Complement activation as a driver of pathology in myasthenia gravis (MG) has been appreciated for decades. The terminal complement component [membrane attack complex (MAC)] is found at the neuromuscular junctions of patients with MG. Animals with experimental autoimmune MG are dependent predominantly on an active complement system to develop weakness. Mice deficient in intrinsic complement regulatory proteins demonstrate a significant increase in the destruction of the neuromuscular junction. As subtypes of MG have been better defined, it has been appreciated that acetylcholine receptor antibody-positive disease is driven by complement activation. Preclinical assessments have confirmed that complement inhibition would be a viable therapeutic approach. Eculizumab, an antibody directed toward the C5 component of complement, was demonstrated to be effective in a Phase 3 trial with subsequent approval by the Federal Drug Administration of the United States and other worldwide regulatory agencies for its use in acetylcholine receptor antibodypositive MG. Second-and third-generation complement inhibitors are in development and approaching pivotal efficacy evaluations. This review will summarize the history and present the state of knowledge of this new therapeutic modality.
Emergency Department (ED) in Alnoor Hospital is considered the pulsating unit in the hospital by facing a daily challenge through a huge exposure to number of patients round between 500 -700 per day in average. With this busy service in ED, our study emerges to measure the quality of provided services to patients in term of measuring the total length of stay time (LOS) in ED and its influencing factors. This is a prospective study aiming to estimate the average time patients spend in ED of Alnoor Hospital during the month of January (2013). In addition, it inspects factors influencing the LOS. The questionnaire which conducted and filled by emergency team over all patients was consisted of the following data: arrival time to ED, initial time of assessment by nurse, initial time of assessment by doctor, time of arrival to specific area, consultation time, arrival time of consulted specialty, time of laboratory investigation, time of radiological investigation, time of final disposition and time of physical disposition. For the 7604 patient visits analyzed, mean ED LOS was 3.02 hour (SD = 5.03 hour). About half of the patients spent less than 59 minutes (44%), 32.6% spent 1 to 3:59 hour, 15.2% spent 4 to 7:59 hour, and 8.2% of the patients spent more than 8 hours. A priceless such study will offer an opportunity to evaluate the recent ED performance and assist to adapt future optimization strategies to improve the quality of services provided to the patient.
This paper aims to explore the assessment of patients with rheumatologic diseases, especially rheumatoid arthritis (RA), before undergoing orthopedic surgery. Perioperative assessment ensures an early diagnosis of the patient's medical condition, overall health, medical co-morbidities, and the assessment of the risk factors associated with the proposed procedures. Perioperative assessment allows for proper postoperative management of complications and of the management of drugs such as disease-modifying anti-rheumatic drugs (DMARD) and anti-platelets, and corticosteroids. The assessment also supports follow up plans, and patient education.Perioperative assessment enables the discussion of the proposed treatment plans and the factors associated with them in each case among the different specialists involved to facilitate an appropriate early decision-making about the assessment and treatment of patients with rheumatologic diseases. It also enables the discussion of both condition and procedure with the patient to ensure a good postoperative care.The article identifies the components of perioperative medical evaluation, discusses perioperative management of co-morbidities and the management of specific clinical problems related to RA, systemic lupus erythematosus, the management of DMARDs, like methotrexate (MTX) and biologic therapies, prophylactic antibiotics, and postoperative follow up, including patient education and rehabilitation
Low back pain (LBP) is primarily managed in general practice and commonly underestimated or misdiagnosed by physicians. This article presents comprehensive review for diagnosis and evaluation of LBP according to current clinical studies guidelines. Our objectives are to define LBP, to establish how to take a detailed history and how to physically examine it in order to enable physicians to make an appropriate differential diagnosis for LBP, and to identify relevant investigations and referrals of patients with LBP. The article first offers a quick description of inflammatory back pain then discusses the importance of screening red flag patients with LBP and the importance of its early detection. Finally, we summarize how to outline a primary plan for managing and treating LBP. The article is prepared in the format of question and answer to make it targeted and accessible.
Although the number of patients seen in outpatient clinics far surpasses those managed in inpatient settings, many medical training programs lack outpatient clinic teaching initiatives. Thus, we have conducted a systematic review of the literature in order to raise awareness of the important role that outpatient clinics can play in enhancing medical education, and to assess current perspectives on improving outpatient training. Our analysis reveals that outpatient clinics can offer an efficient and holistic view of patient care, while covering a wide range of general and specialty medical practices. Moreover, several fundamental skills can be acquired by students in outpatient clinics, which effectively combine elements encountered in routine wardbased teaching (etiology, history, physical examination, laboratory tests, and therapy) with those found in ambulatory care (continuity, context, health education, economics, and responsibility). Approaches to teaching in an outpatient setting vary greatly, with extensive differences in levels of supervision and feedback evident. It is clear that, at present, there is no general consensus on the best strategy for realizing the potential of outpatient clinics in the training of students and junior doctors. With the changing face of health systems, the identification of methods by which maximal benefits of this setting can be achieved would be highly advantageous for future medical trainees.
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