Myocarditis can follow SARS-CoV-2 infection or rarely after vaccination. In both scenarios, younger male patients are at highest risk for this overall rare event. With vaccination, myocarditis is rare and most frequently has been seen in adolescent and young adult males within 7 days after receiving the second dose of an mRNA COVID-19 vaccine. The CDC reports rates of 5 to 97 cases per million people aged 18 to 39 years. With COVID-19, myocarditis affects under-resourced groups disproportionately with death rates highest among self-identified Black persons likely due to both an increase in comorbidities and health care disparities.

Drugs are the cornerstone of modern therapeutics. Nevertheless, it is well recognized among health care providers and the lay community that the outcome of drug therapy varies widely among individuals. While this variability has been perceived as an unpredictable, and therefore inevitable, accompaniment of drug therapy, this is not the case.

There are 12 pairs of cranial nerves, referred to by either name or Roman numeral (Fig 8–1 and Table 8–1). Some authorities contend that the olfactory peduncle (see Chapter 19) and the optic nerve (see Chapter 15) are not true nerves but rather fiber tracts of the brain, whereas nerve XI (the spinal accessory nerve) is derived, in part, from the upper cervical segments of the spinal cord. The remaining nine pairs relate to the brain stem.

Esistono diversi fattori che possono causare, perpetuare o esacerbare il dolore cronico. In primo luogo, naturalmente, il paziente può semplicemente avere una malattia tipicamente dolorosa per la quale attualmente non esiste una cura. Ne sono un esempio l’artrite, il cancro, la cefalea cronica quotidiana, la fibromialgia e la neuropatia diabetica. In secondo luogo, possono esistere fattori secondari di perpetuazione che sono iniziati dalla malattia e persistono dopo che questa si è risolta. Tra gli esempi vi sono i nervi sensoriali danneggiati, l’attività simpatica efferente e la contrazione muscolare riflessa dolorosa (spasmo). Infine, una serie di condizioni psicologiche può esacerbare o addirittura causare il dolore.

Los orígenes de las enfermedades infecciosas son simples. La idea de que las enfermedades contagiosas se debían a un miasma (“mal aire”) puede ubicarse a mediados del siglo XVI, por lo menos. No fue sino hasta el trabajo de Louis Pasteur y Robert Koch a finales del siglo XIX, que hubo evidencia creíble que respaldaba la teoría de gérmenes de la enfermedad; es decir, que los microorganismos son la causa directa de las infecciones. A diferencia de este inicio relativamente lento, en el siglo XX hubo avances notables en el campo de las enfermedades infecciosas, y pronto se identificaron los microorganismos etiológicos de muchas enfermedades infecciosas. Además, el descubrimiento de los antibióticos y el advenimiento de las vacunas contra algunas de las infecciones más

counsel and comfort dying patients and their significant others if an initial trial of invasive supportive care is either not effective or is not appropriate for the patient’s current condition. Critical care physicians often must redirect the goals of care from resuscitation and cure to comfort when the resolution of an underlying illness is not possible. The COVID-19 pandemic has heightened the need and priority for effective critical care practices (Chap. 205), as well as the need for additional support for post-ICU care and

The G-H joint is a true synovial joint connecting the upper extremity to the trunk as part of the upper kinetic chain. The G-H joint is a ball-and-socket joint—the humeral head forms roughly half a ball or sphere (Fig. 16-1), whereas the glenoid fossa forms the socket. The orientation of the articular surface of the glenoid is posterior (retroverted) relative to the transverse plane of the scapular axis. The degree of retroversion varies but on average is less than 7 degrees.2 An increase in the retroversion angle predisposes the shoulder to posterior G-H joint instability and posterior labral tears, whereas a decrease in the retroversion angle (anteversion) predisposes the shoulder to anterior instability.3

The application of current treatment techniques (surgery, radiation therapy, chemotherapy, and biologic therapy) results in the cure of nearly two of three patients diagnosed with cancer. Nevertheless, patients experience the diagnosis of cancer as one of the most traumatic and revolutionary events that has ever happened to them. Independent of prognosis, the diagnosis brings with it a change in a person’s self-image and in their role in the home and workplace. The prognosis of a person who has just been found to have pancreatic cancer is the same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ∼8 months).

En términos generales, las células de un organismo multicelular están programadas para actuar por colaboración; surgen innumerables enfermedades porque las células especializadas no realizan la tarea que tienen asignada. El cáncer lleva esta disfunción una etapa más adelante. Además de la incapacidad de la célula cancerosa para conservar su función especializada, también afecta al resto de las células por sí mismas; la célula cancerosa compite por la supervivencia y usa la mutabilidad natural y la selección biológica para sacar ventaja en relación con las células normales, en una recapitulación de la evolución. Una consecuencia del comportamiento traicionero de las células cancerosas es que el paciente se siente defraudado por su cuerpo. El individuo siente que todo su cuerpo, y no solo una parte, está enfermo.

Patients without significant medical problems—especially those under age 50—are at very low risk for perioperative complications. Their preoperative evaluation should include a history and physical examination; emphasis should be on a pharmacologic history and assessment of functional status, exercise tolerance, and cardiopulmonary status to look for unrecognized disease that may require further evaluation before surgery. In addition, a directed bleeding history (Table 3–1) should be taken to uncover coagulopathy that could contribute to excessive surgical blood loss.