Current management of spontaneous pneumothorax

Spontaneous pneumothorax is divided into primary, when there is no underlying lung disease, and secondary, mainly caused by chronic obstructive pulmonary disease. A variety of different non-invasive and invasive treatment options exist. Due to the lack of large randomised controlled trials no level A evidence is present. A first episode of a primary spontaneous pneumothorax is treated by observation if it is 20%, but recurrences are frequent. For recurrent or persisting pneumothorax a more invasive approach is indicated whereby video-assisted thoracic surgery provides a treatment of lung (resection of blebs or bullae) and pleura (pleurectomy or abrasion). In patients with a secondary spontaneous pneumothorax related to chronic obstructive pulmonary disease, there is an associated increased mortality and a more aggressive approach is warranted consisting of initial thoracic drainage followed by recurrence prevention by thoracoscopy or thoracotomy in patients with a low or moderate operative risk. Talc instillation by the thoracic drain is preferred for patients with a high operative risk

Superficial thrombophlebitis of the lower limb: Practical recommendations for diagnosis and treatment

On behalf of the Thrombosis Guidelines Group of the Belgian Society on Thrombosis and Haemostasis and the Belgian Working Group on Angiologyinfo:eu-repo/semantics/publishe

Beliefs of Health Care Providers, Lay Health Care Providers and Lay Persons in Nigeria Regarding Hypertension. A Systematic Mixed Studies Review

<div><p>Background</p><p>Hypertension is a major health risk factor for mortality globally, resulting in about 13% of deaths worldwide. In Nigeria, the high burden of hypertension remains an issue for urgent attention. The control of hypertension, among other factors, is strongly determined by personal beliefs about the illness and recommended treatment.</p><p>Objective</p><p>The aim of this review is to systematically synthesize available data from all types of studies on beliefs of the Nigerian populace about hypertension</p><p>Methods</p><p>We searched the following electronic databases; Medline, EMBase, PsycInfo, AMED from their inception till date for all relevant articles. A modified Kleinman’s explanatory model for hypertension was used as a framework for extraction of data on beliefs about hypertension.</p><p>Results</p><p>The search yielded a total of 3,794 hits from which 16 relevant studies (2 qualitative, 11 quantitative and 3 mixed methods studies) met the inclusion criteria for the review. Overall, most health care providers (HCPs) believe that stress is a major cause of hypertension. Furthermore, reported cut-off point for uncomplicated hypertension differed widely among HCPs. Lay Health Care Providers such as Patent Medicine Vendors’ beliefs about hypertension seem to be relatively similar to health care professionals in areas of risk factors for hypertension, course of hypertension and methods of treatment. Among Lay persons, misconception about hypertension was quite high. Although some Nigerians believed that life style habits such as alcohol intake, exercise levels, cigarette smoking were risk factors for developing hypertension, there was discordance between belief and practice of control of risk factors. However, beliefs across numerous ethnic groups and settings (urban/rural) in Nigeria have not been explored.</p><p>Conclusion</p><p>In order to achieve control of hypertension in Nigeria, interventions should be informed, among other factors, by adequate knowledge of beliefs regarding hypertension across the numerous ethnic groups in Nigeria, settings (rural/urban), age and sex.</p></div