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PubMed1995

Hypertension in pregnancy. Practical management recommendations.

Hypertension is a common and potentially serious complication of human pregnancy. It can be a marker of underlying maternal disease processes aggravated by pregnancy, or it can be directly related to the pregnancy (pre-eclampsia). It is associated with increased risks of fetal growth retardation and, if severe, can cause both maternal and fetal problems. The risks to both mother and neonate can be reduced by appropriate supervision and therapy. Close monitoring of maternal and fetal welfare will help to determine the optimum time for delivery. Maternal hypertension should be controlled with agents considered to be well tolerated in pregnancy. Following the index pregnancy, all patients with early and/or severe hypertension should be investigated for an underlying cause. Provided that there is clinical resolution of acute pregnancy-related hypertension, investigations are usually postponed until at least 3 months following delivery.

Antihypertensive Agents↗
PubMed2004

Practical management of type 1 diabetes mellitus in adolescent patients: challenges and goals.

Type 1 diabetes mellitus in adolescents presents diagnostic and management challenges. Diagnostically, the challenge is to distinguish type 1 from type 2 diabetes. A thin adolescent in diabetic ketoacidosis is easily recognized as having type 1 diabetes. However, since obesity does not negate the presence of type 1 diabetes, it is appropriate to measure diabetes-related antibody, C-peptide, and insulin levels in individuals who are thought to have type 2 diabetes to ensure that they do not have type 1 or a mixed type of diabetes. The goals for the management of type 1 diabetes in adolescents are to (i) prevent diabetic ketoacidosis; (ii) prevent severe hypoglycemia; (iii) maintain normal growth and development; and (iv) prevent long-term diabetic complications. To prevent diabetic ketoacidosis, patients must take their insulin appropriately. To ensure that this happens, increased parental supervision, psychological counseling, or placement in a different home environment may be necessary. All patients must be taught to appropriately manage sick days and test their urine for ketones when hyperglycemia is present. Prevention of severe hypoglycemia involves ensuring that the patient understands the symptoms of hypoglycemia and knows to test and treat it when the signs are present. Patients and families also need to know how to adjust insulin doses to prevent hypoglycemia and how to manage exercise appropriately. Patients with hypoglycemic unawareness need to meticulously avoid hypoglycemia. To maintain normal growth and development, adolescents with type 1 diabetes must have the appropriate tools to effectively match their meals to their lifestyle and to avoid the increased weight gain associated with improved glycemic control without intentionally manipulating their insulin dose to lose weight. The Diabetes Control and Complications Trial demonstrated that improved glycemic control decreased the risk of long-term diabetic complications. The goals of treatment in this study should be the goals for all adolescents with type 1 diabetes. To reach these goals, home glucose monitoring is critical. Patients need to know how to adjust insulin to maintain glucose levels in the range of 70-120 mg/dL (3.9-6.7 mmol/L) before meals. Insulin regimens need to be individually tailored to meet each patient's needs. Patients should be followed in a clinic using a multidisciplinary team approach at least every 3 months. Glycosylated hemoglobin should be measured at each visit. Regular eye exams, blood pressure monitoring, and urinary microalbumin measurements are critical. In this manner, the goals of management of type 1 diabetes in adolescents can be met.

Adolescent↗
PubMed2006

Practical management of classical myeloproliferative disorder patients: a clinician's guide.

The classical myeloproliferative disorders (MPDs) are comprised of the clonal, BCR-ABL-negative, chronic myeloid disorders of essential thrombocythemia, polycythemia vera, and myelofibrosis with myeloid metaplasia. Management of these disorders remains a significant challenge due to the varied range of prognosis and phenotypic manifestations. Curative therapy, achieved in some patients through allogeneic stem cell transplantation, is elusive or inappropriate in most. Additionally, no available medical therapy has been shown to clearly improve survival or delay disease progression. Current management involves an emphasis on prevention of thrombohemorrhagic complications (through aspirin treatment, phlebotomy and cytoreduction in high-risk patients) in early-stage patients and symptomatic care in those with advanced disease. Leukemic transformation from MPDs remains a rapidly fatal complication, unresponsive to current therapies. Recent elucidation of the role of the activating tyrosine kinase mutation JAK2 (V617F) is anticipated to usher in an era of greater understanding and targeted therapy for the MPDs.

