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Severe mental disorders in older adults include schizophrenia-spectrum disorders, schizoaffective disorder, bipolar disorder, and severe or psychotic major depression. Their clinical expression and management are shaped by cognitive impairment, neurocognitive disease, medical comorbidity, polypharmacy, sensory loss, frailty, social isolation, and increased susceptibility to adverse treatment effects. Late-onset psychosis may feature female predominance, social isolation, and early cognitive deficits, while established schizophrenia-spectrum disorders are associated with prominent negative symptoms, disability, and reduced autonomy. Depression is common in long-term-care settings and contributes to poor functioning and health outcomes. Diagnosis requires longitudinal assessment to distinguish primary psychiatric illness from neurocognitive disorders, mood-related psychosis, medication effects, and illness-related negative symptoms. Treatment should be individualized, regularly reviewed, and integrated with physical-health monitoring, psychosocial care, rehabilitation, caregiver involvement, and attention to mortality and functional risk. Antipsychotics, cautious antidepressant treatment, clozapine for selected treatment-resistant cases, and electroconvulsive therapy (ECT) may all have roles when appropriately indicated.
Question: Severe mental disorders in elderly people
Read the full reviewEl cáncer de próstata puede permanecer asintomático durante años, por lo que la atención primaria desempeña un papel central en la identificación del riesgo, la decisión compartida sobre el antígeno prostático específico (PSA), la evaluación inicial, la derivación oportuna y el seguimiento integral. El PSA es una prueba de evaluación del riesgo, no una confirmación diagnóstica, y sus resultados deben interpretarse junto con el tacto rectal, la evolución temporal, las causas benignas de elevación, los antecedentes familiares, la expectativa de vida y las preferencias del paciente. La confirmación requiere biopsia prostática, con apoyo creciente de la resonancia magnética multiparamétrica para seleccionar y orientar las biopsias. El tratamiento depende del grado, el estadio, el riesgo de progresión, la expectativa de vida, las comorbilidades y los objetivos del paciente. La vigilancia activa puede evitar o retrasar toxicidades en enfermedad localizada de bajo riesgo, mientras que la enfermedad de mayor riesgo o metastásica puede requerir cirugía, radioterapia, privación androgénica, tratamientos sistémicos o medidas paliativas. La atención primaria también debe prevenir y detectar toxicidades cardiovasculares, metabólicas, óseas, urinarias, sexuales y psicosociales.
Question: RESUMEN DE DIAGNOSTICO Y TRATAMIENTO DE CANCER DE PROSTATA PARA MEDICOS DE PRIMER NIVEL
Read the full reviewEl delírium es un síndrome neuropsiquiátrico agudo, de inicio rápido y curso fluctuante, caracterizado por alteraciones de la atención, la conciencia y otras funciones cognitivas, como la orientación, la memoria, el lenguaje y la percepción. Representa la manifestación clínica de una encefalopatía o disfunción cerebral aguda. Puede presentarse en cualquier persona, aunque el riesgo aumenta con la edad avanzada, el deterioro cognitivo previo, la fragilidad funcional, la enfermedad grave, las infecciones, las alteraciones metabólicas, el dolor y la exposición a determinados fármacos. Su fisiopatología es multifactorial e incluye inflamación, lesión neuronal, desequilibrios metabólicos, alteraciones de neurotransmisores y disrupción de la barrera hematoencefálica. El delírium es especialmente frecuente en personas hospitalizadas y pacientes críticos, en quienes se asocia con mayor mortalidad, estancias más prolongadas, ventilación mecánica prolongada y deterioro cognitivo y funcional persistente. El diagnóstico es clínico y requiere comparar el estado mental actual con el basal, apoyándose en herramientas validadas. La prevención y el tratamiento deben centrarse en la detección precoz, la búsqueda y corrección de causas reversibles y la aplicación de intervenciones no farmacológicas multimodales. No existe un tratamiento farmacológico universalmente eficaz ni se recomienda el uso rutinario de antipsicóticos.
Question: Delírium
Read the full reviewLateralization in reverse shoulder arthroplasty (RSA) refers to moving the reconstructed center of rotation, humeral articulation, or both laterally relative to the markedly medialized Grammont-style design. It may be produced on the glenoid side, the humeral side, or through combined bipolar modification. Lateralization is intended to reduce scapular notching and impingement, improve external rotation and residual rotator-cuff mechanics, restore soft-tissue tension, and enhance stability. Comparative evidence generally supports reduced notching and improved external rotation with lateralized constructs, although improvements in elevation, internal rotation, patient-reported outcomes, and stability are less consistent. The principal disadvantages include increased deltoid and joint-reaction forces, greater glenoid baseplate loading, possible over-tensioning, and increased acromial or scapular-spine stress. Because implant geometry, component position, scapular anatomy, and soft-tissue status substantially influence outcomes, no universal amount or location of lateralization has been established.
