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These factors include onset of labor before 37 weeks of gestation (premature birth), prolonged rupture of membranes (≥18h before delivery), intra-partum fever (>38 °C, >100.4 °F), amniotic infections (chorioamnionitis), young maternal age, and low levels of GBS anticapsular polysaccharide antibodies in the mother. Nevertheless, most babies who develop EOD are born to GBS colonized mothers without any additional risk factor. A previous sibling with EOD is also an important risk factor for development of the infection in subsequent deliveries, probably reflecting a lack of GBS polysaccharides protective antibodies in the mother. Heavy GBS vaginal colonization is also associated with a higher risk for EOD. Overall, the case–fatality rates from EOD have declined, from 50% observed in studies from the 1970s to 2 to 10% in recent years, mainly as a consequence of improvements in therapy and management. Fatal neonatal infections by GBS are more frequent among premature infants.GBS LOD affects infants from 7 days to 3 months of age and is more likely to cause bacteremia or meningitis. LOD can be acquired from the mother or from environmental sources. Hearing loss and mental impairment can be a long-term sequela of GBS meningitis. In contrast with EOD, the incidence of LOD has remained unchanged at 0.26 per 1000 live births in the US. S. agalactiae neonatal meningitis does not present with the hallmark sign of adult meningitis, a stiff neck; rather, it presents with nonspecific symptoms, such as fever, vomiting and irritability, and can consequently lead to a late diagnosis. | The risk-based strategy identifies candidates to receive IAP by the aforementioned risk factors known to increase the probability of EOD without considering if the mother is or is not a GBS carrier.IAP is also recommended for women with intrapartum risk factors if their GBS carrier status is not known at the time of delivery, for women with GBS bacteriuria during their pregnancy, and for women who have had an infant with EOD previously. The risk-based approach for IAP is in general less effective than the culture-based approach because in most of the cases EOD develops among newborns, which are born to mothers without risk factors.In 2010, the Centers for Disease Control and Prevention (CDC), in collaboration with several professional groups, issued its revised GBS prevention guidelines.In 2018, the task of revising and updating the GBS prophylaxis guidelines was transferred from the CDC to ACOG (American College of Obstetricians and Gynecologists), the American Academy of Pediatrics and to the American Society for Microbiology. The ACOG committee issued an update document on Prevention of Group B Streptococcal Early-Onset Disease in Newborns in 2019. This document does not introduce important changes from the CDC guidelines. The key measures necessary for preventing neonatal GBS early onset disease continue to be universal prenatal screening by culture of GBS from swabs collected from the lower vagina and rectum, correct collection and microbiological processing of the samples, and proper implementation of intrapartum antibiotic prophylaxis. The ACOG now recommends performing universal GBS screening between 36 and 37 weeks of gestation. | 11
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The most common route of administration for testosterone is by intramuscular injection. However, it has been reported that AndroGel, a transdermal gel formulation of testosterone, has become the most popular form of testosterone in androgen replacement therapy for hypogonadism in the United States. Non-medical use
Athletics
Testosterone is used as a form of doping among athletes in order to improve performance. Testosterone is classified as an anabolic agent and is on the World Anti-Doping Agency (WADA) List of Prohibited Substances and Methods. Hormone supplements cause the endocrine system to adjust its production and lower the natural production of the hormone, so when supplements are discontinued, natural hormone production is lower than it was originally.Anabolic–androgenic steroids (AAS), including testosterone and its esters, have also been taken to enhance muscle development, strength, or endurance. They do so directly by increasing the muscles protein synthesis. As a result, muscle fibers become larger and repair faster than the average persons.After a series of scandals and publicity in the 1980s (such as Ben Johnsons improved performance at the 1988 Summer Olympics), prohibitions of AAS use were renewed or strengthened by many sports organizations. Testosterone and other AAS were designated a "controlled substance" by the United States Congress in 1990, with the Anabolic Steroid Control Act. Their use is seen as an issue in modern sport, particularly given the lengths to which athletes and professional laboratories go to in trying to conceal such use from sports regulators. | Nasal congestion is the blockage of nasal breathing usually due to membranes lining the nose becoming swollen from inflamed blood vessels. Background
In about 85% of cases, nasal congestion leads to mouth breathing rather than nasal breathing. According to Jason Turowski, MD of the Cleveland Clinic, "we are designed to breathe through our noses from birth—its the way humans have evolved." This is referred to as "obligate nasal breathing. "Nasal congestion can interfere with hearing and speech. Significant congestion may interfere with sleep, cause snoring, and can be associated with sleep apnea or upper airway resistance syndrome. In children, nasal congestion from enlarged adenoids has caused chronic sleep apnea with insufficient oxygen levels and hypoxia, as well as right-sided heart failure. The problem usually resolves after surgery to remove the adenoids and tonsils, however the problem often relapses later in life due to craniofacial alterations from chronic nasal congestion. Causes
Allergies, like hay fever, allergic reaction to pollen or grass
Common cold or influenza
Rhinitis medicamentosa, a condition of rebound nasal congestion brought on by extended use of topical decongestants (e.g., oxymetazoline, phenylephrine, xylometazoline, and naphazoline nasal sprays)
Sinusitis or sinus infection
Narrow or collapsing nasal valve
Pregnancy may cause women to suffer from nasal congestion due to the increased amount of blood flowing through the body. Nasal polyps
Gastroesophageal reflux disease (theorized to cause chronic rhinosinusitis- the "airway reflux paradigm")
COVID-19
Nasal obstruction
Nasal obstruction characterized by insufficient airflow through the nose can be a subjective sensation or the result of objective pathology. | 0-1
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CMS prevalence rates reported from the study are summarised below:
Ethiopia [3600–4100 m]: 0%
Tibetan Plateau (Tibetans): 0.91–1.2%
Indian Himalayas [3000–4200 m]: 4–7%
Kyrgyzstan [3000–4200 m]: 4.6%
Tibetan Plateau (Han Chinese): 5.6%
La Paz, Bolivia [3600 m]: 6% to 8%
Bolivia: 8–10%
Cerro de Pasco, Peru [4300 m]: 14.8–18.2%
References
External links
^ Online calculator illustrating blood oxygen carrying capacity at altitude | This treatment includes cognitive behavioral therapy (CBT), anti-depressant medication, and combination therapy. A lot of research supports the notion that minor depressive disorder is an early stage of major depressive disorder, or that it is simply highly predictive of subsequent major depressive disorder. Signs and symptoms
Minor depressive disorder is very similar to major depressive disorder in the symptoms present. Generally, a persons mood is affected by thoughts and feelings of being sad or down on themself or by a loss of interest in nearly all activities. People can experience ups and downs in their life everyday where an event, action, stress or many other factors can affect their feelings on that day. However, depression occurs when those feelings of sadness persist for longer than a few weeks.A person is considered to have minor depressive disorder if they experience 2 to 4 depressive symptoms during a 2-week period. The Diagnostic and Statistical Manual of Mental Disorders lists the major depressive symptoms. Depressed mood most of the day and/or loss of interest or pleasure in normal activities must be experienced by the individual to be considered to have minor depressive disorder. Without either of these two symptoms, the disorder is not classified as minor depressive disorder. Other depressive symptoms include significant weight loss or weight gain without trying to diet (an increase/decrease in appetite can provide clues as well), insomnia or hypersomnia, psychomotor agitation or psychomotor retardation, fatigue or loss of energy, and feelings of worthlessness or excessive guilt. | 0-1
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However, while bicalutamide does not seem to be able to adversely influence testicular spermatogenesis, it may interfere with AR-dependent sperm maturation and transport outside of the testes in the epididymides and vas deferens where androgen levels are far lower, and hence may still be able to impair male fertility. In addition, the combination of bicalutamide with other medications, such as estrogens, progestogens, and GnRH analogues, can compromise spermatogenesis due to their own adverse effects on male fertility. These medications are able to strongly suppress gonadal androgen production, which can severely impair or abolish testicular spermatogenesis, and estrogens also appear to have direct and potentially long-lasting cytotoxic effects in the testes at sufficiently high concentrations. Other activities
Bicalutamide has been found to act as an inhibitor or inducer of certain cytochrome P450 enzymes including CYP3A4, CYP2C9, CYP2C19, and CYP2D6 in preclinical research, but no evidence of this has been found in humans treated with up to 150 mg/day. It has also been identified in vitro as a strong inhibitor of CYP27A1 (cholesterol 27-hydroxylase) and as an inhibitor of CYP46A1 (cholesterol 24-hydroxylase), but this has yet to be assessed or confirmed in vivo or in humans and the clinical significance remains unknown. Bicalutamide has been found to be a P-glycoprotein (ABCB1) inhibitor. Like other first-generation NSAAs and enzalutamide, it has been found to act as a weak non-competitive inhibitor of GABAA receptor-mediated currents in vitro (IC50 = 5.2 μM). | However, unlike enzalutamide, bicalutamide has not been found to be associated with seizures or other related adverse central effects, so the clinical relevance of this finding is uncertain. Pharmacokinetics
Though its absolute bioavailability in humans is unknown, bicalutamide is known to be extensively and well-absorbed. Its absorption is not affected by food. The absorption of bicalutamide is linear at doses up to 150 mg/day and is saturable at doses above this, with no further increases in steady-state levels of bicalutamide occurring at doses above 300 mg/day. Whereas absorption of (R)-bicalutamide is slow, with levels peaking at 31 to 39 hours after a dose, (S)-bicalutamide is much more rapidly absorbed. Steady-state concentrations of the drug are reached after 4 to 12 weeks of treatment independently of dosage, with a 10- to 20-fold progressive accumulation in levels of (R)-bicalutamide. The long time to steady-state levels is the result of bicalutamides very long elimination half-life.The tissue distribution of bicalutamide is not well-characterized. The amount of bicalutamide in semen that could potentially be transferred to a female partner during sexual intercourse is low and is not thought to be important. Based on animal studies with rats and dogs it was thought that bicalutamide could not cross the blood–brain barrier and hence could not enter the brain. As such, it was initially thought to be a peripherally selective antiandrogen. | 11
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If a child is not walking yet, then this is usually caused by a problem in balance, muscle coordination, spasticity, or leg alignment. Each of these reasons should be looked into closely so the problem can be addressed and fixed. 7 to 12 years
“By the time a child reaches this age the rate of physical improvement has leveled off in areas such as balance and coordination, and its a good idea to refocus the child’s attention away from additional physical improvement and toward intellectual learning.” During this time period a child should lean away from physical therapy and do more outdoor or social exercises such as sports and adaptive P.E. Usually by age 8-10 a child has reached maximum walking ability. This will usually decrease a little when a child hits puberty and gains height and weight because walking becomes harder during this changing period. Any significant problems in walking should be addressed with surgery at this stage. 13 to 18 years
“During this time period of a child’s development, a major issue is separating from the family.” Parents should learn how to cope with their child growing up and give them more freedom and independence. Teenagers need to make their own decisions and learn from them. One way to do this is for parents to compromise and let the child make smaller decisions so they feel important. Parents should also understand that their child may regress in walking some from increase in height and weight. | Diplegia, when used singularly, refers to paralysis affecting symmetrical parts of the body. This is different from hemiplegia which refers to spasticity restricted to one side of the body, paraplegia which refers to paralysis restricted to the legs and hip, and quadriplegia which requires the involvement of all four limbs but not necessarily symmetrical. Diplegia is the most common cause of crippling in children, specifically in children with cerebral palsy. Other causes may be due to injury of the spinal cord. There is no set course of progression for people with diplegia. Symptoms may get worse but the neurological part does not change. The primary parts of the brain that are affected by diplegia are the ventricles, fluid filled compartments in the brain, and the wiring from the center of the brain to the cerebral cortex. There is also usually some degeneration of the cerebral neurons, as well as problems in the upper motor neuron system. The term diplegia can refer to any bodily area, such as the face, arms, or legs. Facial diplegia
Facial diplegia refers to people with paralysis of both sides of their face. Bilateral occurs when the onset of the second side occurs within one month of the onset of the first side. Facial diplegia occurs in 50% of patients with Guillain–Barré syndrome. Facioscapulohumeral muscular dystrophy (FSHD) is the second most common adult-onset muscular dystrophy with facial weakness being a distinct feature of FSHD in over 90% of cases. | 11
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Additionally, in another study, androstenedione, testosterone, and dihydrotestosterone (DHT) were found to be either low or normal in males, and follicle-stimulating hormone (FSH) levels were very low (likely due to suppression by estrogen, which has antigonadotropic effects as a form of negative feedback inhibition on sex steroid production in sufficiently high amounts), whereas luteinizing hormone (LH) levels were normal.According to a recent review, estrone levels have been elevated in 17 of 18 patients (94%), while estradiol levels have been elevated only in 13 of 27 patients (48%). As such, estrone is the main estrogen elevated in the condition. In more than half of patients, circulating androstenedione and testosterone levels are low to subnormal. The ratio of circulating estradiol to testosterone is >10 in 75% of cases. FSH levels are said to be consistently low in the condition, while LH levels are in the low to normal range.It is notable that gynecomastia has been observed in patients in whom estradiol levels are within the normal range. | Akhenaten and his relatives, including men and young girls, many of whom were the product of inbreeding, are described as having breasts and wide hips, and Akhenaten was described as having a "beautiful and feminine voice," unusual physical features that could be explained by AEXS or another form of hereditary hyperestrogenism. However, numerous other physical abnormalities were also present in the Akhenaten family, and a variety of other conditions have been proposed to explain the observations instead. Most recently, Loeys–Dietz syndrome was proposed as a probable cause, with gynecomastia and feminization possibly being caused by liver cirrhosis-induced hyperestrogenism. See also
Androgen insensitivity syndrome
Aromatase deficiency
Congenital estrogen deficiency
Disorders of sex development
Estrogen insensitivity syndrome
Hyperestrogenism
Inborn errors of steroid metabolism
Intersex
References
== External links == | 11
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Worry refers to the thoughts, images, emotions, and actions of a negative nature in a repetitive, uncontrollable manner that results from a proactive cognitive risk analysis made to avoid or solve anticipated potential threats and their potential consequences. Introduction
Psychologically, worry is part of
Perseverative Cognition (a collective term for continuous thinking about negative events in the past or in the future). As an emotion "worry" is experienced from anxiety or concern about a real or imagined issue, often personal issues such as health or finances, or external broader issues such as environmental pollution, social structure or technological change. It is a natural response to anticipated future problems. Excessive worry is a primary diagnostic feature of generalized anxiety disorder, but also is pervasive in other psychological disorders, like schizophrenia. Most people experience short-lived periods of worry in their lives without incident; indeed, a mild amount of worrying have positive effects, if it prompts people to take precautions (e.g., fastening their seat belt or buying insurance) or avoid risky behaviors (e.g., angering dangerous animals, or binge drinking), but with excessive worrisome people they overestimate future dangers in their assessments and in its extremities tend to magnify the situation as a dead end which results stress. Overestimation happens because analytic resources are a combination of external locus of control, personal experience and belief fallacies. | Hereditary sclerosing poikiloderma is an autosomal dominant conditions with skin changes consisting of generalized poikiloderma appearing in childhood. : 576
See also
Mandibuloacral dysplasia
Poikiloderma
Skin lesion
References
== External links == | 0-1
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Glomerular disease comprises a diverse group and is classified into:Primary glomerular disease such as focal segmental glomerulosclerosis and IgA nephropathy (or nephritis)
Secondary glomerular disease such as diabetic nephropathy and lupus nephritis
Tubulointerstitial disease includes drug- and toxin-induced chronic tubulointerstitial nephritis, and reflux nephropathy
Obstructive nephropathy, as exemplified by bilateral kidney stones and benign prostatic hyperplasia of the prostate gland; rarely, pinworms infecting the kidney can cause obstructive nephropathy. Other
Genetic congenital disease such as polycystic kidney disease or 17q12 microdeletion syndrome. Mesoamerican nephropathy, is "a new form of kidney disease that could be called agricultural nephropathy". A high and so-far unexplained number of new cases of CKD, referred to as the Mesoamerican nephropathy, has been noted among male workers in Central America, mainly in sugarcane fields in the lowlands of El Salvador and Nicaragua. Heat stress from long hours of piece-rate work at high average temperatures of about 36 °C (96 °F) is suspected, as are agricultural chemicals
Diagnosis
Diagnosis of CKD is largely based on history, examination, and urine dipstick combined with the measurement of the serum creatinine level (see above). Differentiating CKD from acute kidney injury (AKI) is important because AKI can be reversible. One diagnostic clue that helps differentiate CKD from AKI is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks). In many people with CKD, previous kidney disease or other underlying diseases are already known. A significant number present with CKD of unknown cause. | Research
Currently, several compounds are in development for the treatment of CKD. These include the angiotensin receptor blocker (ARB) olmesartan medoxomil; and sulodexide, a mixture of low molecular weight heparin and dermatan sulfate.Unbiased research with complete reporting is required to determine the safety and effectiveness of acupuncture to treat depression, pain, sleep problems, and uraemic pruritus in people who are undergoing dialysis treatments on a regular basis. References
External links
Dialysis Complications of Chronic Renal Failure at eMedicine
Chronic Renal Failure Information Archived 2013-03-15 at the Wayback Machine from Great Ormond Street Hospital
[./Https://www.mybestpdf.com/world-diabetes-day-2022/ How to Prevent Chronic Kidney Disease n World Diabetes Day 2022] | 11
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The third umpire may also be used if the Umpire Decision Review System is available and a team wishes to dispute a call concerning a possible catch. Celebration
Before 2000, the Laws of Cricket defined a catch as being completed when the player had "complete control over the further disposal of the ball". In the very strictest sense, this meant that the player did not finish catching the ball until he threw it away, though the player doesnt have to throw the ball to anyone in particular in so doing. For this reason, even today many cricketers celebrate a catch by lobbing the ball into the air. In a Super Sixes match in the 1999 Cricket World Cup, South African Herschelle Gibbs caught Australian captain Steve Waugh but Waugh was given not out when Gibbs was ruled to not have control of the ball when attempting to throw the ball in celebration. Waugh went on to score a match-winning 120 not out to qualify his team for the semi-finals; Australia went on to win the tournament. Records
Test matches
The wicket-keepers with the highest number of catches taken in Test matches are as follows. Note this excludes catches made while not fielding as a wicket-keeper. Source: Cricinfo Statsguru. Last updated: 19 April 2019. The non-wicket-keepers with the highest number of catches taken in Test matches are as follows. Note this excludes any catches made while fielding as a wicket-keeper. Source: Cricinfo Statsguru. Last updated: 19 April 2019. | Laws
This method of dismissal is covered by Law 33 of the Laws of cricket which reads:
The striker is out Caught if a ball delivered by the bowler, not being a No ball, touches his/her bat without having previously been in contact with any fielder, and is subsequently held by a fielder as a fair catch,..., before it touches the wicket and ground.This means that the batsman cannot be out caught if:
The ball is called a no-ball or dead ball. The batsman does not hit the ball with his bat or a gloved hand holding the bat. The ball, having been hit, makes contact with the field before a fielder catches the ball. The ball does not remain under the control of the fielder. The ball is hit and lands beyond or on the boundary; (six runs). A fielder taking the catch makes contact with the boundary rope or the area outside the boundary, with any part of his body, equipment, when touching the ball. An airborne fielder taking the catch, having not previously legally touched the ball, had his last contact with the ground not entirely within the boundary.Note that if a batsman could be given out both caught and by another method, caught takes precedence, unless the other method is bowled.If a batsman is out caught, any runs scored off that delivery are voided. | 11
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History
Estradiol acetate is relatively recent to the market, having been first approved in a vaginal ring formulation as Menoring in the United Kingdom in 2001, followed by a vaginal ring formulation as Femring in the United States in 2002, and finally as an oral preparation as Femtrace in the United States in 2004. Society and culture
Generic names
Estradiol acetate is the generic name of the drug and its USAN. Brand names
Estradiol acetate is marketed under the brand names Femtrace, Femring, and Menoring. Availability
Estradiol acetate is available in the United States and the United Kingdom. == References == | Diagnosis
Due to their asymptomatic nature, most reported cases of adrenal adenomas have been discerned fortuitously through autopsy, or during medical imaging, particularly CT scan (computed tomography) and magnetic resonance imaging. Hence, they have earned the title incidentaloma referring to small adenoma discovered incidentally. Though adrenocortical adenomas are considered challenging to differentiate from the normal adrenal cortex, they appear as well-circumscribed lesions once isolated.Imaging Diagnostics
Computed Tomography (CT scan)
Magnetic Resonance Imaging (MRI)
Laboratory Tests
CRH Stimulation Test
High-dose-dexamethasone suppression test
Gross Description
Well-circumscribed lesion
Size ≤ 5 cm
Weight ≤ 50 grams
often appear as golden-yellow color mass(may have focal dark regions corresponding to hemorrhage, lipid-depletion, and increased lipofuscin)
Histopathology
The microscopic histopathology analysis of the tissue samples obtained from the adrenal cortex of individuals presenting with adenoma-associated symptoms such as primary aldestronism (PA) indicates that adenoma cells are relatively larger with different cytoplasm, and increased variation in nuclear size. This indication is based on comparison between the healthy (normal) and affected (adenoma-associated) adrenal cortex tissue samples. Adrenocortical adenomas are most commonly distinguished from adrenocortical carcinomas (their malignant counterparts) by the Weiss system, as follows:
Total score indicates:
0-2: Adrenocortical adenoma
3: Undetermined
4-9: Adrenocortical carcinoma
Treatment
Non-functioning cases of adrenocortical adenoma can be managed through long-term followups and monitoring. The treatment approach for the functioning cases of adrenocortical adenoma depends on the type of disorders they induce and their advancement. | 0-1
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The blood–brain barrier becomes more permeable, leading to "vasogenic" cerebral edema (swelling of the brain due to fluid leakage from blood vessels). Large numbers of white blood cells enter the CSF, causing inflammation of the meninges and leading to "interstitial" edema (swelling due to fluid between the cells). In addition, the walls of the blood vessels themselves become inflamed (cerebral vasculitis), which leads to decreased blood flow and a third type of edema, "cytotoxic" edema. The three forms of cerebral edema all lead to increased intracranial pressure; together with the lowered blood pressure often encountered in sepsis, this means that it is harder for blood to enter the brain; consequently brain cells are deprived of oxygen and undergo apoptosis (programmed cell death).It is recognized that administration of antibiotics may initially worsen the process outlined above, by increasing the amount of bacterial cell membrane products released through the destruction of bacteria. Particular treatments, such as the use of corticosteroids, are aimed at dampening the immune systems response to this phenomenon. Diagnosis
Diagnosing meningitis as promptly as possible can improve outcomes. There is no specific sign or symptom that can diagnose meningitis and a lumbar puncture (spinal tap) to examine the cerebrospinal fluid is recommended for diagnosis. Lumbar puncture is contraindicated if there is a mass in the brain (tumor or abscess) or the intracranial pressure (ICP) is elevated, as it may lead to brain herniation. | The response was defined in the study as an increase in hemoglobin (an indirect measurement of the amount of red blood cells that are not destroyed) of 2 g/dL or greater (or to 12 g/dL or greater), and no red blood cell transfusions after the first five weeks of treatment; and no other therapies for cold agglutinin disease as defined in the study.The application for sutimlimab received orphan drug, breakthrough therapy, and priority review designations. Society and culture
Legal status
On 15 September 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for the medicinal product Enjaymo, intended for the treatment of hemolytic anemia in adults with cold agglutinin disease (CAD). The applicant for this medicinal product is Genzyme Europe BV. Names
Sutimlimab is the International nonproprietary name (INN). References
External links
"Sutimlimab". Drug Information Portal. U.S. National Library of Medicine. Clinical trial number NCT03347396 for "A Study to Assess the Efficacy and Safety of BIVV009 (Sutimlimab) in Participants With Primary Cold Agglutinin Disease Who Have a Recent History of Blood Transfusion (Cardinal Study)" at ClinicalTrials.gov | 0-1
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Preservation of lung volumes in the presence of increased interstitial markings is a radiographic hallmark of LAM that helps distinguish it from most other interstitial lung diseases, in which alveolar septal and interstitial expansion tend to increase the lungs elastic recoil properties and decreased lung volumes. Computed tomography
The high-resolution computed tomography (HRCT) chest scan is better than the chest radiograph to detect cystic parenchymal disease and is almost always abnormal at the time of diagnosis, even when the chest radiograph and pulmonary function assessments are normal. The typical CT shows diffuse round, bilateral, thin-walled cysts of varying sizes ranging from 1 to 45 mm in diameter. The numbers of cysts varies in LAM from a few to almost complete replacement of normal lung tissue. The profusion of cysts tends to be milder in patients with TSC-LAM than S-LAM, perhaps explained in part because TSC-LAM patients typically receive earlier screening. Pleural effusions are seen on CT in 12% of patients with S-LAM and 6% of patients with TSC-LAM. Other CT features include linear densities (29%), hilar or mediastinal lymphadenopathy (9%), pneumothorax, lymphangiomyoma, and thoracic duct dilation. Ground-glass opacities (12%) suggest the presence of interstitial edema due to lymphatic congestion. In patients with TSC, nodular densities on HRCT may represent multifocal micronodular pneumocyte hyperplasia (MMPH) made up of clusters of hyperplastic type II pneumocytes. MMPH may be present in males or females with TSC in the presence or absence of LAM, but not in patients with S-LAM. | It is not unusual for DLCO to be reduced out of proportion to forced expiratory volume in 1 second (FEV1). Reduction in DLCO and increase in residual volume are generally considered to be LAMs earliest physiologic manifestations.Cardiopulmonary exercise testing in a much larger cohort of patients with LAM revealed a reduced maximal oxygen consumption (VO2 max) and anaerobic threshold in 217 patients. Exercise-induced hypoxemia was found even in patients who did not have resting abnormalities in FEV1 and DLCO. In most patients, exercise was thought to be ventilation limited, owing to airflow obstruction and increased dead-space ventilation.Disease progression is usually accompanied by a progressive obstructive ventilatory defect. Decline in FEV1 is the most commonly used parameter to monitor disease progression. Although resting pulmonary hypertension appears to be unusual in LAM, pulmonary arterial pressure often rises with low levels of exercise, related in part to hypoxemia. One study reported an increase in intraparenchymal shunts in dyspneic patients with LAM, which may contribute to resting and exercise hypoxemia. Pathology
Grossly, LAM lungs are enlarged and diffusely cystic, with dilated air spaces as large as several centimeters in diameter. Microscopic examination of the lung reveals foci of smooth muscle-like cell infiltration of the lung parenchyma, airways, lymphatics, and blood vessels associated with areas of thin-walled cystic change. LAM lesions often contain an abundance of lymphatic channels, forming an anastomosing meshwork of slit-like spaces lined by endothelial cells. | 11