Humans↗
PubMed2003

Seasonal variation of phenol/benzoate-degrading iron-reducing bacteria in irrigated tropical paddy soils as affected by some management practices.

The study provides the first evidence of the presence and abundance of bacterial population that coupled ferric iron reduction to aromatic compounds degradation in tropical irrigated paddy soils in the Philippines. Culturable phenol/benzoate degrading iron-reducing bacteria was enumerated by the most probable number (MPN) counts using phenol or benzoate as sole carbon source, and ferric oxide [Fe(OH)(3)] as the sole electron acceptor. Population density of phenol degrading iron-reducing bacteria (P-IRB) in irrigated paddy soil ranged from 10(2) to 10(8)g(-1) dry soil, and increased with the progressive rice growth in rice cropping seasons; the study also revealed a significant rhizosphere effect on population of P-IRB. However, high enumeration of benzoate degrading iron-reducing bacteria (B-IRB) was obtained in all the tested soil samples averaging at 1.2 x 10(6)g(-1) dry soil, and did not fluctuate significantly over the rice cropping seasons. Statistical data showed that less cropping density with aerated fallow and high nitrogen rate favored the population growth of P-IRB. However, results showed that population size of B-IRB was relatively insensitive to the effect of either seasonal or extrinsic factors tested in this study.

Agriculture↗
PubMed2006

Stormwater ponds, constructed wetlands, and other best management practices as potential breeding sites for West Nile virus vectors in Delaware during 2004.

We performed longitudinal surveys of mosquito larval abundance (mean mosquito larvae per dip) in 87 stormwater ponds and constructed wetland in Delaware from June to September 2004. We analyzed selected water quality factors, water depth, types of vegetation, degree of shade, and level of insect predation in relation to mosquito abundance. The 2004 season was atypical, with most ponds remaining wet for the entire summer. In terms of West Nile virus (WNV) vectors, wetlands predominantly produce Aedes vexans, culex pipiens pipiens, and Culex restuans. Retention ponds generally produced the same species as wetlands, except that Cx. p. pipiens was more abundant than Cx. restuans in retention ponds. Aedes vexans and Culex salinarius were the most abundant species to Conservation Restoration Enhancement Program ponds. Sand filters uniquely produced high numbers of Cx. restuans, Cx. p. pipiens, and Aedes japonicus japonicus, a newly invasive vector species. Site that alternately dried and flooded, mostly detention ponds, forebays of retention ponds, and some wetlands often produced Ae. vexans, an occasional WNV bridge vector species. Overall, seasonal distribution of vectors was bimodal, with peaks occurring during early and late summer. Ponds with shallow sides and heavy shade generally produced an abundance of mosquitoes, unless insect predators were abundant. Bright, sunny ponds with steep sides and little vegetation generally produced the fewest mosquitoes. The associations among mosquito species and selected vegetation types are discussed.

Aedes↗
PubMed1989

Practical management of NSAID gastropathy in rheumatic patients.

Gastropathy is a relatively common complication of treatment with a non-steroidal anti-inflammatory drug (NSAID). Pre-treatment evaluation of patients is therefore of key importance. Contraindications for NSAID treatment may include a history of gastroduodenal ulcer or of NSAID gastropathy, simultaneous administration of anticoagulant therapy and the existence of risk factors for ulcer disease. After NSAID treatment has begun, clinical follow-up is highly desirable. NSAID gastropathy can be asymptomatic despite the presence of a broad spectrum of gastrointestinal mucosal changes on endoscopy, but in the majority of cases there are clinical symptoms. Management of gastropathy may involve withdrawal of NSAID treatment, replacement therapy with a different type of drug or post hoc treatment of the gastropathy with anti-ulcer compounds.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Characterization of the management practices of the top milk producing herds in the country.

