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The Evaluation and Management of Recurrent Pregnancy Loss
No full textPregnancy loss occurs in approximately 10-15% of pregnancies, but only 2% of women fit the criteria for Recurrent Pregnancy Loss (RPL). RPL is defined as two or more failed consecutive clinical pregnancies. The etiology of RPL is often multifactorial and only about half of cases have a known etiology after medical workup. Abnormal fetal chromosomes account for 50% of genetic factors that attribute to early single pregnancy loss. Most of these are caused from an irregular number of fetal chromosomes arising de novo. Couples experiencing RPL should obtain karyotypes and recommend in-vitro fertilization (IVF) with preimplantation genetics if chromosomal abnormalities are present. Approximately 40% of those with RPL have a concurrent diagnosis of PCOS. Metformin is associated with a reduction in RPL for patients with PCOS. Factor V leiden, Prothrombin G20210A, and antiphospholipid antibody syndrome are commonly linked to RPL. Patients with thrombophilia can be given dual therapy with low-dose aspirin and low-molecular weight heparin (LMWH). Progesterone may be recommended for all patients with RPL because it prepares the endometrium for implantation. Myomectomy can be offered to patients with any leiomyoma that measures larger than 5 cm or in patients with submucosal fibroids. Intrauterine adhesions and a septate uterus may be treated with hysteroscopy
Management of Depression and Anxiety in Adolescence
No full textThis CME article discusses the management of anxiety and depression in adolescents. The prevalence of anxiety and depression in this age group is alarming and a huge issue in society. The CME article explains why adolescents are more vulnerable than other age groups and how this can predispose them to developing mental health disorders. Statistics were analyzed and compared throughout this paper which demonstrate that poor mental health during adolescence will have negative overall health effects in adulthood. Psychotherapy, including cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT), pharmacologic management and inpatient psychiatric treatment are mentioned and discuss whether there are known benefits, or problems with the treatment. This article brings awareness to the existing gap in effective management of adolescent anxiety and depression and further emphasizes the need for improvement
Understanding the Principles of Electrocautery: With Special Attention in Patients with Pacemakers and Implantable Cardioverter Defibrillators.
No full textEvaluating mortality risks prior to surgery has always been a key educational teaching point among physician assistants and medical schools. These risks include, inpatient status, sepsis, functional status, cancer, age, obesity, pulmonary, renal, liver, and cardiac conditions such as chronic heart failure, past myocardial infarction, angina, peripheral arterial disease, and hypertension.11 Although this is a great way to standardize patients to understand preoperative risk, there are other more specific populations that need extra considerations. Patients implanted with devices such as pacemakers or implantable cardioverter defibrillators (ICDs) are a population that has been researched regarding the need for additional prophylaxis prior to surgical procedures
Diagnosis and Management of Cranial Cerebrospinal Fluid (CSF) Leaks
No full textCranial CSF leaks may be difficult to recognize in the clinical or subacute setting, and are important to identify following traumatic injury. Management will vary depending on the etiology and severity of the leak. Clinicians in both the primary care and emergency care setting will benefit from understanding the various etiologies of these leaks, important symptoms and comorbidities to consider on patient presentation, and how they can affect management. Although a majority of CSF leaks will resolve with conservative management, spontaneous leaks that remain untreated can place certain patient populations at risk for infection. This article reviews the causes of cranial CSF leaks and outlines recommendations for conservative versus surgical treatment based on patient presentation
Investigating genetic risk factors associated with sudden infant death syndrome
No full textSudden Infant Death Syndrome (SIDS) is the most common cause of death in infants under one year old in the United States. It is widely accepted that SIDS is a multifactorial condition, likely caused by a combination of environmental and underlying genetic risk factors. Public health campaigns have helped drastically reduced the number of SIDS deaths that occur each year by educating parents and caregivers about safety measures they can take to protect their infant, such as placing the infant on their back to sleep and avoiding cigarettes. However, research surrounding genetic risk factors for SIDS is surprisingly lacking, given other multifactorial conditions such as autism spectrum disorder have been widely investigated for associated genes. This presentation reviews environmental risk factors and briefly discusses some SIDS-associated genes and the current state of research literature regarding genetic risk factors for SIDS
Purposefully Feminizing Masculinity: Femininity in Male Rock and Metal Stars 1950s - 1980s
