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symptoms

Heart attack (or stroke)

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A heart attack occurs when the blood supply is severely reduced or interrupted.

Symptoms include tightness and pain in the center of the chest, pain radiating to the shoulders, neck, and arms, pallor, sweating, nausea, and shortness of breath.

What to do?

  1. Call an ambulance or go to the emergency room.
  2. Check vital parameters.
  3. Help the victim get into the least painful position (usually sitting with legs raised and knees bent).
  4. Check to see if the patient has any medicines prescribed by the doctor, and if the patient is conscious, help the patient to take them.

Source: Mediserve‘s Pocket Guide to First Aid.

Acute abdomen: what to do?

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At the time the acute abdomen occurs, surgical intervention is necessary. Abdominal pain is of different types depending on the etiology. General symptoms are visceral pain, pain from the peritoneum-parietal, and referred pain.

Immediate procedures:

  • Incannulating a vein
  • Hydration
  • Nose-gastric probe
  • Oxygen

Some laboratory tests, such as CBC +F +PLT, ESR, bilirubinemia, transaminases, amylasemia, blood glucose, ionogram; rectal exploration; chest X-ray; direct abdomen; abdominal ultrasonography, should be performed.

If peritonitis or perforation is suspected, contact the surgeon. In the absence of signs of peritonitis or perforation, antipyretics should be taken and possible antibiotic therapy initiated. Do not administer major painkillers or vagolytics because of the danger of covering up the clinical picture before diagnosis.

Source: Medical emergencies in pediatrics from Mediserve

Is it possible to stop the progressive worsening of Parkinson’s disease?

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The
Parkinson’s disease
 is a degenerative disease of the central nervous system, first described in 1817 by an English physician, James Parkinson. It is characterized by three main symptoms: slowness of movement, rigidity and tremor. The causes are related to degeneration of certain structures in the central nervous system, where dopamine, the main neurotransmitter essential for controlling bodily movements, is produced. Treatment of the disease still relies on drugs that can either supply the deficient dopamine through its precursor, L-DOPA, or stimulate the cells on which this transmitter acts, the dopaminergic cells. Unfortunately, due to the processes of neuro-degeneration, inherent in Parkinson’s disease, these drugs gradually lose their effectiveness over time.

A pioneering program involving an experimental and innovative drug treatment to be applied directly to the brains of people with the disease was published in the latest issue of the Journal of Parkinson’s Disease in February 2019.

The hope: to restore cells damaged in the course of the disease.

The study is based on providing Parkinson’s disease-compromised brains with increased levels of a naturally occurring growth factor, glial cell line-derived neurotrophic factor (GDNF), which has been shown to be able to regenerate the brain cells impaired dopaminergic pathways in individuals with this condition.

Six patients took part in the initial pilot study that mainly evaluated the safety of the treatment approach. Another 35 people then participated in the actual study, which was carried out in a double-blind manner for the duration of nine months: half of the randomly selected subjects received monthly infusions of GDNF, while the other half were treated with placebo infusions.

A specially designed delivery system using robot-assisted neurosurgery was implanted in each subject to carry out the monthly infusions. This delivery system made it possible to deliver high-dose infusions of GDNF every four weeks directly to disease-affected brain areas with pinpoint accuracy through a transcutaneous port mounted on the skull behind the ear. The high compliance rate (99.1%) in participants recruited throughout the United Kingdom demonstrated that the drug delivery system, by repeated cerebral infusion, is feasible and tolerable.

After 18 months of therapy, all of the patients who had received GDNF showed improvement in disease-affected brain areas and related symptoms with a moderate to major rating from the researchers compared with the initial condition. This improvement was also observed in those subjects who were initially placed in the placebo group and then switched to GDNF treatment. GDNF administration proved to be safe throughout the study period.

The study’s principal investigator, Dr. Alan L. Whone of Bristol Medical School at the University of Bristol, UK, stated that: “ In GDNF-treated subjects The improvement in disease-affected areas went beyond what has ever been seen before” and then added that: “High doses of GDNF are able to awaken and restore dopaminergic brain cells, which are progressively impaired in the course of Parkinson’s disease.”.

