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Hospital Infection Control

Cardiac catheterization lab/EP lab

What elements of the cardiac catheterization lab/EP lab are necessary for infection prevention and control? Discussion of infection control in the cardiac catheterization lab/ EP lab will be limited to non-valvular cardiovascular devices and procedures. Current guidelines regarding infection control were last published by the Society for Cardiovascular Angiography and Interventions in 2006. The spectrum…
Cardiology

Cardiac Implantable Electrical Devices: Management of Complications; Indications for Lead Extraction

General description of procedure, equipment, technique Introduction The use of cardiac implantable electronic devices (CIED)—namely permanent pacemakers (PPMs); implantable cardioverter defibrillators (ICDs), transvenous and subcutaneous; devices for cardiac resynchronization therapy (CRT); and implantable loop recorders (ILRs)—appears to have increased over the last decade. This is mainly due to the expansion of indications and increasing life…
Cardiology

Selecting PCI, CABG or medical therapy: Current Recommendations

General description of procedure, equipment, technique 1.) Optimal medical therapy (OMT) OMT encompasses the spectrum of medications (and exercise) that reduces morbidity and mortality of the coronary artery disease (CAD) process. In comparison with revascularization, the focus is often on medications that are prescribed to reduce the burden of angina, primarily by allowing vasodilation and…
Obstetrics and Gynecology

Urinary Incontinence

Stress urinary incontinence, urge incontinence, mixed incontinence, overflow incontinence 1. What every clinician should know Urinary incontinence, or the loss of bladder control, is a common condition and has been reported in up to 43% of women aged 37-54. The two phases of the bladder function include filling phase and emptying phase. When these functions…
Nephrology Hypertension

Diabetic Kidney Disease: Hypertension Management

Does this patient have diabetes-related hypertension? Presentation of hypertension in diabetic nephropathy A 58-year-old man presents with elevated blood pressure (BP) confirmed on two occasions by his primary care physician. At his first visit, his BP was 162/88 mmHg, and he was advised to lose weight, exercise, and limit sodium consumption. He currently feels well.…
Nephrology Hypertension

Diabetic Kidney Disease: Hyperglycemia Management

Does this patient have chronic kidney disease related to diabetes mellitus? The patient has had diabetes mellitus (DM) (type 1 or type 2) for at least 5 years. S/he has needed changes in therapy to include increasing doses of insulin or additional therapies to keep the blood sugars in control. S/he may have retinopathy, neuropathy…
Infectious Diseases

Prosthetic Joint Infection

OVERVIEW: What every practitioner needs to know Joint replacement surgery is a remarkable medical advancement that dramatically improves the quality of life. In 2006, nearly 800,000 joint replacements were performed in the United States, involving hips and knees primarily. The shoulder, elbow, wrist, ankle, metacarpophalangeal and interphalangeal joints are also being replaced. It is estimated…
Pulmonary Medicine

Pleurodesis and Use of Long-term Pleural Catheters

General description of procedure, equipment, technique Malignant pleural effusions are common complications of advanced malignancy, usually resulting in significant dyspnea, chest tightness, or cough. The approach to the management of malignant pleural disease has evolved considerably in the past few years, with several options now available to our patients. Traditional treatment methods that aim to…
Pediatrics

Nephrotic syndrome/glomerular and tubular proteinuria

The nephrotic syndrome consists of proteinuria, hypoalbuminemia, and hyperlipidemia with or without edema. In children <10 years, the most common cause is minimal change disease which frequently responds to corticosteroid therapy and has a good long term prognosis. Failure to respond to steroid therapy suggests a poor long term renal prognosis. Proteinuria found incidentally in…
Dermatology

Lupus (profundus) Panniculitis (Lupus Erythematosus Panniculitis, Lupus Panniculitis, Subcutaneous Lupus Erythematosus, Lupus Profundus)

Are You Confident of the Diagnosis? Characteristic findings on physical examination Lupus erythematosus panniculitis (LEP) is characterized by chronic and recurrent subcutaneous inflammatory lesions and is considered a form of chronic cutaneous lupus erythematosus (CLE). Clinically, LEP appears as erythematous, deeply indurated, tender plaques and nodules. The overlying epidermis is typically normal, but over time…
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