bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Cytomegalovirus Infection Following Second and Third Trimester Maternal Infection Is Associated With Mild Childhood Adverse Outcome Not Predicted by Prenatal Imaging
Authors: Elkan Miller Tal , Weisz Boaz , Yinon Yoaz , Weissbach Tal , De Castro Hila , Avnet Hagai , Hoffman Chen , Katorza Eldad , Lipitz Shlomo
Published: November 2020

Background

While it is clear that first trimester congenital cytomegalovirus (CMV) infection can lead to serious neonatal and childhood adverse outcome, the extent of the effect of second and third trimester congenital CMV infection is still unclear. Our aim was to study the short- and long-term outcomes following second and third trimester infection and to evaluate the contribution of prenatal imaging in a prospective cohort.

Methods

We studied pregnant women with primary CMV infection in the second and third trimesters, as diagnosed by well-dated seroconversion, and proof of vertical CMV transmission. All patients underwent serial prenatal ultrasound (US) and most of them fetal magnetic resonance imaging (MRI). Follow-up information was obtained from hospital charts and by telephone interviews with parents.

Results

Primary CMV infection occurred in 135 patients, 107 and 28 with second and third trimester infection, respectively. The incidence proportion of composite outcome (hearing loss or neurodevelopmental impairment) following second trimester infection was 7% (7/100, after excluding cases that were terminated) with a 3% incidence of partial unilateral sensory neural hearing loss and a 5% incidence of minor neurodevelopmental abnormalities, including slight verbal and motor delay. Following third trimester infection, there was one case of a very mild motor delay. The incidence proportion of abnormal prenatal findings on US or MRI was not significantly correlated to hearing loss or neurodevelopmental abnormalities.

Conclusions

Second trimester infection is associated with a slight risk of developing mild childhood sequelae, mostly partial unilateral hearing loss, which may develop late in childhood. Prenatal imaging failed to predict the development of childhood adverse outcome.
Healthcare-Associated Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in a Neonatal Unit: The Importance of Universal Masking, Hand Hygiene, and Symptom Screening in Containment
Authors: Holgate Sandi L , Dramowski Angela , van Niekerk Magriet , Hassan Haseena , Prinsloo Yolande , Bekker Adrie
Published: November 2020

Following exposure to a healthcare worker with an influenza-like illness, 2 preterm neonates and 6 staff members developed symptoms and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This neonatal unit coronavirus disease 2019 outbreak occurred prior to the implementation of universal masking and symptom screening policies. Both neonates and all staff recovered, with no further healthcare-associated SARS-CoV-2 transmission following the implementation of effective outbreak containment measures.
Glycemic Control After Cardiac Surgery
Authors: Shelley Casey , Palmieri Katherine
Published: November 2020

This chapter focuses on hyperglycemia after cardiac surgery, which is an independent predictor of morbidity and mortality, regardless of a history of diabetes. Acute hyperglycemia is common in the cardiac surgical perioperative period. Although many hyperglycemic patients undergoing cardiac surgery carry a preexisting diagnosis of diabetes mellitus, a significant portion will have either undiagnosed diabetes or insulin resistance. Other cardiac surgical patients may be non-diabetic but hyperglycemic due to the stress response related to surgery. This “stress hyperglycemia” is generally defined as a transient increase in blood glucose levels that develops during illness in a non-diabetic patient. A preadmission glycosylated hemoglobin (HbA1c) level measurement is helpful in distinguishing patients with stress hyperglycemia from those with undiagnosed diabetes mellitus and thus guide postoperative management. Patients with elevated HbA1c levels may need further interventions in order to optimize perioperative glycemic management pre-, intra-, and postoperatively. The chapter then details the Society of Thoracic Surgeons clinical practice guidelines and recommendations concerning perioperative glucose control.
Rhabdomyolysis Due to Extracorporeal Membrane Oxygenation
Authors: Metzinger Candice , LacKamp Aaron
Published: November 2020

This chapter studies rhabdomyolysis due to extracorporeal membrane oxygenation (ECMO). Rhabdomyolysis and ischemic muscle injury may result in renal failure, loss of limb, and even death due to hyperkalemia and acidosis. The first step is to identify the cause of the muscle injury. The sheer size of ECMO arterial cannulae can cause decreased blood flow distal to cannula, especially in patients with small-caliber arteries. However, decreased blood flow may also be a manifestation of the technique used to cannulate the artery. Thus, knowledge of the type of cannulation access is required in order to ascertain if ischemia is likely due to the cannulation technique and to evaluate strategies to revise or replace the cannulation site. The chapter then considers the various techniques used to acquire femoral arterial cannulation for ECMO, which may vary in the risk of peripheral ischemia. Other potential sources of peripheral ischemic injury are ischemia due to reperfusion, ischemia–reperfusion injury, and arterial emboli. The chapter also addresses the treatment of rhabdomyolysis, the major goal of which is the prevention of acute kidney failure.
Postoperative Atrial Fibrillation
Authors: Shen Liang
Published: November 2020

