Review Of Clinical Evaluation Research Articles

Anosmia: A Clinic Based Review

Anosmia and hyposmia, the inability or decreased ability to smell, is estimated to afflict 3–20% of the population.Risk of olfactory dysfunction increases with old age and may also result from chronic sinonasal diseases, severehead trauma, and upper respiratory infections, or neurodegenerative diseases. These disorders impair the ability tosense warning odors in foods and the environment, as well as hinder the quality of life related to social interactions,eating, and feelings of well-being. This article reports and extends on a clinical update commencing at the 2016Association for Chemoreception Sciences annual meeting. Included were reports from: a patient perspective onlosing the sense of smell with information on Fifth Sense, a nonprofit advocacy organization for patients witholfactory disorders; an otolaryngologist’s review of clinical evaluation, diagnosis, and management/treatment ofanosmia; and researchers’ review of recent advances in potential anosmia treatments from fundamental science,in animal, cellular, or genetic models. As limited evidence-based treatments exist for anosmia, dissemination ofinformation on anosmia-related health risks is needed. This could include feasible and useful screening measuresfor olfactory dysfunction, appropriate clinical evaluation, and patient counseling to avoid harm as well as managehealth and quality of life with anosmia.

Hemorrhoids: which is the best therapeutic option?

Hemorrhoids are one of the commonest of rectal diseases seen all across the globe. Constipation and bleeding are the main symptoms associated with this condition. The condition maybe associated with an underlying carcinoma as well. Understanding the pathophysiology will enable the surgeon to determine the best therapeutic option for this condition. A brief review of clinical evaluation and treatment options is presented in this paper.

A Review of Clinical Evaluation and Management of Delirium

A Review of Clinical Evaluation and Management of Delirium

Anosmia-A Clinical Review.

Anosmia and hyposmia, the inability or decreased ability to smell, is estimated to afflict 3-20% of the population. Risk of olfactory dysfunction increases with old age and may also result from chronic sinonasal diseases, severe head trauma, and upper respiratory infections, or neurodegenerative diseases. These disorders impair the ability to sense warning odors in foods and the environment, as well as hinder the quality of life related to social interactions, eating, and feelings of well-being. This article reports and extends on a clinical update commencing at the 2016 Association for Chemoreception Sciences annual meeting. Included were reports from: a patient perspective on losing the sense of smell with information on Fifth Sense, a nonprofit advocacy organization for patients with olfactory disorders; an otolaryngologist's review of clinical evaluation, diagnosis, and management/treatment of anosmia; and researchers' review of recent advances in potential anosmia treatments from fundamental science, in animal, cellular, or genetic models. As limited evidence-based treatments exist for anosmia, dissemination of information on anosmia-related health risks is needed. This could include feasible and useful screening measures for olfactory dysfunction, appropriate clinical evaluation, and patient counseling to avoid harm as well as manage health and quality of life with anosmia.

Factors influencing cognitive functioning following mild traumatic brain injury in OIF/OEF burn patients1

To examine the relationship between mild traumatic brain injury (mTBI), psychiatric conditions, pain medications, and injury severity on cognitive functioning in service members admitted to a burn unit. We hypothesize that psychiatric co-morbidity and pain medications will have a stronger relationship with cognitive dysfunction than mTBI diagnosis in this population. Retrospective review of clinical evaluations (n=194) completed between September 2005 - October 2007 on service members with burn injuries secondary to explosive munitions. Evaluations were completed during the acute stage of recovery (mean=7.87 weeks). mTBI diagnosis (n=50) was made through a clinical interview using ACRM criteria. Exclusion criteria included duration of posttraumatic amnesia > 24 hours (n=10); and inability to complete neurocognitive measures due to severe bimanual burns and/or amputations (n=17). Cognitive functioning was evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Subjects who sustained mTBI demonstrated significantly greater difficulty on the RBANS visuospatial and attention/processing speed indices. A hierarchical linear regression, using mTBI diagnosis, psychiatric diagnosis, time since injury, presence of pain medications, and measures of trauma severity as predictive factors, found that mTBI diagnosis had a significant, but small unique effect on cognitive functioning. Contrary to our hypothesis, psychiatric co-morbidity was not shown to have a significant effect on this population of acutely injured service members. While the relationship between severe TBI and cognitive functioning is well established, the relationship between mTBI and its effects on cognitive and behavioral abilities is less clear. The current study demonstrates that mTBI and analgesic medications have a small effect neurocognitive functioning in this population. Continued examination of this relationship is warranted.

Long-Term Risk of Atrial Fibrillation With Symptomatic Gastroesophageal Reflux Disease and Esophagitis

The mechanisms underlying the triggers and maintenance of atrial fibrillation (AF) are not fully understood. One potential unproved mechanism is that gastroesophageal reflux disease (GERD), in which acid reflux induces local and systemic inflammation, may increase triggered activity in the myocardium and pulmonary veins and increase AF risk. A self-report questionnaire was mailed to a random sample of 5,288 residents of Olmsted County, Minnesota, aged 25 to 74 years to assess the presence and frequency of GERD from 1988 to 1994. The long-term risk for AF over a period of 11.4 +/- 5.0 years was determined through review of clinical evaluations and the electrocardiographic database in those without previous AF. The average age was 53 +/- 17 years, and 2,571 subjects (49%) were man. Of these patients, 741 developed AF (cumulative probability of AF at 18 years 20%, 95% confidence interval [CI] 17% to 22%). Age (hazard ratio [HR] 1.09, 95% CI 1.08 to 1.10, p <0.001), male gender (HR 1.81, 95% CI 1.53 to 2.14, p <0.001), hypertension (HR 1.36, 95% CI 1.14 to 1.61, p = 0.0006), and heart failure (HR 1.74, 95% CI 1.16 to 2.60, p = 0.007) were independently associated with the risk of AF. The presence of any GERD was not associated with risk for AF (HR 0.81, 95% CI 0.68 to 0.96, p = 0.014) after adjustment for other risk factors. The frequency of GERD did not significantly affect the risk for AF, although patients with more frequent GERD had a slightly higher AF risk. Esophagitis increased the risk for AF (HR 1.94, 95% CI 1.35 to 2.78, p <0.001), but the association did not persist when accounting for other risk factors (p = 0.72). In conclusion, in this large population-based study of patients surveyed for GERD, no association was found with the presence or frequency of symptoms and AF. Patients with esophagitis were more likely to develop AF, although this association requires further study.