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Other
While inherited deficiencies in uroporphyrinogen decarboxylase often lead to the development of PCT, there are a number of risk factors that can both cause and exacerbate the symptoms of this disease. One of the most common risk factors observed is infection with the Hepatitis C virus. One review of a collection of PCT studies noted Hepatitis C infection in 50% of documented cases of PCT. Additional risk factors include alcohol use disorder, excess iron (from iron supplements as well as cooking on cast iron skillets), and exposure to chlorinated cyclic hydrocarbons and Agent Orange.It can be a paraneoplastic phenomenon. Exacerbating factors
Alcohol
Estrogen
Iron
Hepatitis C virus
Pathogenesis
Porphyria cutanea tarda is primarily caused by uroporphyrinogen decarboxylase deficiency (UROD). Uroporphyrinogen decarboxylase occurs in nature as a homodimer of two subunits. It participates in the fifth step in heme synthesis pathway, and is active in the cytosol. This enzymatic conversion results in coproporphyrinogen III as the primary product. This is accomplished by the clockwise removal of the four carboxyl groups present in the cyclic uroporphyrinogen III molecule. Therefore, a deficiency in this enzyme causes the aforementioned buildup of uroporphyrinogen and hepta-carboxylic porphyrinogen, and to a lesser extent hexa-carboxylic porphyrinogen, and penta-carboxylic porphyrinogen in the urine, which can be helpful in the diagnosis of this disorder.The dermatological symptoms of PCT that include blistering and lesions on sun-exposed areas of the skin are caused by a buildup of porphyrin compounds (specifically uroporphyrinogen) close to the surface of the skin that have been oxidized by free radicals or sunlight. | A small waist to hip ratio indicates less android fat, high waist to hip ratios indicate high levels of android fat.As WHR is associated with a womans pregnancy rate, it has been found that a high waist-to-hip ratio can impair pregnancy, thus a health consequence of high android fat levels is its interference with the success of pregnancy and in-vitro fertilisation. Body fat distribution is also related to the sex ratio of offspring. Women with large waists (a high WHR) tend to have an android fat distribution caused by a specific hormone profile, that is, having higher levels of androgens. This leads to such women having more sons. Liposuction
Liposuction is a medical procedure used to remove fat from the body, common areas being around the abdomen, thighs and buttocks. Liposuction does not improve an individuals health or insulin sensitivity and is therefore considered a cosmetic surgery. liposuction improves quality of life in everyday activities and issues regarding ones psychological state or social life after liposuction are less serious. It has been found that abdominal exercise alone cannot reduce android fat around the trunk and abdomen so liposuction is often a short term solution. As liposuction can lower a persons waist–hip ratio by removing fat from locations where android fat accumulates, it can give the appearance of a more attractive body shape, and imitate an indication of reproductive health. | 0-1
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Other sedative and analgesic drugs, such as opiate narcotics and benzodiazepines, add to narcosis. Mechanism
The precise mechanism is not well understood, but it appears to be the direct effect of gas dissolving into nerve membranes and causing temporary disruption in nerve transmissions. While the effect was first observed with air, other gases including argon, krypton and hydrogen cause very similar effects at higher than atmospheric pressure. Some of these effects may be due to antagonism at NMDA receptors and potentiation of GABAA receptors, similar to the mechanism of nonpolar anesthetics such diethyl ether or ethylene. However, their reproduction by the very chemically inactive gas argon makes them unlikely to be a strictly chemical bonding to receptors in the usual sense of a chemical bond. An indirect physical effect – such as a change in membrane volume – would therefore be needed to affect the ligand-gated ion channels of nerve cells. Trudell et al. have suggested non-chemical binding due to the attractive van der Waals force between proteins and inert gases.Similar to the mechanism of ethanols effect, the increase of gas dissolved in nerve cell membranes may cause altered ion permeability properties of the neural cells lipid bilayers. | Katsurano et al. indicated that macrophages and neutrophils in an inflamed colonic epithelium are the source of reactive oxygen species causing the DNA damages that initiate colonic tumorigenesis. Some sources of DNA damage are indicated in the boxes at the top of the figure in this section. Individuals with a germ line mutation causing deficiency in any of 34 DNA repair genes (see article DNA repair-deficiency disorder) are at increased risk of cancer. Some germ line mutations in DNA repair genes cause up to 100% lifetime chance of cancer (e.g., p53 mutations). These germ line mutations are indicated in a box at the left of the figure with an arrow indicating their contribution to DNA repair deficiency. About 70% of malignant neoplasms have no hereditary component and are called "sporadic cancers". Only a minority of sporadic cancers have a deficiency in DNA repair due to mutation in a DNA repair gene. However, a majority of sporadic cancers have deficiency in DNA repair due to epigenetic alterations that reduce or silence DNA repair gene expression. For example, of 113 sequential colorectal cancers, only four had a missense mutation in the DNA repair gene MGMT, while the majority had reduced MGMT expression due to methylation of the MGMT promoter region (an epigenetic alteration). | 0-1
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It is available in 50 mg, 80 mg (in Japan), and 150 mg tablets for oral administration. The drug is registered for use as a 150 mg/day monotherapy for the treatment of LAPC in at least 55 countries, with the U.S. being a notable exception where it is registered only for use at a dosage of 50 mg/day in combination with castration. No other formulations or routes of administration are available or used. All formulations of bicalutamide are specifically indicated for the treatment of prostate cancer alone or in combination with surgical or medication castration. A combined formulation of bicalutamide and the GnRH agonist goserelin in which goserelin is provided as a subcutaneous implant for injection and bicalutamide is included as 50 mg tablets for oral ingestion is marketed in Australia and New Zealand under the brand name ZolaCos CP (Zoladex–Cosudex Combination Pack). Contraindications
Bicalutamide is pregnancy category X, or "contraindicated in pregnancy", in the U.S., and pregnancy category D, the second most restricted rating, in Australia. As such, it is contraindicated in women during pregnancy, and women who are sexually active and who can or may become pregnant are strongly recommended to take bicalutamide only in combination with adequate contraception. | Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction. In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis. Conversely, bicalutamide monotherapy is associated with much higher rates of breast tenderness, gynecomastia, and feminization in men than GnRH analogues and CPA. However, gynecomastia with bicalutamide is rarely severe and discontinuation rates due to this side effect are fairly low. These differences in side effects between bicalutamide monotherapy, GnRH analogues, and CPA are attributed to the fact that whereas GnRH analogues and CPA suppress estrogen production, bicalutamide monotherapy does not lower estrogen levels and in fact actually increases them.Bicalutamide does not share the risk of neuropsychiatric side effects like depression and fatigue as well as cardiovascular side effects like coagulation changes, blood clots, fluid retention, ischemic cardiomyopathy, and adverse serum lipid changes that CPA has been associated with. It has a much lower risk of hepatotoxicity than flutamide and CPA and of interstitial pneumonitis than nilutamide. The drug also does not share the unique risks of diarrhea with flutamide and nausea, vomiting, visual disturbances, and alcohol intolerance with nilutamide. Unlike enzalutamide, bicalutamide is not associated with seizures or related central side effects like anxiety and insomnia. However, although the risk of adverse liver changes with bicalutamide is low, enzalutamide differs from bicalutamide in having no known risk of elevated liver enzymes or hepatotoxicity. | 11
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Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used in civilian psychiatry. It is historically linked to shell shock and can sometimes precurse post-traumatic stress disorder. Combat stress reaction is an acute reaction that includes a range of behaviors resulting from the stress of battle that decrease the combatants fighting efficiency. The most common symptoms are fatigue, slower reaction times, indecision, disconnection from ones surroundings, and the inability to prioritize. Combat stress reaction is generally short-term and should not be confused with acute stress disorder, post-traumatic stress disorder, or other long-term disorders attributable to combat stress, although any of these may commence as a combat stress reaction. The US Army uses the term/acronym COSR (Combat Stress Reaction) in official medical reports. This term can be applied to any stress reaction in the military unit environment. Many reactions look like symptoms of mental illness (such as panic, extreme anxiety, depression, and hallucinations), but they are only transient reactions to the traumatic stress of combat and the cumulative stresses of military operations.In World War I, shell shock was considered a psychiatric illness resulting from injury to the nerves during combat. The horrors of trench warfare meant that about 10% of the fighting soldiers were killed (compared to 4.5% during World War II) and the total proportion of troops who became casualties (killed or wounded) was about 57%. | 8p23.1 duplication syndrome is a rare genetic disorder caused by a duplication of a region from human chromosome 8. This duplication syndrome has an estimated prevalence of 1 in 64,000 births and is the reciprocal of the 8p23.1 deletion syndrome. The 8p23.1 duplication is associated with a variable phenotype including one or more of speech delay, developmental delay, mild dysmorphism, with prominent forehead and arched eyebrows, and congenital heart disease (CHD). Presentation
The phenotypic data on 11 patients indicated that cases are not always ascertained for CHD but that CHD was the most common single feature found in 6 out of 11 individuals. Developmental delay and/or learning difficulties were found in 5 out of 11 cases, but one prenatal case was developing normally at 15 months of age (Case 1,). Three other prenatal cases could not yet be reliably assessed. A variable degree of facial dysmorphism was present in 5 out of 11 individuals. Partial toe syndactyly has been found in one mother and son diad and adrenal anomalies in two probands but not in the duplicated mother of one of them. The phenotype is compatible with independent adult life with varying degrees of support. Duplication of the GATA4 transcription factor (OMIM: 600576) is believed to underlie the congenital heart disease and other genes, common to the duplication and deletion syndromes, can be regarded as candidates for the 8p23.1 duplication syndrome. These include the SOX7 transcription factor (OMIM: 612202) for both CHD and developmental delay and the TNKS gene (OMIM: 603303) for behavioural difficulties. | 0-1
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The advantage of NPH is its low cost, the fact that you can mix it with short-acting forms of insulin, thereby minimizing the number of injections that must be administered, and that the activity of NPH will peak 4–6 hours after administration, allowing a bedtime dose to balance the tendency of glucose to rise with the dawn, along with a smaller morning dose to balance the lower afternoon basal need and possibly an afternoon dose to cover evening need. A disadvantage of bedtime NPH is that if not taken late enough (near midnight) to place its peak shortly before dawn, it has the potential of causing hypoglycemia. One theoretical advantage of glargine and detemir is that they only need to be administered once a day, although in practice many people find that neither lasts a full 24 hours. They can be administered at any time during the day as well, provided that they are given at the same time every day. Another advantage of long-acting insulins is that the basal component of an insulin regimen (providing a minimum level of insulin throughout the day) can be decoupled from the prandial or bolus component (providing mealtime coverage via ultra-short-acting insulins), while regimens using NPH and regular insulin have the disadvantage that any dose adjustment affects both basal and prandial coverage. Glargine and detemir are significantly more expensive than NPH, lente and ultralente, and they cannot be mixed with other forms of insulin.A short-acting insulin is used to simulate the endogenous insulin surge produced in anticipation of eating. | However, the clinical preparations prepared from such insulins differ from endogenous human insulin in several important respects; an example is the absence of C-peptide which has in recent years been shown to have systemic effects itself. Novo Nordisk has also developed a genetically engineered insulin independently using a yeast process.According to a survey that the International Diabetes Federation conducted in 2002 on the access to and availability of insulin in its member countries, approximately 70% of the insulin that is currently sold in the world is recombinant, biosynthetic human insulin. A majority of insulin used clinically today is produced this way, although clinical experience has provided conflicting evidence on whether these insulins are any less likely to produce an allergic reaction. Adverse reactions have been reported; these include loss of warning signs that patients may slip into a coma through hypoglycemia, convulsions, memory lapse and loss of concentration. However, the International Diabetes Federations position statement from 2005 is very clear in stating that "there is NO overwhelming evidence to prefer one species of insulin over another" and "[modern, highly purified] animal insulins remain a perfectly acceptable alternative. "Since January 2006, all insulins distributed in the U.S. and some other countries are synthetic "human" insulins or their analogues. | 11
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A positive Coombs test is a relative contraindication to transfuse the patient. In cold hemolytic anemia there is advantage in transfusing warmed blood. In severe immune-related hemolytic anemia, steroid therapy is sometimes necessary. In steroid resistant cases, consideration can be given to rituximab or addition of an immunosuppressant (azathioprine, cyclophosphamide). Association of methylprednisolone and intravenous immunoglobulin can control hemolysis in acute severe cases. Sometimes splenectomy can be helpful where extravascular hemolysis, or hereditary spherocytosis, is predominant (i.e., most of the red blood cells are being removed by the spleen).Mitapivat was approved for medical use in the United States in February 2022. Other animals
Hemolytic anemia affects nonhuman species as well as humans. It has been found, in a number of animal species, to result from specific triggers.Some notable cases include hemolytic anemia found in black rhinos kept in captivity, with the disease, in one instance, affecting 20% of captive rhinos at a specific facility. The disease is also found in wild rhinos.Dogs and cats differ slightly from humans in some details of their RBC composition and have altered susceptibility to damage, notably, increased susceptibility to oxidative damage from consumption of onion. Garlic is less toxic to dogs than onion. References
== External links == | The cilia defects adversely affect "numerous critical developmental signaling pathways" essential to cellular development and thus offer a plausible hypothesis for the often multi-symptom nature of a large set of syndromes and diseases. Known ciliopathies include primary ciliary dyskinesia, Bardet–Biedl syndrome, polycystic kidney and liver disease, nephronophthisis, Alström syndrome, Meckel–Gruber syndrome and some forms of retinal degeneration. See also
Anencephaly
Notes
External links
NINDS Overview
Obgyn.net | 0-1
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Ovulation induction is the stimulation of ovulation by medication. It is usually used in the sense of stimulation of the development of ovarian follicles to reverse anovulation or oligoovulation. Scope
The term ovulation induction can potentially also be used for:
Final maturation induction, in the sense of triggering oocyte release from relatively mature ovarian follicles during late follicular phase. In any case, ovarian stimulation (in the sense of stimulating the development of oocytes) is often used in conjunction with triggering oocyte release, such as for proper timing of artificial insemination. Controlled ovarian hyperstimulation (stimulating the development of multiple follicles of the ovaries in one single cycle), has also appeared in the scope of ovulation induction. Controlled ovarian hyperstimulation is generally part of in vitro fertilization, and the aim is generally to develop multiple follicles (optimally between 11 and 14 antral follicles measuring 2–8 mm in diameter), followed by transvaginal oocyte retrieval, co-incubation, followed by embryo transfer of a maximum of two embryos at a time. Also, where anovulation or oligovulation is secondary to another disease, the treatment for the underlying disease can be regarded as ovulation induction, by indirectly resulting in ovulation.However, this article focuses on medical ovarian stimulation, during early to mid-follicular phase, without subsequent in vitro fertilization, with the aim of developing one or two ovulatory follicles (the maximum number before recommending sexual abstinence). Indications
Ovulation induction helps reversing anovulation or oligoovulation, that is, helping women who do not ovulate on their own regularly, such as those with polycystic ovary syndrome (PCOS). | Final maturation induction
Final maturation induction and release, such as by human chorionic gonadotropin (HCG or hCG) or recombinant luteinizing hormone, results in a predictable time of ovulation, with the interval from drug administration to ovulation depending on the type of drug. This avails for sexual intercourse or intrauterine insemination to conveniently be scheduled at ovulation, the most likely time to achieve pregnancy.As evidenced by clomifene-induced cycles, however, triggering oocyte release has been shown to decrease pregnancy chances compared to frequent monitoring with LH surge tests. Therefore, in such cases, triggering oocyte release is best reserved for women who require intrauterine insemination and in whom luteinizing hormone monitoring proves difficult or unreliable. It may also be used when luteinizing hormone monitoring has no shown an luteinizing hormone surge by cycle day 18 (where cycle day 1 is the first day of the preceding menstruation) and there is an ovarian follicle of over 20 mm in size. Repeat cycles
Ovulation induction can be repeated every menstrual cycle. For clomifene, the dosage may be increased by 50-mg increments in subsequent cycles until ovulation is achieved. However, at a dosage of 200 mg, further increments are unlikely to increase pregnancy chances.It is not recommended by the manufacturer of clomifene to use it for more than 6 consecutive cycles. | 11
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However, about 10-15 percent of people that develop the disease without any family history also have a mutation in the SQSTM1 gene.Pagets disease of bone is associated with mutations in RANK. Receptor Activator of Nuclear Factor κ B (RANK), which is a type I membrane protein that is expressed on the surface of osteoclasts and is involved in their activation upon ligand binding. Additional genetic associations include:
Pathogenesis
The pathogenesis of Pagets disease is described in four stages:
Osteoclastic activity
Mixed osteoclastic – osteoblastic activity
Osteoblastic activity
Malignant degenerationInitially, there is a marked increase in the rate of bone resorption in localized areas, caused by large and numerous osteoclasts. These localized areas of pathological destruction of bone tissue (osteolysis) are seen radiologically as an advancing lytic wedge in long bones or the skull. When this occurs in the skull, it is called osteoporosis circumscripta. The osteolysis is followed by a compensatory increase in bone formation induced by the bone-forming cells, called osteoblasts, that are recruited to the area. This is associated with accelerated deposition of lamellar bone in a disorganized fashion. This intense cellular activity produces a chaotic picture of trabecular bone ("mosaic" pattern), rather than the normal linear lamellar pattern. The resorbed bone is replaced and the marrow spaces are filled by an excess of fibrous connective tissue with a marked increase in blood vessels, causing the bone to become hypervascular. The bone hypercellularity may then diminish, leaving a dense "pagetic bone," also known as burned-out Pagets disease. | Folliculitis nares perforans is characterized by small pustules near the tip of the inside of the nose, lesions that become crusted, and when the crust is removed it is found that the bulbous end of the affected vibrissa is embedded in the inspissated material. : 774
See also
Skin lesion
== References == | 0-1
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The United Kingdom DVLA (Driver & Vehicle Licensing Agency) states that people with dementia who specifically have poor short-term memory, disorientation, or lack of insight or judgment are not allowed to drive, and in these instances the DVLA must be informed so that the driving license can be revoked. They acknowledge that in low-severity cases and those with an early diagnosis, drivers may be permitted to continue driving. Many support networks are available to people with dementia and their families and caregivers. Charitable organizations aim to raise awareness and campaign for the rights of people living with dementia. Support and guidance are available on assessing testamentary capacity in people with dementia.In 2015, Atlantic Philanthropies announced a $177 million gift aimed at understanding and reducing dementia. The recipient was Global Brain Health Institute, a program co-led by the University of California, San Francisco and Trinity College Dublin. This donation is the largest non-capital grant Atlantic has ever made, and the biggest philanthropic donation in Irish history.In October 2020, the Caretakers last music release, Everywhere at the End of Time, was popularized by TikTok users for its depiction of the stages of dementia. Caregivers were in favor of this phenomenon; Leyland Kirby, the creator of the record, echoed this sentiment, explaining it could cause empathy among a younger public.On 2 November 2020, Scottish billionaire Sir Tom Hunter donated £1 million to dementia charities, after watching a former music teacher with dementia, Paul Harvey, playing one of his own compositions on the piano in a viral video. | Many countries consider the care of people living with dementia a national priority and invest in resources and education to better inform health and social service workers, unpaid caregivers, relatives and members of the wider community. Several countries have authored national plans or strategies. These plans recognize that people can live reasonably with dementia for years, as long as the right support and timely access to a diagnosis are available. Former British Prime Minister David Cameron described dementia as a "national crisis", affecting 800,000 people in the United Kingdom. In fact, dementia has become the leading cause of death for women in England.There, as with all mental disorders, people with dementia could potentially be a danger to themselves or others, they can be detained under the Mental Health Act 1983 for assessment, care and treatment. This is a last resort, and is usually avoided by people with family or friends who can ensure care. Some hospitals in Britain work to provide enriched and friendlier care. To make the hospital wards calmer and less overwhelming to residents, staff replaced the usual nurses station with a collection of smaller desks, similar to a reception area. The incorporation of bright lighting helps increase positive mood and allow residents to see more easily.Driving with dementia can lead to injury or death. Doctors should advise appropriate testing on when to quit driving. | 11
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Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosis, and hallucinations from alcohol withdrawal. It may be used by mouth or injection into a muscle or a vein. Haloperidol typically works within 30 to 60 minutes. A long-acting formulation may be used as an injection every four weeks by people with schizophrenia or related illnesses, who either forget or refuse to take the medication by mouth.Haloperidol may result in a movement disorder known as tardive dyskinesia which may be permanent. Neuroleptic malignant syndrome and QT interval prolongation may occur. In older people with psychosis due to dementia it results in an increased risk of death. When taken during pregnancy it may result in problems in the infant. It should not be used by people with Parkinsons disease.Haloperidol was discovered in 1958 by Paul Janssen, prepared as part of a structure-activity relationship investigation into analogs of pethidine (meperidine). It is on the World Health Organizations List of Essential Medicines. It is the most commonly used typical antipsychotic. In 2017, it was the 296th most commonly prescribed medication in the United States, with more than one million prescriptions. Medical uses
Haloperidol is used in the control of the symptoms of:
Acute psychosis, such as drug-induced psychosis caused by, amphetamines, ketamine, and phencyclidine, and psychosis associated with high fever or metabolic disease. Some evidence, however, has found haloperidol to worsen psychosis due to psilocybin. | Onychophosis is a localized or diffuse hyperkeratotic tissue that develops on the lateral or proximal nailfolds, within the space between the nailfolds and the nail plate, and is a common finding in the elderly. Onychophosis may involve the subungual area, as a direct result of repeated minor trauma, and most frequently affects the first and fifth toe. == References == | 0-1
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Size at birth
The average stretched penile length at birth is about 4 cm (1.6 in), and 90% of newborn boys will be between 2.4 and 5.5 cm (0.94 and 2.17 in). Limited growth of the penis occurs between birth and 5 years of age, but very little occurs between 5 years and the onset of puberty. The average size at the beginning of puberty is 6 cm (2.4 in) with adult size reached about 5 years later. W.A. Schonfeld published a penis growth curve in 1943. Size with ageing
Authors of a paper reviewing research on area of penis sizes conclude that "flaccid penile length is just under 4 cm (1.6 in) at birth and changes very little until puberty, when there is marked growth. "Age is not believed to negatively correlate with penis size. "Individual research studies have... suggested that penis size is smaller in studies focusing on older men, but Wylie and Eardley found no overall differences when they collated the results of various studies [over a 60 year period]." Size and height
A 2015 review of the literature found two studies finding height and stretched or flaccid length to be moderately correlated, seven studies finding weak correlation for flaccid, stretched, or erect length, and two studies that found no correlation between flaccid length and height. Size and hands
One study investigated the relationship with digit ratio and found that men with longer ring fingers than index fingers had slightly longer penises. However, the common misconception that hand size predicts penis size has been widely discredited. | Both PCBs and the plasticizer DEHP have been associated with smaller penis size. DEHP metabolites measured from the urine of pregnant women have been significantly associated with the decreased penis width, shorter anogenital distance and the incomplete descent of testicles of their newborn sons, replicating effects identified in animals. According to a 2008 study published by the US National Library of Medicine, approximately 25% of US women have phthalate levels similar to those observed in animals.A 2007 study by the University of Ankara, Faculty of Medicine found that penile size may decrease as a result of some hormonal therapy combined with external beam radiation therapy. In addition, some estrogen-based fertility drugs like diethylstilbestrol (DES) have been linked to genital abnormalities or a smaller than normal penis (microphallus).A 2016 Korean study found that newborn male circumcision is associated with shorter penile length. Historical perceptions
Prehistory
Perceptions of penis size are culture-specific. Some prehistoric sculptures and petroglyphs depict male figures with exaggerated erect penises. Ancient Egyptian cultural and artistic conventions generally prevented large penises from being shown in art, as they were considered obscene, but the scruffy, balding male figures in the Turin Erotic Papyrus are shown with exaggeratedly large genitals. The Egyptian god Geb is sometimes shown with a massive erect penis and the god Min is almost always shown with an erection. Ancient
The ancient Greeks believed that small penises were ideal. | 11
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See also
22q11 deletion syndrome
Absent radius
CHARGE Association
Holt–Oram syndrome
Feingold syndrome
Pallister–Hall syndrome
Townes–Brocks syndrome
References
Further reading
McMullen, KP; Karnes, PS; Moir, CR; Michels, VV (Jun 28, 1996). "Familial recurrence of tracheoesophageal fistula and associated malformations". American Journal of Medical Genetics. 63 (4): 525–8. doi:10.1002/(sici)1096-8628(19960628)63:4<525::aid-ajmg3>3.0.co;2-n. PMID 8826429. == External links == | It can be given subcutaneously, intramuscularly, intravenously, or, when a tablet is crushed, in the conjunctiva of the eye. The oral route is ineffective, as apomorphine cannot cross the blood–brain barrier fast enough, and blood levels dont reach a high enough concentration to stimulate the chemoreceptor trigger zone. It can remove around 40–60% of the contents in the stomach.One of the reasons apomorphine is a preferred drug is its reversibility: in cases of prolonged vomiting, the apomorphine can be reversed with dopamine antagonists like the phenothiazines (for example, acepromazine). Giving apomorphine after giving acepromazine, however, will no longer stimulate vomiting, because apomorphines target receptors are already occupied. An animal who undergoes severe respiratory depression due to apomorphine can be treated with naloxone.Apomorphine does not work in cats, who have too few dopamine receptors. See also
Apomorphine (data page)
Propylnorapomorphine
References
External links
"Apomorphine". Drug Information Portal. U.S. National Library of Medicine. | 0-1