This chapter focuses on postoperative atrial fibrillation (POAF), which is very common after cardiothoracic surgery. Prevention of POAF involves continuation of preoperative beta-blockers, initiation of postoperative beta-blockers, and consideration of initiation of preoperative amiodarone in high-risk groups. In all patients, initial management of POAF includes correcting hypoxia and electrolyte abnormalities and consideration of weaning stimulating agents such as inotrope infusions. Medical management of hemodynamically stable patients includes the use of rate control agents such as beta-blockers, calcium-channel blockers, and digoxin or rhythm control agents such as amiodarone. When the patient is hemodynamically unstable, emergent synchronized cardioversion should be performed. Meanwhile, in refractory cases of rapid POAF, an aggressive rate control strategy may be pursued using one or more medications, but this approach must be weighed against the risk of requiring temporary or permanent pacing. Atrial flutter also occurs after cardiothoracic surgery, though at lower rates than POAF. It may be managed similarly to POAF, but it is typically more amenable to electrical cardioversion.
Advanced Cardiovascular Life Support Post–Cardiac Surgery
Authors: Bailey Caryl , Faulkner Michael
Published: November 2020

This chapter explores advanced cardiovascular life support (ACLS) after cardiac surgery. In 2009, the European Association of Cardiothoracic Surgeons provided recommendations for the management of post–cardiac surgery arrest, which have since been augmented by publication of consensus guidelines from the European Resuscitation Council in 2015 and the Society of Thoracic Surgeons in 2017. These guidelines are preferred over traditional ACLS guidelines for cardiac arrest resuscitation of post–cardiac surgery patients. Ventricular fibrillation is the cause of 25%–50% of cardiac arrests in post–cardiac surgery patients. Guidelines recommend up to 3 attempted shocks prior to external cardiac massage (ECM) if they can be delivered within 1 minute of arrest. Early defibrillation is often successful in this population and minimizes potential intrathoracic trauma from ECM on a fresh sternotomy. In patients with severe bradycardia or asystole, the epicardial pacer should be set to emergency mode, which provides dual-chamber, asynchronous pacing at 80–100 bpm with maximum atrial and ventricular amperage. Resternotomy within 5 minutes is recommended when resuscitation after cardiac arrest has been unsuccessful or when cardiac arrest from tamponade is highly likely.
Left Ventricular Assist Device Implantation and Management
Authors: Tam Christopher W.
Published: November 2020

This chapter studies left ventricular assist device (LVAD) implantation. A thorough preoperative evaluation of a patient undergoing LVAD implantation is of utmost importance because of the confluence of associated medical problems patients can have secondary to heart failure. Knowledge of the indications and contraindications for LVAD implantation is needed to provide proper consultation. Indications for LVAD implantation include bridge to transplantation, destination therapy, bridge to decision, and bridge to recovery. Contraindications to LVAD implantation include neurological changes following implantation, pulmonary dysfunction, renal dysfunction, and hepatic dysfunction. Intraoperative management of LVAD implantation involves monitoring, anesthetic induction/maintenance, and device management. Echocardiography is an invaluable tool in the perioperative monitoring and diagnostic assessment of LVAD implantation. The chapter then looks at early complications such as hypovolemia, vasoplegia, and right ventricular failure.
Left Ventricular Assist Device Troubleshooting: Bleeding and Thrombosis
Authors: Griffin Jan M. , Taha Bushra W. , Axsom Kelly M.
Published: November 2020

Postoperative bleeding following durable left ventricular assist device (LVAD) implantation is one of the most common early complications, occurring in around 48% of patients. The incidence of bleeding requiring blood product transfusion or reoperation is 31%–81%. Postoperative bleeding is frequently mediastinal or within the thoracic-pleural space. Once chest and mediastinal tube output has stabilized, systemic anticoagulation with heparin is initiated. Long-term recommendations for anticoagulation in LVAD patients include an antiplatelet agent (aspirin 81–325 mg) and warfarin to reduce the risk of thrombosis. A major risk of subtherapeutic international normalized ratio (INR) in patients supported on LVAD is stroke, and those who experience stroke have a 2-fold higher risk of death compared to those without stroke. Thrombosis can occur within areas of stagnant blood flow such as the aortic valve and root, left atrium, left ventricle, device inflow cannula, or device outflow cannula. Patients can develop worsening heart failure symptoms, thromboembolism, or even complete obstruction of flow through the device and pump failure. Risk factors for pump thrombosis include surgical implant technique, lower pump speeds, concurrent infection, and subtherapeutic INR. In cases of hemodynamic instability, emergent pump exchange or urgent heart transplantation is recommended. Gastrointestinal bleeding is another significant sequela of LVAD implantation, and a separate chapter is devoted to this topic.
Orthotopic Heart Transplant Management
Authors: Emple Artem , Axsom Kelly M.
Published: November 2020

