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1.
Indian J Med Ethics ; 2023 Sep; 8(3): 237-240
Artigo | IMSEAR | ID: sea-222720

RESUMO

When a patient loses decisional capacity, the responsibility to make treatment decisions often falls on a family member who becomes the surrogate decision-maker. This case study provides an example of a situation where the medical team and the surrogate decision-maker initially disagreed on the best course of action for the patient. The ethicist was called in to lead a guided conversation to help the team and the surrogate decision-maker reach a consensus. This case illustrates the importance of allowing the surrogate decision-maker to ask clarifying questions and process their emotions before making a decision.

2.
Yenagoa Medical Journal ; 4(1): 1-5, January 2022. Figures
Artigo em Inglês | AIM | ID: biblio-1392189

RESUMO

Breast cancer is the commonest cancer in women in Nigeria. Pregnancy Associated Breast Cancer (PABC) is breast cancer occurring in pregnancy up to one year after delivery. Due to some misconceptions, mistakes occur in the management of these patients leading to poor outcomes. There may be difficulties in the diagnosis of PABC due to the clinical features being mistaken for the normal physiologic changes of pregnancy. The physiologic changes may interfere with radiological and pathological interpretations. Fine needle aspiration cytology (FNAC) or a trucut biopsy confirms the diagnosis. There have been debates on maternal versus foetal wellbeing in PABC. Chemotherapy is safe after 10 weeks of pregnancy when organogenesis is complete. Delaying chemotherapy till after pregnancy worsens the prognosis. Hormonal treatment is contraindicated in PABC. Method: This is a retrospective observational study of cases of PABC at the Niger Delta University Teaching Hospital, Okolobiri, Bayelsa State, Nigeria, from January 2019 to January 2021. Results: Seven cases were seen with ages ranging from 28 to 37. All patients presented with breast lumps. Diagnosis was by FNAC and trucut biopsy. None of the patients received care for the cancer during pregnancy as they were advised by their doctors not to and to present after delivery due to the percermived haful effects of treatment on the foetus. All seven patients presented with advanced stage disease after delivery. They all received chemotherapy and hormonal therapy. Eventually all patients were lost to follow up. Conclusion: Patients diagnosed with PABC in peripheral hospitals should be referred for specialist care. Treatment modalities like surgery and chemotherapy are feasible in PABC and should not be unduly delayed. Continuing education on the topic and feedback to colleagues at peripheral hospitals should be ensured


Assuntos
Terapêutica , Neoplasias da Mama , Gravidez , Mulheres , Cesárea
3.
Journal of the Korean Child Neurology Society ; (4): 28-35, 2008.
Artigo em Coreano | WPRIM | ID: wpr-212005

RESUMO

PURPOSE: Status epilepticus(SE) is a common neurological emergency in childhood. SE is defined as a seizure or series of seizures without recovery of consciousness between seizures lasting at least 30 minutes. We investigated treatment modalities and clinical courses of patients with SE and tried to find out the differences between international standards. METHODS: We reviewed the medical records of 36 cases of SE who visited our hospitals from January 2002 to December 2007. We analyzed age, duration of seizures before and after arrival at hospital, time taken for administration of antiepileptic drugs(AED) and compared them with APLS guideline(3rd edition). RESULTS: There were 32 cases in which lorazepam was used as the first AED and the mean time needed for administration was 4.6+/-6.7minutes. Thirty cases needed a second dose of lorazepam and the mean time needed for administration was 10.2+/-8.2 minutes. Seven patients(21.1%) received inappropriate treatment at the first step and 25 patients(83.3%) and 21 patients(84.0%) at the second and the third step respectively. There were 15 cases in which phenytoin or phenobarbital was used as the second line AED and the mean time needed for administration was 25.8+/-61.8 minutes. CONCLUSION: Early treatment of SE is important in reducing mortality and morbidity associated with SE. In this study we found that a large number of patients were not treated according to the international guideline. Further study is needed to understand the reasons for such differences.


Assuntos
Humanos , Estado de Consciência , Emergências , Lorazepam , Prontuários Médicos , Fenobarbital , Fenitoína , Cimentos de Resina , Convulsões , Estado Epiléptico
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