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Åke Thörn, The Emergence and preservation of sick building syndrome, KI 1999. Charlotte Brauer, The sick building syndrome revisited, Copenhagen 2005. Michelle Murphy, Sick Building Syndrome and the Problem of Uncertainty, 2006. Johan Carlson, "Gemensam förklaringsmodell för sjukdomar kopplade till inomhusmiljön finns inte" [Unified explanation for diseases related to indoor environment not found]. Läkartidningen 2006/12. Research Committee Report on Diagnosis and Treatment of Chronic Inflammatory Response Syndrome Caused by Exposure to the Interior Environment of Water-Damaged Buildings (PDF). Bulletin of the Transilvania University of Braşov, Series I: Engineering Sciences • Vol. 5 (54) No. 1 2012 "Impact of Indoor Environment Quality on Sick Building Syndrome in Indian Leed Certified Buildings". by Jagannathan Mohan
== External links == | Disseminated coccidioidomycosis is a systemic infection with Coccidioides immitis, in which 15-20% of people develop skin lesions. : 315
See also
Coccidioidomycosis
List of cutaneous conditions
== References == | 0-1
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An iron insufficiency in the bone marrow can be detected very early by a rise in free erythrocyte protoporphyrin.Further testing may be necessary to differentiate iron-deficiency anemia from other disorders, such as thalassemia minor. It is very important not to treat people with thalassemia with an iron supplement, as this can lead to hemochromatosis. A hemoglobin electrophoresis provides useful evidence for distinguishing these two conditions, along with iron studies. Screening
It is unclear if screening pregnant women for iron-deficiency anemia during pregnancy improves outcomes in the United States. The same holds true for screening children who are 6 to 24 months old. Even so, screening is a Level B recommendation suggested by the US Preventative Services Task Force in pregnant women without symptoms and in infants considered high risk. Screening is done with either a hemoglobin or hematocrit lab test. Treatment
Treatment should take into account the cause and severity of the condition. If the iron-deficiency anemia is a result of blood loss or another underlying cause, treatment is geared toward addressing the underlying cause. Most cases of iron deficiency anemia are treated with oral iron supplements. In severe acute cases, treatment measures are taken for immediate management in the interim, such as blood transfusions or intravenous iron.For less severe cases, treatment of iron-deficiency anemia includes dietary changes to incorporate iron-rich foods into regular oral intake and oral iron supplementation. Foods rich in ascorbic acid (vitamin C) can also be beneficial, since ascorbic acid enhances iron absorption. Oral iron supplements are available in multiple forms. | With more severe iron-deficiency anemia, the peripheral blood smear may show hypochromic, pencil-shaped cells and, occasionally, small numbers of nucleated red blood cells. The platelet count may be slightly above the high limit of normal in iron-deficiency anemia (termed a mild thrombocytosis), but severe cases can present with thrombocytopenia (low platelet count).Iron-deficiency anemia is confirmed by tests that include serum ferritin, serum iron level, serum transferrin, and total iron binding capacity. A low serum ferritin is most commonly found. However, serum ferritin can be elevated by any type of chronic inflammation and thus is not consistently decreased in iron-deficiency anemia. Serum iron levels may be measured, but serum iron concentration is not as reliable as the measurement of both serum iron and serum iron-binding protein levels. The percentage of iron saturation (or transferrin saturation index or percent) can be measured by dividing the level of serum iron by total iron binding capacity and is a value that can help to confirm the diagnosis of iron-deficiency anemia; however, other conditions must also be considered, including other types of anemia.Another finding that can be used is the level of red blood cell distribution width. During haemoglobin synthesis, trace amounts of zinc will be incorporated into protoporphyrin in the place of iron which is lacking. Protoporphyrin can be separated from its zinc moiety and measured as free erythrocyte protoporphyrin, providing an indirect measurement of the zinc-protoporphyrin complex. The level of free erythrocyte protoporphyrin is expressed in either μg/dl of whole blood or μg/dl of red blood cells. | 11
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Plasma cell gingivitis is a rare condition, appearing as generalized erythema (redness) and edema (swelling) of the attached gingiva, occasionally accompanied by cheilitis (lip swelling) or glossitis (tongue swelling). It is called plasma cell gingivitis where the gingiva (gums) are involved, plasma cell cheilitis, where the lips are involved, and other terms such as plasma cell orifacial mucositis, or plasma cell gingivostomatitis where several sites in the mouth are involved. On the lips, the condition appears as sharply outlined, infiltrated, dark red plaque with a lacquer-like glazing of the surface of the involved oral area. Signs and symptoms
Plasma cell gingivitis appears as mild gingival enlargement and may extend from the free marginal gingiva on to the attached gingiva. Sometimes it is blended with a marginal, plaque induced gingivitis, or it does not involve the free marginal gingiva. It may also be found as a solitude red area within the attached gingiva (pictures). In some cases the healing of a plaque-induced gingivitis or a periodontitis resolves a plasma cell gingivitis situated a few mm from the earlier plaque-infected marginal gingiva. In case of one or few solitary areas of plasma cell gingivitis, no symptoms are reported from the patient. Most often solitary entities are therefore found by the dentist.The gums are red, friable, or sometimes granular, and sometimes bleed easily if traumatised. The normal stippling is lost. There is not usually any loss of periodontal attachment. | In a few cases a sore mouth can develop, and if so pain is sometimes made worse by toothpastes, or hot or spicy food. The lesions can extend to involve the palate.Plasma cell cheilitis appears as well defined, infiltrated, dark red plaque with a superficial lacquer-like glazing. Plasma cell cheilitis usually involves the lower lip. The lips appear dry, atrophic and fissured. Angular cheilitis is sometimes present.Where the condition involves the tongue, there is an erythematous enlargement with furrows, crenation and loss of the normal dorsal tongue coating. Causes
Plasma cell gingivitis and plasma cell cheilitis are thought to be hypersensitivity reactions to some antigen. Possible sources of antigens include ingredients in toothpastes, chewing gum, mints, pepper, or foods. Specifically, cinnamonaldehyde and cinnamon flavoring are often to blame. However, the exact cause in most is unknown. Diagnosis
Histologically plasma cell gingivitis shows mainly plasma cells. The differential diagnosis is with acute leukemia and multiple myeloma. Hence, blood tests are often involved in ruling out other conditions. A biopsy is usually taken, and allergy testing may also be used. The histopathologic appearance is characterized by diffuse, sub-epithelial plasma cell inflammatory infiltration into the connective tissue. The epithelium shows spongiosis. Some consider that plasmoacanthoma (solitary plasma cell tumor) is part of the same spectrum of disease as plasma cell cheilitis. Classification
Depending upon the site of involvement, this condition could be considered a type of gingivitis (or gingival enlargement); a type of cheilitis; glossitis; or stomatitis. | 11
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Railways began reappearing in Europe after the Dark Ages. The earliest known record of a railway in Europe from this period is a stained-glass window in the Minster of Freiburg im Breisgau dating from around 1350. In 1515, Cardinal Matthäus Lang wrote a description of the Reisszug, a funicular railway at the Hohensalzburg Fortress in Austria. The line originally used wooden rails and a hemp haulage rope and was operated by human or animal power, through a treadwheel. 1769 Nicolas-Joseph Cugnot is often credited with building the first self-propelled mechanical vehicle or automobile in 1769. In Russia, in the 1780s, Ivan Kulibin developed a human-pedalled, three-wheeled carriage with modern features such as a flywheel, brake, gear box and bearings; however, it was not developed further. 1783 Montgolfier brothers first balloon vehicle
1801 Richard Trevithick built and demonstrated his Puffing Devil road locomotive, which many believe was the first demonstration of a steam-powered road vehicle, though it could not maintain sufficient steam pressure for long periods and was of little practical use. 1817 Push bikes, draisines or hobby horses were the first human means of transport to make use of the two-wheeler principle, the draisienne (or Laufmaschine, "running machine"), invented by the German Baron Karl von Drais, is regarded as the forerunner of the modern bicycle (and motorcycle). It was introduced by Drais to the public in Mannheim in summer 1817. | Intuitively, propellers cannot work in space as there is no working fluid, however some sources have suggested that since space is never empty, a propeller could be made to work in space.Similarly to propeller vehicles, some vehicles use wings for propulsion. Sailboats and sailplanes are propelled by the forward component of lift generated by their sails/wings. Ornithopters also produce thrust aerodynamically. Ornithopters with large rounded leading edges produce lift by leading-edge suction forces. Research at the University of Toronto Institute for Aerospace Studies lead to a flight with an actual ornithopter on July 31, 2010. Paddle wheels are used on some older watercraft and their reconstructions. These ships were known as paddle steamers. Because paddle wheels simply push against the water, their design and construction is very simple. The oldest such ship in scheduled service is the Skibladner. Many pedalo boats also use paddle wheels for propulsion. Screw-propelled vehicles are propelled by auger-like cylinders fitted with helical flanges. Because they can produce thrust on both land and water, they are commonly used on all-terrain vehicles. The ZiL-2906 was a Soviet-designed screw-propelled vehicle designed to retrieve cosmonauts from the Siberian wilderness. Friction
All or almost all of the useful energy produced by the engine is usually dissipated as friction; so minimising frictional losses is very important in many vehicles. The main sources of friction are rolling friction and fluid drag (air drag or water drag). Wheels have low bearing friction and pneumatic tyres give low rolling friction. | 11
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Clostridial necrotizing enteritis (CNE) is a severe and potentially fatal type of food poisoning caused by a β-toxin of Clostridium perfringens, Type C. It occurs in some developing regions, particularly in New Guinea, where it is known as pig-bel. The disease was also documented in Germany following World War II, where it was called Darmbrand (literally "bowel fire," or bowel necrosis). The toxin is normally inactivated by certain proteolytic enzymes and by normal cooking, but when these protections are impeded by diverse factors, and high protein is consumed, the disease can emerge. Sporadic and extremely rare cases occur in diabetics. In New Guinea, where people generally have low-protein diets apart from tribal feasts, a number of factors—diet and endemic helminth infections among them—compound to result in pig-bel. Preterm infants
The majority of preterm infants who develop NEC are generally healthy, feeding well, and growing prior to developing NEC. The most frequent sign of NEC is a sudden change in feeding tolerance, which can be manifest by numerous clinical signs listed below. While gastric residuals are often seen in early NEC, there is no evidence that routine measurement of gastric residual volumes in asymptomatic infants is a useful guide to prevent or detect the onset of NEC, or help to advance feeds. The timing of the onset of symptoms varies and appears to be inversely related to gestational age (GA). | In New Guinea (origin of the term "pig-bel"), the disease is usually spread through contaminated meat (especially pork) and perhaps by peanuts. CNE was also diagnosed in post-World War II Germany, where it was known as Darmbrand or "bowel fire," and reached epidemic proportions. The causative agents of these CNE cases have since been described as Type C isolates of C. perfringens, which possessed genes for β-toxins and enterotoxins.In developed countries, CNE can also occur in people with diabetes, including children. This form of CNE is extremely rare: to demonstrate its scope, only three such cases have been reported in the United States up to 2002. Diagnosis
An abdominal x-ray shows multiple dilated loops of small bowel and gas. The abdomen can be tender, distended, and soft. A differential diagnosis can be an intussusception. Treatment
Treatment involves suppressing the toxin-producing organisms with antibiotics such as penicillin G or metronidazole. About half of seriously ill patients require surgery for perforation, persistent intestinal obstruction, or failure to respond to the antibiotics. An investigational toxoid vaccine has been used successfully in some developing countries but is not available outside of research. Antibiotic therapy — For all infants with suspected or established NEC, we suggest initiating broad-spectrum antibiotics after obtaining appropriate specimens for culture. The empiric antibiotic regimen should provide broad-spectrum coverage, including coverage for common causes of late-onset neonatal sepsis. The choice is also guided by the local susceptibility patterns (ie, the local antibiogram in a particular neonatal intensive care unit [NICU]). | 11
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It was made by generic drug maker Serum Institute of India and cost 50 U.S. cents per injection. Beginning in Burkina Faso in 2010, it has been given to 215 million people across Benin, Cameroon, Chad, Ivory Coast, Ethiopia, Ghana, Mali, Niger, Mauritania, Nigeria, Senegal, Sudan, Togo and Gambia. The vaccination campaign has resulted in near-elimination of serogroup A meningitis from the participating countries. Treatment
Persons with confirmed N. meningitidis infection should be hospitalized immediately for treatment with antibiotics. Because meningococcal disease can disseminate very rapidly, a single dose of intramuscular antibiotic is often given at the earliest possible opportunity, even before hospitalization, if disease symptoms look suspicious enough. Third-generation cephalosporin antibiotics (i.e. cefotaxime, ceftriaxone) should be used to treat a suspected or culture-proven meningococcal infection before antibiotic susceptibility results are available. Clinical practice guidelines endorse empirical treatment in the event a lumbar puncture to collect cerebrospinal fluid (CSF) for laboratory testing cannot first be performed. Antibiotic treatment may affect the results of microbiology tests, but a diagnosis may be made on the basis of blood-cultures and clinical examination. Epidemiology
N. meningitidis is a major cause of illness, developmental impairment and death during childhood in industrialized countries and has been responsible for epidemics in Africa and in Asia. Every year, about 2,500 to 3,500 people become infected with N. meningitidis in the US, with a frequency of about 1 in 100,000. Children younger than 5 years are at greatest risk, followed by teenagers of high school age. | Amitriptyline/perphenazine (Duo-Vil, Etrafon, Triavil, Triptafen) is a formulation that contains the tricyclic antidepressant amitriptyline and the medium-potency typical (first-generation) antipsychotic, perphenazine. In the United States amitriptyline/perphenazine is marketed by Mylan Pharmaceuticals Inc. and Remedy Repack Inc.
Medical uses
In the United States amitriptyline/perphenazine is indicated for the treatment of patients with:
Moderate-severe anxiety and/or agitation and depression
Depression and anxiety in association with chronic physical disease
Schizophrenia with prominent depressive symptoms
Adverse effects
Common (>1% incidence) adverse effects include
Sedation
Hypertension — high blood pressure. Neurological impairments (such as extrapyramidal side effects which include dystonia, akathisia, parkinsonism, muscle rigidity, etc.) Anticholinergic side effects such as:- Blurred vision
- Constipation
- Dry mouth
- Nasal congestionIncreased appetite
Weight gain
Nausea
Dizziness
Headache
VomitingUnknown frequency adverse effects include
Diarrhoea
Alopecia — hair loss
Photophobia
Pigmentation
Eczema up to exfoliative dermatitis
Urticaria
Erythema
Itching
Photosensitivity (increased sensitivity of affected skin to sunlight)
Hypersalivation — excessive salivation. Hyperprolactinaemia — elevated blood prolactin levels. This may present with the following symptoms:- Galactorrhea — the release of milk that is not associated with pregnancy or breastfeeding
- Gynaecomastia — the development of breast tissue in males
- Disturbances in menstrual cycle
- Sexual dysfunctionPigmentation of the cornea and lens
Hyperglycaemia — elevated blood glucose (sugar) levels. Hypoglycaemia — low blood glucose (sugar) levels. Disturbed concentration
Excitement
Anxiety
Insomnia
Restlessness
Nightmares
Weakness
Fatigue
Diaphoresis — excessive/abnormal sweating.Uncommon/Rare adverse effects include
Tardive dyskinesia, an often irreversible adverse effect that usually results from chronic use antipsychotic medications, especially the high-potency first-generation antipsychotics. It is characterised by slow (hence tardive), involuntary, repetitive, purposeless muscle movements. Neuroleptic malignant syndrome, a potentially fatal complication of antipsychotic drug use. It is characterised by the following symptoms:- Muscle rigidity
- Tremors
- Mental status change (e.g. hallucinations, agitation, stupor, confusion, etc.) | 0-1
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Non-occlusive disease (NOD) or Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition including all types of mesenteric ischemia without mesenteric obstruction. It affects mainly elderly patients above 50 years of age who suffer from cardiovascular disease (myocardial infarction, congestive heart failure or aortic regurgitation), hepatic, chronic kidney disease or diabetes mellitus. It can be triggered also by a previous cardiac surgery with a consequent heart shock. It represents around 20% of cases of acute mesenteric ischaemia. Pathophysiology
Non-occlusive mesenteric ischemia occurs due to severe vasoconstriction of mesenteric vessels supplying the intestine. Acute abdominal pain is the only early acute symptom in those patients, which makes early diagnosis difficult. Diagnosis
CT angiography would be helpful in differentiating occlusive from non-occlusive causes of mesenteric ischaemia. Prognosis
Non-occlusive disease has a poor prognosis with survival rate between 40-50%. == References == | Certain genetic variations within the TPMT gene can lead to decreased or absent TPMT enzyme activity, and individuals who are homozygous or heterozygous for these types of genetic variations may have increased levels of TGN metabolites and an increased risk of severe bone marrow suppression (myelosuppression) when receiving azathioprine. In many ethnicities, TPMT polymorphisms that result in decreased or absent TPMT activity occur with a frequency of approximately 5%, meaning that about 0.25% of patients are homozygous for these variants. However, an assay of TPMT activity in red blood cells or a TPMT genetic test can identify patients with reduced TPMT activity, allowing for the adjustment of azathioprine dose or avoidance of the drug entirely. The FDA-approved drug label for azathioprine recommends testing for TPMT activity to identify patients at risk for myelotoxicity. Indeed, testing for TPMT activity is one of the few examples of pharmacogenetics being translated into routine clinical care. Missense SNP in NUDT15 (e.g., rs116855232, inducing R139C)) has been identified to be a causal factor for AZA-induced leukopenia through a genome wide association study (GWAS) in East Asians. Cancers
Azathioprine is listed as a human carcinogen in the 12th Report on Carcinogens by the National Toxicology Program of U.S. Department of Health and Human Services, asserting that it is "known to be a human carcinogen based on sufficient evidence of carcinogenicity from studies in humans." | 0-1
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Medication
Prescribing medication to treat suicidal ideation can be difficult. One reason for this is that many medications lift patients energy levels before lifting their mood. This puts them at greater risk of following through with attempting suicide. Additionally, if a person has a comorbid psychiatric disorder, it may be difficult to find a medication that addresses both the psychiatric disorder and suicidal ideation. Antidepressants may be effective. Often, SSRIs are used instead of TCAs as the latter typically have greater harm in overdose.Antidepressants have been shown to be a very effective means of treating suicidal ideation. One correlational study compared mortality rates due to suicide to the use of SSRI antidepressants in certain counties. The counties which had higher SSRI use had a significantly lower number of deaths caused by suicide. Additionally, an experimental study followed depressed patients for one year. During the first six months of that year, the patients were examined for suicidal behavior including suicidal ideation. The patients were then prescribed antidepressants for the six months following the first six observatory months. During the six months of treatment, experimenters found suicide ideation reduced from 47% of patients down to 14% of patients. Thus, it appears from current research that antidepressants have a helpful effect on the reduction of suicidal ideation. Although research is largely in favor of the use of antidepressants for the treatment of suicidal ideation, in some cases antidepressants are claimed to be the cause of suicidal ideation. | Labour or labor may refer to:
Childbirth, the delivery of a baby
Labour (human activity), or work
Manual labour, physical work
Wage labour, a socioeconomic relationship between a worker and an employer
Organized labour and the labour movement, consisting principally of labour unions
The Labour Party (UK)
Literature
Labor (journal), an American quarterly on the history of the labor movement
Labour/Le Travail, an academic journal focusing on the Canadian labour movement
Labor (Tolstoy book) or The Triumph of the Farmer or Industry and Parasitism (1888)
Places
La Labor, Honduras
Labor, Koper, Slovenia
Other uses
Labor (album), a 2013 album by MEN
Labor (area), a Spanish customary unit
"Labor", an episode of TV series Superstore
Labour (constituency), a functional constituency in Hong Kong elections
Labors, fictional robots in Patlabor
People with the surname
Earle Labor (born 1928), professor of American literature
Jérémy Labor (born 1992), French footballer
Josef Labor (1842–1924), Austrian musician and composer
See also
Labor Day (disambiguation)
Labour law
Labour Party (disambiguation)
Work (disambiguation)
All pages with titles beginning with Labour
All pages with titles containing Labour
All pages with titles beginning with Labor
All pages with titles containing Labor | 0-1
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Nasopharyngeal angiofibroma is an angiofibroma also known as juvenile nasal angiofibroma, fibromatous hamartoma, and angiofibromatous hamartoma of the nasal cavity. It is a histologically benign but locally aggressive vascular tumor of the nasopharynx that arises from the superior margin of the sphenopalatine foramen and grows in the back of the nasal cavity. It most commonly affects adolescent males (because it is a hormone-sensitive tumor). Though it is a benign tumor, it is locally invasive and can invade the nose, cheek, orbit (frog face deformity), or brain. Patients with nasopharyngeal angiofibroma usually present with one-sided nasal obstruction with profuse epistaxis. Signs and symptoms
Frequent chronic epistaxis or blood-tinged nasal discharge
Nasal obstruction and rhinorrhea
Facial dysmorphism (when locally invasive)
Conductive hearing loss from eustachian-tube obstruction
Diplopia, which occurs secondary to erosion into superior orbital fissure and due to third and sixth nerve palsy. Proptosis when having intraorbital extension. Rarely anosmia, recurrent otitis media, and eye pain. Diagnosis
If nasopharyngeal angiofibroma is suspected based on physical examination (a smooth vascular submucosal mass in the posterior nasal cavity of an adolescent male), imaging studies such as CT or MRI should be performed. | Biopsy should be avoided as to avoid extensive bleeding since the tumor is composed of blood vessels without a muscular coat.Antral sign or Holman-Miller sign (forward bowing of posterior wall of maxilla) is pathognomic of angiofibroma.DSA (digital subtraction angiography) of carotid artery to see the extension of tumors and feeding vessels
Differential diagnosis
Antro-choanal polyp (benign non neoplastic growth)
Rhinosporidiosis (as bleeding point is here too)
Malignancy—nasopharyngeal carcinoma, lymphoma, plasmacytoma, rhabdomyosarcoma
Chordoma
Nasopharyngeal cyst
Pyogenic granuloma
Staging
There are many different staging- systems published. One of the most used is that of Radkowsky:
Treatment
Treatment for Nasopharyngeal angiofibroma (JNA) is primarily surgical. The tumor is primarily excised by external or endoscopic approach. Medical treatment and radiation therapy are only of historical interest.External approaches:
transpalatine approach
transpalatine + sublabial (Sardanas) Approach
infratemporal Approach
nasal endoscopic Approach
transmaxillary Approach
maxillary swing Approach or Facial translocationEndoscopic approach is an excellent tool in primary and recurrent JNA, it allows visualisation and precise removal of the lesion. Preoperative embolisation of tumour may be of some use in reducing intraoperative bleeding.Direct visualization is not common-
If the tumor is limited to nasopharynx and nose, for endoscopic approach or Wilsons transpalatal approach is used. It can be extended into Sardanas approach if the tumor extends laterally. For tumors of infratemporal fossa, Maxillary Swing approach is used. Transmaxillary Le Fort 1 approach is used for tumors extending into maxillary and ethmoid sinuses and pterygopalatine fossa. If the tumor extend up to the cheek, for Weber–Ferguson approach should be used. Prognosis
Prognosis for nasopharyngeal angiofibroma is favorable. Because these tumors are benign, metastasis to distal sites does not occur. | 11
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A reduced OVD can lead to craniofacial dysgnathia, poor tooth aesthetics, and disorders during chewing, swallowing, speaking and eating.The baby (primary) teeth are usually more severely affected than adult (permanent) teeth.Enamel is usually lost early because it is further inclined to attrition due to loss of scalloping at the dentinoenamel junction (DEJ). It was suggested that the scalloping is beneficial for the mechanical properties of teeth as it reinforces the anchor between enamel and dentine. However, the teeth are not more susceptible to dental caries than normal ones. Periodontal disease, or gum disease, is a common finding amongst individuals with dentinogenesis imperfecta despite no clinical findings of tooth decay (dental caries). The reason for this is currently not well understood.Certain patients with dentinogenesis imperfecta will suffer from multiple periapical abscesses apparently resulting from pulpal strangulation secondary to pulpal obliteration or from pulp exposure due to extensive coronal wear. They may need apical surgery to save the involved teeth.Note that, although dentine exposure is a common clinical finding, individuals with dentinogenesis imperfecta usually do not experience tooth sensitivity as the exposed dentine is typically sclerosed (hardened), thereby appearing glassy/shiny. | Challenges are associated with root canal treatment of teeth affected by DI due to pulp chamber and root canal obliteration, or narrowing of such spaces. If root canal treatment is indicated, it should be done in a similar way like with any other tooth. Further consideration is given for restoring the root-treated tooth as it has weaker dentine which may not withstand the restoration.Preservation of occlusal face height may be tackled by use of stainless steel crowns which are advocated for primary teeth where occlusal face height may be hugely compromised due to loss of tooth tissue as a result of attrition, erosion of enamel.In most cases, full-coverage crowns or veneers (composite/porcelain) are needed for aesthetic appearance, as well as to prevent further attrition. Another treatment option is bonding, putting lighter enamel on the weakened enamel of the teeth and with many treatments of this bonding, the teeth appear whiter to the eye, but the teeth on the inside and under that cover are still the same. Due to the weakened condition of the teeth, many common cosmetic procedures such as braces and bridges are inappropriate for patients with Dentinogenesis imperfecta and are likely to cause even more damage than the situation they were intended to correct. | 11
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The arthritis may be "additive" (more joints become inflamed in addition to the primarily affected one) or "migratory" (new joints become inflamed after the initially inflamed site has already improved).Reactive arthritis is an RF-seronegative, HLA-B27-linked arthritis often precipitated by genitourinary or gastrointestinal infections. The most common triggers are intestinal infections (with Salmonella, Shigella or Campylobacter) and sexually transmitted infections (with Chlamydia trachomatis); however, it also can happen after group A streptococcal infections.It most commonly strikes individuals aged 20–40 years of age, is more common in men than in women, and more common in white than in black people. This is owing to the high frequency of the HLA-B27 gene in the white population. It can occur in epidemic form. Patients with HIV have an increased risk of developing reactive arthritis as well. Numerous cases during World Wars I and II focused attention on the triad of arthritis, urethritis, and conjunctivitis (often with additional mucocutaneous lesions), which at that time was also referred to as Fiessenger-Leroy-Reiter syndrome. Signs and symptoms
Because common systems involved include the eye, the urinary system, and the hands and feet, one clinical mnemonic in reactive arthritis is "Cant see, cant pee, cant climb a tree." The classic triad consists of:
Conjunctivitis
Nongonococcal urethritis
Asymmetric oligoarthritis
Symptoms generally appear within 1–3 weeks but can range from 4 to 35 days from the onset of the inciting episode of the disease. The classical presentation of the syndrome starts with urinary symptoms such as burning pain on urination (dysuria) or an increased frequency of urination. | Furthermore, he was not the first physician to make associations between the arthritis and other symptoms—the names arthritis urethritica, venereal arthritis and polyarteritis enterica had previously been applied—and the full triad was described by another physician in the 19th century. Notable cases
It has been postulated that Italian-born explorer Christopher Columbus had reactive arthritis, dying from a heart attack caused by the condition. Pat Buchanan, American conservative political commentator, author, syndicated columnist, politician and broadcaster
P. J. Gallagher
Ian Murray, Scottish football player
Mark St. John, one-time guitarist for Kiss
Kirk Brandon, lead singer for Spear of Destiny
Daniel Johns, Australian musician, lead singer for Silverchair
Steve Walters, football player and survivor of sexual abuse by football trainer Barry Bennell
See also
List of medical eponyms with Nazi associations
References
External links
eMedicine
Questions and Answers about Reactive Arthritis - US National Institute of Arthritis and Musculoskeletal and Skin Diseases | 11