This chapter details the management of orthotopic heart transplant, which is a treatment for end-stage heart failure. Early and intensive hemodynamic monitoring after heart transplant is critical for management. The chapter distinguishes primary graft dysfunction (PGD) from secondary graft failure. PGD is defined as left ventricular, right ventricular, or biventricular dysfunction that occurs within 24 hours after surgery and is not associated with a discernible cause. Although the etiology of PGD is poorly understood, donor-related, recipient-related, and procedure-related factors all play a role. Once PGD is diagnosed, pharmacotherapy with vasopressors, inotropes, and pulmonary vasodilators should be instituted and maximized while consulting the surgical team for early initiation of mechanical circulatory support. The chapter then considers the risk factors for PGD. The right ventricle in general, and specifically in a transplanted heart, is extremely sensitive to volume and pressure loads. As such, preload and afterload should be judiciously managed.
Orthotopic Heart Transplant Rejection and Immunosuppression
Authors: Clerkin Kevin J. , Farr Maryjane A.
Published: November 2020

This chapter focuses on orthotopic heart transplant rejection. Hyperacute rejection is a catastrophic complication that occurs early post-transplantation. This type of rejection is most often due to pre-formed donor-specific anti–human leukocyte antigen antibodies or an ABO blood type mismatch and is rarely seen in the current era because pre-transplant virtual and prospective crossmatch has become routine practice. Meanwhile, immune activation of recipient T cells against the cardiac allograft causes acute cellular rejection (ACR). Treatment of ACR will vary depending on the grade of rejection, symptoms, and hemodynamic significance. On the other hand, antibody-mediated rejection (AMR), previously known as humoral or vascular rejection, is primarily mediated by antibodies and not T cells, as in ACR. AMR is difficult to treat because it may persist or be recurrent and is associated with an increased risk of cardiac allograft vasculopathy and mortality. The chapter then discusses the management of acute rejection. Induction therapy is augmented immunosuppression in the early period following heart transplantation, when the recipient is at the greatest risk of rejection. Maintenance immunosuppression includes calcineurin inhibitors, anti-metabolites, glucocorticoids, and proliferation signal inhibitors.
Pulmonary Infiltrates and Hypoxemia After Lung Transplantation
Authors: Sutherland Lauren D. , Mulaikal Teresa A.
Published: November 2020

This chapter assesses pulmonary infiltrates and hypoxemia after lung transplantation. Primary graft dysfunction (PGD) is a syndrome of acute lung injury occurring within the first 72 hours of lung transplantation, characterized by diffuse pulmonary infiltrates and hypoxemia; however, PGD is a diagnosis of exclusion. Other causes of early respiratory failure with pulmonary infiltrates, including volume overload, infection, acute antibody-mediated rejection, and vascular complications, must first be considered to ensure proper treatment. Patients with PGD should be managed with supportive therapy such as lung-protective ventilation, targeted to the donor's ideal body weight to prevent volutrauma. Inhaled pulmonary vasodilators such as inhaled nitric oxide can improve oxygenation by optimizing ventilation–perfusion matching and as well as right ventricular function by reducing right ventricular afterload. Moreover, venovenous extracorporeal membrane oxygenation (ECMO) is preferable to venoarterial ECMO in the management of severe cases of PGD; however, venoarterial ECMO may be useful in cases of severe preoperative pulmonary hypertension.
Cardiac Tamponade
Authors: Read Christopher , Curran Emer
Published: November 2020

The incidence of cardiac tamponade following cardiothoracic surgery can reach 6% and can be a life-threatening emergency. The diagnosis of cardiac tamponade in the postoperative setting can be challenging for several reasons, which include the variety of etiologies of shock after cardiac surgery, that the historical clinical signs are seldom seen, and because investigative aids, such as echocardiography, have their limitations. A high index of suspicion of cardiac tamponade is therefore always warranted when assessing a deteriorating patient following cardiac surgery along with an up-to-date knowledge of cardiac arrest after cardiac surgery management. Surgical decompression of the mediastinum by emergency resternotomy is required for 20%–50% of cardiac arrests after cardiac surgery and may need to take place in the critical care environment, so awareness of and training in this procedure are imperative.
Coagulopathy in Cardiac Surgery: Etiology and Treatment Options
Authors: Teodorescu Dana , Larkin Caroline
Published: November 2020

This chapter reviews the causes and outlines an approach to the management of coagulopathy following cardiac surgery. Bleeding after cardiac surgery is common and expected up to a rate of 2 mL/kg/h for the first 6 hours. A more significant hemorrhage needs to be investigated and treated. Causes are often multifactorial. It is imperative that surgical causes be excluded early concomitant to providing resuscitation, investigating other medical causes for bleeding, and treating coagulopathy empirically until laboratory testing becomes available. The most frequent causes for coagulopathy post–cardiac surgery are excess heparinization, prolonged cardiopulmonary bypass time, hypothermia, acidosis, and preexisting bleeding diathesis. The management of coagulopathy implies maintenance of the normal physiological conditions for coagulation, reversal of excess heparinization, treatment of hyperfibrinolysis, maintaining normal levels of coagulation factors, and transfusion of platelets if thrombocytopenia or platelet dysfunction occurs. The chapter reviews what is involved in standard laboratory testing (complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, etc.) for coagulopathy. Also discussed is point-of-care testing and how the results from these tests should be interpreted. The chapter details the various blood products that are required in this scenario and suggests doses and transfusion thresholds.
Postoperative Diastolic Heart Failure
Authors: Dunne Éimhín , Fanning Niall
Published: November 2020

