, from 2000 to 2019, by 25 centers contributing to the National Echocardiography Database of Australia. Survival status and cause of death were ascertained in all adults from the National Death Index of Australia. The relationship between TR severity and mortality was examined. Of those studied, 311,604 (70.9%) had no/trivial TR; 94,172 (21.4%), mild TR; 26,056 (5.9%), moderate TR; and 7,726 (1.8%), severe TR. During a median 4.1years (interquartile range, 2.2-7.0years) of follow-up, 109,004 died (49% from cardiovascular causes). Moderate or greater TR was associated with older age and female sex (P<.001). Individuals with moderate and severe TR had a 2.0- to 3.2-fold increased risk of all-cause long-term mortality after adjustment for age and sex compared with those with no/trivial TR (P<.001 for both comparisons). Even those with mild TR had a significantly increased risk for mortality (hazard ratio [HR]=1.29; 95% CI, 1.27-1.31). In fully adjusted models, including for RV systolic pressure, atrial fibrillation, and significant left heart disease, there remained a 1.24- to 2.65-fold increased risk of mortality with mild (HR=1.24; 95% CI, 1.23-1.26), moderate (HR=1.72; 95% CI, 1.68-1.75), or severe TR (HR=2.65; 95% CI, 2.57-2.73), compared with those with no/trivial TR (P<.001 for all). Tricuspid regurgitation is a common condition in adults referred for echocardiography. Moreover, even in the presence of other cardiac disease, increasing grades of TR are independently associated with increasing risks of cardiovascular and all-cause mortality. Furthermore, we show that even mild TR is independently associated with a significant increase in mortality.

DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE.

Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual's well-being. To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient's needs. CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

Adaptation of Adult Pathways to Improve the Care of Adult Patients at Pediatric Hospitals.

Adaptation of Adult Pathways to Improve the Care of Adult Patients at Pediatric Hospitals.

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times

Introduction: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing through a double stapler technique to resect the adequate amount of prolapse, finally coming to the use of high volume devices. Methods: Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. Results: Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results. Conclusions: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.

Prevalence of the persistent median artery in patients undergoing surgical open carpal tunnel release: A case series

BackgroundCarpal tunnel syndrome is a common condition in adults with an estimated prevalence of up to 5% in the general population. The presence of a persistent median artery is an important consideration for plastic and orthopedic surgeons who frequently perform carpal tunnel release. This artery may persist into adulthood and constitute a significant supply of blood to the hand, sometimes compressing the median nerve. PurposeIn this case series, we describe the prevalence of the persistent median artery identified intraoperatively in Polish subjects undergoing surgical open carpal tunnel release. MethodsThe data regarding the prevalence of persistent median artery were retroactively collected postoperatively from the standard surgical protocols. ResultsPersistent median artery was identified in 36 out of 1285 operated hands (2.8%). The observed PMAs were identified in 15 (2.0%) cases out of 750 right upper limbs and in 21 (3.9%) cases out of the 535 left upper limbs. ConclusionsPersistent median artery can be present in the operating field of any surgeon that performs carpal tunnel release and any other surgical procedures in the wrist region. Therefore awareness of its presence is crucial to minimize intraoperative complications such as bleeding or digital ischemia.

Utilidad de los estudios en busca de autoinmunidad en pacientes con urticaria crónica espontánea

Chronic spontaneous urticaria (CSU) is a common condition in adults, especially among women; this entity is frequently associated with autoimmune diseases. Our goal is to assess through laboratory studies whether patients with autoimmune CSU presented data. A cross-sectional study of 35 patients was done in the area of Allergy and Immunology at Hospital Juarez de Mexico diagnosed with CSU. We performed the following tests: complete blood count, thyroid antibodies (antiperoxidase and thyroglobulin), antinuclear antibodies, rheumatoid factor, lupus anticoagulant, LE cells Autologous Serum Skin Test (ASST), add (C3 and C4). In addition, we made Helicobacter pylori test, thyroid hormones (T3, T4, TSH) and D-dimer. We evaluated 35 adult patients, 27 female; ASST was positive in 4 patients, negative antinuclear antibodies in all cases, but positive anti thyroid (AAT) antibodies in 4. The LE cell, lupus anticoagulant, complement, dimer D, thyroid and Helicobacter pylori profile were normal or negative and rheumatoid factor was positive in one patient. All AAT-positive patients were women, but 26 of them had negative ASST. The correlation between ASST and AAT was not significant. Most patients were women UCE and only 4 had positive ASST, but this does not correlate with the presence of anti-thyroid antibodies. Most studies were normal, so we suggest not making unnecessary laboratory studies in this disease.

Vibegron: a β3-adrenergic agonist for the treatment of overactive bladder.