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Klismaphilia (or klysmaphilia), from the Greek words κλύσμα ("enema", from κατακλυσμός, "deluge, flood") and φιλία ("love"), is a paraphilia involving enjoyment of, and sexual arousal from, enemas. History
The term klismaphilia was coined in 1973 by Dr. Joanne Denko, an early investigator in this field, in her article "Klismaphilia: Enema as a Sexual Preference[:] Report of Two Cases," to describe the activities of some of her patients, whom she referred to as klismaphiliacs. Klismaphile has come into use as a synonym for klismaphiliac. Manifestation
Klismaphiles might gain pleasure from a large, water distended belly or the feeling of internal pressure. An enema fetish may include the sexual attraction to the equipment, processes, environments, situations, or scenarios, and some may be sexually aroused by the preparations, such as by the feel and smell of a latex rubber or plastic syringe, by the smell of soapsuds enema solution, or by preparing the recipient. Often, klismaphiles report discovering these desires after a chance administration of an enema sometime in their childhood, but some do report discovering these feelings later on. Klismaphiles can gain satisfaction of enemas through fantasies, by actually receiving or giving one, or through the process of eliminating steps to being administered one (e.g., under the pretense of being constipated). Usually, klismaphiles carry out normal lives and successfully engage in this behavior secretly. An enema can be an auxiliary to, or a substitute for, genital sexual activity.That some women use enemas while masturbating was documented by Alfred Kinsey in "Sexual Behavior in the Human Female." | He stated, "There still other masturbatory techniques which were regularly or occasionally employed by some 11 percent of the females in the sample ... enemas, and other anal insertions, ... were employed.Sadomasochistic activities may incorporate enemas for erotic humiliation or for physical discomfort. BDSM punishment scenes can involve administering an enema in a manner that is humiliating and painful and for producing pain and cramps an extra-large volumes or highly irritating substances can be injected. Among the attractions to enema play in BDSM are erotic humiliation, dominance and submission, discipline, psychodrama, power exchange, and so on. An erotic enema allows acting out vulnerability in a primal form. Classification
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) classifies klismaphilia under the diagnosis of "Paraphilias, Not Otherwise Specified". The diagnostic code is 302.9. Proactive treatment for klismaphilics is not generally recommended, due to the lack of any significant desire to be "cured". Health treatment for klismaphilia thus is typically only focused on ensuring the techniques employed and chemicals used are not harmful to the practitioner. Caution should always be maintained on the part of the practitioners experimenting with new techniques and concoctions; in certain cases cramps produced by the chemicals used have led to hospitalizations, in other circumstances the effects can even be life-threatening. References
Notes
Agnew, J. (2000). "Klismaphilia". Venereology. 13 (2): 75–79. ISSN 1032-1012. Retrieved 29 September 2018. Brame, Gloria; Brame, William D.; Jacobs, Jon (1993). Different loving – The World of Sexual Dominance and Submission. Villard Books. ISBN 978-0-6797-6956-9. | 11
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While genetic testing may be useful in the diagnosis of FEVR, a negative genetic test does not rule out the disease.Diagnosis
Diagnosis of FEVR is often made through direct visualization of the retina and fluorescein angiography, along with personal and family medical history. Hallmark characteristics of FEVR include lack of blood vessels in the peripheral retina. Other findings may include vessel and macular dragging, sub-retinal exudates, neovascularization, retinal folds, and retinal detachments. FEVR must be differentiated from other diseases involving incomplete vascularization of the retina including retinopathy of prematurity (ROP), Norrie disease, Coats disease, and others. Severity of disease is highly variable and can range from mild visual impairment to complete vision loss. Based on the severity of the disease, FEVR is diagnosed based on a clinical staging scale from 1 to 5. Since FEVR often runs in families, immediate relatives of someone diagnosed with FEVR should be examined by an ophthalmologist because the disease can have no symptoms before complications arise including retinal detachments.Treatment
Treatment is largely aimed at reducing the amount of new blood vessel growth and preventing complications that may arise as a result, including retinal tears and detachments. Using a laser, an ophthalmologist burns the portions of the retina that are not supported by blood vessels, a technique known as laser photocoagulation. By doing so, this tissue will no longer release molecules that stimulate blood vessel growth. If a retinal detachment occurs, laser therapy or surgery may be required to repair the retina. | Familial exudative vitreoretinopathy (FEVR, pronounced as fever) is a genetic disorder affecting the growth and development of blood vessels in the retina of the eye. This disease can lead to visual impairment and sometimes complete blindness in one or both eyes. FEVR is characterized by incomplete vascularization of the peripheral retina. This can lead to the growth of new blood vessels which are prone to leakage and hemorrhage and can cause retinal folds, tears, and detachments. Treatment involves laser photocoagulation of the avascular portions of the retina to reduce new blood vessel growth and risk of complications including leakage of retinal blood vessels and retinal detachments. Information
Pathophysiology
FEVR is caused by genetic defects involving the regulation of blood vessel growth in developing eyes. As a result, there is poor blood vessel growth to the periphery of the retina. The lack of blood supply to the peripheral retina triggers the release of molecules that stimulate blood vessel growth, such as vascular endothelial growth factor (VEGF). However, this new blood vessel growth, also known as neovascularization, can lead to further complications such as the leakage and hemorrhage of retinal blood vessels, retinal tears, and detachments.Genetics
There have been several gene mutations associated with FEVR. These genes code for proteins involved in the WNT signaling pathway, which is involved in the development of the human eye and regulation of blood vessel growth. Depending on the genes involved, FEVR can follow an autosomal dominant, autosomal recessive, or X-linked inheritance pattern. There is varying penetrance and expressivity depending on the genes involved. | 11
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This leads to activation of epidermal inflammatory dendritic and innate lymphoid cells which subsequently attracts Th2 CD4+ helper T cells to the skin. This dysregulated Th2 inflammatory response is thought to lead to the eczematous lesions. The Th2 helper T cells become activated, leading to the release of inflammatory cytokines including IL-4, IL-13 and IL-31 which activate downstream Janus kinase (Jak) pathways. The active Jak pathways lead to inflammation and downstream activation of plasma cells and B lymphocytes which release antigen specific IgE contributing to further inflammation. Other CD4+ helper T-cell pathways thought to be involved in atopic dermatitis inflammation include the Th1, Th17, and Th22 pathways. Some specific CD4+ helper T-cell inflammatory pathways are more commonly activated in specific ethnic groups with AD (for example, the Th-2 and Th-17 pathways are commonly activated in Asian people) possibly explaining the differences in phenotypic presentation of atopic dermatitis in specific populations.Mutations in the filaggrin gene, FLG, also cause impairment in the skin barrier that contributes to the pathogenesis of AD. Filaggrin is produced by epidermal skin cells (keratinocytes) in the horny layer of the epidermis. Filaggrin stimulates skin cells to release moisturizing factors and lipid matrix material, which cause adhesion of adjacent keratinocytes and contributes to the skin barrier. A loss-of-function mutation of filaggrin causes loss of this lipid matrix and external moisturizing factors, subsequently leading to disruption of the skin barrier. | Another monoclonal antibody treatment, lebrikizumab, is in phase 3 trials in the US; the drug has been granted Fast Track Designation by the FDA, and Eli Lilly and Company is expected to apply for FDA approval of the drug in the second half of 2022.Some JAK inhibitors such as abrocitinib, trade name Cibinquo, and upadacitinib, trade name Rinvoq, have been approved in the US for the treatment of moderate-to-severe eczema as of January 2022. Tentative, low-quality evidence indicates that allergy immunotherapy is effective in AD. This treatment consists of a series of injections or drops under the tongue of a solution containing the allergen.Antibiotics, either by mouth or applied topically, are commonly used to target overgrowth of S. aureus in the skin of people with AD, but a 2019 meta-analysis found no clear evidence of benefit. Light
A more novel form of treatment involves exposure to broad- or narrow-band ultraviolet (UV) light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares. In particular, the usage of UVA1 is more effective in treating acute flares, whereas narrow-band UVB is more effective in long-term management scenarios. However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk. UV phototherapy is not indicated in young adults and children due to this risk of skin cancer with prolonged use or exposure. | 11
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Malnutrition or chronic disease
When underweight or sickly children present with pubertal delay, it is warranted to search for illnesses that cause a temporary and reversible delay in puberty. Chronic conditions such as sickle cell disease and thalassemia, cystic fibrosis, HIV/AIDS, hypothyroidism, chronic kidney disease, and chronic gastroenteric disorders (such as coeliac disease and inflammatory bowel disease) cause a delayed activation of the hypothalamic region of the brain to send signals to start puberty.Childhood cancer survivors can also present with delayed puberty secondary to their cancer treatments, especially males. The type of treatment, amount of exposure/dosage of drugs, and age during treatment determine the level by which the gonads are affected with younger patients at a lower risk of negative reproductive effects.Excessive physical exercise and physical stress, especially in athletes can also delay pubertal onset. Eating disorders such as bulimia nervosa and anorexia nervosa can also impair puberty due to undernutrition.Carbohydrate-restricted diets for weight loss has also been shown to decrease the stimulation of insulin which in turn does not stimulate kisspeptin neurons vital in the release of puberty-starting hormones. This shows that carbohydrate restricted children and children with diabetes mellitus type 1 can have delayed puberty. Primary failure of the ovaries or testes (hypergonadotropic hypogonadism)
Primary failure of the ovaries or testes (gonads) will cause delayed puberty due to the lack of hormonal response by the final receptors of the HPG axis. | Management
The goals of short-term hormone therapy are to induce the beginning of sexual development and induce a growth spurt, but should be limited to children with severe distress or anxiety secondary to their delayed puberty. Bone age must be monitored frequently to prevent precocious closure of the bone plates, thereby stunting growth. Constitutional and physiologic delay
If a child is healthy with a constitutional delay of growth and puberty, reassurance and prediction based on the bone age can be provided. No other intervention is usually necessary, but repeat evaluation by measuring serum testosterone or estrogen is recommended. Furthermore, the diagnosis of hypogonadism can be excluded once the adolescent has started puberty by age 16–18.Boys aged >14 years old whose growth is severely stunted or are experiencing severe distress secondary to their lack of puberty can be started on testosterone to increase their height. Testosterone treatment can also be used to stimulate sexual development, but it can close bone plates prematurely stopping growth altogether if not carefully administered. Another therapeutic option is the use of aromatase inhibitors to inhibit the conversion of androgens to estrogens as estrogens are responsible for stopping bone growth plate development and thus growth. However, due to side effects, therapy with testosterone alone is most often used. | 11
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In view of ensuring the bodily integrity and well-being of intersex people, autonomous non-pathologising psycho-social and peer support be available to intersex people throughout their life (as self-required), as well as to parents and/or care providers." Genetic selection and terminations: The ethics of preimplantation genetic diagnosis to select against intersex traits was the subject of 11 papers in the October 2013 issue of the American Journal of Bioethics. There is widespread evidence of pregnancy terminations arising from prenatal testing, as well as prenatal hormone treatment to prevent intersex traits. Behrmann and Ravitsky find social concepts of sex, gender and sexual orientation to be "intertwined on many levels. Parental choice against intersex may thus conceal biases against same-sex attractedness and gender nonconformity." Medical display. Photographs of intersex childrens genitalia are circulated in medical communities for documentary purposes, and individuals with intersex traits may be subjected to repeated genital examinations and display to medical teams. Problems associated with experiences of medical photography of intersex children have been discussed along with their ethics, control and usage. "The experience of being photographed has exemplified for many people with intersex conditions the powerlessness and humiliation felt during medical investigations and interventions". Gender dysphoria: The DSM-5 included a change from using gender identity disorder to gender dysphoria. This revised code now specifically includes intersex people who do not identify with their sex assigned at birth and experience clinically significant distress or impairment, using the language of disorders of sex development. | The base of the basilar membrane is narrow and stiff, resulting in it responding best to high frequency sounds. The apex of the basilar membrane is wider and much less stiff in comparison to the base, causing it to respond best to low frequencies.This selectivity to certain frequencies can be illustrated by neural tuning curves. These demonstrate the frequencies a fiber responds to, by showing threshold levels (dB SPL) of auditory nerve fibers as a function of different frequencies. This demonstrates that auditory nerve fibers respond best, and hence have better thresholds at the fibers characteristic frequency and frequencies immediately surrounding it. The basilar membrane is said to be ‘sharply tuned’ due to the sharp ‘V’ shaped curve, with its ‘tip’ centered at the auditory fibers characteristic frequency. This shape shows how few frequencies a fiber responds to. If it were a broader ‘V’ shape, it would be responding to more frequencies (See Figure 4). IHC vs OHC hearing loss
A normal neural tuning curve is characterised by a broadly tuned low frequency ‘tail’, with a finely tuned middle frequency ‘tip’. However, where there is partial or complete damage to the OHCs, but with unharmed IHCs, the resulting tuning curve would show the elimination of sensitivity at the quiet sounds. I.e. where the neural tuning curve would normally be most sensitive (at the ‘tip’) (See Figure 5).Where both the OHCs and the IHCs are damaged, the resulting neural tuning curve would show the elimination of sensitivity at the ‘tip. | 0-1
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There is little to no compensatory increase in heart rate or blood pressure when standing for up to 10 minutes. This is often due to an underlying disorder or medication use and is accompanied by other hypoadrenergic signs. Central nervous system ischemia
The central ischemic response is triggered by an inadequate supply of oxygenated blood in the brain. Common examples include strokes and transient ischemic attacks. While these conditions often impair consciousness they rarely meet the medical definition of syncope. Vertebrobasilar transient ischemic attacks may produce true syncope as a symptom.The respiratory system may compensate for dropping oxygen levels through hyperventilation, though a sudden ischemic episode may also proceed faster than the respiratory system can respond. These processes cause the typical symptoms of fainting: pale skin, rapid breathing, nausea, and weakness of the limbs, particularly of the legs. If the ischemia is intense or prolonged, limb weakness progresses to collapse. The weakness of the legs causes most people to sit or lie down if there is time to do so. This may avert a complete collapse, but whether the patient sits down or falls down, the result of an ischaemic episode is a posture in which less blood pressure is required to achieve adequate blood flow. An individual with very little skin pigmentation may appear to have all color drained from his or her face at the onset of an episode. This effect combined with the following collapse can make a strong and dramatic impression on bystanders. | A chest injury, also known as chest trauma, is any form of physical injury to the chest including the ribs, heart and lungs. Chest injuries account for 25% of all deaths from traumatic injury. Typically chest injuries are caused by blunt mechanisms such as direct, indirect, compression, contusion, deceleration, or blasts- caused by motor vehicle collisions or penetrating mechanisms such as stabbings. Classification
Chest injuries can be classified as blunt or penetrating. Blunt and penetrating injuries have different pathophysiologies and clinical courses. Specific types of injuries include:
Injuries to the chest wall
Chest wall contusions or hematomas. Rib fractures
Flail chest
Sternal fractures
Fractures of the shoulder girdle
Pulmonary injury (injury to the lung) and injuries involving the pleural space
Pulmonary contusion
Pulmonary laceration
Pneumothorax
Hemothorax
Hemopneumothorax
Injury to the airways
Tracheobronchial tear
Cardiac injury
Pericardial tamponade
Myocardial contusion
Traumatic arrest
Hemopericardium
Blood vessel injuries
Traumatic aortic rupture
Thoracic aorta injury
Aortic dissection
And injuries to other structures within the torso
Esophageal injury (Boerhaave syndrome)
Diaphragm injury
Diagnosis
Most blunt injuries are managed with relatively simple interventions like tracheal intubation and mechanical ventilation and chest tube insertion. Diagnosis of blunt injuries may be more difficult and require additional investigations such as CT scanning. Penetrating injuries often require surgery, and complex investigations are usually not needed to come to a diagnosis. Patients with penetrating trauma may deteriorate rapidly, but may also recover much faster than patients with blunt injury. See also
Transmediastinal gunshot wound
Commotio thoracis
References
== External links == | 0-1
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The reason for this delay in declaring postmenopause is that periods are usually erratic at this time of life. Therefore, a reasonably long stretch of time is necessary to be sure that the cycling has ceased. At this point a woman is considered infertile; however, the possibility of becoming pregnant has usually been very low (but not quite zero) for a number of years before this point is reached. A womans reproductive hormone levels continue to drop and fluctuate for some time into post-menopause, so hormone withdrawal effects such as hot flashes may take several years to disappear. A period-like flow during postmenopause, even spotting, may be a sign of endometrial cancer. Management
Perimenopause is a natural stage of life. It is not a disease or a disorder. Therefore, it does not automatically require any kind of medical treatment. However, in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the life of the woman experiencing them, palliative medical therapy may sometimes be appropriate. Menopausal Hormone therapy
In the context of the menopause, Menopausal hormone therapy (MHT) is the use of estrogen in women without a uterus and estrogen plus progestogen in women who have an intact uterus.MHT may be reasonable for the treatment of menopausal symptoms, such as hot flashes. It is the most effective treatment option, especially when delivered as a skin patch. Its use, however, appears to increase the risk of strokes and blood clots. | This is a medical coinage; the Greek word for menses is actually different. In Ancient Greek, the menses were described in the plural, ta emmēnia, ("the monthlies"), and its modern descendant has been clipped to ta emmēna. The Modern Greek medical term is emmenopausis in Katharevousa or emmenopausi in Demotic Greek. The word "menopause" was coined specifically for human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruations. However, menopause exists in some other animals, many of which do not have monthly menstruation; in this case, the term means a natural end to fertility that occurs before the end of the natural lifespan. Menopause in popular culture
In recent years celebrities have spoken out about their experiences of the menopause which has led to it becoming less of a taboo as it has boosted awareness of the debilitating symptoms. This has led to TV shows running features on the menopause to help women experiencing symptoms. In the UK Lorraine Kelly has been an advocate for getting women to speak about their experiences including sharing her own. This has led to an increase in women seeking treatment such as HRT
Evolutionary rationale
Few animals have a menopause: humans are joined by just four other species in which females live substantially longer than their ability to reproduce. The others are all cetaceans: beluga whales, narwhals, orcas and short-finned pilot whales. | 11
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Fleming first used the purified penicillin to treat streptococcal meningitis in 1942. For the discovery, Fleming shared the 1945 Nobel Prize in Physiology or Medicine with Florey and Chain. Several semisynthetic penicillins are effective against a broader spectrum of bacteria: these include the antistaphylococcal penicillins, aminopenicillins and the antipseudomonal penicillins. Nomenclature
The term "penicillin" is defined as the natural product of Penicillium mould with antimicrobial activity. It was coined by Alexander Fleming on 7 March 1929 when he discovered the antibacterial property of Penicillium rubens. Fleming explained in his 1929 paper in the British Journal of Experimental Pathology that "to avoid the repetition of the rather cumbersome phrase Mould broth filtrate, the name penicillin will be used." The name thus refers to the scientific name of the mould, as described by Fleming in his Nobel lecture in 1945:I have been frequently asked why I invented the name "Penicillin". I simply followed perfectly orthodox lines and coined a word which explained that the substance penicillin was derived from a plant of the genus Penicillium just as many years ago the word "Digitalin" was invented for a substance derived from the plant Digitalis.In modern usage, the term penicillin is used more broadly to refer to any β-lactam antimicrobial that contains a thiazolidine ring fused to the β-lactam core, and may or may not be a natural product. Like most natural products, penicillin is present in Penicillium moulds as a mixture of active constituents (gentamicin is another example of a natural product that is an ill-defined mixture of active components). | Other consequences include arterial stiffening, which involves a gradual breakdown of elastic fibers and intima (the innermost layer of a blood vessel) thickening. Glomerular hypertension and glomerular hyperfiltration
An alternative mechanism of hypertensive nephropathy is prolonged glomerular hypertension and hence glomerular hyperfiltration. These can occur simultaneously but not necessarily. The idea is that hypertension results in sclerosis of the glomeruli which ultimately means reduced kidney function. As a compensatory mechanism, the unaffected nephrons (specifically, the preglomerular arterioles) vasodilate to increase blood flow to the kidney perfusion and increase glomerular filtration across undamaged glomeruli. Diagnosis
Diagnosis of HN is made from clinical history and biochemical investigations. Chronic hypertension with progressive kidney disease progresses over a long period of time. Damage to the glomeruli allows proteins that are usually too large to pass into the nephron to be filtered. This leads to an elevated concentration of albumin in the urine (albuminuria). This albuminuria usually does not cause symptoms but can be indicative of many kidney disorders. Protein in the urine (proteinuria) is best identified from a 24-hour urine collection.Bilateral renal artery stenosis should always be considered as a differential diagnosis for the presentation of HN. Kidney disease with this etiology can potentially be reversed following vascular intervention. Histology
In benign nephrosclerosis, the changes occurring are gradual and progressive, however, there can be sufficient kidney reserve capacity to maintain adequate kidney function for many years. The large renal arteries exhibit intimal thickening, medial hypertrophy, duplication of the elastic layer. | 0-1
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Diagnosis
Pain is the most common reason for people with TMD to seek medical advice. Joint noises may require auscultation with a stethoscope to detect. Clicks of the joint may also be palpated, over the joint itself in the preauricular region, or via a finger inserted in the external acoustic meatus, which lies directly behind the TMJ. The differential diagnosis is with degenerative joint disease (e.g. osteoarthritis), rheumatoid arthritis, temporal arteritis, otitis media, parotitis, mandibular osteomyelitis, Eagle syndrome, trigeminal neuralgia, oromandibular dystonia, deafferentation pains, and psychogenic pain. Diagnostic criteria
Various diagnostic systems have been described. Some consider the Research Diagnostic Criteria method the gold standard. Abbreviated to "RDC/TMD", this was first introduced in 1992 by Dworkin and LeResche in an attempt to classify temporomandibular disorders by etiology and apply universal standards for research into TMD. This method involves 2 diagnostic axes, namely axis I, the physical diagnosis, and axis II, the psychologic diagnosis. Axis I contains 3 different groups which can occur in combinations of 2 or all 3 groups, (see table). McNeill 1997 described TMD diagnostic criteria as follows:
Pain in muscles of mastication, the TMJ, or the periauricular area (around the ear), which is usually made worse by manipulation or function. Asymmetric mandibular movement with or without clicking. Limitation of mandibular movements. | It is the gold standard method for assessing disc position and is sensitive for intra-articular degenerative alterations.Indications for MRI are pre-auricular pain, detection of joint clicking and crepitus, frequent incidents of subluxation and jaw dislocation, limited mouth opening with terminal stiffness, suspicion of neoplastic growth, and osteoarthritic symptoms. It is also useful for assessing the integrity of neural tissues, which may produce orofacial pain when compressed.MRI provides evaluation of pathology such as necrosis and oedema all without any exposure to ionizing radiation. However, there is a high cost associated with this method of imaging, due to the need for sophisticated facilities. Caution should be taken in patient selection, as MRI is contraindicated in those with claustrophobic tendencies, pacemakers and metallic heart valves, ferromagnetic foreign bodies and pregnant women. Ultrasound
Where internal TMJ disorders are concerned, ultrasound (US) imaging can be a useful alternative in assessing the position of the disc While having significant diagnostic sensitivity, US has inadequate specificity when identifying osteoarthrosis. Moreover, it is not accurate enough for the diagnosis of cortical and articular disc morphology based on the findings done related to morphological alterations. However, with US, identification of effusion in individuals with inflammatory conditions associated with pain is possible and confirmed by MRIUS can be a useful alternative in initial investigation of internal TMJ dysfunctions especially in MRI contraindicated individuals despite its limitations. | 11
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COVID-19: preliminary research indicates that COVID-19 viral infection may affect sexual and reproductive healthSurgical intervention for a number of conditions may remove anatomical structures necessary to erection, damage nerves, or impair blood supply. ED is a common complication of treatments for prostate cancer, including prostatectomy and destruction of the prostate by external beam radiation, although the prostate gland itself is not necessary to achieve an erection. As far as inguinal hernia surgery is concerned, in most cases, and in the absence of postoperative complications, the operative repair can lead to a recovery of the sexual life of people with preoperative sexual dysfunction, while, in most cases, it does not affect people with a preoperative normal sexual life.ED can also be associated with bicycling due to both neurological and vascular problems due to compression. The increased risk appears to be about 1.7-fold.Concerns that use of pornography can cause ED have little support in epidemiological studies, according to a 2015 literature review. According to Gunter de Win, a Belgian professor and sex researcher, "Put simply, respondents who watch 60 minutes a week and think theyre addicted were more likely to report sexual dysfunction than those who watch a care-free 160 minutes weekly." Pathophysiology
Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli. The former involves the peripheral nerves and the lower parts of the spinal cord, whereas the latter involves the limbic system of the brain. | The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. The effect that Brindley discovered established the fundamentals for the later development of specific, safe, and orally effective drug therapies.The current first-line treatment for ED, the oral PDE5 inhibitor, was introduced by Pfizer in 1999. Anthropology
Anthropological research presents ED not as a disorder but, as a normal, and sometimes even welcome sign of healthy aging. Wentzells study of 250 Mexican men in their 50s and 60s found that “most simply did not see decreasing erectile function as a biological pathology”. The men interviewed described the decrease in erectile function “as an aid for aging in socially appropriate ways”. A common theme amongst the interviewees showed that respectable older men shifted their focus toward the domestic sphere into a “second stage of life”. The Mexican men of this generation often pursued sex outside of marriage; decreasing erectile function acted as an aid to overcoming infidelity thus helping to attain the ideal “second stage” of life. A 56-year-old about to retire from the public health service said he would now "dedicate myself to my wife, the house, gardening, caring for the grandchildren—the Mexican classic". Wentzell found that treating ED as a pathology was antithetical to the social view these men held of themselves, and their purpose at this stage of their lives. In the 20th and 21st centuries, anthropologists investigated how common treatments for ED are built upon assumptions of institutionalized social norms. | 11