This chapter explores acute diastolic heart failure, which presents a difficult management scenario in the early post–cardiac surgery period. Initial diagnosis is assisted by knowledge of the patient's medical history and intraoperative course. It is made using both clinical and echocardiographic parameters. Diastolic dysfunction often remains asymptomatic until late in the disease process. When it presents clinically, it can be associated with an abnormal ejection fraction or, more commonly, with preserved ejection fraction. The diagnosis of diastolic dysfunction requires 3 conditions: the presence of signs and/or symptoms, normal left ventricular systolic function, and increased diastolic filling pressures. Treatment for diastolic heart failure includes fluid therapy, diuretics, vasoactive medicines, control of ventricular rate in atrial fibrillation, and amiodarone.
“I just found out that I have HIV”
Authors: Lubelchek Ronald
Published: November 2020

Use of antiretroviral therapy (ART) to treat HIV leads to extensive benefits at both the individual and the public health levels. By gaining a more complete appreciation of the many benefits of ART, clinicians can make informed decisions regarding when to initiate ART for patients recently diagnosed with HIV. This chapter reviews both the immunologic and longevity gains attributable to ART, as well as ART’s effectiveness for preventing onward HIV transmission. Considering its effectiveness and due to improvements in ART’s potency, along with concomitant declines in ART-related adverse effects and pill burden, the pendulum of when to initiate ART has swung toward early imitation. Same day-of-diagnosis ART initiation, or rapid start within several days of diagnosis, has moved from the realm of research to clinical care. In the United States, the Centers for Disease Control and Prevention estimates that only 53% of people living with HIV have achieved virologic suppression. In recognition of the need to improve HIV-related outcomes, the US government has launched its Ending the HIV Epidemic (EtHE) initiative, which seeks a 90% reduction in the number of annual, new HIV diagnoses by 2030. HIV treatment, inclusive of the rapid start of ART, represents one of the EtHE initiative’s fundamental pillars. This chapter reviews the benefits of ART, highlights data supporting same-day/rapid ART imitation, and discusses its real-world application.
A “false-positive” HIV test?
Authors: Peluso Michael J. , Henrich Timothy J.
Published: November 2020

Individuals capable of naturally controlling HIV infection in the absence of ART represent both a diagnostic and a management challenge for the treating clinician. In this chapter, we review what is known about the epidemiology, biology, and clinical outcomes of individuals across the clinical spectrum of natural HIV control and provide suggestions for the management of such individuals in a clinical setting.
“I’ve got HIV and I want to have a baby”
Authors: Khawcharoenporn Thana , Sha Beverly E.
Published: November 2020

Perinatal transmission is one of the important routes of HIV transmission that is preventable in the era of effective combination antiretroviral therapy (ART). This chapter presents the case of a known HIV-infected, ART-naïve pregnant woman who establishes antenatal and HIV care late, at 32 weeks’ gestational age. Her presentation raises concerns about the potential risk of HIV transmission to her baby given limited time to achieve HIV virologic suppression. The appropriate management is discussed, which includes first-encounter screening, management of opportunistic infections and sexually transmitted infections, risk behavior modification and counseling, ART initiation and treatment monitoring, intrapartum management, infant prophylaxis, and postpartum HIV care. The case presentation and discussion highlight the importance of comprehensive management of HIV infection in pregnant women to minimize the risk of mother-to-infant HIV transmission and optimize HIV control in the mothers.
“I’ve been rashed and confused”: Part 3
Authors: Barker David E.
Published: November 2020

Stroke syndromes are not markedly increased in persons living with HIV. Watershed strokes involving the distribution of one or more cerebral arteries suggest embolization from within the vascular tree (rather than a cardioembolic source). Increasingly some strokes (and arteritis) are being recognized as being related to infection rather than atherosclerosis or thrombosis. Past medical history can be an important source of clues to arrive the correct diagnosis, and treatment.
“This lump under my jaw doesn’t hurt but keeps getting bigger”
Authors: Gauto-Mariotti Estefania , Rubinstein Paul G.
Published: November 2020

Lymphoma in patients living with HIV/AIDS (PLWHA) is one of the leading causes of cancer and morbidity and mortality. The principles on how to manage cancer in the HIV population, will become important, as patients will be increasingly treated in both the university and private practice setting. Below is a chapter that describes, how the field of lymphoma has evolved and what principles are now utilized that have improved outcomes that are similar to the non-HIV population.
“I did have some cough when I was still living in Africa six months ago”
Authors: Beth Gadkowski L. , Haley Connie
Published: November 2020

