RESUMEN
BACKGROUND: Patients with internal herniation after Roux-en-Y gastric bypass might present with normal laboratory values, minimal physical examination findings, and nonspecific radiographic results, making early diagnosis difficult and resulting in catastrophic bowel necrosis. OBJECTIVE: Our purpose is to increase awareness so physicians of all specialties caring for these patients have a heightened suspicion and low threshold to obtain early surgical consultation in bypass patients with unexplained abdominal pain. CASE REPORT: A 36-year-old female had a delayed presentation of internal herniation 4 years after laparoscopic retrocolic Roux-en-Y gastric bypass for morbid obesity. Initially, she had unremarkable physical examination, laboratory results, and plain x-ray findings, which made diagnosis challenging. During emergent exploratory laparotomy, she was found to have a strangulated Petersen's space hernia with volvulus, necessitating extensive gastric, small bowel, and colonic resection. She was referred for small bowel transplantation and has survived more than 8 years. CONCLUSIONS: The occurrence of Petersen's hernias has increased with laparoscopic Roux-en-Y gastric bypass due to less postoperative adhesions. Whether days or several years after gastric bypass, patients with intermittent abdominal pain, nausea, or vomiting need to be carefully evaluated. These herald signs of internal herniation should prompt early surgical consultation. Pain out of proportion to physical examination often indicates need for urgent surgical intervention. Physicians need to be educated about this potentially life-threatening complication so early diagnosis and treatment can avoid catastrophic bowel gangrene.
Asunto(s)
Gangrena/etiología , Derivación Gástrica/efectos adversos , Hernia/etiología , Enfermedades Intestinales/etiología , Adulto , Femenino , HumanosRESUMEN
The objective of the present study was to compare the efficacy and safety of low-dose unfractionated heparin (UFH) and a low-molecular-weight heparin (LMWH) as prophylaxis against venous thromboembolism in critically ill surgical patients undergoing major surgery. This was a randomized prospective study in which critically ill patients scheduled to undergo major elective surgery were allocated to receive subcutaneously either LMWH once daily and a placebo injection containing sterile 0.9% normal saline or 5000 IU UFH twice daily subcutaneously. Each patient was evaluated postoperatively clinically and confirmed by Doppler study for development of deep vein thrombosis (DVT). One hundred and fifty-six patients completed the protocol. There was similar efficacy of UFH as compared with LMWH in the prophylaxis of DVT. There was also no statistically significant difference in the incidence of major complications in the heparin group as compared with the LMWH group. However, minor hemorrhagic complications such as wound hematoma and surgical site bleeding were significantly more in the heparin group as compared with the LMWH group. Both UFH 5000 units subcutaneously twice daily and LMWH 40 mg once daily provide highly effective and well tolerated prophylaxis for critically ill surgical patients. Considering the advantage of once-daily dosing, a wider adoption of prophylaxis with LMWH may be justified on the basis of patient acceptability and saving of nursing time.
Asunto(s)
Anticoagulantes/uso terapéutico , Enfermedad Crítica , Procedimientos Quirúrgicos Electivos , Enoxaparina/uso terapéutico , Heparina/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Premedicación , Trombosis de la Vena/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Esquema de Medicación , Enoxaparina/administración & dosificación , Enoxaparina/efectos adversos , Femenino , Estudios de Seguimiento , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Heparina/administración & dosificación , Heparina/efectos adversos , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de Riesgo , Ultrasonografía , Trombosis de la Vena/diagnóstico por imagenRESUMEN
This study was carried out to assess the fluoride concentration in groundwater in some villages of northern Rajasthan, India, where groundwater is the main source of drinking water. Water samples collected form deep aquifer based hand-pumps were analysed for fluoride content. Fluoride in presently studied sites was recorded in the ranges of 4.78 and 1.01 mg/l. The average fluoride concentration for this region was recorded 2.82 mg/l. As per the desirable and maximum permissible limit for fluoride in drinking water, determined by WHO or by Bureau of Indian Standards, the groundwater of about 95 of the studied sites is unfit for drinking purposes. Due to the higher fluoride level in drinking water several cases of dental and skeletal fluorosis have appeared at alarming rate in this region. The middle and eastern parts of the Hanumangarh, a northern most district of the state, can be classified as higher risk area for fluorosis; due to relatively high concentrations of fluoride (3-4 mg/l) in groundwater of this region. After evaluating the data of this study it is concluded that there is an instant need to take ameliorative steps in this region to prevent the population from fluorosis.
Asunto(s)
Fluoruros/análisis , Salud Rural , Contaminantes Químicos del Agua/análisis , Abastecimiento de Agua , Humanos , IndiaRESUMEN
Ground water quality of Hisar city was assessed for its suitability for drinking purposes. Samples collected from the Bore-wells (forms a part of municipal water supply) and handpumps (direct consumption) were analyzed for the various physico-chemical parameters including pH, electrical conductivity, total dissolved salts, total hardness, total alkalinity, sodium, potassium, calcium, magnesium, carbonate, bicarbonate, chloride and sulfate. The concentrations of magnesium, sodium, potassium, sulfate and especially of chloride were found moderately higher than the WHO standards for the drinking water. Further a comparison of fluoride (F-) levels in groundwater of various cities and towns of Haryana state was performed. The relatively higher concentrations of F- in groundwater of Haryana raise the risk of fluorosis and hence groundwater must be used with proper treatment. Promising defluoridation methods using locally available materials and technologies are discussed for the prevention and control of fluorosis. Data were assessed statistically to find the suitable markers of ground water quality as an aid to monitoring groundwater quality.