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Most commonly from Ureaplasma, Fusobacterium, and Streptococcus bacteria species. Less commonly, Gardnerella, Mycoplasma, and Bacteroides bacteria species. Sexually transmitted infections, chlamydia and gonorrhea, can cause development of the condition as well. Studies are continuing to identify other microorganism classes and species as infection sources. Obstetric and other
Birthing-related events, lifestyle, and ethnic background have been linked to an increase in the risk of developing chorioamnionitis apart from bacterial causation. Premature deliveries, ruptures of the amniotic sac membranes, prolonged labor, and primigravida childbirth are associated with this condition. At term mothers who experience a combination of pre-labor membrane ruptures and multiple invasive vaginal examinations, prolonged labor, or have meconium appear in the amniotic fluid are at higher risk than at term mothers experiencing just one of those events. In other studies, smoking, alcohol use and drug use are noted as risk factors. Those of African American ethnicity are noted to be at higher risk. Anatomy
The amniotic sac consists of two parts:
The outer membrane is the chorion. It is closest to the mother and physically supports the much thinner amnion. The chorion is the last and outermost of the membranes that make up the amniotic sac. The inner membrane is the amnion. It is in direct contact with the amniotic fluid, which surrounds the fetus. The amniotic fluid exists within the amnion, and is where the fetus is able to grow and develop. | Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes (amnion and chorion), usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert panel recommended use of the term "triple I" to address the heterogeneity of this disorder. The term triple I refers to intrauterine infection or inflammation or both and is defined by strict diagnostic criteria, but this terminology has not been commonly adopted although the criteria are used.Chorioamnionitis results from an infection caused by bacteria ascending from the vagina into the uterus and is associated with premature or prolonged labor. It triggers an inflammatory response to release various inflammatory signaling molecules, leading to increased prostaglandin and metalloproteinase release. These substances promote uterine contractions and cervical ripening, causations of premature birth. The risk of developing chorioamnionitis increases with number of vaginal examinations performed in the final month of pregnancy, including labor. Tobacco and alcohol use also puts mothers at risk for chorioamnionitis development.Chorioamnionitis is caught early by looking at signs and symptoms such as fever, abdominal pain, or abnormal vaginal excretion. Administration of antibiotics if the amniotic sac bursts prematurely can prevent chorioamnionitis occurrence. Signs and symptoms
The signs and symptoms of clinical chorioamnionitis include fever, leukocytosis (>15,000 cells/mm³), maternal (>100 bpm) or fetal (>160 bpm) tachycardia, uterine tenderness and preterm rupture of membranes. Causes
Causes of chorioamnionitis stem from bacterial infection as well as obstetric and other related factors. Microorganisms
Bacterial, viral, and even fungal infections can cause chorioamnionitis. | 11
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Cysteamine hydrochloride (5%) over-the-counter Mechanism of action seems to involve inhibition of melanin synthesis pathway
Kojic acid (2%) OTC
Flutamide (1%)
Chemical peels
Microdermabrasion to dermabrasion (light to deep)
Galvanic or ultrasound facials with a combination of a topical crème/gel, either in an aestheticians office or as a home massager unit
Laser but not intense pulsed light (which can make the melasma darker)
Effectiveness
Evidence-based reviews found that the most effective therapy for melasma includes a combination of topical agents. Triple combination creams formulated with hydroquinone, tretinoin, and a steroid component have shown to be more effective than dual combination therapy or hydroquinone alone. More recently, a systematic review found that oral medications also have a role in melasma treatment, and have been shown to be efficacious with a minimal number and severity of adverse events. Oral medications and dietary supplements employed in the treatment of melasma include tranexamic acid, Polypodium leucotomos extract, beta‐carotenoid, melatonin, and procyanidin.Oral procyanidin combined with vitamins A, C, and E shows promise as safe and effective for epidermal melasma. In an 8-week randomized, double-blind, placebo-controlled trial in 56 Filipino women, treatment was associated with significant improvements in the left and right malar regions, and was safe and well tolerated.In all of these treatments, the effects are gradual and a strict avoidance of sunlight is required. The use of broad-spectrum sunscreens with physical blockers, such as titanium dioxide and zinc oxide, is preferred, because UV-A, UV-B, and visible lights are all capable of stimulating pigment production. | The medial border is thicker, of greater length, and consequently more prominent, than the lateral.The grooved portion of the articular surface fits accurately within the semilunar notch of the ulna; it is broader and deeper on the posterior than on the anterior aspect of the bone, and is inclined obliquely downward and forward toward the medial side. Articulations
At the shoulder, the head of the humerus articulates with the glenoid fossa of the scapula. More distally, at the elbow, the capitulum of the humerus articulates with the head of the radius, and the trochlea of the humerus articulates with the trochlear notch of the ulna. Nerves
The axillary nerve is located at the proximal end, against the shoulder girdle. Dislocation of the humeruss glenohumeral joint has the potential to injure the axillary nerve or the axillary artery. Signs and symptoms of this dislocation include a loss of the normal shoulder contour and a palpable depression under the acromion. The radial nerve follows the humerus closely. At the midshaft of the humerus, the radial nerve travels from the posterior to the anterior aspect of the bone in the spiral groove. A fracture of the humerus in this region can result in radial nerve injury. The ulnar nerve lies at the distal end of the humerus near the elbow. When struck, it can cause a distinct tingling sensation, and sometimes a significant amount of pain. | 0-1
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The Weibull distribution predicts the survival probability of a fraction of samples with a certain volume that survive a tensile stress sigma, and is often used to better assess the success of a ceramic in avoiding fracture. Fiber bundles
To model fracture of a bundle of fibers, the Fiber Bundle Model was introduced by Thomas Pierce in 1926 as a model to understand the strength of composite materials. The bundle consists of a large number of parallel Hookean springs of identical length and each having identical spring constants. They have however different breaking stresses. All these springs are suspended from a rigid horizontal platform. The load is attached to a horizontal platform, connected to the lower ends of the springs. When this lower platform is absolutely rigid, the load at any point of time is shared equally (irrespective of how many fibers or springs have broken and where) by all the surviving fibers. This mode of load-sharing is called Equal-Load-Sharing mode. The lower platform can also be assumed to have finite rigidity, so that local deformation of the platform occurs wherever springs fail and the surviving neighbor fibers have to share a larger fraction of that transferred from the failed fiber. The extreme case is that of local load-sharing model, where load of the failed spring or fiber is shared (usually equally) by the surviving nearest neighbor fibers. Disasters
Failures caused by brittle fracture have not been limited to any particular category of engineered structure. | This value
c
{\textstyle \mathrm {c} }
is used in the above equations for determining
K
c
{\textstyle \mathrm {K} _{\mathrm {c} }}
.Following this test, the sample can then be reoriented such that further loading of a load (F) will extend this crack and thus a load versus sample deflection curve can be obtained. | 11
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Another consequence was an increasing amount of time and effort devoted to understanding and treating shell shock symptoms. Soldiers who returned with shell shock generally could not remember much because their brain would shut out all the traumatic memories. By the Battle of Passchendaele in 1917, the British Army had developed methods to reduce shell shock. A man who began to show shell-shock symptoms was best given a few days rest by his local medical officer. Col. Rogers, Regimental Medical Officer, 4th Battalion Black Watch wrote:
You must send your commotional cases down the line. But when you get these emotional cases, unless they are very bad, if you have a hold of the men and they know you and you know them (and there is a good deal more in the man knowing you than in you knowing the man) … you are able to explain to him that there is really nothing wrong with him, give him a rest at the aid post if necessary and a day or two’s sleep, go up with him to the front line, and, when there, see him often, sit down beside him and talk to him about the war and look through his periscope and let the man see you are taking an interest in him. | It may seem cruel that those whose sufferings are real, whose illness has been brought on by enemy action and very likely in the course of patriotic service, should be treated with such apparent callousness. But there can be no doubt that in an overwhelming proportion of cases, these patients succumb to ‘shock’ because they get something out of it. To give them this reward is not ultimately a benefit to them because it encourages the weaker tendencies in their character. The nation cannot call on its citizens for courage and sacrifice and, at the same time, state by implication that an unconscious cowardice or an unconscious dishonesty will be rewarded. Development of psychiatry
At the beginning of World War II, the term "shell shock" was banned by the British Army, though the phrase "postconcussional syndrome" was used to describe similar traumatic responses. Society and culture
Shell shock has had a profound impact in British culture and the popular memory of World War I. At the time, war writers like the poets Siegfried Sassoon and Wilfred Owen dealt with shell shock in their work. Sassoon and Owen spent time at Craiglockhart War Hospital, which treated shell shock casualties. Author Pat Barker explored the causes and effects of shell shock in her Regeneration Trilogy, basing many of her characters on real historical figures and drawing on the writings of the first world war poets and the army doctor W. H. R. Rivers. | 11
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Depending on the type of society, excess weight can be perceived as an indicator of wealth and prestige due to excess food, or as a sign of poor health due to lack of exercise. In many cultures, bare abdomens are distinctly sexualized and perceived similarly to breast cleavage. Exercise
Being key elements of spinal support, and contributors to good posture, it is important to properly exercise the abdominal muscles together with the back muscles because when these are weak or overly tight they can suffer painful spasms and injuries. When properly exercised, abdominal muscles contribute to improved posture and balance, reduce the likelihood of back pain episodes, reduce the severity of back pain, protect against injury by responding efficiently to stresses, help avoid some back surgeries, and help with the healing of back problems, or after spine surgery. When strengthened, the abdominal muscles provide flexibility as well. The abdominal muscles can be worked by practicing disciplines of general body strength such as Pilates, yoga, Tai chi, and jogging. There are also specific routines which target each of these muscles. Clinical significance
Abdominal obesity is a condition where abdominal fat or visceral fat, has built up excessively between the abdominal organs. This is associated with a higher risk of heart disease, asthma and type 2 diabetes. Abdominal trauma is an injury to the abdomen and can involve damage to the abdominal organs. There is an associated risk of severe blood loss and infection. | Perifolliculitis is the presence of inflammatory cells in the skin around the hair follicles. It is often found accompanying folliculitis, or inflammation of the hair follicle itself. It can have infectious or non-infectious causes. == References == | 0-1
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Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connects tissues not normally connected. Pathophysiology
Adhesions form as a natural part of the bodys healing process after surgery in a similar way that a scar forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. Adhesion formation post-surgery typically occurs when two injured surfaces are close to one another. According to the "classical paradigm" of adhesion formation, the pathogenesis starts with inflammation and activation of the coagulation system which causes fibrin deposits onto the damaged tissues. The fibrin then connects the two adjacent structures where damage of the tissues occurred. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal, pericardial, and synovial cavities, a family of fibrinolytic enzymes may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases, the production or activity of these enzymes are compromised because of inflammation following injury or infection, however, and the fibrinous adhesion persists. | This distortion may prevent an ovum from traveling to the fimbriated end of the Fallopian tube.A meta-analysis in 2012 came to the conclusion that there is only little evidence for the surgical principle that using less invasive techniques, introducing fewer foreign bodies, or causing less ischemia reduces the extent and severity of adhesions in pelvic surgery. Pericardial adhesions
Adhesions forming between the heart and the sternum after cardiac surgery place the heart at risk of catastrophic injury during re-entry for a subsequent procedure. Peridural adhesions
Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain. Peritendinous adhesions
Adhesions and scarring occurring around tendons after hand surgery restrict the gliding of tendons in their sheaths and compromise digital mobility. Association with surgical procedures
Applying adhesion barriers during surgery may help to prevent the formation of adhesions. There are two methods that are approved by the U.S. Food and Drug Administration (FDA) for adhesion prevention: Intercede and Seprafilm. One study found that Seprafilm is twice as effective at preventing adhesion formation when compared to just surgical technique alone. Surgical humidification therapy may also minimise the incidence of adhesion formation. Laparoscopic surgery has a reduced risk for creating adhesions. | 11
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Veterinary medicine
Ketoprofen is a common NSAID, antipyretic, and analgesic used in horses and other equines. It is most commonly used for musculoskeletal pain, joint problems, and soft tissue injury, as well as laminitis. It is also used to control fevers and prevent endotoxemia. It is also used as a mild painkiller in smaller animals, generally following surgical procedures. In horses, it is given at a dose of 2.2 mg/kg/day. Studies have shown that it does not inhibit 5-lipoxygenase and leukotriene B4, as originally claimed. It is therefore not considered superior to phenylbutazone as previously believed, although clinical signs of lameness are reduced with its use. In fact, phenylbutazone was shown superior to ketoprofen in cases of experimentally-induced synovitis when both drugs were used at labeled dosages. Administration
Ketoprofen, when administered intravenously, is recommended for a maximum of five days of use. Its analgesic and antipyretic effects begin to occur one to two hours following administration. The most common dosage is 1 mg/ lb, once per day, although this dosage may be lowered for ponies, which are most susceptible to NSAID side effects. It is also available as a capsule dosage form and tablet. Ecological problems
Experiments have found ketoprofen, like diclofenac, is a veterinary drug causing lethal effects in red-headed vultures. Vultures feeding on the carcasses of recently treated livestock develop acute kidney failure within days of exposure. References
External links
"Ketoprofen". Drug Information Portal. U.S. National Library of Medicine. | A biopsy of the lesions will show extravasated erythrocytes within dermal papillae and dyskeratotic cells within the dermis.A set of validated diagnostic criteria for pityriasis rosea is as follows:
A patient is diagnosed as having pityriasis rosea if:
On at least one occasion or clinical encounter, the patient has all the essential clinical features and at least one of the optional clinical features, and
On all occasions or clinical encounters related to the rash, the patient does not have any of the exclusional clinical features.The essential clinical features are the following:
Discrete circular or oval lesions,
Scaling on most lesions, and
Peripheral collarette scaling with central clearance on at least two lesions.The optional clinical features are the following:
Truncal and proximal limb distribution, with less than 10% of lesions distal to mid-upper-arm and mid-thigh,
Orientation of most lesions along skin cleavage lines, and
A herald patch (not necessarily the largest) appearing at least two days before eruption of other lesions, from history of the patient or from clinical observation.The exclusional clinical features are the following:
Multiple small vesicles at the centre of two or more lesions,
Two or more lesions on palmar or plantar skin surfaces, and
Clinical or serological evidence of secondary syphilis. Treatment
The condition usually resolves on its own, and treatment is not required. Oral antihistamines or topical steroids may be used to decrease itching. Steroids do provide relief from itching, and improve the appearance of the rash, but they also cause the new skin that forms (after the rash subsides) to take longer to match the surrounding skin color. | 0-1
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As a result, the probability that pathogens will reach sufficient numbers to cause illness is reduced. Innate immune system
Microorganisms or toxins that successfully enter an organism encounter the cells and mechanisms of the innate immune system. The innate response is usually triggered when microbes are identified by pattern recognition receptors, which recognize components that are conserved among broad groups of microorganisms, or when damaged, injured or stressed cells send out alarm signals, many of which are recognized by the same receptors as those that recognize pathogens. Innate immune defenses are non-specific, meaning these systems respond to pathogens in a generic way. This system does not confer long-lasting immunity against a pathogen. The innate immune system is the dominant system of host defense in most organisms, and the only one in plants. Immune sensing
Cells in the innate immune system use pattern recognition receptors to recognize molecular structures that are produced by pathogens. They are proteins expressed, mainly, by cells of the innate immune system, such as dendritic cells, macrophages, monocytes, neutrophils and epithelial cells to identify two classes of molecules: pathogen-associated molecular patterns (PAMPs), which are associated with microbial pathogens, and damage-associated molecular patterns (DAMPs), which are associated with components of hosts cells that are released during cell damage or cell death.Recognition of extracellular or endosomal PAMPs is mediated by transmembrane proteins known as toll-like receptors (TLRs). TLRs share a typical structural motif, the leucine rich repeats (LRR), which give them a curved shape. | It is divided into four classes (Type I – IV) based on the mechanisms involved and the time course of the hypersensitive reaction. Type I hypersensitivity is an immediate or anaphylactic reaction, often associated with allergy. Symptoms can range from mild discomfort to death. Type I hypersensitivity is mediated by IgE, which triggers degranulation of mast cells and basophils when cross-linked by antigen. Type II hypersensitivity occurs when antibodies bind to antigens on the individuals own cells, marking them for destruction. This is also called antibody-dependent (or cytotoxic) hypersensitivity, and is mediated by IgG and IgM antibodies. Immune complexes (aggregations of antigens, complement proteins, and IgG and IgM antibodies) deposited in various tissues trigger Type III hypersensitivity reactions. Type IV hypersensitivity (also known as cell-mediated or delayed type hypersensitivity) usually takes between two and three days to develop. Type IV reactions are involved in many autoimmune and infectious diseases, but may also involve contact dermatitis. These reactions are mediated by T cells, monocytes, and macrophages. Idiopathic inflammation
Inflammation is one of the first responses of the immune system to infection, but it can appear without known cause. Inflammation is produced by eicosanoids and cytokines, which are released by injured or infected cells. Eicosanoids include prostaglandins that produce fever and the dilation of blood vessels associated with inflammation, and leukotrienes that attract certain white blood cells (leukocytes). | 11
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Therefore, it shows that rehabilitation effort needs to be continuous for word-finding abilities to improve from the baseline. The studies show that verbs are harder to recall or repeat, even with rehabilitation.Other methods in treating anomic aphasia include circumlocution-induced naming therapy (CIN), wherein the patient uses circumlocution to assist with his or her naming rather than just being told to name the item pictured after given some sort of cue. Results suggest that the patient does better in properly naming objects when undergoing this therapy because CIN strengthens the weakened link between semantics and phonology for patients with anomia, since they often know what an object is used for, but cannot verbally name it.Anomia is often challenging for the families and friends of those affected by it. One way to overcome this is computer-based treatment models, effective especially when used with clinical therapy. Leemann et al. provided anomic patients with computerized-assisted therapy (CAT) sessions, along with traditional therapy sessions using treatment lists of words. Some of the patients received a drug known to help relieve symptoms of anomia (levodopa), while others received a placebo. The researchers found that the drug had no significant effects on improvement with the treatment lists, but almost all of the patients improved after the CAT sessions. They concluded that this form of computerized treatment is effective in increasing naming abilities in anomic patients.Additionally, one study researched the effects of using "excitatory (anodal) transcranial direct current stimulation" over the right temporoparietal cortex, a brain area that seems to correlate to language. | those produced as by-products in industrial processes such as the acid vat treatment (pickling) of steel):
Oxidation of Fe metal in the Laux process where nitrobenzene is treated with iron metal using FeCl2 as a catalyst to produce aniline:C6H5NO2 + 3 Fe + 2 H2O → C6H5NH2 + Fe3O4Oxidation of FeII compounds, e.g. the precipitation of iron(II) salts as hydroxides followed by oxidation by aeration where careful control of the pH determines the oxide produced.Reduction of Fe2O3 with hydrogen:
3Fe2O3 + H2 → 2Fe3O4 +H2OReduction of Fe2O3 with CO:
3Fe2O3 + CO → 2Fe3O4 + CO2Production of nano-particles can be performed chemically by taking for example mixtures of FeII and FeIII salts and mixing them with alkali to precipitate colloidal Fe3O4. | 0-1
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The body takes a deep breath to avoid aspirating vomit. Retroperistalsis starts from the middle of the small intestine and sweeps up digestive tract contents into the stomach, through the relaxed pyloric sphincter. Intrathoracic pressure lowers (by inspiration against a closed glottis), coupled with an increase in abdominal pressure as the abdominal muscles contract, propels stomach contents into the esophagus as the lower esophageal sphincter relaxes. The stomach itself does not contract in the process of vomiting except for at the angular notch, nor is there any retroperistalsis in the esophagus. Vomiting is ordinarily preceded by retching. Vomiting also initiates an SNS response causing both sweating and increased heart rate. Phases
The vomiting act has two phases. In the retching phase, the abdominal muscles undergo a few rounds of coordinated contractions together with the diaphragm and the muscles used in respiratory inspiration. For this reason, an individual may confuse this phase with an episode of violent hiccups. In this retching phase, nothing has yet been expelled. In the next phase, also termed the expulsive phase, intense pressure is formed in the stomach brought about by enormous shifts in both the diaphragm and the abdomen. These shifts are, in essence, vigorous contractions of these muscles that last for extended periods of time—much longer than a normal period of muscular contraction. The pressure is then suddenly released when the upper esophageal sphincter relaxes resulting in the expulsion of gastric contents. Individuals who do not regularly exercise their abdominal muscles may experience pain in those muscles for a few days. | Minor wounds, like bruises, will heal on their own, with skin discoloration usually disappearing in 1–2 weeks. Abrasions, which are wounds with intact skin (non-penetration through dermis to subcutaneous fat), usually require no active treatment except keeping the area clean, initially with soap and water. Puncture wounds may be prone to infection depending on the depth of penetration. The entry of puncture wound is left open to allow for bacteria or debris to be removed from inside. Cleaning
Evidence to support the cleaning of wounds before closure is scant. For simple lacerations, cleaning can be accomplished using a number of different solutions, including tap water and sterile saline solution. Infection rates may be lower with the use of tap water in regions where water quality is high. Cleaning of a wound is also known as wound toilet. It is not clear if delaying a shower following a surgery helps reduce complications related to wound healing. Wound cleansing solutions
Evidence is insufficient to conclude whether cleaning wounds is beneficial or whether wound cleaning solutions (polyhexamethylene biguanide, aqueous oxygen peroxide, etc.) are better than sterile water or saline solutions to help venous leg ulcers heal. It is also uncertain whether the choice of cleaning solution or method of application makes any difference to venous leg ulcer healing. Closure
If a person presents to a healthcare center within 6 hours of a laceration they are typically closed immediately after evaluating and cleaning the wound. | 0-1
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Recent research has shown that a mutation in the SOD1 gene is a risk factor for developing degenerative myelopathy in several breeds. Mutations in SOD1 are also associated with familial amyotrophic lateral sclerosis (Lou Gehrigs disease) in people. More than 100 SOD1 gene mutations are involved in human familial amyotrophic lateral sclerosis (ALS), and the pathologic spinal lesions of ALS are similar to those of canine DM, making canine DM a potentially useful animal model of ALS. Known causes of spinal cord dysfunction should be excluded before accepting the diagnosis of degenerative myelopathy; disc disease (protrusions) or spinal cord tumors can cause compression of the spinal cord with similar signs to degenerative myelopathy. Treatment
Degenerative myelopathy is an irreversible, progressive disease that cannot currently be cured. There are no treatments that have been clearly shown to stop or slow progression of DM. Exercise
Exercise has been recommended to maintain the dogs ability to walk. Physiotherapy may prolong the length of time that the dog remains mobile and increase survival time. Canine hydrotherapy (swimming) may be more useful than walking. Use of a belly sling or hand-held harness allows the handler the ability to support the dogs hind legs for exercising or going up and down stairs. A 2-wheel dog cart, or "dog wheelchair" can allow the dog to remain active and maintain its quality of life once signs of weakness or paralysis of the hind limbs is detected. Prognosis
The prognosis for the disease is generally poor. | As for all other opioid-based medications, naloxone (trade name Narcan) is the definitive antidote for overdose. Depending on the amount administered, it can reverse the respiratory depression and, if enough is administered, completely reverse the effects of sufentanil. See also
Betahydroxythiofentanyl
Carfentanil
R-30490
Thiafentanil
References
External links
"Sufentanil". Drug Information Portal. U.S. National Library of Medicine. "Sufentanil citrate". Drug Information Portal. U.S. National Library of Medicine. | 0-1
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Methohexital or methohexitone (marketed under the brand names Brevital and Brietal) is a drug which is a barbiturate derivative. It is classified as short-acting, and has a rapid onset of action. It is similar in its effects to sodium thiopental, a drug with which it competed in the market for anaesthetics. Pharmacology
Methohexital binds to a distinct site which is associated with Cl− ionophores at GABAA receptors. This increases the length of time which the Cl− ionopores are open, thus causing an inhibitory effect. Metabolism of methohexital is primarily hepatic via demethylation and oxidation. Side-chain oxidation is the primary means of metabolism involved in the termination of the drugs biological activity. Indications
Methohexital is primarily used to induce anesthesia, and is generally provided as a sodium salt (i.e. methohexital sodium). It is only used in hospital or similar settings, under strict supervision. It has been commonly used to induce deep sedation or general anesthesia for surgery and dental procedures. Unlike many other barbiturates, methohexital actually lowers the seizure threshold, a property that makes it particularly useful when anesthesia is provided for an electroconvulsive therapy (ECT). Its rapid recovery rate with consciousness being gained within three to seven minutes after induction and full recovery within 30 minutes is a major advantage over other ECT barbiturates. Synthesis
Methohexital can be synthesized in the classic manner of making barbituric acid derivatives, in particular by the reaction of malonic ester derivatives with derivatives of urea. | The resulting allyl-(1-methyl-2-pentynyl) malonic ester is synthesized by subsequent alkylation of the malonic ester itself, beginning with 2-bromo-3-hexyne, which gives (1-methyl-2-pentynyl)malonic ester, and then by allylbromide. In the final step, reaction of the disubstituted malonic ester with N-methylurea gives methohexital. References
External links
"Methohexital". Drug Information Portal. U.S. National Library of Medicine. "Methohexital sodium". Drug Information Portal. U.S. National Library of Medicine. | 11