In patients with HIV infection, tuberculosis (TB) can present at any CD4 T-cell count, with a diversity of pulmonary and extrapulmonary manifestations. Because TB is spread via a respiratory route and may rapidly progress if untreated, providers should maintain a high level of suspicion for TB disease. Diagnostic evaluation includes testing of sputum or other clinical samples using acid-fast bacilli smear, mycobacterial culture, and molecular testing to detect Mycobacterium tuberculosis DNA and mutations that confer TB drug resistance. Treatment of drug-susceptible TB consists of isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months. Monitoring for drug interactions, toxicity, immune reconstitution inflammatory syndrome, and nonadherence can improve patient outcomes. Patients living with HIV should be screened and treated for latent TB infection and given antiretroviral therapy to prevent TB disease.
“Am I going to need dialysis the rest of my life?”
Authors: Saeed Huma , Santos Carlos A. Q.
Published: November 2020

Renal transplantation is becoming a standard of care in patients with HIV and end-stage kidney disease. The survival benefit and risks of complications following renal transplantation of those who are living with HIV are comparable to those of recipients who are HIV negative. Drug interactions between various immunosuppressant and antiretroviral regimens remain a major concern, and integrase-based regimens are preferred due to their favorable safety profile. Rates of allograft rejection in renal transplant recipients who are living with HIV are considerably higher compared to patients who are not living with HIV despite the use of immunosuppression. Following renal transplantation, infection risks in recipients who are living with HIV are similar to individuals without HIV and warrant initiation of chemoprophylaxis against Pneumocystis jirovecii pneumonia as well as other opportunistic infections.
Silent No More
Authors: Shephard Rebekah , Vergara-Rodriguez Pamela
Published: November 2020

“Silent No More” is the story of a resilient 58-year-old man who has a complex history of alcohol use disorder, depression, HIV, and social isolation. The important factors that contribute to depression, stigma, and social isolation are reviewed. Using these factors, a comprehensive approach to the patient’s problems and needs is presented. The evidence for treatment of depression and depression cofactors for people living with HIV is reviewed. Education about mental health, substance use disorders, and trauma must be presented. Syndemics also must be discussed. Comprehensive mental health care involves medication and nonmedication strategies. Because people living with HIV are living longer, their quality of life must be addressed in relation to the information presented.
“My gums are really red”
Authors: Younai Fariba
Published: November 2020

Oral manifestations are among the earliest presentations of HIV infection. They appear during the course of HIV disease progression and immune deterioration and also in association with many sexually transmitted infections. In the era of effective retroviral therapies, HIV-related oral soft tissue lesions are seen in less frequently, and their presence may indicate undiagnosed HIV infection or treatment failure. Patients living with HIV and AIDS continue to experience salivary gland abnormalities, such as xerostomia, periodontal disease, and sexually transmitted human papilloma virus infection, which can increase their risk of developing oropharyngeal cancer. In addition to conventional adult gingivitis and periodontitis in persons living with HIV with immune recovery, unique features of severe periodontal disease can be associated with poorly controlled HIV.
Tray Tables Up, Ready for Departure
Authors: Huhn Gregory D.
Published: November 2020

For international travel, securing both an experience free from illness and preserving uninterrupted access to antiretroviral therapy requires persons living with HIV (PLWH) to carefully adopt sensible precautions and receive appropriate vaccinations that match their destination. Because PLWH may have reduced immune responses to vaccination, with limitations on the use of live-attenuated vaccines in PLWH with depressed CD4 counts, HIV-specific recommendations can guide clinicians toward the most safe and effective options to best achieve seroprotection against vaccine-preventable infections. This chapter presents relevant travel-health issues among PLWH and provides general information highlighting the most common considerations for traveler’s diarrhea, malaria prophylaxis, and vaccination.
An approach to pre-hospital care
Authors: Greaves Ian , Porter Keith
Published: November 2020

Like any other subject, the secret of success in pre-hospital care is preparation. This chapter is a brief introduction for anyone beginning to work in the pre-hospital care environment, covering the training and education required to work in pre-hospital care and what to expect from a career in the discipline, as well as individual qualifications and their entry requirements. Medical equipment is discussed with a rationale for a choice of both basic and advanced equipment. A suggested drug list is offered and methods of transport and vehicles are also covered. Legal considerations in relation to consent, competence, and working with other emergency services within the law (including an overview of the roles of the emergency services) are discussed in detail and finally, a list of resources is included.
Acute medical and surgical problems
Authors: Greaves Ian , Porter Keith
Published: November 2020