Asunto(s)
Fluoruros/análisis , Iones/análisis , Contaminantes Químicos del Agua/análisis , Ciudades , Fluoruros/normas , Agua Dulce/análisis , India , Contaminantes Químicos del Agua/normasRESUMEN
Groundwater samples collected either from the bore-wells (forms a part of municipal water supply) or from the hand pumps (direct consumption) were analysed for fluoride in Hisar city, India. The results indicate considerable variations among the analysed groundwater samples and the concentration of fluoride ranged from 0.03--16.6 mg/l. In most of the groundwater samples the concentration of fluoride was found to be moderately higher, when compared to the WHO standard for drinking water, which may lead to associated health risks in urban population, if the groundwater is being used without proper treatment. Furthermore, it is suggested that the sources of municipal water supply must be established in a region where an adequate level of fluoride was observed.
Asunto(s)
Monitoreo del Ambiente , Fluoruros/análisis , Contaminantes Químicos del Agua/análisis , Abastecimiento de Agua , Demografía , Humanos , India , Medición de Riesgo , Población Urbana , Abastecimiento de Agua/análisis , Abastecimiento de Agua/normasRESUMEN
Asthma patients' knowledge and perceptions about asthma management regimens have been shown to correlate with the quality of their asthma management and outcomes. This study addresses adult ambulatory asthma patients' knowledge and perception of the asthma management guidelines issued by the National Asthma Education and Prevention Program. We interviewed 76 patients at three adult medicine outpatient clinics. Of 37 patients who knew about peak flow monitoring, 21 found it to be useful, only 10 were using it regularly, and 7 had a notation about it in their chart. Eight patients knew about patient self-assessment forms, 6 found them useful, 3 had used one recently, and only 1 patient had one in the chart. Six patients knew about asthma action plans, 4 of them thought that these plans were useful, but only 1 patient was actively using it. This study demonstrates major gaps in the asthma patients knowledge, perceptions, and their adherence to recommendations and also with the documentation in the medical record.
Asunto(s)
Asma , Conocimiento , Cooperación del Paciente , Percepción , Antiinflamatorios/uso terapéutico , Asma/psicología , Asma/terapia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Monitoreo Ambulatorio , New York , Atención al Paciente/normas , Educación del Paciente como Asunto , Pruebas de Función Respiratoria , Reología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: To survey a cross section of patients presenting to three urban primary care clinics to understand online health information search behaviors. DESIGN AND ANALYSIS: At three urban primary care clinics affiliated with University at Buffalo, School of Medicine, 315 patients were interviewed. Interview questions included items on education, demographic information, employment, number of current prescriptions, insurance, online access, and specifics of health-searching behaviors. Chart review determined patient body mass index and number of chronic illnesses. Logistic regression and chi2 statistics were used to investigate the relationship between patient characteristics and the proportion of patients who use the Web for seeking health information. RESULTS: Approximately 53% of respondents reported using Web or e-mail in the past year and 68% (33% of total sample) of those who accessed the Web used it to search for health information. The two most commonly cited search areas included information about a physical illness and nutrition/fitness. Education and race significantly predicted online health-seeking behavior when considering all factors in the study. Many patients (22%) relied on friends and family to navigate the Web, and 45% of patients reported that the information that they sought was unrelated to their clinical visit. CONCLUSION: Current use of the Internet for health information was limited among more disadvantaged patient groups. More research is needed to examine the relationship between health-seeking behavior and patients' management of their health and well-being.
Asunto(s)
Educación en Salud/estadística & datos numéricos , Servicios de Información/estadística & datos numéricos , Internet/estadística & datos numéricos , Aceptación de la Atención de Salud , Adolescente , Adulto , Anciano , Instituciones de Atención Ambulatoria , Distribución de Chi-Cuadrado , Femenino , Educación en Salud/métodos , Estado de Salud , Humanos , Almacenamiento y Recuperación de la Información , Entrevistas como Asunto , Modelos Logísticos , Masculino , Persona de Mediana Edad , New York , Atención Primaria de Salud , Servicios Urbanos de SaludRESUMEN
BACKGROUND: Complementary and alternative medicines (CAM) include a number of different modalities to improve health. The popularity of such healing methods has increased, although reports of problems and adverse effects have also increased. Difficulties have also been identified in communication between patients and their providers. Previous reports concerning CAM may have undersampled lower socioeconomic groups as a result of the telephone survey techniques used. METHODS: All patients with valid appointments for internal medicine resident teaching clinics at 2 publicly supported centers were considered for eligibility. Patients were surveyed about current medications and a variety of CAM modalities. Medical records were reviewed for demographic information and to confirm diagnoses, allergies, medications, and any documented adverse effects. RESULTS: Use of CAM was common by 85.4% of patients, including those using some form of diet, exercise, and prayer. A smaller number (32.3%) were currently using alternate health care providers and products. About 5% of the population used 6 products or more. Use by this primarily poor urban population appeared similar to that in previous reports, with some exceptions. Expensive modalities were less frequently used, whereas use of prayer appears more prevalent. CONCLUSIONS: Complementary and alternate medical modalities are as commonly used by poor urban populations as by the general population. Quantification of use depends on the types of CAM used and the time frame asked. Although much of the use does not appear to be maladaptive, a small percentage of individuals have enthusiastically adapted CAM in ways that would not be endorsed by most allopathic physicians.