Harefuah
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Secondary prevention treatment with aspirin/ clopidogrel, beta blockers, inhibitors of the rennin-angiotensin-aldosterone converting system and statins reduces the morbidity and mortality of patients after acute coronary syndrome (ACS). However, clinical experience suggests that prescription rates in patients hospitalized in internal medicine departments may be low. ⋯ The prescription of full secondary prevention treatment in ACS patients hospitalized in internal medicine departments is suboptimal. Further efforts are needed to implement comprehensive guideline-based management.
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Obesity has become a "global pandemic" in the modern world. One of the anesthetic challenges associated with obesity is securing the patients' airway. ⋯ In this review, we describe the specific reasons for difficulty in securing the airway in the obese patient population. We present the complications and the typical problems that the anesthesiologist may encounter in each stage of anesthesia and suggest ways to solve them.
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Emergence delirium (ED) is a common problem among children and adults recovering from general anesthesia after surgery. Its symptoms include psychomotor agitation, hallucinations, and aggressive behavior. The phenomenon, which is most probably an adverse effect of general anesthesia agents, harms the recovery process and endangers the physical safety of patients and their health. Ranging between 10% and 80%, the exact prevalence of ED is unknown, and the risk factors of the phenomenon are unclear. ⋯ Results showed the prevalence of ED among children. ED was significantly correlated with patients' age, type of surgery and premedication. ED was not correlated with severity of pain, type of anesthesia or with patients' sex.
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Spinal anesthesia and lumbar puncture may lead to intracerebral, subdural or subarachnoid bleeding and there have been previous reports on patients who developed subdural hematoma a few days after surgery on the spine. This is a case report of a patient who developed acute subdural hematoma during surgery performed to remove an intradural spine tumor. This report suggests that the possibility of an intracranial hematoma should be considered in cases of neurological deterioration following spinal surgery.
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As life expectancy rises, so do the rates of operable chronic and/or non-urgent conditions, and the prevalence of the elderly among elective surgery patients. Pre-operative assessments have so far been based on standards of internal and anaesthetic medicine, and focused on the physical aspect. This paper presents a groundbreaking modified assessment for detecting geriatric risks and selecting appropriate interventions. ⋯ The screening of elderly patients above 70 years of age in elective surgery focuses resources on only one fifth of them, who are at geriatric risk. Providing solutions for the individual, the system, the family and the post-discharge services, improves care during hospitalization and afterwards.