This chapter starts with the ABCDE approach to the acute medical patient, then outlines a symptom-based approach for assessment, alongside pre-hospital investigations and monitoring measures. It goes on to cover cardiological emergencies, basic and advanced life support, bradycardias and tachycardias, myocardial ischaemia, pericarditis, shingles, acute pulmonary oedema, sepsis, acute exacerbations of asthma, COPD, pulmonary embolism, pneumothorax, hyperventilation syndrome, care of the unconscious patient, cerebrovascular events, fitting, meningitis and septicaemia, diabetic emergencies, and the acute abdomen. For each topic the symptoms, clinical presentation, assessment, and treatment are outlined.
Formulary
Authors: Greaves Ian , Porter Keith
Published: November 2020

This chapter describes the drugs most commonly used in pre-hospital care. As a result, it is restricted to indications which are likely to be encountered in the pre-hospital management of patients and only describes formulations which are used in these circumstances. For example, the use of oral amiodarone is not discussed, neither is the use of oral steroids in the management of chronic inflammatory conditions, although intravenous steroids in acute asthma and anaphylaxis are mentioned. Significant acute side-effects are listed.
Child health
Authors: Greaves Ian , Porter Keith
Published: November 2020

This chapter covers managing the acutely ill or injured child. It starts with taking a history from a child, and ways of communicating with the child. Direct questions to ask from carers are also listed. The assessment of children is detailed, and recognition of ABC problems is covered, alongside the management of ABC emergencies. Paediatric emergencies and their treatment are explained, and life support of children is included. Trauma in children (the leading cause of death in children over 1 year of age) and management, consent, analgesia, and child abuse and neglect are all contained in this chapter. Finally, paediatric drug doses are tabulated.
Patient rescue and transportation
Authors: Greaves Ian , Porter Keith
Published: November 2020

This chapter provides the principles of patient rescue and transportation. It starts with immobilization and extrication, and then goes on to look at types of extrication (conventional, rapid, and snatch rescue), the principles of immobilization (prevention of further injury, pain relief, reduction of blood loss and the incidence of fat emboli, and facilitation of rescue), before going on to examine methods. It includes extrication devices, transport in pre-hospital care, and the benefits and risks of different sorts of vehicles.
Genitourinary medicine and Hiv
Authors: Wingfield Tom , Sethi Cindy , Edwards Simon
Published: November 2020

This chapter outlines the basic science and theory of GUM medicine and HIV required for MRCP Part 1, before addressing the clinical aspects of GUM medicine and HIV for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Infectious Diseases and Tropical Medicine
Authors: Fink Douglas , Smith Penelope
Published: November 2020

This chapter outlines the basic science and theory of infectious diseases and tropical medicine required for MRCP Part 1, before addressing the clinical aspects of infectious diseases and tropical medicine for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables and boxes to highlight key facts.
Principles of oncology and palliative care
Authors: Smyth Elizabeth , Fontana Elisa , Cunningham David
Published: November 2020

This chapter outlines the basic science and theory of Principles of oncology and palliative care required for MRCP Part 1, before addressing the clinical aspects of Principles of oncology and palliative care for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Neurology
Authors: Adam Robert , Marshall Charles , Birns Jonathan
Published: November 2020

This chapter outlines the basic science and theory of neurology required for MRCP Part 1, before addressing the clinical aspects of neurology for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Ophthalmology
Authors: Chatterjee Anupam , Bessant David
Published: November 2020

This chapter outlines the basic science and theory of ophthalmology required for MRCP Part 1, before addressing the clinical aspects of ophthalmology for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Dermatology
Authors: Crawley Jennifer , O'Kane Donal
Published: November 2020

This chapter outlines the basic science and theory of dermatology required for MRCP Part 1, before addressing the clinical aspects of dermatology for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Obstetric Medicine
Authors: Kevat Dev , Mackillop Lucy
Published: November 2020

This chapter outlines the basic science and theory of obstetric medicine required for MRCP Part 1, before addressing the clinical aspects of obstetric medicine for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables and boxes to highlight key facts.
Environmental Medicine
Authors: Stacey Mike , Lamb Lucy , Woods David R.
Published: November 2020

This chapter outlines the basic science and theory of environmental medicine required for MRCP Part 1, before addressing the clinical aspects of environmental medicine for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables and boxes to highlight key facts.
Statistics
Authors: Whitaker John , Brooms Anthony C.
Published: November 2020

This chapter outlines the basic science and theory of statistics required for MRCP Part 1, before addressing the clinical aspects of Statistics for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables, and boxes to highlight key facts.
Medical Law and Ethics
Authors: Glickstein Benjamin , Fertleman Michael , Howard Philip
Published: November 2020

This chapter outlines the basic science and theory of medical law and ethics required for MRCP Part 1, before addressing the clinical aspects of medical law and ethics for MRCP Part 2. To ensure effective revision, material is presented in short sections with bullet lists, tables and boxes to highlight key facts.
Cancer services for children, teenagers, and young adults
Authors: Boterberg Tom , Dieckmann Karin , Woodman Helen , Gaze Mark
Published: November 2020

