Harefuah
-
Multi-casualty events are characterized by a large number of wounded people arriving at trauma centers in a short period of time. These wounded suffer distinctive injuries in accordance with the cause of the event. Close to 50 percent of all injuries in a multi-casualty event are musculoskeletal injuries. ⋯ A "damage control" policy should be implemented in all stages of the patient's care. Orthopedic care has been revolutionized several times--developing from delayed care, to early total care and finally to "damage control" orthopedics. "Damage control" orthopedics emphasizes initial stabilization and control of injuries, due to the systemic cytokine storm after polytrauma, prior to final corrective surgery of the patient's fractures. In this article the authors review the orthopedic care in a multi-casualty event, and the specific care given to each of the wounded in such an event.
-
Allergic rhinitis causes major illness and disability worldwide, but it is still underdiagnosed and undertreated. Allergic rhinitis is a risk factor for both the development and for exacerbations of asthma. Up to 30% of patients with rhinitis suffer from asthma, and the majority of patients with asthma suffer from rhinitis. ⋯ Due to new studies and diagnostic techniques the ARIA guidelines, initially formed in 1999, were recently updated. They are intended for specialists, general physicians and health care providers in order to increase the knowledge on allergic rhinitis and its impact on asthma and to provide evidence-based revision on the diagnostic methods, treatments and a stepwise approach to management. There is a need for a collaborative effort of all specialists and primary physicians involved in the treatment of rhinitis and asthma for the proper implementation of the guidelines.
-
During the last decade, the production of medical information has doubled every 14 months. It is predicted that information will double at an even faster rate. This dramatic rate of changing medical knowledge presents a challenge for physicians to keep up to date. ⋯ If the new information has been proven to be reliable and relevant, it is integrated into existing information systems to be used by physicians all over the world. This approach is called evidence-based medicine. This review will summarize the four leading clinical databases which are evidence based medicine oriented: Dynamed, Cochrane Library, Trip database and Attract, and short presentation of the best evidence based medicine "secondary literature".
-
The increased diagnoses of autism and developmental disorders in recent decades, together with the childhood vaccination program, has led to the hypothesis that vaccination in general, and the measles, mumps, and rubella virus live vaccine, and vaccines that contain mercury, in particular, cause autism. It has been hypothesized that intestinal infection caused by live virus vaccines change the permeability of the intestinal wall, and subsequently, the passage of peptides through the intestinal wall to the blood, and from there to the brain. It has been suggested that the accumulation of these peptides in the central nervous system causes autism. ⋯ Recent studies have refuted the theory that the consecutive administration of vaccines weakens the young immune system in children, and leads to an autoimmune process that causes autism. The etiology of autism is still unknown, with research continuing from different directions. The extensive research conducted so far indicates that childhood vaccination is not a cause of the sharp increase in autism diagnoses in recent decades.
-
Urinary tract infections (UTIs) occur in 3-5% of girls and 1% of boys. UTIs have been considered an important risk factor for the development of renal insufficiency, hypertension or end-stage renal disease. Hence, there is a need for early diagnosis and management of UTI to prevent renal scarring. The guidelines concerning the prophylactic treatment and the imaging studies have changed during the past year. It was believed that reflux predisposed to renal infection (pyelonephritis) by causing renal injury or scarring and that imaging studies in children with UTI were meant to identify anatomic abnormalities that predispose them to infection and renal scaring. Today, this concept is no longer prevalent and there is no recommendation to perform voiding cystourethrogram (VCUG] after every UTI. ⋯ There is a need to improve the doctors' explanation regarding the performance of VCUG test post UTI. This will improve the patients' compliance to perform their post discharge recommendation.