Get PDFTraditionally in Western culture, men have had the privilege of promoting rebellion while women have had to be submissive and socially desirable. This expectation applied to all women but especially women in the rock ‘n’ roll scene. The overwhelming loudness of rock and the typical message of rebellion was connected to the power that men held within society.1 The combination of loud and fast paced music with the electronic nature of the instruments is what sets rock ‘n’ roll and metal apart from other genres. The attention that rock ‘n’ roll music demands, both from the challenging nature of the music’s messages and the difficulty in ignoring the volume was not rare in the mid-twentieth century in the Western world. Despite already holding power, some men wanted to gain more popularity or wealth by utilizing traditionally feminine presentations. Some artists who participated in establishing the genres of rock ‘n’ roll, glam rock, and hair metal blurred the lines between masculinity and femininity for their own personal gain. To identify how male artists in the 1950s - 1980s walked the line between masculine and feminine, this essay will look at traditionally feminine features, such as hairstyle and gender based physical presentation, as well as specific musical aspects, to show how masculine artists employed traditional feminine presentations
Controlling Images: Black Male and Female Representations
Get PDFAmerican culture has a very rich history that has shaped our society in the present day. One thing in history that has stayed with us throughout the years is racism. This phenomenon has had a big impact on our society throughout the years. And if it never came into existence, our world would be a much different place. Racism affects any and everything imaginable. It affects the way we see each other, communicate, and interact with each other. Slavery was a turning point for racism and it allowed for racism to flourish by dehumanizing people just because of the color of their skin. This concept transgressed itself into the civil rights era. Here, black Americans were freed from their physical shackles and indentured servitude, but they couldn\u27t escape the shackles placed on them by society. They are hard to throw away because the images that were used to justify the harsh reality of slavery are still used to justify the mistreatment of black Americans today. This paper will examine how images that were created in the past that depict black people as less than are still being used today to continue the ongoing narrative. These images were made from white supremacists beliefs to keep black people as subservient. After being treated as such for decades, it is hard to break the shackles of white supremacy. In order to be seen for our full potential, we have to get rid of these ideals to further help black people advance in society socially and economically
Screening for Eating Disorders in the Pediatric Population
No full textEating disorders have been increasing in prevalence over the past few years (Currin et a., 2005). Primary care providers, especially those who work with the pediatrics population sometimes have a difficult time screening for eating disorders due to a variety of reasons like lack of time and concern for other diseases like obesity (Rosen, 2010). Most screening surveys regarding eating usually focus on habits that lead to obesity or food insecurity, but these are difficult to differentiate from questions about eating disorder behaviors. Because of the complexity of screening for eating disorders, there is a need for a clear-cut, quick process outline for busy primary care pediatricians
Management of Parkinson\u27s Disease
No full textParkinson\u27s disease (PD) is a neurocognitive disease affecting over 6.2 million individuals, with the projected number of individuals affected being 12 million by 2040. Patients with PD have the classical presentation of bradykinesia, resting tremors, muscle rigidity and postural/gait abnormalities. The current pharmacological treatments for PD are levodopa/carbidopa, COMT inhibitors, Monoamine oxidase-B (MAO-B) inhibitors, dopamine (DA) receptor agonists, anticholinergics, and amantadine with levodopa/carbidopa being the gold standard. Exercise serves as a non-pharmacological therapeutic option. Even though the research is limited, boxing continues to grow in popularity across the US as a therapeutic option for PD. With PD incidence on the rise, it is crucial that practitioners are prepared to ensure the best possible outcome for their patients
Recognizing Food Insecurity Risk Factors to Improve Outcomes for Adults with Diabetes
No full textFood insecurity is defined as the ability to have enough food to live an active and healthy life. It has been found to be associated with medication nonadherence among patients with diabetes. This is through patients having to make critical decisions between buying their food or their medications. This can lead to adverse health outcomes for patients with diabetes and overall higher medical costs. This paper aims to educate primary care providers on key risk factors to food insecurity among patients with diabetes in order to prevent medication nonadherence earlier. Early interventions can be implemented when these risk factors are acknowledged