Chapter 2 discusses cancer services for children, teenagers, and young adults. Paediatric and teenage and young adult practice covers an age range from babies through adolescence to maturity. Oncological services should be age and developmentally appropriate. As cancers in this age group are rare and different from common adult malignancies, specialist treatment should be limited to regional centres with the required expertise. Multidisciplinary teams with diagnostic, therapeutic, and supportive-care expertise are needed. As decision-making can be challenging, wider discussions are sometimes required to select the best treatment option. The aim is to maximize the chance of cure with the fewest late effects. Radiotherapy for children and young people is complex and requires a team approach including specialist radiographers and radiation oncologists, as well as support from paediatric medical, nursing, and anaesthetic staff. Enrolment into clinical trials is the standard of care. Paediatric radiation oncologists should be involved in these trials.
Central nervous system
Authors: Ajithkumar Thankamma , Boterberg Tom , Cheesman Edmund , D’Arco Felice , Dieckmann Karin , Gaze Mark , Horan Gail , Janssens Geert , Kortmann Rolf-Dieter , Thorp Nicky , Whitfield Gillian
Published: November 2020

Chapter 6 discusses brain tumours, the commonest solid neoplasms of children and young people, which account for about one-quarter of all malignancies in this age group. There are many different varieties: medulloblastomas and other embryonal tumours, and low- and high-grade gliomas, form the commonest categories. Craniopharyngiomas, ependymomas, intracranial germ cell tumours, and other rare types are less frequently encountered. Most brain and spinal tumours are treated with a multimodality schedule comprising surgery, chemotherapy, and radiotherapy. The place of radiotherapy in the management of central nervous system tumours is described in detail.
Extracranial solid tumours
Authors: Ajithkumar Thankamma , Boterberg Tom , Castel Victoria , Dieckmann Karin , Gains Jennifer , Gaze Mark , Horan Gail , Humphries Paul , Kelsey Anna , Mandeville Henry , Olsen Øystein , Pearson Andrew , Roebuck Derek , Saunders Daniel , Sethuraman Chitra
Published: November 2020

Chapter 7 discusses paediatric extracranial solid tumours. Paediatric extracranial solid tumours are very diverse. They include soft tissue and bone sarcomas, embryonal tumours such as neuroblastoma and Wilms tumour, and carcinomas. The prognosis of each type varies considerably depending on stage, tumour biology, and other factors. Careful risk stratification is necessary to determine the best approach to treatment. This is often multimodal, usually including chemotherapy and surgery, and sometimes radiotherapy. It is often possible to avoid radiotherapy in the better-prognosis risk groups, reserving this treatment, and the associated late effects, for those with the worst outlook. A strong evidence base has developed for the most common tumour types, but further clinical trials are required to optimize the role of radiotherapy.
Lymphoid and haematological malignancy and related conditions
Authors: Boterberg Tom , Chang Yen-Ch’ing , Dieckmann Karin , Gallop-Evans Eve , Gaze Mark , Humphries Paul , Kelsey Anna , Olsen Øystein , Roebuck Derek , Sethuraman Chitra
Published: November 2020

Chapter 8 discusses lymphoid and haematological malignancy and related conditions in children and young people. Radiotherapy is less frequently used in haematological malignancy and allied disorders than it once was. In Hodgkin lymphoma, better risk stratification, more effective systemic therapy and the use of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET) imaging to assess response to chemotherapy have facilitated a safe reduction in the indications for radiotherapy. Nonetheless, radiotherapy remains an important component of multimodality therapy in patients with advanced or poorly responding disease. In acute leukaemia, radiotherapy is no longer used as part of first-line treatment schedules. Instead, it is reserved for refractory and relapsed disease. Total body irradiation remains valuable as part of conditioning prior to haemopoietic stem cell transplantation. Cranial and testicular radiotherapy is helpful for selected patients who relapse in these sanctuary sites. Radiotherapy is also indicated infrequently in some unusual and benign haematological conditions.
Recovery room routines
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