Overactive bladder (OAB) is an extremely common condition in adults of both sexes. It is characterized by an urgent need to micturate often accompanied by incontinence. The condition may also increase the number of micturitions in a 24-hour period as well as nocturia. The syndrome is not due to a urinary infection or other obvious pathology. In terms of drug treatment of OAB, there are two main approaches. One is the use of anticholinergic drugs that reduce the effect of the parasympathetic nervous system on the bladder. The other involves the use of drugs that are agonists at β3-adrenergic receptors in the bladder. These drugs increase the capacity of the bladder and cause reductions in the number of daily micturitions and nocturia and also importantly reduce the frequency of urinary urgency and urinary urgency incontinence. Vibegron is the second β3-adrenergic agonist to be approved for the treatment of OAB.

Understanding the role of diet in adult constipation.

Constipation is a common condition in adults and symptoms such as straining and the sensation of incomplete bowel emptying can be distressing for patients. The nurse's role includes preventing, monitoring and managing the condition. Fibre and fluid intake have an important role in prevention, while first-line treatments include increased consumption of wholegrain carbohydrates, fruit and vegetables. This article outlines the role of diet in preventing and managing constipation in adults and offers practical advice for nurses caring for this group of patients.

Which procedures are performed by general internists practicing primary care in Germany? - a cross-sectional study

BackgroundDue to differences of residency training programs’ emphases – inpatient vs office-based – internal medicine and family medicine residents consistently reported differences in preparedness to care for common adult conditions. Study’s aim was to add knowledge about procedures that a) are performed by general internists working in primary care and b) should be learned during residency in general internists’ appraisal.MethodsA cross-sectional postal survey was carried out by using a questionnaire that comprised 90 procedures relevant in primary care. Each procedure implied the two questions “Do you perform this procedure in your own practice?” and “How important do you think it is to learn this procedure during residency?” The final questionnaire was sent to 1002 general internists working in primary care in Germany in May 2015. Data analysis was performed using SPSS Version 24.0 (SPSS inc., IBM). Next to descriptive statistics subgroup analyses were performed using cross tabulation and Chi-square tests for evaluation of differences in the performance of most frequently performed procedures in urban or rural areas as well as by male or female physicians.ResultsTwenty-eight percent of sent questionnaires (276/1002) could be included in analysis. Mean age of participants was 52 years with 13 years of practice experience; 40% were female.Twenty-nine (32%) of 90 given procedures were performed by at least half of the participants, foremost technical diagnostics, punctures, procedures of the integument and resuscitation. After Bonferroni correction, five of those procedures were performed by more male than female physicians and two procedures by more physicians working in a rural practice than physicians practicing in an urban location. Moreover, 46 (51%) procedures were assessed as important to learn during residency by at least 50% of participants.ConclusionsGeneral internists working in German primary care perform a narrow scope of procedures offered by primary care physicians. In order to provide best ambulatory care for patients, residency training programs must ensure training in procedures that are necessary for providing high quality care. Therefore, a consensus aligned with patients’ and health-systems’ needs on procedures required for working as a general internist in primary care is necessary.

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times.

Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing through a double stapler technique to resect the adequate amount of prolapse, finally coming to the use of high volume devices. Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left. Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results. Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.

SECULAR TREND OF AMBULATORY BLOOD PRESSURE MONITORING USE AT ST. LUKE's MEDICAL CENTER

Hypertension (HTN), a common adult condition, confers significant risk in the development of cardiovascular (CV) disease. Ambulatory blood pressure monitoring (ABPM) is superior to office measurements alone in the management of HTN. Despite advances in technology making ABPMs easier and more cost-

Effect of Patients' Education on Their Performance and Outcomes Regarding Lumbar Disk Herniation

Context: Lumbar disc herniation is a common condition in adults and can impose a heavy burden on both the individual and society.Aim: The present study aimed to evaluate the effect of patients' education on their performance and outcomes regarding lumbar disk herniation.Methods: Quasi-experimental design used to achieve aim in this study. The study conducted at the orthopedic outpatient clinic at Benha University Hospital. Purposive sample of 60 patients of both genders who aged from (18-60 years old) included in the study. Patients who were attending surgical operation regarding lumbar disk herniation excluded. Three tools used to collect the study data. These are structured interview questionnaire regarding the patients' demographic characteristics, medical data, and patient's knowledge regarding lumbar disk herniation, observational checklist for patient's practice regarding lumbar disk herniation exercises, and modified Oswestry low back pain &amp; disability scaleResult: There was a statistically significant improvement in the total level of patient's knowledge, practices &amp; outcomes immediately post and three months post-program implementation. Also, there was a significant statistical correlation between patients' knowledge and pain disability scale three months post-program implementation.Conclusion: The results of the study conclude that the educational program was effective and resulted in a significant improvement in patient's knowledge, practice, and outcomes regarding lumbar disk herniation. The study suggested equips the orthopedic department with simple illustrated guidelines protocol covering lumbar disc herniation practices, knowledge; reapply this research on a more substantial probability sample acquired from different geographical areas in Egypt for generalization.

Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

BackgroundADHD is a highly prevalent disease in childhood which often persists into adulthood, then co-occurring with common adult conditions. Especially for adult ADHD, little is known about the costs of ADHD and the additional costs of comorbid conditions. AimsTo determine medical costs of ADHD and costs of comorbidities (mood, anxiety and substance use disorders, obesity), including their co-occurrence rates, stratified by age and gender. MethodClaims data from a German Statutory Health Insurance database with approximately four million member-records per year were analysed. A total of 25,300 prevalent ADHD patients were identified by means of an ICD-10 GM diagnosis of ADHD. A 1:1 age and gender adjusted reference group without ADHD diagnosis was randomly selected. Total health claims and health care costs related to ADHD were analysed, in addition to more targeted analyses of the occurrence and costs of pre-defined common comorbidities of, in particular, adult ADHD (SUD, mood and anxiety disorders, obesity). Outcomes were mean costs per patient and occurrence rates of comorbid conditions. Surplus costs of a comorbid condition in persons with ADHD relative to costs of this condition in persons without ADHD were calculated. Subgroup analyses were conducted based on age (0–12 years, 13–17 years, 18–30years, 30+ years) and gender. ResultsPatients with ADHD were €1500 more expensive annually than individuals without ADHD (p < 0.001). Main cost drivers were inpatient care, psychiatrists and psychotherapists. Mood, anxiety, substance use disorders and obesity were significantly more frequent in ADHD patients and additional costs resulting from the comorbid conditions amounted up to €2800. Costs were slightly higher in women than men and increased with age for both genders. In young adults (18–30 years) health care costs dropped notably, especially costs for the medical treatment of ADHD with stimulants and costs for psychiatrists, before rising again in the group of patients over 30 years who had higher comorbidity rates. ConclusionsMedical costs for ADHD are substantial, in part through frequently occurring comorbid conditions, and particularly in adulthood, and are likely to further accelerate in the coming years. A gap of care was found, starting with the transition age group of patients over 17 years, as indicated by reduced costs per person during young adulthood, as well as an overall strong drop in administrative prevalence. In the future, approaches to improve the situation of care and reduce costs at the same time, i.e. through managed care programmes, should be implemented and benefit from detailed knowledge on age and gender-specific cost-drivers.

Diagnosis and treatment of constipation: a clinical update based on the Rome IV criteria

The aim of this study was to evaluate the published professional association guidelines regarding the current diagnosis and treatment of functional intestinal constipation in adults and to compare those guidelines with the authors’ experience to standardize actions that aid clinical reasoning and decision-making for medical professionals. A literature search was conducted in the Medline/PubMed, Scielo, EMBASE and Cochrane online databases using the following terms: chronic constipation, diagnosis, management of chronic constipation, Roma IV and surgical treatment. Conclusively, chronic intestinal constipation is a common condition in adults and occurs most frequently in the elderly and in women. Establishing a precise diagnosis of the physiopathology of functional chronic constipation is complex and requires many functional tests in refractory cases. An understanding of intestinal motility and the defecatory process is critical for the appropriate management of chronic functional intestinal constipation, with surgery reserved for cases in which pharmacologic intervention has failed. The information contained in this review article is subject to the critical evaluation of the medical specialist responsible for determining the action plan to be followed within the context of the conditions and clinical status of each individual patient.

Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis.

IntroductionLumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH.Methods and analysisWe will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software.Ethics and disseminationNo ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences.Trial registration numberCRD42016038166.

The relation of social support and depression in patients with chronic low back pain

Purpose: Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP.Method: Patients with LBP (n = 483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression.Results: More social support (overall functional social support) at baseline was associated with recovery from depression (OR = 0.24; 95% CI 0.10, 0.55) and less depressive symptoms (β = 1.68; 95% CI = 0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes.Conclusions: Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation.Implications for RehabilitationDepression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes.This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems.Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.

Does Hearing Aid Use Increase the Likelihood of Cerumen Impaction?

Background and ObjectivesImpacted cerumen is a common condition in adults. It is commonly believed that wearing hearing aids may increase the cerumen impaction, although no empirical evidence exist. The current study was aimed at studying if the use of hearing aids increase the likelihood of impaction of cerumen.Subjects and MethodsThe study used retrospective design. The study sample included 164 consecutive patients who were referred to cerumen clinic from Royal Glamorgan Hospital, Wales. Audiologist classified the cerumen impaction into four categories (i.e., no cerumen; non-occluding cerumen; occluding cerumen; and fully non-occluding cerumen and debris). Chi-square analysis was performed to study the association between hearing aid use and cerumen impaction.ResultsThe current study results showed no association between hearing aid use and cerumen impaction. Also, there was no association between right/left ear and cerumen impaction.ConclusionsThese results interesting and contrary to our assumption that hearing aid use increases the likelihood of cerumen impaction. More well-controlled studies with prospective designs are needed to confirm if these results are accurate.

Meralgia paresthetica in an obese child

Meralgia paresthetica is relatively a common condition in adults but rare in children. Here we report the presentation, clinical features and response to conservative treatment in a 12-year-old boy affected with this condition. The etiologies and differential diagnosis of this entity are also discussed.