Al-Alawi M.,Our Lady of Lourdes Hospital |
Hassan T.,Materials Misericordiae Hospital |
Chotirmall S.H.,St Jamess Hospital
American Journal of Medicine | Year: 2014
Global estimates on aging predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis, and management in clinical practice require optimization. This review aims to provide an update for clinicians, highlighting advances in the understanding of the aging process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Aging impacts airway responses and immune function, and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence, and side-effect profiles persist in the older patient, while novel recording devices developed to aid detection of an adequate inhalation evaluate treatment effectiveness and compliance more accurately than previously attainable. Anticytokine therapies improve control of brittle asthma, while bronchial thermoplasty is an option in refractory cases. Multidimensional intervention strategies prove best in the management of asthma in the older adult, which remains a condition that is not rare but rarely diagnosed in this patient population.
Ho R.T.,Thomas Jefferson University |
Frisch D.R.,Thomas Jefferson University |
Pavri B.B.,Thomas Jefferson University |
Levi S.A.,Our Lady of Lourdes Hospital |
Greenspon A.J.,Thomas Jefferson University
Circulation: Arrhythmia and Electrophysiology | Year: 2013
Background-Diagnosing atypical atrioventricular node-dependent long RP supraventricular tachycardias (SVTs) can be challenging. Methods and Results-Nineteen patients with 20 SVTs (atypical atrioventricular nodal reentrant tachycardia without [n=11]/with [n=3] a bystander nodofascicular [NF] accessory pathway, orthodromic reciprocating tachycardia [ORT] using a decremental atrioventricular [permanent form of junctional reciprocating tachycardia; n=4] or NF [NF reentrant tachycardia; n=2]) accessory pathway underwent electrophysiological study. Postpacing interval (PPI)-tachycardia cycle length (TCL), corrected PPI, ΔVA (ventriculoatrial), ΔHA (His-atrial), ΔAH (atrio-His) values, and responses to His-refractory ventricular premature depolarizations were studied. Compared with atrioventricular nodal reentrant tachycardia, ORT patients were younger (42±13 years versus 54±19 years; P=0.036) and were women (5/6 [83%] versus 3/14 [21%]; P=0.036); TCLs were similar (435 ms versus 429 ms; 95% confidence interval, -47.5 to 35.5). PPI-TCL was shorter for ORT (118 ms versus 176 ms; 95% confidence interval, 26.3-89.7) but only 50% had PPI-TCL <115 ms, whereas 5 of 6 (83%) had PPI-TCL <125 ms (sensitivity, 83%; specificity, 100%). Corrected PPI <110 ms, ΔVA <85 ms, and ΔHA <0 ms had equivalent sensitivity (67%) and 100% specificity for ORT. Compared with permanent form of junctional reciprocating tachycardia, NF reentrant tachycardia/atrioventricular nodal reentrant tachycardia had longer ΔAH (29 ms versus 10 ms; 95% confidence interval, 3.03-35.0) or AH(SVT)
Idrees A.,Our Lady of Lourdes Hospital
Journal of the Pakistan Medical Association | Year: 2012
The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.
McCarthy J.,Massachusetts General Hospital |
Mc Millan S.,Our Lady of Lourdes Hospital
Orthopedic Clinics of North America | Year: 2013
Hip arthroscopy is a rapidly progressing field that has advanced in function and survivorship over the past decade. As increasing literature is published on outcomes of hip arthroscopy, a retrospective review has allowed for the identification of factors that affect survivorship. Within this review, the authors present the factors identified to date that affect survivorship after hip arthroscopy while raising questions about the future direction of the field. © 2013 Elsevier Inc.
Raza H.,Our Lady of Lourdes Hospital |
Mahapatra A.,Our Lady of Lourdes Hospital
Advances in Orthopedics | Year: 2015
Almost all orthopaedic surgeons come across acute compartment syndrome (ACS) in their clinical practice. Diagnosis of ACS mostly relies on clinical findings. If the diagnosis is missed and left untreated, it can lead to serious consequences which can endanger limb and life of the patient and also risk the clinician to face lawsuits. This review article highlights the characteristic features of ACS which will help an orthopaedic surgeon to understand the pathophysiology, natural history, high risk patients, diagnosis, and surgical management of the condition. © 2015 Hasnain Raza and Anant Mahapatra.