Even in light of the neurodegenerative process underlying Parkinson’s disease, the drugs currently in use are likely to gradually lose their effectiveness. Therefore, there is no doubt that this study, if confirmed by subsequent evaluations, represents a decisive breakthrough in the treatment of Parkinson’s disease.

Source: Alan L. Whone et al:“Extended Treatment with Glial Cell Line-Derived Neurotrophic Factor in Parkinson’s Disease” published online in the Journal of Parkinson’s Disease, in advance of Volume 9, Issue 2 (April 2019) by IOS Press

Irritable bowel syndrome, psychological approach effective

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Cognitive behavioral therapy is the latest recommended treatment in the fight against irritable bowel syndrome: according to a study published in the medical journal Gut, it is more effective in relieving patients’ discomfort than current standard therapy.

Irritable bowel syndrome affects about 10 percent of the population and is responsible for persistent symptoms such as stomach pain or cramping, abdominal bloating, constipation, or diarrhea; other frequent signs are also flatulence, fatigue, nausea, and incontinence. In its most severe form, the condition can have a major impact on the daily routine and quality of life of the sufferer, however, it is a so-called “functional disorder,” a way of saying that no one really knows the cause, in fact it is not associated with pathological changes that can be detected today with specific tests: the diagnosis is made on the basis of symptoms.

Current treatment approaches include medications and lifestyle and dietary advice, but psychological therapy could be an alternative method of managing the symptoms of irritable bowel syndrome.

The study involved 558 patients who had longstanding symptoms and had tried other treatments for at least one year: while some continued to receive the traditional treatments, others were offered eight sessions of cognitive behavioral therapy specifically designed for the treatment of irritable bowel syndrome. Twelve months later, it was the second group that reported the most significant improvements in symptoms: based on a measurement system on a scale from 0 to 500 (Irritable bowel syndrome severity scoring system – IBS-SSS), their symptoms were 61 points lower. Surprisingly, cognitive behavioral therapy proved effective even when it was not delivered through face-to-face interviews with the therapist: “the fact that both phone and Web-based therapy sessions have been shown to be effective is a really important and exciting finding, – said Hazel Everitt, associate professor of general medicine at the University of Southampton, England, and first author of the study – patients can follow these treatments at home, at the most convenient times.”.

Everitt HA, Landau S et al. Assessing telephone-delivered cognitive-behavioural therapy (CBT) and web-delivered CBT versus treatment as usual in irritable bowel syndrome (ACTIB): a multicentre randomized trial. Gut. 2019 Apr 10. pii: gutjnl-2018-317805.

Febrile convulsions in children

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Febrile seizures are seizures in the course of fever in a subject between 6 months and 5 years of age who has no signs of concomitant acute or chronic brain disease. Symptoms present generalized tonic, clonic or tonic-clonic seizures. The duration is a few minutes and rarely lasts for more than 30 minutes. Usually the child comes to the hospital when the seizure is over, so no urgent action is needed unless a relapse occurs.

Laboratory tests to be performed are blood glucose, calcemia, and electrolytes. Treatment performed only of seizure recurrence involves Diazepam rectally.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

What is hematemesis?

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Hematemesis is the oral emission of blood with vomiting. Symptomatology and objective signs depend on etiology. In the case of massive hemorrhage, symptomatology and objectivity in hypovolemic shock will be present. Immediate procedures such as cannulation of the vein, suspension of solid and liquid feeding, and insertion of a naso-gastric tube must be performed.

Laboratory tests to be performed are CBC, azotemia, blood glucose, ionogram, endoscopy, angiography, radioactive isotope radiological investigations, ECG, PA. In the case of esophageal varices, urgent perendoscopic sclerotherapy, endoscopic hemostasis and a possible infusion of Samotostatin is essential. For hematemesis of other nature sometimes targeted surgery or random therapy is needed.

Source: Medical Emergencies in Pediatrics by Mediserve edited by Maurizio Vanelli

What is epiglottitis?

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Epiglottitis is an acute infection, most common from 3 to 6 years of age. Symptoms exhibited during the onset of epiglottitis are fever, septic status, forced posture, dysphagia, hoarse voice, dyspnea, and sialorrhea. It is important to avoid any maneuvers that might agitate the child, not to lie the child on the bed, not to remove the child from the parents, not to take blood samples, and not to inspect the oral head.