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A notable example is Heinrich von Kleists classic novella, The Earthquake in Chile, which describes the destruction of Santiago in 1647. Haruki Murakamis short fiction collection After the Quake depicts the consequences of the Kobe earthquake of 1995. The most popular single earthquake in fiction is the hypothetical "Big One" expected of Californias San Andreas Fault someday, as depicted in the novels Richter 10 (1996), Goodbye California (1977), 2012 (2009) and San Andreas (2015) among other works. Jacob M. Appels widely anthologized short story, A Comparative Seismology, features a con artist who convinces an elderly woman that an apocalyptic earthquake is imminent.Contemporary depictions of earthquakes in film are variable in the manner in which they reflect human psychological reactions to the actual trauma that can be caused to directly afflicted families and their loved ones. Disaster mental health response research emphasizes the need to be aware of the different roles of loss of family and key community members, loss of home and familiar surroundings, loss of essential supplies and services to maintain survival. Particularly for children, the clear availability of caregiving adults who are able to protect, nourish, and clothe them in the aftermath of the earthquake, and to help them make sense of what has befallen them has been shown even more important to their emotional and physical health than the simple giving of provisions. | Recovery times will vary based off the level of damage along with the socioeconomic status of the impacted community. Landslides
Earthquakes can produce slope instability leading to landslides, a major geological hazard. Landslide danger may persist while emergency personnel are attempting rescue work. Fires
Earthquakes can cause fires by damaging electrical power or gas lines. In the event of water mains rupturing and a loss of pressure, it may also become difficult to stop the spread of a fire once it has started. For example, more deaths in the 1906 San Francisco earthquake were caused by fire than by the earthquake itself. Tsunami
Tsunamis are long-wavelength, long-period sea waves produced by the sudden or abrupt movement of large volumes of water—including when an earthquake occurs at sea. In the open ocean, the distance between wave crests can surpass 100 kilometres (62 mi), and the wave periods can vary from five minutes to one hour. Such tsunamis travel 600–800 kilometers per hour (373–497 miles per hour), depending on water depth. Large waves produced by an earthquake or a submarine landslide can overrun nearby coastal areas in a matter of minutes. Tsunamis can also travel thousands of kilometers across open ocean and wreak destruction on far shores hours after the earthquake that generated them.Ordinarily, subduction earthquakes under magnitude 7.5 do not cause tsunamis, although some instances of this have been recorded. Most destructive tsunamis are caused by earthquakes of magnitude 7.5 or more. Floods
Floods may be secondary effects of earthquakes, if dams are damaged. | 11
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Antibiotics
If diarrhea becomes severe (typically defined as three or more loose stools in an eight-hour period), especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools, medical treatment should be sought. Such patients may benefit from antimicrobial therapy. A 2000 literature review found that antibiotic treatment shortens the duration and severity of TD; most reported side effects were minor, or resolved on stopping the antibiotic.The antibiotic recommended varies based upon the destination of travel. Trimethoprim–sulfamethoxazole and doxycycline are no longer recommended because of high levels of resistance to these agents. Antibiotics are typically given for three to five days, but single doses of azithromycin or levofloxacin have been used. Rifaximin and rifamycin are approved in the U.S. for treatment of TD caused by ETEC. If diarrhea persists despite therapy, travelers should be evaluated for bacterial strains resistant to the prescribed antibiotic, possible viral or parasitic infections, bacterial or amoebic dysentery, Giardia, helminths, or cholera. Antimotility agents
Antimotility drugs such as loperamide and diphenoxylate reduce the symptoms of diarrhea by slowing transit time in the gut. They may be taken to slow the frequency of stools, but not enough to stop bowel movements completely, which delays expulsion of the causative organisms from the intestines. They should be avoided in patients with fever, bloody diarrhea, and possible inflammatory diarrhea. Adverse reactions may include nausea, vomiting, abdominal pain, hives or rash, and loss of appetite. Antimotility agents should not, as a rule, be taken by children under age two. | Idiopathic giant-cell myocarditis (IGCM) is a cardiovascular disease of the muscle of the heart (myocardium). The condition is rare; however, it is often fatal and there is no proven cure because of the unknown nature of the disorder. IGCM frequently leads to death with a high rate of about 70% in first year. A patient with IGCM typically presents with symptoms of heart failure, although some may present initially with ventricular arrhythmia or heart block. Median age from the time the disease is diagnosed to the time of death is approximately 6 months. 90% of patients are either deceased by the end of 1 year or have received a heart transplant. Diagnosis is made by endomyocardial biopsy during heart catheterization. Biopsy shows multinucleated giant cells and thus the name. While previously cases universally required heart transplantation, recent studies show that two-thirds of patients can survive past one year with high doses of immunosuppressants such as prednisone and cyclosporine. The transplanted heart has a high chance of disease recurrence. Compared to lymphocytic (presumed viral) myocarditis, giant cell myocarditis is much more severe with much more rapid progression. It is suggested to be caused by T-lymphocytes. See also
Idiopathic
Giant cell
Myocarditis
References
== External links == | 0-1
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Within ten years of the accident, it became clear that thyroid damage caused by released radioactive iodine was virtually the only adverse health effect that could be measured. As reported by the NRC, studies after the accident showed that "As of 1996, except for thyroid cancer, there has been no confirmed increase in the rates of other cancers, including leukemia, among the... public, that have been attributed to releases from the accident. "But equally important to the question of KI is the fact that radioactivity releases are not "local" events. Researchers at the World Health Organization accurately located and counted the residents with cancer from Chernobyl and were startled to find that "the increase in incidence [of thyroid cancer] has been documented up to 500 km from the accident site... significant doses from radioactive iodine can occur hundreds of kilometers from the site, beyond emergency planning zones." Consequently, far more people than anticipated were affected by the radiation, which caused the United Nations to report in 2002 that "The number of people with thyroid cancer... has exceeded expectations. Over 11,000 cases have already been reported." Nagasaki
These findings were consistent with studies of the effects of previous radioactivity releases. In 1945, millions of Japanese were exposed to radiation from nuclear weapons, and the effects can still be measured. | Athelia is the congenital absence of one or both nipples. It is a rare condition. It sometimes occurs on one side in children with the Poland sequence and on both sides in certain types of ectodermal dysplasia. Sources
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Mitral stenosis is uncommon and not as age-dependent as other types of valvular disease.Mitral insufficiency can be caused by dilation of the left heart, often a consequence of heart failure. In these cases, the left ventricle of the heart becomes enlarged and causes displacement of the attached papillary muscles, which control the mitral. Pulmonary and tricuspid valve disorders
Pulmonary and tricuspid valve diseases are right heart diseases. Pulmonary valve diseases are the least common heart valve disease in adults.Pulmonary valve stenosis is often the result of congenital malformations and is observed in isolation or as part of a larger pathologic process, as in Tetralogy of Fallot, Noonan syndrome, and congenital rubella syndrome. Unless the degree of stenosis is severe, individuals with pulmonary stenosis usually have excellent outcomes and better treatment options. Often patients do not require intervention until later in adulthood as a consequence of calcification that occurs with aging.Pulmonary valve insufficiency occurs commonly in healthy individuals to a very mild extent and does not require intervention. More appreciable insufficiency is typically the result of damage to the valve due to cardiac catheterization, intra-aortic balloon pump insertion, or other surgical manipulations. Additionally, insufficiency may be the result of carcinoid syndrome, inflammatory processes such a rheumatoid disease or endocarditis, or congenital malformations. It may also be secondary to severe pulmonary hypertension.Tricuspid valve stenosis without co-occurrent regurgitation is highly uncommon and typically the result of rheumatic disease. | Typically the pump function of the heart during systole is normal, but an echocardiogram will show flow reversal during diastole. This disease is classified using regurgitant fraction (RF), or the amount of volume that flows back through the valve divided by the total forward flow through the valve during systole. Severe disease has an RF of >50%, while progressive aortic regurgitation has an RF of 30–49%. Mitral stenosis
Chest x-ray in mitral stenosis will typically show an enlarged left atrium, and may show dilation of the pulmonary veins. ECG can show left atrial enlargement, due to increased pressures in the left atrium. Echocardiography is helpful in determining the severity of the disease by estimating the pulmonary artery systolic pressure. This test can also show leaflet calcification and the pressure gradient over the mitral valve. Severe mitral stenosis is defined as a mitral valve area <1.5 cm2. Progressive mitral stenosis has a normal valve area but will have increased flow velocity across the mitral valve. Mitral regurgitation
Chest x-ray in mitral regurgitation can show an enlarged left atrium, as well as pulmonary venous congestion. It may also show valvular calcifications specifically in combined mitral regurgitation and stenosis due to rheumatic heart disease. ECG typically shows left atrial enlargement, but can also show right atrial enlargement if the disease is severe enough to cause pulmonary hypertension. Echocardiography is useful in visualizing the regurgitant flow and calculating the RF. It can also be used to determine the degree of calcification, and the function and closure of the valve leaflets. | 11
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Prevention
There is no vaccine for SARS, although immunologist Anthony Fauci mentioned that the CDC developed one and placed it in the US national stockpile. That vaccine, however, is a prototype and not field-ready as of March 2020. Clinical isolation and quarantine remain the most effective means to prevent the spread of SARS. Other preventive measures include:
Hand-washing with soap and water, or use of alcohol-based hand sanitizer
Disinfection of surfaces of fomites to remove viruses
Avoiding contact with bodily fluids
Washing the personal items of someone with SARS in hot, soapy water (eating utensils, dishes, bedding, etc.) Avoiding travel to affected areas
Wearing masks and gloves
Keeping people with symptoms home from school
Simple hygiene measures
Isolating oneself as much as possible to minimize the chances of transmission of the virusMany public health interventions were made to try to control the spread of the disease, which is mainly spread through respiratory droplets in the air, either inhaled or deposited on surfaces and subsequently transferred to a bodys mucous membranes. These interventions included earlier detection of the disease; isolation of people who are infected; droplet and contact precautions; and the use of personal protective equipment (PPE), including masks and isolation gowns. A 2017 meta-analysis found that for medical professionals wearing N-95 masks could reduce the chances of getting sick up to 80% compared to no mask. A screening process was also put in place at airports to monitor air travel to and from affected countries.SARS-CoV is most infectious in severely ill patients, which usually occurs during the second week of illness. | Research
In July 2004, Actelion started a clinical trial of miglustat to treat Tay–Sachs disease, particularly late-onset Tay–Sachs with an estimated enrollment of 10 subjects; the trial ended August 2007.In November 2007, Actelion initiated a clinical trial with miglustat in people with cystic fibrosis (CF) who have the ΔF508 in both copies of the cystic fibrosis transmembrane conductance regulator (CFTR) gene; the study ended in March 2008. The cystic fibrosis trial showed no effect. See also
Migalastat, a drug for the treatment of Fabry disease, with a similar structure
Miglitol, an oral antidiabetic drug with a similar structure
References
External links
"Miglustat". Drug Information Portal. U.S. National Library of Medicine. | 0-1
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However, in 2004, a committee advisory to the WHO voted in favor of allowing editing of the genome of the two remaining samples of Variola major to add a marker gene. This gene, called GFP, or green fluorescent protein, would cause live samples of the virus to glow green under fluorescent light. The insertion of this gene, which would not influence the virulence of the virus, would be the only allowed modification of the genome. The committee stated the proposed modification would aid in research of treatments by making it easier to assess whether a potential treatment was effective in killing viral samples. The recommendation could only take effect if approved by the WHA. When the WHA discussed the proposal in 2005, it refrained from taking a formal vote on the proposal, stating that it would review individual research proposals one at a time. Addition of the GFP gene to the Vaccinia genome is routinely performed during research on the closely related Vaccinia virus. Controversies
The public availability of variolas complete sequence has raised concerns about the possibility of illicit synthesis of infectious virus. Vaccinia, a cousin of the smallpox virus, was artificially synthesized in 2002 by NIH scientists. They used a previously established method that involved using a recombinant viral genome to create a self-replicating bacterial plasmid that produced viral particles.In 2016, another group synthesized the horsepox virus using publicly available sequence data for horsepox. | If ORS is possible, pelvic should be performed to evaluate for a pelvic mass. [1]
Diagnosis
Surgical exploration and confirmation of possible ovarian tissue is required for the definitive diagnosis of ORS, and treatment by excision of the remnant ovarian tissue may be performed during the same procedure. For women who are not candidates for surgery, a clinical diagnosis can be made based on the symptoms and levels (follicle-stimulating hormone and estradiol, after bilateral oophorectomy) and/or findings consistent with the presence of residual ovarian tissue. Laparoscopy and histological assessment can aid in diagnosis. Treatment
Treatment for ovarian remnant (ORS) is generally indicated for women with suspected ORS who have symptoms (such as pain); have a pelvic mass; or need or desire complete removal of to decrease the risk of ovarian (for example, BRCA ). The mainstay of treatment is surgery to remove the residual ovarian tissue. Women with ORS with a pelvic mass should have appropriate evaluation for malignancy (cancer). Hormonal therapy to suppress ovarian function is an alternative treatment for those who refuse surgery, or those who are not candidates for surgery. Medications may be used to treat ORS and include GnRH agonists, danazol, or progesterone. Epidemiology
The incidence of ovarian remnant syndrome is difficult to determine. The available data are limited to case reports or to retrospective case series. The best available data are from a study describing the frequency and outcome of laparoscopy in women with chronic pelvic pain and/or a pelvic mass who were found to have ovarian remnants. | 0-1
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Thus, this somatosensory information would fail to be transmitted to language areas in the left hemisphere, in turn resulting in the inability to name the object in the left hand. In this example, the patient would have no problem with naming, if the test object were to be held in the right hand. This type of anomia may also arise as a consequence of a disconnect between sensory and language cortices. Articulatory initiation anomia results from damage to the frontal area. Characteristics of this anomia are non-fluent output, word-finding pauses, deficient word lists. Patients perform better at confrontation naming tasks, the selection of a label for a corresponding picture, than word list tasks. Patients are aided in word selection by prompting, unlike those with word selection anomia. Phonemic substitution anomia results from damage to the inferior parietal area. Patients maintain fluent output but exhibit literal and neologistic paraphasia. Literal paraphasia is the incorrect substitution of phonemes, and neologistic paraphasia is the use of non-real words in the place of real words. Patients naming ability is contaminated by paraphasia. Modality-specific anomia is caused by damage to the sensory cortex, pathways to the dominant angular gyrus, or both. In these patients, word-finding is worst in one sensory modality, for example visual or tactile. Causes
Anomic aphasia occurring by itself may be caused by damage to almost anywhere in the left hemisphere and in some cases can be seen in instances of right hemisphere damage. | Deposition on the tongue and throat may promote oral candidiasis, which appears as a white coating, possibly with irritation. This may usually be prevented by rinsing the mouth with water after using the inhaler. Other adverse drug reaction side effects may rarely include: a smell similar to burning plastic, unpleasant taste, hoarseness or nasal congestion, pain or headache, and visual changes. Allergic reactions may occur, but rarely. Nasal corticosteroids may be associated with central serous retinopathy. Pharmacology
Beclometasone is mainly a glucocorticoid. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebrate animal cell. The activated glucocorticoid receptor-glucocorticoid complex up-regulates the expression of anti-inflammatory proteins in the nucleus (a process known as transactivation) and represses the expression of proinflammatory proteins in the cytosol by preventing the translocation of other transcription factors from the cytosol into the nucleus (transrepression).Glucocorticoids are part of the feedback mechanism in the immune system which reduces certain aspects of immune function, such as inflammation. Names
Beclometasone dipropionate is the INN modified and beclomethasone dipropionate is the USAN and former BAN. It is a prodrug of the free form, beclometasone (INN). The prodrug beclometasone is marketed in Norway and Russia.Clenil, Qvar are brandnames for the inhalers. Beconase, Alanase, Vancenase, Qnasl for the nasal spray or aerosol. References
External links
"Beclometasone". Drug Information Portal. U.S. National Library of Medicine. | 0-1
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Consequently, assessment of nightmare disorders using polysomnography has to last for a longer period, in order to let the patient getting used to the artificial environment.Self-report by a questionnaire or by a diary is another way to investigate nightmare disorders. However, these methods are questionable. Indeed, when filling out questionnaires with questions about a long period, people often tend to underestimate the frequency of their nightmares because of forgetting. On the contrary, filling out a diary every day may lead to an overestimation of the numbers of nightmares, because of the focusing on this phenomenon. Comorbidity
Studies have reported that nightmare disorders were present in 50- 70% of the cases for PTSD, in 17.5% for depression, in 18.3% for insomnia, in 16.7% for schizophrenia and in 49% for borderline personality disorder. For all psychiatric disorders taken together, nightmare disorders are present in 29.9% of the cases, a much bigger rate than for the general population, which is 2-5%. Nightmare disorders can also be associated with sleep disorders such as night terrors, chronic insomnia and sleep-disordered breathing. The presence of nightmares before a trauma would influence severity of PTSD symptoms. Furthermore, having nightmares is linked to a significantly higher risk of attempting suicide and of death by suicide. Treatment
Stress reduction techniques such as yoga, meditation and exercise may help to eliminate stress and create a more peaceful sleeping atmosphere.Diagnosis and medication can only be given to patients that report the recurring nightmares to a psychiatrist or other physician. | Myxoid foci and oligodendroglioma-like cells may also be present, though these are not specific to pilocytic astrocytoma. Long-standing lesions may show hemosiderin-laden macrophages and calcifications. Treatment
The most common form of treatment is having the tumor surgically removed. Complete removal of the tumor will generally allow functional survival for many years. In particular for pilocytic astrocytomas (commonly indolent masses that may permit normal neurologic function), surgeons may decide to monitor the neoplasms evolution and postpone surgical intervention for some time. However, total resection is often not possible. The location could prohibit access to the neoplasm and lead to incomplete or no resection at all. Left unattended, these tumors may eventually lead to further symptoms due to continued slow growth. Extremely rarely, they may also undergo malignant transformation. If surgery is not possible, recommendations such as chemotherapy or radiation may be suggested. However, side effects from these treatments can be extensive and long term, resulting in some cases in life-long difficulties. Side effects
After treatment, children with pilocytic astrocytoma may experience an improvement of symptoms related to the tumor itself depending on the location, but may also experience side effects related to the treatment:
Symptoms related to increased pressure in the brain often disappear after surgical removal of the tumor. Effects on coordination and balance may improve and might progressively (to completely) disappear as recovery progresses. Steroid treatment is often used to control tissue swelling that may occur pre-and post-operatively. Patients can, however, also develop long-term side effects due to the type of treatment they may receive. | 0-1
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This expansion may pulverize the anode, resulting in poor performance. To fix this problem scientists looked into varying the dimensionality of the Si. Many studies have been developed in Si nanowires, Si tubes as well as Si sheets. As a result, composite hierarchical Si anodes have become the major technology for future applications in Lithium Ion Batteries. In the early 2020s technology is reaching commercial levels with factories being built for mass production of anodes in the United States. Furthermore, metallic Lithium is another possible candidate for the anode. It boasts a higher specific capacity than Silicon, however, does come with the drawback of working with the highly unstable metallic lithium. Similarly to graphite anodes, dendrite formation is another major limitation of metallic lithium, with the solid electrolyte interphase being a major design challenge. In the end, if stabilized, metallic lithium would be able to produce batteries that hold the most charge, while being the lightest. Mechanical Properties
A common failure mechanism of batteries is mechanical shock, which breaks either the electrode or the system’s container, leading to poor conductivity and electrolyte leakage. However, the relevance of mechanical properties of electrodes goes beyond the resistance to collisions due to its environment. During standard operation, the incorporation of ions into electrodes leads to a change in volume. This is well exemplified by Si electrodes in Lithium-ion batteries expanding around 300% during lithiation. Such change may lead to the deformations in the lattice and, therefore stresses in the material. | In which the
λ
{\displaystyle \lambda }
is the reorganisation energy. Filling this result in the classically derived Arrhenius equation
leads to
With A being the pre-exponential factor which is usually experimentally determined, although a semi classical derivation provides more information as will be explained below. This classically derived result qualitatively reproduced observations of a maximum electron transfer rate under the conditions
Δ
G
†
=
λ
{\displaystyle \Delta G^{\dagger }=\lambda }
. For a more extensive mathematical treatment one could read the paper by Newton. | 11
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Sulindac seems to have a property, independent of COX-inhibition, of reducing the growth of polyps and precancerous lesions in the colon, especially in association with familial adenomatous polyposis, and may have other anti-cancer properties. Adverse effects
In October 2020, the U.S. Food and Drug Administration (FDA) required the drug label to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy. Society and culture
Litigation
In September 2010 a federal jury in New Hampshire awarded $21 million to Karen Bartlett, a woman who developed Stevens–Johnson syndrome/Toxic epidermal necrolysis as a result of taking a generic brand of sulindac manufactured by Mutual Pharmaceuticals for her shoulder pain. Ms. Bartlett sustained severe injuries including the loss of over 60% of her surface skin and permanent near-blindness. The case had been appealed to the United States Supreme Court, where the main issue was whether federal law preempts Ms. Bartletts claim. On June 24, 2013, the Supreme Court ruled 5–4 in favor of Mutual Pharmaceuticals, throwing out the earlier $21 million jury verdict. Synthesis
Rxn of p-fluorobenzyl chloride (1) with the anion of diethylmethyl malonate (2) gives intermediate diester (3), saponification of which and subsequent decarboxylation leads to 4. {Alternatively it can be formed by Perkin reaction between p-fluorobenzaldehyde and propionic anhydride in the presence of NaOAc, followed by catalytic hydrogenation of the olefinic bond using a palladium on carbon catalyst.} | Fluocinolone acetonide is a corticosteroid primarily used in dermatology to reduce skin inflammation and relieve itching. It is a synthetic hydrocortisone derivative. The fluorine substitution at position 9 in the steroid nucleus greatly enhances its activity. It was first synthesized in 1959 in the Research Department of Syntex Laboratories S.A. Mexico City. Preparations containing it were first marketed under the name Synalar. A typical dosage strength used in dermatology is 0.01–0.025%. One such cream is sold under the brand name Flucort-N and includes the antibiotic neomycin. Fluocinolone acetonide was also found to strongly potentiate TGF-β-associated chondrogenesis of bone marrow mesenchymal stem/progenitor cells, by increasing the levels of collagen type II by more than 100 fold compared to the widely used dexamethasone.Fluocinolone acetonide intravitreal implants have been used to treat non-infectious uveitis. A systematic review could not determine whether fluocinolone acetonide implants are superior to standard of care treatment for uveitis. A fluocinolone acetonide intravitreal implant with the brand name Iluvien is sold by biopharmaceutical company Alimera Sciences to treat diabetic macular edema (DME).It was approved for medical use in 1961. Classification
Fluocinolone is a group V (0.025%) or group VI (0.01%) corticosteroid under US classification. See also
Topical steroid
Fluocinonide
Ciprocinonide
Glucocorticoid
References
External links
"Fluocinolone acetonide". Drug Information Portal. U.S. National Library of Medicine. | 0-1
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By 2004 this had increased to 29% and further to 32% (76 million US adults) by 2017. In 2017, with the change in definitions for hypertension, 46% of people in the United States are affected. African-American adults in the United States have among the highest rates of hypertension in the world at 44%. It is also more common in Filipino Americans and less common in US whites and Mexican Americans. Differences in hypertension rates are multifactorial and under study. Children
Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States. Childhood hypertension, particularly in pre-adolescents, is more often secondary to an underlying disorder than in adults. Kidney disease is the most common secondary cause of hypertension in children and adolescents. Nevertheless, primary or essential hypertension accounts for most cases. Prognosis
Hypertension is the most important preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease, strokes, peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, cancers, leukemia and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and dementia. Other complications include hypertensive retinopathy and hypertensive nephropathy. History
Measurement
Modern understanding of the cardiovascular system began with the work of physician William Harvey (1578–1657), who described the circulation of blood in his book "De motu cordis". The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733. | Paranoid social cognition
Social psychological research has proposed a mild form of paranoid cognition, paranoid social cognition, that has its origins in social determinants more than intra-psychic conflict. This perspective states that in milder forms, paranoid cognitions may be very common among normal individuals. For instance, it is not strange that people may exhibit in their daily life, self-centered thought such as they are being talked about, suspiciousness about other’ intentions, and assumptions of ill-will or hostility (i.e. people may feel as if everything is going against them). According to Kramer, (1998) these milder forms of paranoid cognition may be considered as an adaptive response to cope with or make sense of a disturbing and threatening social environment. Paranoid cognition captures the idea that dysphoric self-consciousness may be related with the position that people occupy within a social system. This self-consciousness conduces to a hypervigilant and ruminative mode to process social information that finally will stimulate a variety of paranoid-like forms of social misperception and misjudgment. This model identifies four components that are essential to understanding paranoid social cognition: situational antecedents, dysphoric self-consciousness, hypervigilance and rumination, and judgmental biases. Situational antecedents
Perceived social distinctiveness, perceived evaluative scrutiny and uncertainty about the social standing. Perceived social distinctiveness: According to the social identity theory, people categorize themselves in terms of characteristics that made them unique or different from others under certain circumstances. Gender, ethnicity, age, or experience may become extremely relevant to explain peoples behavior when these attributes make them unique in a social group. | 0-1
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Phakomatoses, also known neurocutaneous syndromes, are a group of multisystemic diseases that most prominently affect structures primarily derived from the ectoderm such as the central nervous system, skin and eyes. The majority of phakomatoses are single-gene disorders that may be inherited in an autosomal dominant, autosomal recessive or X-linked pattern. Presentations may vary dramatically between patients with the same particular syndrome due to mosaicism, variable expressivity, and penetrance.Many phakomatoses are caused by mutations which alter functioning of the RAS–mitogen-activated protein kinase (MAPK) pathway that regulates cellular growth, differentiation, proliferation and death. This results in a tendency for individuals with these mutations to develop various types of benign or malignant tumors depending on the particular mutation. The presence of these tumors may result in functional and/or cosmetic problems depending on their type and location. History
