Postgraduate medicine
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Cigarette smoking, one of the main causes of preventable morbidity and mortality, has a multitude of well-known side effects. The relationship between cigarette smoking and infertility has been studied for decades; however, large-scale, population-wide prospective studies are lacking. The majority of the current literature is in the form of retrospective studies focused on the effects of smoking on semen analyses. ⋯ The effects of smoking on assisted reproduction and in vitro fertilization outcomes are noted. The consequences of smoking while pregnant on future fertility as well as the outcomes of second-hand smoke are analyzed. The current evidence suggests that men should be advised to abstain from smoking in order to improve reproductive outcomes.
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Perianal involvement in Crohn's disease (CD), which encompasses fistulas, ulcers, abscesses, strictures and cancer, can lead to significant impairment in quality of life. The objective of this article is to review the major perianal complications of CD and the current medical and surgical modalities used to treat them. Antibiotics are commonly used despite a lack of controlled trials to validate their use and should be used as a bridge to maintenance therapy. ⋯ Surgery, particularly lateral internal sphincterotomy, in combination with medical therapy is associated with higher fissure healing rates in the absence of proctitis. Fistulotomy is curative for most simple low perianal fistulae, but complex fistulas often require sphincter-sparing surgical procedures. Less invasive approaches such as a chemical sphincterotomy should be used first, with therapy escalated only if this fails.
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Postgraduate medicine · Apr 2015
Debunking myths about "allergy" to radiocontrast media in an academic institution.
Patients with "allergy" to iodine and shellfish often do not obtain necessary radiologic procedures due to anxiety about potential radiocontrast media reactions. This study assesses the impact of an educational intervention to dispel these myths. ⋯ An educational intervention helps rectify misconceptions among health care professionals about radiocontrast media reactions and their perceived relationship to shellfish or iodine allergy.
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Postgraduate medicine · Apr 2015
Conduct behaviors and oppositional defiant behaviors in children and adolescents with ADHD.
There is controversy about the association among attention deficit hyperactivity disorder (ADHD), conduct disorder behaviors, and oppositional defiant behaviors. This study examines whether different subcategories of conduct behaviors co-occur in children with ADHD, and investigates the association of conduct behaviors with ADHD symptoms and oppositional defiant behavior, considering the covariant factors of parental age and educational level. A total of 441 children and adolescents with ADHD participated in this study - 342 (77.6%) boys and 99 girls (22.4%). ⋯ The severity of hyperactivity/impulsivity was associated with the subcategory of "destruction of property." The inattentiveness score was associated with "aggression to people and animals." The current results do not suggest that conduct behaviors exclude oppositional defiant behaviors. The subcategories of conduct behaviors occur in a cluster rather than as a solitary behavior. Larger family size and lower educational level of the father increase the risk of aggression to people and animals in children with ADHD.