The examinations to be performed are lateral neck X-ray, fiberoptic nasopharyngoscopy, and blood culture before therapy.

Source: Medical Emergencies in Pediatrics by Mediserve edited by Maurizio Vanelli

Kawasaki syndrome and disease

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Kawasaki syndrome is a disease also known as mucocutaneous lymph node syndrome. It is a vasculitis, sometimes affecting coronary arteries, that tends to occur in infants and children between 1 year and 8 years of age. The most common symptoms are anorexia, hyperemia, oropharyngeal erythema, strawberry tongue, erythematous eruptions, hardening of the hands and feet, desquamation of the fingertips, arthritis, and meningism.

Which are the immediate procedures?

In case of cardiac involvement, it is necessary to maintain respiration and hydrate by fluid infusion. Laboratory tests to be performed are CBC + formula + PLT, ESR, urine, blood glucose, azotemia, electrolytes, Ca, Mg, cratinemia, ECG.

In addition, it is necessary to monitor the patient with a variety of tests, such as echocardiography, scintigraphy, and other laboratory tests.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Laryngitis-tracheo-bacterial bronchitis: what to do?

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This is an infection of the subglottic tissue characterized by the presence of purulent discharge. The most frequent pathogen is staphylococcus, followed by streptococcus and pneumococcus. It is a rare disease that occurs in children under the age of six. The presenting symptoms are: septic status, fever, stridor and cough, rapidly worsening dyspnea.

It is very important to tranquilize the child right away and undergo chest Rx and/or lateral neck Rx, fiberoptic nasopharyngoscopy. Usually intravenous antibiotic therapy with Teicoplanin 10 mg/kg, Ceftriaxone 50 mg/Kg/day and Chloramphenicol 100 mg/kg/day is recommended.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Hyperventilation: what to do?

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Hyperventilation is when breathing is faster and deeper than usual as a result of emotional stress or anxiety. Symptoms of hyperventilation include fast and deep breathing, dizziness, chest pain, sweating, and tingling in the hands and around the mouth.

What to do?

  1. It is necessary to have the patient lie down in a quiet place for 15-30 minutes.
  2. Have the patient breathe more slowly and avoid breathing into a paper bag, as serious problems may arise.
  3. Reassure the patient and if he/she faints take appropriate measures.

Source: Mediserve‘s Pocket Guide to First Aid.

Menstrual symptoms reduce productivity in women of childbearing age

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If you think that the physical and psychological discomforts that can accompany the days of menstrual flow and those leading up to it are a minor thing, you are either a man or a very lucky woman. Even when one does not suffer from actual conditions associated with the menstrual cycle such as endometriosis, in fact, the symptoms that most women have to deal with periodically throughout all or part of their fertile lives are quite challenging to endure and manage. Cramps and pain in the lower abdomen, which may radiate to the legs; back pain; nausea and intestinal discomfort; difficulty concentrating and headache; fatigue and general malaise; irritability, nervousness; depression or anxiety. Although benign and transient, combined in various ways in type and intensity, these manifestations can significantly interfere with daily activities for one or more days, preventing one from fulfilling one’s study and work commitments to the best of one’s ability. With socioeconomic repercussions as well, given the loss of productivity. A nationwide Dutch study involving nearly 33 thousand women, recruited from the general female population of childbearing age (15-45 years), assessed this impact through the administration of online questionnaires that investigated both the loss of productivity associated with menstrual flow-related absences from school or the workplace and that associated with “presenteeism,” i.e., being present in less than excellent mental and physical condition. The responses obtained showed that 13.8 percent of women of childbearing age occasionally have to take time off work or study commitments due to menstrual disorders, losing an average of 1.3 days per year. While this figure may appear reassuring (but it is not, considering that this is an average value and that menstrual flow is a physiological phenomenon and not a disease), the same cannot be said of the percentage of related presenteeism and reduced productivity, experienced by as many as 80.7 percent of the study participants for an average of 23.2 days per year (i.e., about 2 days per cycle). The researchers calculated that a loss of productivity of one-third (33 percent) of that secured under optimal psychophysical conditions for the average recorded period of presenteeism corresponds to a total annual loss of productivity of nearly 9 days: on a par with real illness. In addition, it should be considered that the absenteeism found among the women involved in the survey is likely to be lower than the actual absenteeism, since those responding to the online questionnaire were predominantly women with higher levels of education and engaged in activities that require less physical exertion than those performed by women with lower levels of education. The study also confirms that despite the considerable discomfort caused by menstrual flow, only a minority of women turn to the doctor for a satisfactory solution (45 percent according to the Dutch research, but around 15 percent in other surveys), resigning themselves to living with periodic discomfort. This is a situation that should be sought to be changed through increased education of both women and physicians in the protection of women’s well-being and reproductive health, and by developing labor policies geared toward providing greater flexibility of hours and tasks, with a view to reducing inconvenience and loss of productivity during the most critical phase of the cycle. For the benefit of all.