The term phakomatosis originated in 1923, when the Dutch ophthalmologist van der Hoeve used the term phakoma to refer to a "mother spot" or birthmark, a physical characteristic common to patients with tuberous sclerosis and neurofibromatosis that he examined. The term phakomatoses was derived from phakos, the Greek term for birthmark. He originally used the phrase to describe two diseases: neurofibromatosis and tuberous sclerosis. This term later became imprecise when van der Hoeve also used it to include those with Sturge-Weber syndrome as they do not have similar lesions on the skin. In addition, the term phakomatosis makes no reference to the central nervous system involvement. | The term neurocutaneous syndrome was subsequently defined by the Russian-American neurologist Paul Ivan Yakovlev and psychiatrist Riley H. Guthrie and it is currently more commonly used.The first clinical description was made in “Monstrorum Historia” by an Italian physician and naturalist named Ulisse Aldrovandi who described a patient with probable neurofibromatosis type I in 1592. He described a short man with a large tumor which was likely a plexiform neurofibroma. However, there are artistic or descriptive representations which have been speculated to depict individuals with phakomatoses as far back as the Hellenistic period and ancient Egypt.Over time, the number of neurocutaneous syndromes have increased and there are several dozen that have been characterized. Types
There are a large number of neurocutaneous syndromes that exceed the scope of this article. Therefore, characteristics of a few of the more common types are summarized. Neurofibromatosis Type I (von Recklinghausen disease)
Neurofibromatosis type 1 is the most common phakomatosis and it affects approximately 1 in 2500-3000 live births. It is a genetic disorder due to a germline mutation in the NF1 gene. This gene encodes a protein called neurofibromin that is involved in controlling cellular growth. Malfunction of the gene results in multisystem manifestations involving the skin, central nervous system, peripheral nervous system, eyes and musculoskeletal system. The condition is inherited in an autosomal dominant manner. However, approximately one-half of patients with this condition have no family history and the mutation occurs spontaneously. | 11
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Gray baby syndrome (also termed Gray or Grey syndrome) is a rare but serious, even fatal, side effect that occurs in newborn infants (especially premature babies) following the accumulation of antibiotic chloramphenicol. Chloramphenicol is a broad-spectrum antibiotic that has been used to treat a variety of bacteria infections like Streptococcus pneumoniae as well as typhoid fever, meningococcal sepsis, cholera, and eye infections. Chloramphenicol works by binding to ribosomal subunits which blocks transfer ribonucleic acid and prevents the synthesis of bacterial proteins. Chloramphenicol has also been used to treat neonates born before 37 weeks of the gestational period for prophylaxis purposes. In 1958, newborns born prematurely due to rupture of the amniotic sac were given chloramphenicol to prevent possible infections, and it was noticed that these newborns had a higher mortality rate compared with those who were not treated with the antibiotic. Over the years, chloramphenicol has been used less in clinical practices due to the risks of toxicity not only to neonates, but also to adults due to the risk of aplastic anemia. Chloramphenicol is now reserved to treat certain severe bacteria infections that were not successfully treated with other antibiotic medications. Signs and symptoms are summarized in the WHO Model Formulary for Children 2010 under the rare adverse effect section of chloramphenicol. Signs and symptoms
Since the syndrome is due to the accumulation of chloramphenicol, the signs and symptoms are dose related. | Additionally there is:
CT scan
MRI scans
Classification
There are two types of empty sella syndrome: primary and secondary. Primary empty sella syndrome occurs when a small anatomical defect above the pituitary gland increases pressure in the sella turcica and causes the gland to flatten out along the interior walls of the sella turcica cavity. Primary empty sella syndrome is associated with obesity and increase in intracranial pressure in women. In most cases, especially in people with primary empty sella syndrome, there are no symptoms and it does not affect life expectancy or health. Some researchers have estimated that less than 1% of affected people ever develop symptoms of the condition. Secondary empty sella syndrome is the result of the pituitary gland regressing within the cavity after an injury, surgery, or radiation therapy. Individuals with secondary empty sella syndrome due to destruction of the pituitary gland have symptoms that reflect the loss of pituitary functions, such as intolerance to stress and infection. Differential diagnosis
The major differential to consider in empty sella syndrome is intracranial hypertension, of both unknown and secondary causes, and an epidermoid cyst, which can mimic cerebrospinal fluid due to its low density on CT scans, although MRI can usually distinguish the latter diagnosis. Treatment
In terms of management, unless the syndrome results in other medical problems, treatment for endocrine dysfunction associated with pituitary malfunction is symptomatic and thus supportive; however, surgery may be needed in some cases. References
Further reading
Disorders, National Organization for Rare (2003). NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. ISBN 9780781730631. | 0-1
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Skin
Leiomyomas of the skin are generally (1) acquired, and (2) divided into several categories:
Solitary cutaneous leiomyoma
Multiple cutaneous (or pilar) leiomyomas arising from the arrectores pilorum muscles
Angioleiomyomas (vascular leiomyomas) that are thought to arise from vascular smooth muscle
Dartoic (or genital) leiomyomas originating in the dartos muscles of the genitalia, areola, and nipple
Angiolipoleiomyoma
Esophagus, stomach and small intestines
Leiomyoma is the most common benign mesenchymal tumor of esophagus and second most common benign tumor of the small bowel (with gastrointestinal stromal tumor as most common). Although leiomyoma is the most common benign esophageal tumor, malignant carcinoma is still 50 times more likely. Approximately 50% of cases are found in the jejunum, followed by the ileum in 31% of cases. Almost one half of all lesions are less than 5 centimeters. Other locations, metastatic leiomyoma
Metastatic leiomyoma are an extremely rare complication after surgery to remove the uterus for uterine fibroids. The most frequent sites of occurrence are the lungs and pelvis. The lesions are hormonally responsive. Fibromyoma of the breast is an extremely rare benign breast neoplasm. Most reports in literature mention a history of hysterectomy for uterine fibroids, although the question of whether these fibromyomas are possibly metastases of the uterine fibroids has not been investigated. An alternative hypothesis is an origin from the smooth muscle of the nipple. Leiomyoma may spontaneously occur in any muscle. Depending on the location of the tumor, identification may not be timely until overall mass becomes undeniably noticeable. The symptoms for a 30-year-old male with a 10 cm leiomyoma included "dead leg" pains. | Tumor was intertwined with quadriceps muscles, making identification and excision difficult. Tumor was successfully excised with only minor rehabilitation required. Familial leiomyoma
Associated with papillary variant of renal cell carcinoma and multiple cutaneous leiomyoma. Defect is in the fumarate hydratase gene in the long arm of chromosome 1. See also
Leiomyosarcoma
Elagolix/estradiol/norethindrone acetate
References
External links
Esophageal Leiomyoma at eMedicine | 11
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Because of the health risks of exposing children to radiation, ultrasound is the preferred first choice with CT scan being a legitimate follow-up if the ultrasound is inconclusive. CT scan is more accurate than ultrasound for the diagnosis of appendicitis in adults and adolescents. CT scan has a sensitivity of 94%, specificity of 95%. Ultrasonography had an overall sensitivity of 86%, a specificity of 81%. Ultrasound
Abdominal ultrasonography, preferably with doppler sonography, is useful to detect appendicitis, especially in children. Ultrasound can show the free fluid collection in the right iliac fossa, along with a visible appendix with increased blood flow when using color Doppler, and noncompressibility of the appendix, as it is essentially walled-off abscess. Other secondary sonographic signs of acute appendicitis include the presence of echogenic mesenteric fat surrounding the appendix and the acoustic shadowing of an appendicolith. In some cases (approximately 5%), ultrasonography of the iliac fossa does not reveal any abnormalities despite the presence of appendicitis. This false-negative finding is especially true of early appendicitis before the appendix has become significantly distended. Also, false-negative findings are more common in adults where larger amounts of fat and bowel gas make visualizing the appendix technically difficult. Despite these limitations, sonographic imaging with experienced hands can often distinguish between appendicitis and other diseases with similar symptoms. Some of these conditions include inflammation of lymph nodes near the appendix or pain originating from other pelvic organs such as the ovaries or Fallopian tubes. Ultrasounds may be either done by the radiology department or by the emergency physician. | The performance of scores such as the Alvarado score and the Pediatric Appendicitis Score, however, are variable.The Alvarado score is the most known scoring system. A score below 5 suggests against a diagnosis of appendicitis, whereas a score of 7 or more is predictive of acute appendicitis. In a person with an equivocal score of 5 or 6, a CT scan or ultrasound exam may be used to reduce the rate of negative appendectomy. Pathology
Even for clinically certain appendicitis, routine histopathology examination of appendectomy specimens is of value for identifying unsuspected pathologies requiring further postoperative management. Notably, appendix cancer is found incidentally in about 1% of appendectomy specimens.Pathology diagnosis of appendicitis can be made by detecting a neutrophilic infiltrate of the muscularis propria. Periappendicitis, inflammation of tissues around the appendix, is often found in conjunction with other abdominal pathology. Differential diagnosis
Children: Gastroenteritis, mesenteric adenitis, Meckels diverticulitis, intussusception, Henoch–Schönlein purpura, lobar pneumonia, urinary tract infection (abdominal pain in the absence of other symptoms can occur in children with UTI), new-onset Crohns disease or ulcerative colitis, pancreatitis, and abdominal trauma from child abuse; distal intestinal obstruction syndrome in children with cystic fibrosis; typhlitis in children with leukemia. Women: A pregnancy test is important for all women of childbearing age since an ectopic pregnancy can have signs and symptoms similar to those of appendicitis. | 11
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This process does not lead to an economic explosion not only because of the supply-side barriers at potential output (full employment) but because at each "round", the increase in consumer spending is less than the increase in consumer incomes. That is, the marginal propensity to consume (MPC) is less than one, so that each round some extra income goes into saving, leaking out of the cumulative process. Each increase in spending is thus smaller than that of the previous round, preventing an explosion. Efforts to preserve ecosystems at risk
Some of the worlds most exceptional biodiversity is located in the Galapagos Islands. These islands were designated a UNESCO World Heritage site in 1979, then added to UNESCOs List of World Heritage in Danger in 2007. IGTOA is a non-profit dedicated to preserving this unique living laboratory against the challenges of invasive species, human impact, and tourism. For travelers who want to be mindful of the environment and the impact of tourism, it is recommended to utilize an operator that is endorsed by a reputable ecotourism organization. In the case of the Galapagos, IGTOA has a list of the worlds premiere Galapagos Islands tour companies dedicated to the lasting protection and preservation of the destination. Natural resource management
Natural resource management can be utilized as a specialized tool for the development of ecotourism. There are several places throughout the world where a number of natural resources are abundant, but with human encroachment and habitats, these resources are depleting. | While some ecotourism projects, including some found in the United States, can support such claims, many projects have failed to address some of the fundamental issues that nations face in the first place. Consequently, ecotourism may not generate the very benefits it is intended to provide to these regions and their people, and in some cases leaving economies in a state worse than before.The following case studies illustrate the rising complexity of ecotourism and its impacts, both positive and negative, on the environment and economies of various regions in the world. Ecotourism in Costa Rica
Ecotourism in Jordan
Ecotourism in South Africa
Ecotourism in the United States
See also
References
Further reading
Burger, Joanna (2000). "Landscapes, tourism, and conservation". Science of the Total Environment. 249 (1–3): 39–49. Bibcode:2000ScTEn.249...39B. doi:10.1016/s0048-9697(99)00509-4. PMID 10813445. Ceballos-Lascurain, H. 1996. Tourism, Ecotourism, and Protected Areas. Larkin, T. and K. N. Kähler. 2011. "Ecotourism." Encyclopedia of Environmental Issues. Rev. ed. Pasadena: Salem Press. Vol. 2, pp. 421–424. ISBN 978-1-58765-737-5
IUCN. The International Union for the Conservation of Nature. 301 pp. Ceballos-Lascurain, H. 1998. Ecoturismo. Naturaleza y Desarrollo Sostenible. Duffy, Rosaleen (2000). "Shadow players: Ecotourism development, corruption and state politics in Belize". Third World Quarterly. 21 (3): 549–565. doi:10.1080/713701038. S2CID 153634543. Gutzwiller, Kevin J.; Anderson, Stanley H. (1999). "Spatial Extent of Human-Intrusion Effects on Subalpine Bird Distributions". The Condor. 101 (2): 378–389. doi:10.2307/1370001. JSTOR 1370001. Orams, Mark B.; Nowaczek, Agnes M.K. (2010). "Ecotourism: Principles and Practices". Annals of Tourism Research. 37: 270–271. doi:10.1016/j.annals.2009.10.007. Orams, Mark B. (2000). "Tourists getting close to whales, is it what whale-watching is all about?". Tourism Management. | 11
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Flatulence, in humans, is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environmental air, and hence flatus is not entirely generated in the stomach or bowels. The scientific study of this area of medicine is termed flatology.Flatus is brought to the rectum and pressurized by muscles in the intestines. It is normal to pass flatus ("to fart"), though volume and frequency vary greatly among individuals. It is also normal for intestinal gas to have a feculent or unpleasant odor, which may be intense. The noise commonly associated with flatulence ("blowing a raspberry") is produced by the anus and buttocks, which act together in a manner similar to that of an embouchure. Both the sound and odor are sources of embarrassment, annoyance or amusement (flatulence humor). There are several general symptoms related to intestinal gas: pain, bloating and abdominal distension, excessive flatus volume, excessive flatus odor, and gas incontinence. Furthermore, eructation (colloquially known as "burping") is sometimes included under the topic of flatulence. When excessive or malodorous, flatus can be a sign of a health disorder, such as irritable bowel syndrome, celiac disease or lactose intolerance. Terminology
Non-medical definitions of the term include "the uncomfortable condition of having gas in the stomach and bowels", or "a state of excessive gas in the alimentary canal". | Sinecatechins (USAN, trade names Veregen and Polyphenon E) is a specific water extract of green tea leaves from Camellia sinensis that is the active ingredient in an ointment approved by the FDA in 2006 as a botanical drug to treat genital warts. Sinecatechins are mostly catechins, 55% of which is epigallocatechin gallate. It was the first botanical drug approved by the US FDA. == References == | 0-1
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Posterior cord syndrome (PCS), also known as posterior spinal artery syndrome (PSA), is a type of incomplete spinal cord injury. PCS is the least commonly occurring of the six clinical spinal cord injury syndromes, with an incidence rate of less than 1%. PCS originates from an infarct in the posterior spinal artery and is caused by lesions on the posterior portion of the spinal cord, specifically the posterior column, posterior horn, and posterolateral region of the lateral column. These lesions can be caused by trauma to the neck, occlusion of the spinal artery, tumors, disc compression, vitamin B12 deficiency, syphilis, or multiple sclerosis. Despite these numerous pathological pathways, the result is an interruption in transmission of sensory information and motor commands from the brain to the periphery. Causes
Trauma to the spinal cord, such as neck hyperflexion injuries, are often the result of car accidents or sports-related injuries. In such injuries, posterior dislocations and extensions occur without the rupture of ligaments. This blunt trauma may be further complicated with subsequent disc compression. In addition to these complications, transient ischemic attacks could occur in the spinal cord during spinal artery occlusion.Common pathological sources of PCS include Friedreichs Ataxia, an autosomal-recessive inherited disease, and tumors such as astrocytoma, ependymoma, meningioma, neurofibroma, sarcoma, and schwannoma. Cobalamin, commonly known as vitamin B12, plays a crucial role in the synthesis and maintenance of myelin in neurons found in the spinal cord. | As a flavouring agent in drinks, quinine is limited to less than 83 parts per million in the United States, and 100 mg⁄l in the European Union. Scientific
Quinine (and quinidine) are used as the chiral moiety for the ligands used in Sharpless asymmetric dihydroxylation as well as for numerous other chiral catalyst backbones. Because of its relatively constant and well-known fluorescence quantum yield, quinine is used in photochemistry as a common fluorescence standard. Contraindications
Because of the narrow difference between its therapeutic and toxic effects, quinine is a common cause of drug-induced disorders, including thrombocytopenia and thrombotic microangiopathy. Even from minor levels occurring in common beverages, quinine can have severe adverse effects involving multiple organ systems, among which are immune system effects and fever, hypotension, hemolytic anemia, acute kidney injury, liver toxicity, and blindness. In people with atrial fibrillation, conduction defects, or heart block, quinine can cause heart arrhythmias, and should be avoided.Quinine can cause hemolysis in G6PD deficiency (an inherited deficiency), but this risk is small and the physician should not hesitate to use quinine in people with G6PD deficiency when there is no alternative. Adverse effects
Quinine can cause unpredictable serious and life-threatening blood and cardiovascular reactions including low platelet count and hemolytic-uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP), long QT syndrome and other serious cardiac arrhythmias including torsades de pointes, blackwater fever, disseminated intravascular coagulation, leukopenia, and neutropenia. Some people who have developed TTP due to quinine have gone on to develop kidney failure. | 0-1
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In clinical trials, a similar increase in heart rate was observed in both Cleviprex and comparator arms. Dihydropyridine calcium channel blockers can produce negative inotropic effects and exacerbate heart failure. Heart failure patients should be monitored carefully. Cleviprex gives no protection against the effects of abrupt beta-blocker withdrawal. Most common adverse reactions (>2%) are headache, nausea, and vomiting. Cleviprex should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Maintain aseptic technique while handling Cleviprex. Cleviprex contains phospholipids and can support microbial growth. Do not use if contamination is suspected. Once the stopper is punctured, use or discard within 12 hours. Drug interactions
No clinical drug interaction studies were conducted. Cleviprex does not have the potential for blocking or inducing any CYP enzymes. Storage
Cleviprex is available in ready-to-use 50- and 100-mL glass vials at a concentration of 0.5 mg/mL of clevidipine butyrate. Vials should be refrigerated at 2-8oC (36-46 °F). Cleviprex can be stored to controlled room temperature for up to 2 months. Cleviprex is photosensitive and storage in cartons protects against photodegradation. Protection from light during administration is not required. Phase III clinical trial results
Cleviprex has been evaluated in 6 Phase III clinical studies including the perioperative and emergency department/intensive care settings. These include ESCAPE-1, ESCAPE-2, ECLIPSE, and VELOCITY trials. ESCAPE-1 was a double-blind, randomized, placebo-controlled efficacy trial of 105 cardiac surgery patients. | The maximum infusion rate for Cleviprex is 32 mg/hour. Most patients in clinical trials were treated with doses of 16 mg/hour or less. Because of lipid load restrictions, no more than 1000 mL (or an average of 21 mg/hour) of Cleviprex infusion is recommended per 24 hours. In clinical studies, no significant changes occurred in serum triglyceride levels in the Cleviprex treated patients. There is little experience with infusion durations beyond 72 hours at any dose. The infusion can be reduced or discontinued to achieve desired blood pressure while appropriate oral therapy is established. Safety information
Cleviprex is intended for intravenous use. Titrate drug depending on the response of the individual patient to achieve the desired blood pressure reduction. Monitor blood pressure and heart rate continually during infusion, and then until vital signs are stable. Patients who receive prolonged Cleviprex infusions and are not transitioned to other antihypertensive therapies should be monitored for the possibility of rebound hypertension for at least 8 hours after the infusion is stopped. In clinical trials, the safety profile of clevidipine was generally similar to sodium nitroprusside, nitroglycerin, or nicardipine in patients undergoing cardiac surgery.Cleviprex is contraindicated in patients with allergies to soybeans, soy products, eggs, or egg products; defective lipid metabolism such as pathologic hyperlipemia (rare genetic disorders characterized by abnormal triglyceride metabolism), lipoid nephrosis, or acute pancreatitis if it is accompanied by hyperlipidemia; and in patients with severe aortic stenosis. Hypotension and reflex tachycardia are potential consequences of rapid upward titration of Cleviprex. | 11
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If the swelling is untreated, it causes death by brain herniation.The brain swelling is likely a result of vasogenic edema, the penetration of the blood–brain barrier by fluids. This process has been observed in MRI studies. Hypoxia increases extracellular fluid, which passes through the vasogenic endothelium in the brain. The leaking may be caused by increased pressure, or it may be caused by inflammation that makes the endothelium vulnerable to leaking. An MRI study found microhemorrhages in the corpus callosum of HACE patients, and hypoxia may also cause microvascular permeability. It has been hypothesized that vascular endothelial growth factor may cause the vascular permeability at the root of HACE. MRI scans of patients with HACE showed increased T2 in the corpus callosum, although grey matter was unchanged. This demonstrated that the blood-brain barrier was broken by cerebral blood vessels, thus interfering with white matter metabolism. Another study looked at the brains of people with HACE several months after their recovery; it showed hemosiderin deposits in the corpus callosum, evidence of vascular permeability.While there is strong evidence that vasogenic edema plays a major role in HACE, cytotoxic edema, cellular retention of fluids, may contribute as well. Cytotoxic edema may be caused by the failure of cellular ion pumps, which results from hypoxia. Then intracellular sodium and osmolarity increase, and there is an influx of water that causes cellular swelling. After the failure of the ATPase pumps, free radicals form and cause damage that complicates the edema. | It should be the first diagnosis ruled out when sickness occurs while ascending to a high altitude. Prevention
HACE is generally preventable by ascending gradually with frequent rest days while climbing or trekking. Not ascending more than 1,000 metres (3,300 ft) daily and not sleeping at a greater height than 300 metres (980 ft) more than the previous night is recommended. The risk of developing HACE is diminished if acetazolamide or dexamethasone are administered. Generally, the use of acetazolamide is preferred, but dexamethasone can be used for prevention if there are side effects or contraindications. Some individuals are more susceptible to HACE than others, and physical fitness is not preventive. Age and sex do not by themselves affect vulnerability to HACE. Treatment
Patients with HACE should be brought to lower altitudes and provided supplemental oxygen, and rapid descent is sometimes needed to prevent mortality. Early recognition is important because as the condition progresses patients are unable to descend without assistance. Dexamethasone should also be administered, although it fails to ameliorate some symptoms that can be cured by descending to a lower altitude. It can also mask symptoms, and they sometimes resume upon discontinuation. Dexamethasones prevention of angiogenesis may explain why it treats HACE well. Three studies that examined how mice and rat brains react to hypoxia gave some credence to this idea.If available, supplemental oxygen can be used as an adjunctive therapy, or when descent is not possible. | 11
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This subunit interacts with other proteins (in particular, the minK beta subunit) to create the channel, which carries the delayed potassium rectifier current IKs responsible for the repolarisation phase of the cardiac action potential.Variants in KCNQ1 cause the LQT1 subtype of Romano–Ward syndrome when a single copy of the variant is inherited (heterozygous, autosomal dominant inheritance). When two copies of the variant are inherited (homozygous, autosomal recessive inheritance) the more severe Jervell and Lange-Nielsen syndrome is found, associated with more marked QT prolongation, congenital sensorineural deafness, and a greater risk of arrhythmias.LQT1 is associated with a high risk of faints but lower risk of sudden death than LQT2.LQT1 may also affect glucose regulation. After ingesting glucose, those with LQT1 produce more insulin than would be expected, which is followed by a period of insulin resistance. When the resistance diminishes, abnormally low blood glucose levels (hypoglycaemia) are sometimes seen. LQT2
The LQT2 subtype is the second-most common form of Romano–Ward syndrome, responsible for 25 to 30% of all cases. This form of Romano–Ward syndrome is caused by variants in the KCNH2 gene on chromosome 7. KCNH2 (also known as hERG) encodes the potassium channel which carries the rapid inward rectifier current IKr. This current contributes to the terminal repolarisation phase of the cardiac action potential, and therefore the length of the QT interval. LQT3
The LQT3 subtype of Romano–Ward syndrome is caused by variants in the SCN5A gene located on chromosome 3p21-24. | The QTc is less than 450 ms in 95% of normal males, and less than 460 ms in 95% of normal females. Romano–Ward syndrome is suggested if the QTc is longer than these cutoffs. However, as 5% of normal people also fall into this category, some suggest cutoffs of 470 and 480 ms for males and females respectively, corresponding with the 99th centiles of normal values.The major subtypes of Romano–Ward syndrome are associated with specific ECG features. LQT1 is typically associated with broad-based T-waves, whereas the T-waves in LQT2 are notched and of lower amplitude, whilst in LQT3 the T-waves are often late onset, being preceded by a long isoelectric segment.Other factors beyond the QT interval should be taken into account when making a diagnosis, some of which have been incorporated into scoring systems such as the Schwartz score. These factors include a history of characteristic abnormal heart rhythms (Torsades de Pointes), unexplained blackouts (syncope), and a family history of confirmed LQT syndrome. Other investigations that may suggest a diagnosis of the LQT1 form of Romano–Ward syndrome include paradoxical lengthening of the QT interval in response to exercise (QTc >470 ms at 2–4 minutes of recovery) or during an artificial infusion of adrenaline (lengthening of the absolute QT interval >30 ms during low dose adrenaline). Treatment
The treatment for Romano–Ward syndrome aims to reduce the risk of arrhythmias. Lifestyle measures include avoiding very strenuous or competitive exercise. | 11
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Styes normally heal on their own by rupturing within a few days to a week causing the relief of symptoms, but if it does not improve or it worsens within two weeks, a doctors opinion should be sought. Few people require surgery as part of stye treatment. With adequate treatment, styes tend to heal quickly and without complications. The prognosis is better if one does not attempt to squeeze or puncture the stye, as infection may spread to adjacent tissues. Also, patients are recommended to call a doctor if they encounter problems with vision, the eyelid bump becomes very painful, the stye bleeds or reoccurs, or the eyelid or eyes becomes red. Etymology
The word stye (first recorded in the 17th century) is probably a back-formation from styany (first recorded in the 15th century), which in turn comes from styan plus eye, the former of which in turn comes from the old English stīġend, meaning "riser", from the verb stīgan, "to rise". The older form styan is still used in Ulster Scots today. The homonym sty found in the combination pigsty has a slightly different origin, namely it comes from the Old English stiġ-fearh—fearh (farrow) is the Old English word for "piglet"—where stiġ meant "hall" (cf. steward), possibly an early Old Norse loanword, which could be cognate with the word stīgan above.The synonymous late Latin expression is hordeolum a modulation of the word hordeolus simply related to hordeum ("barley"), after its resemblance to a barleycorn. | Hydrocortisone sodium succinate is a synthetic glucocorticoid corticosteroid and a corticosteroid ester. == References == | 0-1