Out of 128 surveys mailed to dairy farms that had been identified by the nine DHI processing centers as the top milk producing herds in the country, 61 surveys were returned. The predominant forage being fed was corn silage, followed by legume hay and haylage. On average, 6.7 feed additives and 3.5 alternative feeds were fed. Producers reported the following incidences of metabolic disorders: parturient paresis, 7.2%; displaced abomasum, 3.3%; ketosis, 3.7%; and nonspecific downer cow syndrome, 1.1%. Producers scheduled detection of estrus 3.1 times per day. Only 18.3% of the herds used routine synchronization of estrus. Artificial insemination was used on 94.8% of the cows and 88.5% of the heifers. The most important trait in sire selection was PTA for milk. For mastitis control, 75.4% of the producers practiced predipping, 85.2% used individual paper towels, 93.4% practiced postdipping, and 95.1% treated all cows at cessation of milking. Increased profitability and lower costs or higher returns were the primary motivators of these producers. Veterinarians were the most frequent source of information, followed by farm magazines. Satellite delivery of educational programs was the least acceptable delivery method. Extension professionals need to be cognizant of the producers' preferred information sources and delivery systems to ensure accurate, timely, cost-effective transfer of technological advances.

Animal Feed↗
PubMed1999

Management practices associated with the incidence rate of clinical mastitis.

Risk factors for the incidence rate of clinical mastitis were studied in 274 Dutch dairy herds. Variables that were associated with resistance to disease were the feeding, housing, and milking machine factors. Variables that were associated with exposure were grazing, combined housing of dry cows and heifers, and calving area hygiene. Postmilking teat disinfection in herds with a low bulk milk somatic cell count and years of practicing dry cow therapy were positively associated with the incidence rate of clinical mastitis. Herds with a low bulk milk somatic cell count and in which postmilking teat disinfection was not used had lower incidence rates of clinical mastitis than did other herds. The incidence rate of clinical mastitis caused by Escherichia coli was mostly related to housing conditions, hygiene, and machine milking. The incidence rate of clinical mastitis caused by Staphylococcus aureus was mostly related to factors associated with bulk milk somatic cell count and factors that might be due to cause and effect reversal. A strong positive correlation existed between the incidence rate of clinical mastitis caused by Streptococcus dysgalactiae and the incidence rate of clinical mastitis caused by Staph. aureus. The incidence rate of clinical mastitis caused by Streptococcus dysgalactiae was related to nutrition, milking technique, and machine milking. The incidence rate of clinical mastitis caused by Streptococcus uberis was associated with factors related to housing, nutrition, and machine milking.

Animal Nutritional Physiological Phenomena↗
PubMed2001

Practical management of acute diarrhea.

A careful history and physical examination are usually enough to assess illness severity, the need for further labortory tests, and often the cause. Supportive treatment generally suffices However, antibiotic or probiotic therapy should be considered in selected patients.

Acute Disease↗
PubMed1999

Practical management of pleural effusions. When and how should fluid accumulations be drained?

Management of pleural effusions requires recognition of the cause and initiation of disease-specific therapy. However, it is important to be forewarned that breathing problems do not always improve in these patients, since other disease processes may be contributing to dyspnea. Many options are available for draining effusions and preventing recurrence, but decisions often need to be made quickly so the process does not progress to the point at which intervention becomes much more difficult.

Drainage↗
PubMedDate not supplied

Practical management of amblyopia.

One hundred sixteen strabismus patients with amblyopia treated with initial full-time or part-time conventional occlusion of the preferred eye followed when necessary with maintenance occlusion up to a maximum of nine years were studied. Based on the need for maintenance occlusion, patients were divided into a primary occlusion group, composed of patients who did not require maintenance occlusion and a maintenance group occlusion group, composed of patients who did require maintenance occlusion. The main difference between the two groups of patients was the degree of amblyopia at the onset of occlusion therapy, being significantly greater in the maintenance occlusion group. The maintenance occlusion group showed a significantly higher incidence of visual acuity regression when evaluated at ages 12 and 13 years. Occlusion therapy administered to strabismus patients in the manner described in this study resulted in significant visual improvement with a regression in visual acuity of no more than an average of one line on the Snellen chart.

Adolescent↗