In this chapter patients are followed from the operating theatre to the recovery room. Their care is discussed and routine procedures described. Nurse and anaesthetist handovers are outlined, and the transfer of the patient back to the ward is explained.
Recovery room procedures
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Airway protection, laryngeal masks, and intubation are described as well as gas delivery circuits. Emergency equipment required for reintubation, and the technique for this procedure, are outlined. Instructions for intravenous and intramuscular injections are clearly explained.
Monitoring and equipment
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Routine monitoring is an essential part of recovery room procedure. Respiration, a vital concern while awakening after anaesthesia, is given specific attention with reference to modern capnography. This chapter also describes additional monitoring in detail: pulse oximetry, blood pressure, central venous pressure, and arterial blood gases are clearly described. A comprehensive description of electrocardiography guides the student through this complicated subject. The monitoring of temperature and warming blankets, with suggestions for purchasing equipment, are included.
Postoperative pain
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This chapter begins with a list of pain principles. It goes on to describe misunderstandings about pain and guidelines are given for diagnosing non-surgical causes of pain, such as myocardial ischaemia. Gauging the severity of pain and using pain scales are explained as well as the use of an acute pain service. Different techniques are described for assessing pain in different groups including the elderly, neonates, and the mentally impaired. Pre-emptive analgesia and multimodal analgesia are discussed. Suggestions for looking after patients with nerve blocks and day surgery patients are offered.
Regional analgesia
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This chapter discusses the care of patients with nerve blocks. These may be epidural, spinal, or other local blocks. Epidural analgesia with its risks and complications, advantages and problems is thoroughly explained.
Paediatrics
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Babies and small children of all ages have surgery and come to the recovery room with special needs. Airway management, apnoea and pneumothorax, laryngospasm, and fluid management are some of the important features covered in this chapter. The diagnosis and treatment of shock and cardiac arrest are also covered in depth.
Respiratory physiology
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Breathing and normal respiration must be understood by recovery room staff. This chapter explains how patients breathe and what is happening when patterns of respiration alter. Terms that sound complicated, like functional residual capacity, are explained and the way in which breathing is driven from the brain and by chemoreceptors in the lungs is simply described.
Cardiovascular physiology
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This is a difficult chapter but read it carefully and you will be rewarded with a clear understanding of how the heart works. ECGs are revisited and there are sections on caring for patients with pacemakers and stents.
Shock
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Shock is a clinical diagnosis that occurs when the circulation fails. Read this chapter carefully and learn to recognize the early signs and symptoms of shock. Ideally you should be treating shock even as you make the diagnosis. This chapter will teach you about the different types of shock, their distinguishing features, and specific treatments. You will also learn to distinguish the different stages of shock and the physiology paragraphs will help you understand the changes the body’s metabolism.
Crisis management
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This chapter will give you the fundamental information to prepare your recovery room for any crisis. Crisis protocols and guidelines will help you to prepare for and conduct a full resuscitation. The management of anaphylaxis and seizures is described in detail.
Metabolism
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This chapter tells you how homeostasis in the body is achieved. Contributing factors such as stress, hormones, and the automatic nervous system are integrated into the discussion in a thoughtful way. The problem of cold postoperative patients is thoroughly referenced to modern investigation. Diabetes, how surgery destabilizes diabetics, and how to use insulin is explained. Malignant hyperthermia, thyroid storm, and acid–base disorders are all problems that can occur in the recovery room and guidelines for the management of these patients are outlined. Hydrogen ions affect haemoglobin and biochemical reactions and can cause acidosis and alkalosis—this chapter outlines how to interpret the blood gas results. How to distinguish between respiratory and metabolic causes of acid–base disorders is simply and clearly explained.
Chronic disorders
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Diseases not covered elsewhere are found in this chapter. The subjects are AIDS, alcoholism, drug addiction, epilepsy, liver disease, multiple myeloma, musculoskeletal disease, myasthenia gravis, muscular dystrophy, Paget’s disease, Parkinson’s disease, psychiatric disease, phaeochromocytoma, porphyria, sickle cell disease, smoking, stroke, hypothyroidism, and many others.
Surgical issues
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

Every type of surgery (excluding cardiac and neurosurgery) is referenced in this chapter with special attention to the recovery room needs of each specialty. The immediate postoperative care of the patients is simply and thoughtfully discussed so that their postoperative care will give them the best possible chance for a positive result after their surgery. Drains, catheters, and special procedures like bronchoscopy are also described.
Working with facts
Authors: Craig Anne , Hatfield Anthea
Published: November 2020

This is basically an introduction to statistics. Even if you have never approached the subject before we hope you will not find it daunting. Once you understand statistics you can read articles where facts and figures appear with real understanding. Sit down quietly and take one section at a time. Once you have digested this chapter turn to the suggested reading at the end of the chapter.
Relative scale setting for two-color QCD with $N_f=2$ Wilson fermions
Authors: Iida Kei , Itou Etsuko , Lee Tong-Gyu
Published: November 2020

We determine the scale-setting function and the pseudocritical temperature on the lattice in $N_f=2$ two-color quantum chromodynamics (QCD) using the Iwasaki gauge and Wilson fermion actions. Although two-color QCD does not correspond to the real world, it is very useful as a good testing ground for three-color QCD. The scale-setting function gives the relative lattice spacings of simulations performed at different values of the bare coupling. It is a necessary tool for taking the continuum limit. First, we measure the meson spectra for various combinations of ($\beta,\kappa$) and find a line of constant physics in the $\beta$–$\kappa$ plane. Next, we determine the scale-setting function via $w_0$ scale in the gradient flow method. Furthermore, we estimate the pseudocritical temperature at zero chemical potential from the chiral susceptibility. Combining these results, we can discuss the QCD phase diagram in which both axes are given by dimensionless quantities, namely the temperature normalized by the pseudocritical temperature on the lattice and the chemical potential normalized by the pseudoscalar meson mass. This makes it easy to compare among several lattice studies, and also makes it possible to compare theoretical analyses and lattice studies in the continuum limit.