Question: offset (lateralization) in reverse shoulder arthroplasty (RSA)
Read the full reviewDifferences between potassium measured on a blood-gas analyzer and potassium measured in serum in patients with chronic kidney disease (CKD) may reflect preanalytical factors, specimen-matrix differences, analytical variation, or genuine biological changes. Blood-gas analysis generally uses rapidly analyzed, heparinized whole blood, whereas serum potassium is measured after clotting, transport, centrifugation, and analysis on a chemistry platform. Hemolysis, delayed processing, temperature, transport, clotting-related potassium release, thrombocytosis, leukocytosis, sampling location, and analyzer methodology may therefore produce discordant results. CKD-related impairment of potassium excretion and associated acid–base or treatment changes can also cause genuine temporal variation. The supplied evidence does not directly establish a CKD-specific bias, conversion factor, or quantitative comparison between blood-gas and serum potassium. Unexpected discrepancies should consequently be evaluated with attention to specimen quality, blood counts, timing, sampling conditions, acid–base status, dialysis, and medications.
Question: Causes of differences between blood gas potassium and serum potassium in chronic kidney disease patients
Read the full reviewEvidence directly evaluating agreement between point-of-care (POC) or blood-gas potassium and central laboratory serum or plasma potassium in chronic kidney disease (CKD) is limited, heterogeneous, and concentrated in patients receiving hemodialysis. Available studies generally indicate good concordance and low systematic bias, supporting POC testing as a rapid assessment when urgent decisions are required. However, important exceptions include clinically meaningful individual differences, incomplete reporting of method-comparison statistics, uncertainty regarding specimen types and analyzers, and limited evaluation across CKD stages and marked hyperkalemia. POC results that are unexpected, markedly abnormal, or treatment-critical should therefore be confirmed by central laboratory measurement, with interpretation accounting for hemolysis, collection technique, specimen matrix, and processing delays.
Question: Agreement between blood gas potassium and serum potassium in chronic kidney disease patients
Read the full reviewBroiler ascites, also termed pulmonary hypertension syndrome (PHS), is a multifactorial cardiopulmonary and metabolic disorder arising when oxygen demand exceeds the functional capacity of the cardiopulmonary system. Rapid growth, high metabolic rate, limited pulmonary vascular capacity, environmental stress, vascular remodeling, and genetic susceptibility can increase pulmonary vascular resistance and pulmonary arterial pressure. The resulting right-ventricular hypertrophy and failure produce venous congestion and fluid accumulation in the abdominal cavity. Evidence indicates that modern production traits, cold exposure, hypoxia, inadequate ventilation, high stocking density, ammonia, and other conditions contribute to disease expression. Prevention combines controlled growth, appropriate nutrition and temperature management, effective ventilation, and genetic selection for resistance.
Question: ascites in broilers
Read the full reviewLow bone mineral density (BMD) is common after spinal cord injury (SCI), but the prevalence of BMD below the expected range for age in younger adults remains uncertain. In a retrospective study of 63 adults aged 18–50 years, 38.1% had a DXA Z-score of ≤ −2.0. Other studies used T-scores, absolute BMD thresholds, or comparisons with age-matched controls, limiting direct synthesis. Bone loss is predominantly regional, with the femoral neck, total hip, distal femur, and proximal tibia more affected than the lumbar spine. Associated factors include longer time since injury, early immobilization, complete or severe neurological injury, lower body mass index, reduced muscle mass, poorer fitness, limited mechanical loading, smoking, and increased bone turnover. Fracture risk is not fully captured by DXA-defined BMD and may also reflect mobility, falls, spasticity, muscle mass, and bone quality. Larger prospective studies using standardized age-adjusted Z-scores and consistent hip and knee measurement sites are needed.
Question: Prevalence and associated factors of bone mineral density below the expected range for age in younger adults with spinal cord injury: a systematic review and meta-analysis
Read the full reviewAutonomous AI agents can plan and execute multistep tasks, access data and external tools, modify software or models, coordinate with other agents, and act in high-impact environments. These capabilities require governance that is risk-proportionate, capability-based, lifecycle-oriented, and sensitive to context. The supplied evidence supports a layered framework combining agentic profiling, bounded authority, least-privilege access, sandboxing, meaningful human oversight, transparency, validation, continuous monitoring, incident response, privacy and security controls, and clearly assigned accountability. Governance should address not only initial deployment but also tool use, memory, adaptation, self-correction, self-improvement, model and code modification, and changing operating contexts. Because autonomy can produce cascading errors, unauthorized actions, unclear responsibility, and behavior that changes after deployment, increasing autonomy should be matched by stronger authorization, traceability, verification, supervision, and rollback or shutdown capacity. In high-stakes settings, autonomous systems should augment rather than replace qualified human judgment.
Question: Autonomous agent system governance ou Autonomous AI agent governance
Read the full reviewBroiler ascites, also called pulmonary hypertension syndrome, pulmonary arterial hypertension syndrome, or right-sided heart failure, is a multifactorial disorder characterized by pulmonary hypertension, right-ventricular remodeling, venous congestion, and accumulation of protein-containing fluid in the abdominal cavity. Its development reflects an imbalance between the high oxygen requirements of rapidly growing broilers and the capacity of their pulmonary and cardiovascular systems to deliver oxygen. Limited pulmonary vascular capacity, hypoxic pulmonary vasoconstriction, vascular remodeling, altered blood rheology, respiratory impairment, myocardial injury, environmental stress, and genetic susceptibility all contribute to disease expression. Hypoxia, cold exposure, inadequate ventilation, high altitude, and nutritional strategies that promote excessive growth can increase risk. Genetic variation is substantial, supporting selection for resistance, while management approaches that moderate growth and maintain oxygen availability can reduce incidence, although potential effects on production performance must be considered.
Question: Ascites in Broilers
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