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Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Hansen's disease (HD), once called “leprosy,” a most ancient, feared and disabling disease in humans, is a neurological and dermatological disease of long duration with 70% of cases involving the ulnar nerve (rarely median and radial nerve) in the upper extremity. M. lepra, an acid-fast bacillus infects nerves in the cooler parts of the body, terminal dermal nerves, small subcutaneous nerves, superficially located large nerve trunk (ulnar, common peroneal nerve) and causes sensory loss initially. Deeper nerve trunk damage causes subsequent motor loss. The nerve lesions are the result of immune reactions caused by the lepra infection and the antigens present cause intraneural inflammation and permanent nerve fibrosis. Also, the infected nerves are replaced with hyaline fibrous tissue where the M. lepra hides and is not amenable to drugs causing relapses of the disease. Skin lesions (anaesthetic patch) and sensory loss are the common presenting symptoms. About 30% of sensory fibres must be destroyed before sensory impairment becomes evident. The nerve infection is well advanced in a patient with skin patches, and they have palpable, thickened, enlarged adjacent subcutaneous nerves. Apart from skin lesions, the eyes, upper respiratory tract and testis are involved. Untreated cases may have mitten hands and feet because of profound sensory loss and subsequent absorption from damages (Table 2.24).
Epidermolysis bullosa
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Palms and soles must be kept dry in the summer season. Cotton mittens can be used to prevent itching. Wear two pairs of cotton socks to minimize friction. Cornstarch can be sprinkled into shoes or socks to reduce friction.
Suckling and the Being of the Newborn
Published in Michael van Manen, Phenomenology of the Newborn, 2018
The premature or ill newborn inhabits a different oral world than the healthy newborn. In the NICU, the baby’s mouth is usually the necessary entry for breathing and feeding tubes. Silastic devices may be needed for days, weeks, or even months such that the texture of oral sensuality becomes in part the constant contact with plastic tubes, adhesive tapes, or other material-devices. The mouth may be intermittently suctioned for secretions. Hands may be bundled in mittens to discourage direct contact between hands and mouth for fear of dislocating necessary medical equipment. We do not really understand the nature of sensuality of such experiences. Researchers have shown that infants who have been cared for in a NICU, and presumably exposed to odorous disinfectant and detergents, show different cerebral hemodynamic responses compared to the exposure of seemingly pleasant flavors like vanilla and colostrum (Bartocci et al., 2000, 2001).
Clinical characteristics, treatment patterns and adherence in patients with asthma on multiple inhaler triple therapy: a review of findings
Published in Expert Review of Respiratory Medicine, 2022
Mario Cazzola, Luigino Calzetta, Barbara Rinaldi, Vito De Novellis, Paola Rogliani, Maria Gabriella Matera
The use of MITT is not very frequent in asthma patients, unlike in patients with COPD. Its larger use in individuals with ACO is, therefore, not surprising. Women of mature age predominate among MITT users. Comorbidities associated with asthma are also often present in these patients who, in addition, are more frequently exacerbators. In any case, the use of MITT in asthma is linked to low levels of adherence and persistence. Nevertheless, real-life studies confirmed the efficacy of MITT in reducing the risk of exacerbations, as had emerged in pivotal studies investigating the effectiveness of tiotropium in asthma. It is much more challenging to draw conclusions on the true pharmacoeconomic impact of MITTs in asthma because of contradictory results and the diversity of demographics and metrics considered in the various studies.
Technical Tips: Restraint Use in Healthcare - What Neurodiagnostic Technologists Need to Know
Published in The Neurodiagnostic Journal, 2021
Erik Padilla, Patricia A. Lordeon
Hand mitts are often applied to a patient in situations where the provider would like to keep the patient from manipulating surgical dressings or IV sites. In these situations, the mitts are not being used as a restraint. But, if the mitts are so bulky that the patient is unable to use their hand, or the mitt is applied so tightly that the patient cannot move their fingers within the device, or the mitt is secured to the bed/rails or bedding, then the mitts are categorized as a restraint. In each of these examples, the patient is unable to freely move or use their hands, which is a determining factor in labeling a device a restraint (Federal Register 2006). If the patient is not undergoing continuous or long-term EEG monitoring, having a family member or staff member gently hold the patient’s hands during the short time needed for testing will keep the electrodes safe and the patient as calm as possible. Likewise, distracting a patient with hand-held games or sensory items will often alleviate the short-term need for mitts.
Surgical management of hand deformities in patients with recessive dystrophic epidermolysis bullosa
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Xianyu Zhou, Yan Zhang, Mengmeng Zhao, Yuluo Jian, Jinny Huang, Xusong Luo, Jun Yang, Di Sun
We have presented our outcomes for treating malformed hands in RDEB patients with surgical management combined with postoperative special dressings. This approach is shown to temporarily help regain good functional and cosmetic outcomes for mitten-hands. Despite the high reoccurrence rate of deformities, the temporary recovery of function and appearance in mitten-hands helps reintegrate RDEB patients into family life and society.