Source: Schoep ME et al. Productivity loss due to menstruation-related symptoms: a nationwide crosssectional survey among 32748 women. BMJ Open 2019;9:e026186. doi:10.1136/bmjopen-2018-026186
Photo by Katarzyna Grabowska on Unsplash

Hypoglottic laryngitis

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It is an infection of the subglottic tissue with edema caused by a virus. Hypoglottic laryngitis occurs mainly in children under three years of age, with sudden onset after previous airway inflammation.

The most common symptoms are cough and inspiratory stridor. It is very important to calm the child and proceed with aerosols of beclomethasone and Salbutamol every 4 hours.

The examinations to be performed are lateral neck Rx and possible blood gas analysis. Necessary is clinical monitoring with assessment of general status and dyspnea and instrumental with assessment of HR, FR, O2 saturation.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Six signs and symptoms not to be underestimated

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There is certainly no need to be too alarmed at the first speck on the skin, for a little discomfort in the throat or at every slightest tingle Of unclear origin. However, there are some signs and symptoms, including. modest, which it is good not to underestimate and which, if they do not pass in a reasonable period of time or worsen, they should prompt consultation with the doctor of family to have competent judgment and initiate, if necessary, appropriate Insights. Do you know what are the signals of our body not to be neglected? Here are six particularly important ones to pay attention to.

Myxoedema: symptoms and monitoring

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Myxoedema is the metabolic decompensation due to reduced thyroid hormone uptake. This condition is very rare in pediatric age.

The main symptoms are drowsiness, lethargy, hypoventilation, hypothermia, and coma. Immediate procedures to be performed are heat support, maintenance of respiration, and maintenance of circulation.

Examinations and monitoring

Tests to be performed immediately are: arterial PH, CBC, azotemia, blood glucose, electrolytes, transaminases, TSH, FT3, FT4, T3, T4.

Clinical monitoring with cardiology checks, psychological evaluation, and regression of symptoms is necessary. Regarding instrumental and laboratory monitoring perform thyroid function tests, ultrasonography, thyroid gland scintigraphy, brain MRI.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

Do you know how to recognize the symptoms of depression?

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In autumn, you know, everyone is a little less cheerful. The hours of light diminish, weather conditions worsen and take away the desire to go out to meet friends and engage in physical activity or simply stroll, work is in full swing, and everything seems a little heavier than the due. These and other factors cause those suffering from depression, in autumn, may go through a worsening of typical symptoms of the illness: deep sadness much of the time, desire to cry unmotivated, sense of loneliness and abandonment, decrease in energy, loss of interest and inability to derive pleasure from activities and situations, fatigue constant and increased need for sleep, altered appetite. But the depression can also have atypical symptoms, which few people know about, but which do not are to be neglected. These, for example. .

Coma: what to do?

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The Coma is the morbid condition characterized by loss of consciousness with reduced o absent responsiveness to sensory stimuli and preservation of function vegetative. Four levels of coma are distinguished: awake coma, mild coma, coma medium and deep coma. Symptoms are variable depending on the cause and the coma level.

Immediate procedures are needed to intervene: check motor response, pupils, and verbal response. Regarding the medical history, one needs to assess the time and mode of onset, past or coincidental trauma, past or current illnesses taking drugs or toxicants. Laboratory tests such as CBC, blood glucose, azotemia, electrolytes, transaminases, amylasemia, creatininemia, and urinalysis should be performed.

Source: Mediserve‘s Medical Emergencies in Pediatrics.

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