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The way mothers speak to their children ("motherese") is better suited to support very young children in their efforts to understand speech (in context of the reference English) than fathers.Since the 1970s, in vitro fertilization has made pregnancy possible at ages well beyond "natural" limits, generating ethical controversy and forcing significant changes in the social meaning of motherhood. This is, however, a position highly biased by Western world locality: outside the Western world, in-vitro fertilization has far less prominence, importance or currency compared to primary, basic healthcare, womens basic health, reducing infant mortality and the prevention of life-threatening diseases such as polio, typhus and malaria. Traditionally, and still in most parts of the world today, a mother was expected to be a married woman, with birth outside of marriage carrying a strong social stigma. Historically, this stigma not only applied to the mother, but also to her child. This continues to be the case in many parts of the developing world today, but in many Western countries the situation has changed radically, with single motherhood being much more socially acceptable now. For more details on these subjects, see Legitimacy (family law) and single parent. The total fertility rate (TFR), that is, the number of children born per woman, differs greatly from country to country. The TFR in 2013 was estimated to be highest in Niger (7.03 children born per woman) and lowest in Singapore (0.79 children/woman).In the United States, the TFR was estimated for 2013 at 2.06 births per woman. | In modern Western countries the current maternal mortality rate is around 10 deaths per 100,000 births. Religious
Nearly all world religions define tasks or roles for mothers through either religious law or through the glorification of mothers who served in substantial religious events. There are many examples of religious law relating to mothers and women. Major world religions which have specific religious law or scriptural canon regarding mothers include: Christianity, Judaism, and Islam. Some examples of honoring motherhood include the Madonna or Blessed Virgin Mother Mary for Catholics, and the multiple positive references to active womanhood as a mother in the Book of Proverbs. Hindus Mother Goddess and Demeter of ancient Greek pre-Christian belief are also mothers. Mother-offspring violence
History records many conflicts between mothers and their children. Some even resulted in murder, such as the conflict between Cleopatra III of Egypt and her son Ptolemy X. In modern cultures, matricide (the killing of ones mother) and filicide (the killing of ones son or daughter) have been studied but remain poorly understood. Psychosis and schizophrenia are common causes of both, and young, indigent mothers with a history of domestic abuse are slightly more likely to commit filicide. Mothers are more likely to commit filicide than fathers when the child is 8 years old or younger. Matricide is most frequently committed by adult sons.In the United States in 2012, there were 130 matricides (0.4 per million people) and 383 filicides (1.2 per million), or 1.4 incidents per day. | 11
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In the past decade, itraconazole has been explored as an anticancer agent for patients with basal cell carcinoma, non-small cell lung cancer, and prostate cancer. For example, in a phase II study involving men with advanced prostate cancer, high-dose itraconazole (600 mg/day) was associated with significant PSA responses and a delay in tumor progression. Itraconazole also showed activity in a phase II trial in men with non-small cell lung cancer when it was combined with the chemotherapy agent, pemetrexed. A recent review has also highlights its use topically and orally in conjunction with other chemotherapeutic agents for advanced and metastatic basal cell carcinomas that cannot be treated surgically. Available forms
Itraconazole is produced as blue 22 mm (0.87 in) capsules with tiny 1.5 mm (0.059 in) blue pellets inside. Each capsule contains 100 mg and is usually taken twice a day at twelve-hour intervals. The Sporanox brand of itraconazole has been developed and marketed by Janssen Pharmaceutica, a subsidiary of Johnson & Johnson. The three-layer structure of these blue capsules is complex because itraconazole is insoluble and is sensitive to pH. The complicated procedure not only requires a specialized machine to create it, but also the method used has manufacturing problems. Also, the pill is quite large, making it difficult for many patients to swallow. Parts of the processes of creating Sporanox were discovered by the Korean Patent Laid-open No. 10-2001-2590. The tiny blue pellets contained in the capsule are manufactured in Beerse, Belgium.The oral solution is better absorbed. | Myeloperoxidase deficiency is a disorder featuring lack in either the quantity or the function of myeloperoxidase–an iron-containing protein expressed primarily in neutrophil granules. There are two types of myeloperoxidase deficiency: primary/inherited and secondary/acquired. Lack of functional myeloperoxidase leads to less efficient killing of intracellular pathogens, particularly Candida albicans, as well as less efficient production and release of neutrophil extracellular traps (NETs) from the neutrophils to trap and kill extracellular pathogens. Despite these characteristics, more than 95% of individuals with myeloperoxidase deficiency experience no symptoms in their lifetime. For those who do experience symptoms, the most common symptom is frequent infections by Candida albicans. Individuals with myeloperoxidase deficiency also experience higher rates of chronic inflammatory conditions. Myeloperoxidase deficiency is diagnosed using flow cytometry or cytochemical stains. There is no treatment for myeloperoxidase deficiency itself. Rather, in the rare cases that individuals experience symptoms, these infections should be treated. Pathophysiology
The innate immune system responds quickly to infection, with neutrophils (a type of white blood cells) being the first responders. Neutrophils enter the site of infection and begin to phagocytose (take up) pathogens. Once engulfed, the neutrophils must then degrade the captured pathogens–a process known as intracellular killing.One method of intracellular killing which takes place in the phagolysosomes of neutrophils involves the reaction of myeloperoxidase with hydrogen peroxide (H2O2) acquired in the cells from NADPH oxidase through the respiratory bursts. This reaction generates several acidic products including hypochlorous acid (HClO), which can break down pathogens. | 0-1
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The first case was identified as a fatal wasting syndrome in the 1960s. It was then recognized as a transmissible spongiform encephalopathy in 1978. Surveillance studies showed the endemic of CWD in free-ranging deer and elk spread in northeastern Colorado, southeastern Wyoming and western Nebraska. It was also discovered that CWD may have been present in a proportion of free-ranging animals decades before the initial recognition. In the United States, the discovery of CWD raised concerns about the transmission of this prion disease to humans. Many apparent cases of CJD were suspected transmission of CWD, however the evidence was lacking and not convincing.In the 1980s and 1990s, bovine spongiform encephalopathy (BSE or "mad cow disease") spread in cattle at an epidemic rate. The total estimated number of cattle infected was approximately 750,000 between 1980 and 1996. This occurred because the cattle were fed processed remains of other cattle. Then human consumption of these infected cattle caused an outbreak of the human form CJD. There was a dramatic decline in BSE when feeding bans were put in place. On May 20, 2003, the first case of BSE was confirmed in North America. The source could not be clearly identified, but researchers suspect it came from imported BSE-infected cow meat. In the United States, the USDA created safeguards to minimize the risk of BSE exposure to humans.Variant Creutzfeldt-Jakob disease (vCJD) was discovered in 1996 in England. There is strong evidence to suggest that vCJD was caused by the same prion as bovine spongiform encephalopathy. | A total of 231 cases of vCJD have been reported since it was first discovered. These cases have been found in a total of 12 countries with 178 in the United Kingdom, 27 in France, five in Spain, four in Ireland, four in the United States, three in the Netherlands, three in Italy, two in Portugal, two in Canada, and one each in Japan, Saudi Arabia, and Taiwan. History
In the 5th century BCE, Hippocrates described a disease like TSE in cattle and sheep, which he believed also occurred in man. Publius Flavius Vegetius Renatus records cases of a disease with similar characteristics in the 4th and 5th centuries AD. In 1755, an outbreak of scrapie was discussed in the British House of Commons and may have been present in Britain for some time before that. Although there were unsupported claims in 1759 that the disease was contagious, in general it was thought to be due to inbreeding and countermeasures appeared to be successful. Early-20th-century experiments failed to show transmission of scrapie between animals, until extraordinary measures were taken such as the intra-ocular injection of infected nervous tissue. No direct link between scrapie and disease in man was suspected then or has been found since. TSE was first described in man by Alfons Maria Jakob in 1921. Daniel Carleton Gajduseks discovery that Kuru was transmitted by cannibalism accompanied by the finding of scrapie-like lesions in the brains of Kuru victims strongly suggested an infectious basis to TSE. | 11
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Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered to women considering surgery as a non-surgical alternative. Surgery
With surgery (for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, colpocleisis). Surgery is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. Evidence does not support the use of transvaginal surgical mesh compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. For posterior vaginal repair, the use of mesh or graft material does not seem to provide any benefits. Safety and efficacy of many newer meshes is unknown. The use of a transvaginal mesh in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation. Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. According to the FDA, serious complications are "not rare." A number of class action lawsuits have been filed and settled against several manufacturers of TVM devices.Compared to native tissue repair, transvaginal permanent mesh probably reduces womens perception of vaginal prolapse sensation and probably reduces the risk of recurrent prolapse and of having repeat surgery for prolapse. On the other hand, transvaginal mesh probably has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure. | Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting.In men, it may occur after the prostate gland is removed. The injury occurs to fascia membranes and other connective structures that can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery. Types
Anterior vaginal wall prolapse
Cystocele (bladder into vagina)
Urethrocele (urethra into vagina)
Cystourethrocele (both bladder and urethra)
Posterior vaginal wall prolapse
Enterocele (small intestine into vagina)
Rectocele (rectum into vagina)
Sigmoidocele
Apical vaginal prolapse
Uterine prolapse (uterus into vagina)
Vaginal vault prolapse (roof of vagina) – after hysterectomy
Grading
Pelvic organ prolapses are graded either via the Baden–Walker System, Shaws System, or the Pelvic Organ Prolapse Quantification (POP-Q) System. Shaws System
Anterior wall
Upper 2/3 cystocele
Lower 1/3 urethrocelePosterior wall
Upper 1/3 enterocele
Middle 1/3 rectocele
Lower 1/3 deficient perineumUterine prolapse
Grade 0 Normal position
Grade 1 descent into vagina not reaching introitus
Grade 2 descent up to the introitus
Grade 3 descent outside the introitus
Grade 4 Procidentia
Baden–Walker
POP-Q
Management
Vaginal prolapses are treated according to the severity of symptoms. Non-surgical
With conservative measures, such as changes in diet and fitness, Kegel exercises, and pelvic floor physical therapy.With a pessary, a rubber or silicone rubber device fitted to the patient which is inserted into the vagina and may be retained for up to several months. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. | 11
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The hindlimb development lags behind forelimb development by 1–2 days. Function
As the femur is the only bone in the thigh, it serves as an attachment point for all the muscles that exert their force over the hip and knee joints. Some biarticular muscles – which cross two joints, like the gastrocnemius and plantaris muscles – also originate from the femur. In all, 23 individual muscles either originate from or insert onto the femur. In cross-section, the thigh is divided up into three separate fascial compartments divided by fascia, each containing muscles. These compartments use the femur as an axis, and are separated by tough connective tissue membranes (or septa). Each of these compartments has its own blood and nerve supply, and contains a different group of muscles. These compartments are named the anterior, medial and posterior fascial compartments. Muscle attachments
Clinical significance
Fractures
A femoral fracture that involves the femoral head, femoral neck or the shaft of the femur immediately below the lesser trochanter may be classified as a hip fracture, especially when associated with osteoporosis. Femur fractures can be managed in a pre-hospital setting with the use of a traction splint. Diversity among animals
In primitive tetrapods, the main points of muscle attachment along the femur are the internal trochanter and third trochanter, and a ridge along the ventral surface of the femoral shaft referred to as the adductor crest. The neck of the femur is generally minimal or absent in the most primitive forms, reflecting a simple attachment to the acetabulum. | The size of the tubercle varies and it is not always located on the intertrochanteric crest and that also adjacent areas can be part of the quadrate tubercle, such as the posterior surface of the greater trochanter or the neck of the femur. In a small anatomical study it was shown that the epiphyseal line passes directly through the quadrate tubercle. Body
The body of the femur (or shaft) is large, thick and almost cylindrical in form. It is a little broader above than in the center, broadest and somewhat flattened from before backward below. It is slightly arched, so as to be convex in front, and concave behind, where it is strengthened by a prominent longitudinal ridge, the linea aspera which diverges proximally and distal as the medial and lateral ridge. Proximally the lateral ridge of the linea aspera becomes the gluteal tuberosity while the medial ridge continues as the pectineal line. Besides the linea aspera the shaft has two other bordes; a lateral and medial border. These three bordes separates the shaft into three surfaces: One anterior, one medial and one lateral. Due to the vast musculature of the thigh the shaft can not be palpated.The third trochanter is a bony projection occasionally present on the proximal femur near the superior border of the gluteal tuberosity. When present, it is oblong, rounded, or conical in shape and sometimes continuous with the gluteal ridge. | 11
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This can be seen in people who are experiencing the classic signs of pericarditis but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, pulsus paradoxus (decrease of at least 10 mmHg of the systolic blood pressure upon inspiration), low blood pressure (due to decreased cardiac index), (jugular vein distention from right sided heart failure and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid.In such cases of cardiac tamponade, EKG or Holter monitor will then depict electrical alternans indicating wobbling of the heart in the fluid filled pericardium, and the capillary refill might decrease, as well as severe vascular collapse and altered mental status due to hypoperfusion of body organs by a heart that can not pump out blood effectively.The diagnosis of tamponade can be confirmed with trans-thoracic echocardiography (TTE), which should show a large pericardial effusion and diastolic collapse of the right ventricle and right atrium. Chest X-ray usually shows an enlarged cardiac silhouette ("water bottle" appearance) and clear lungs. Pulmonary congestion is typically not seen because equalization of diastolic pressures constrains the pulmonary capillary wedge pressure to the intra-pericardial pressure (and all other diastolic pressures). Causes
Infectious
Pericarditis may be caused by viral, bacterial, or fungal infection. In the developed world, viruses are believed to be the cause of about 85% of cases. | Diagnosis
In the diagnosis of pulmonary insufficiency both echocardiograms and ECG is used to ascertain if the individual has this condition, as well as, the use of a chest x-ray to expose enlargement of the right atrium or ventricle. Treatment
In treating pulmonary insufficiency, it should be determined if pulmonary hypertension is causing the problem to therefore begin the most appropriate therapy as soon as possible (primary pulmonary hypertension or secondary pulmonary hypertension due to thromboembolism). Furthermore, pulmonary insufficiency is generally treated by addressing the underlying condition, in certain cases, the pulmonary valve may be surgically replaced. See also
Pulmonary valve stenosis
References
Further reading
Lake, Carol L.; Booker, Peter D. (2005-01-01). Pediatric Cardiac Anesthesia. Lippincott Williams & Wilkins. ISBN 9780781751759. Bruce, Charles J.; Connolly, Heidi M. (2009-05-26). "Right-Sided Valve Disease Deserves a Little More Respect". Circulation. 119 (20): 2726–2734. doi:10.1161/CIRCULATIONAHA.108.776021. ISSN 0009-7322. PMID 19470901. M.D, Steven Lehrer (2011-12-27). Understanding Pediatric Heart Sounds. Steven Lehrer. ISBN 9781468138030. External links
"Problem: Pulmonary Valve Regurgitation". www.heart.org. Retrieved 2015-08-29. | 0-1
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It tends to progress rapidly and is fatal in about half of sinus cases and almost all cases of the widespread type.Mucormycosis is usually rare, affecting fewer than 2 people per million people each year in San Francisco, but is now ~80 times more common in India. People of any age may be affected, including premature infants. The first known case of mucormycosis was possibly the one described by Friedrich Küchenmeister in 1855. The disease has been reported in natural disasters; 2004 Indian Ocean tsunami and the 2011 Missouri tornado. During the COVID-19 pandemic, an association between mucormycosis and COVID-19 has been reported. This association is thought to relate to reduced immune function during the course of the illness and may also be related to glucocorticoid therapy for COVID-19. A rise in cases was particularly noted in India. Classification
Generally, mucormycosis is classified into five main types according to the part of the body affected. A sixth type has been described as mucormycosis of the kidney, or miscellaneous, i.e., mucormycosis at other sites, although less commonly affected. Sinuses and brain (rhinocerebral); most common in people with poorly controlled diabetes and in people who have had a kidney transplant. Lungs (pulmonary); the most common type of mucormycosis in people with cancer and in people who have had an organ transplant or a stem cell transplant. Stomach and intestine (gastrointestinal); more common among young, premature, and low birth weight infants, who have had antibiotics, surgery, or medications that lower the bodys ability to fight infection. | The appearances can vary but generally show wide, ribbon-like filaments that generally do not have septa and that—unlike in aspergillosis—branch at right angles, resembling antlers of a moose, which may be seen to be invading blood vessels. Other
Matrix-assisted laser desorption/ionization may be used to identify the species. A blood sample from an artery may be useful to assess for metabolic acidosis. Differential diagnosis
Other filamentous fungi may however look similar. It may be difficult to differentiate from aspergillosis. Other possible diagnoses include anthrax, cellulitis, bowel obstruction, ecthyma gangrenosum, lung cancer, clot in lungs, sinusitis, tuberculosis and fusariosis. Prevention
Preventive measures include wearing a face mask in dusty areas, washing hands, avoiding direct contact with water-damaged buildings, and protecting skin, feet, and hands where there is exposure to soil or manure, such as gardening or certain outdoor work. In high risk groups, such as organ transplant patients, antifungal drugs may be given as a preventative. Treatment
Treatment involves a combination of antifungal drugs, surgically removing infecting tissue and correcting underlying medical problems, such as diabetic ketoacidosis. Medication
Once mucormycosis is suspected, amphotericin B at an initial dose of 1 mg is initially given slowly over 10–15 minutes into a vein, then given as a once daily dose according to body weight for the next 14 days. It may need to be continued for longer. Isavuconazole and Posaconazole are alternatives. Surgery
Surgery can be very drastic, and, in some cases of disease involving the nasal cavity and the brain, removal of infected brain tissue may be required. | 11
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With the discontinuation of the steroid drop the subretinal fluid resolved and did not show any sign of recurrence. Thus indicating the steroid was the probable cause of the CSR. A study of 60 persons with Cushings syndrome found CSR in 3 (5%). Cushings syndrome is characterized by very high cortisol levels. Certain sympathomimetic drugs have also been associated with causing the disease.Evidence has also implicated helicobacter pylori (see gastritis) as playing a role. It would appear that the presence of the bacteria is well correlated with visual acuity and other retinal findings following an attack. Evidence also shows that people with MPGN type II kidney disease can develop retinal abnormalities including CSR caused by deposits of the same material that originally damaged the glomerular basement membrane in the kidneys. Diagnosis
The diagnosis usually starts with a dilated examination of the retina, followed with confirmation by optical coherence tomography and fluorescein angiography. The angiography test will usually show one or more fluorescent spots with fluid leakage. In 10%-15% of the cases these will appear in a "classic" smokestack shape. Differential diagnosis should be immediately performed to rule out retinal detachment, which is a medical emergency. A clinical record should be taken to keep a timeline of the detachment. The affected eye will sometimes exhibit a refractive spectacle prescription that is more far-sighted than the fellow eye due to the decreased focal length caused by the raising of the retina. | With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area and replace it with new living tissue. The replacement can happen in two ways: by regeneration in which the necrotic cells are replaced by new cells that form "like" tissue as was originally there; or by repair in which injured tissue is replaced with scar tissue. Most organs will heal using a mixture of both mechanisms.Within surgery, healing is more often referred to as recovery, and postoperative recovery has historically been viewed simply as restitution of function and readiness for discharge. More recently, it has been described as an energy‐requiring process to decrease physical symptoms, reach a level of emotional well‐being, regain functions, and re‐establish activitiesHealing is also referred to in the context of the grieving process.In psychiatry and psychology, healing is the process by which neuroses and psychoses are resolved to the degree that the client is able to lead a normal or fulfilling existence without being overwhelmed by psychopathological phenomena. This process may involve psychotherapy, pharmaceutical treatment or alternative approaches such as traditional spiritual healing. Regeneration
In order for an injury to be healed by regeneration, the cell type that was destroyed must be able to replicate. Cells also need a collagen framework along which to grow. | 0-1
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Lorazepam tablets of the Ativan brand also contain lactose, microcrystalline cellulose, polacrilin, magnesium stearate, and coloring agents (indigo carmine in blue tablets and tartrazine in yellow tablets). Lorazepam for injection formulated with polyethylene glycol 400 in propylene glycol with 2.0% benzyl alcohol as preservative. Lorazepam injectable solution is administered either by deep intramuscular injection or by intravenous injection. The injectable solution comes in 1 mL ampoules containing 2 or 4 mg of lorazepam. The solvents used are polyethylene glycol 400 and propylene glycol. As a preservative, the injectable solution contains benzyl alcohol. Toxicity from propylene glycol has been reported in the case of a person receiving a continuous lorazepam infusion. Intravenous injections should be given slowly and they should be closely monitored for side effects, such as respiratory depression, hypotension, or loss of airway control. Peak effects roughly coincide with peak serum levels, which occur 10 minutes after intravenous injection, up to 60 minutes after intramuscular injection, and 90 to 120 minutes after oral administration, but initial effects will be noted before this. A clinically relevant lorazepam dose will normally be effective for six to 12 hours, making it unsuitable for regular once-daily administration, so it is usually prescribed as two to four daily doses when taken regularly, but this may be extended to five or six, especially in the case of elderly people who could not handle large doses at once. | A very rapid descent, usually by accident, may exceed the rate at which the breathing gas supply can equalise the pressure causing a temporary squeeze. The introduction of the non-return valve and high maximum gas supply flow rates have all but eliminated both these risks. In helmets fitted with a neck dam, the dam will admit water into the helmet if the internal pressure gets too low; this is less of a problem than helmet squeeze but the diver may drown if the gas supply is not reinstated quickly. : 90 This form of barotrauma is avoidable by controlled descent rate, which is standard practice for commercial divers, who will use shotlines, diving stages and wet bells to control descent and ascent rates. Medical screening
Professional divers are screened for risk factors during initial and periodical medical examination for fitness to dive. In most cases recreational divers are not medically screened, but are required to provide a medical statement before acceptance for training in which the most common and easy to identify risk factors must be declared. If these factors are declared, the diver may be required to be examined by a medical practitioner, and may be disqualified from diving if the conditions indicate.Asthma, Marfan syndrome, and COPD pose a very high risk of pneumothorax. In some countries these may be considered absolute contraindications, while in others the severity may be taken into consideration. Asthmatics with a mild and well controlled condition may be permitted to dive under restricted circumstances. | 0-1
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The doctors also must consider the possibility of reconstructive surgery and the social and learning issues the twins may have to face after they are separated. Due to advances in neuroimaging, neuroanesthesia, and neurosurgical techniques, successful separation operations have become more common. Physical traits like joined brain tissue, shared arteries and veins, as well as defects in the skull and dura mater complicate a separation operation.Neuroimaging especially plays an important role because it is imperative in surgical planning to understand the shared vascular anatomy—including the brain parenchyma, calvaria, and dura mater—because separating shared vessels can lead to thrombosis, air embolism, cerebral infarction, and hemorrhage. Technologies such as CT scans, MRIs, and angiography are used to map the shared vascular structures. Cases
Emilie and Elisabeth Stoll were born on January 17, 1912. Their parents exhibited them until their death in July 1912. Their cause of death is unknown, but they were probably weakened by the stress of travelling and exhibition. Rodney and Roger Brodie were born in Rock Island, Illinois, in 1951. In December 1952 a medical team led by neurosurgeon Oscar Sugar attempted to separate the 15-month old twins in a surgery that lasted 12 hours. During surgery, the doctors discovered that the twins shared the superior sagittal sinus, the canal that drains blood from the brain to the heart. This vessel was retained by Rodney Brodie. Both twins survived the surgery, although Roger did not regain consciousness and died 34 days later. | Another study found that for craniopagus twins, their connection to each other is comparable to our normal appendages and that their bodies have obvious overlapping physically and psychologically. Because most cases of craniopagus twins are unique, the research outlining general connections between craniopagus twins is limited. However, this example provides insight into the effects of a union between twins who essentially share the same sensory relay system in the thalamus. History
Conjoined twinning is one of the oldest known birth defects in history and examples with humans fascination with twins is extremely evident throughout historical literature. Although there are cases of conjoined twins dating back to as early as the 10th century, it was not until 1491 that the first case was documented. Apart from that, Sebastian Münster’s Cosmographia universalis provides the true first account of craniopagus twins who happened to live for ten years, exceeding many expectations during that time. He describes the set of twins as being a unique malformation and a punishment from their mothers mistake. In French barber surgeon Ambroise Paré’s 16th-century book, On Monsters and Marvels, various types of "supernatural" twinning are illustrated and described as "monstrous and marvelous creatures that proceed from the judgment of God", suggesting that conjoined twins and specifically craniopagus twins were viewed as literal monsters in the 16th century. See also
Conjoined twins
Parasitic twin
Twin
References
== External links == | 11
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Arterial blood with an elevated methemoglobin level has a characteristic chocolate-brown color as compared to normal bright red oxygen-containing arterial blood; the color can be compared with reference charts.The SaO2 calculation in the arterial blood gas analysis is falsely normal, as it is calculated under the premise of hemoglobin either being oxyhemoglobin or deoxyhemoglobin. However, co-oximetry can distinguish the methemoglobin concentration and percentage of hemoblobin. At the same time, the SpO2 concentration as measured by pulse ox is false high, because methemoglobin absorbs the pulse ox light at the 2 wavelengths it uses to calculate the ratio of oxyhemoglobin and deoxyhemoglobin. For example with a methemoglobin level of 30-35%, this ratio of light absorbance is 1.0, which translates into a false high SpO2 of 85%. Differential diagnosis
Other conditions that can cause bluish skin include argyria, sulfhemoglobinemia, heart failure, Amiodarone-induced bluish skin pigmentation and acrodermatitis enteropathica. Treatment
Methemoglobinemia can be treated with supplemental oxygen and methylene blue. Methylene blue is given as a 1% solution (10 mg/ml) 1 to 2 mg/kg administered intravenously slowly over five minutes. Although the response is usually rapid, the dose may be repeated in one hour if the level of methemoglobin is still high one hour after the initial infusion. Methylene blue inhibits monoamine oxidase, and serotonin toxicity can occur if taken with an SSRI (selective serotonin reuptake inhibitor) medicine.Methylene blue restores the iron in hemoglobin to its normal (reduced) oxygen-carrying state. | Instead of being red in color, the arterial blood of met-Hb patients is brown. This results in the skin of white patients gaining a bluish hue. Hereditary met-Hb is caused by a recessive gene. If only one parent has this gene, offspring will have normal-hued skin, but if both parents carry the gene, there is a chance the offspring will have blue-hued skin.Another cause of congenital methemoglobinemia is seen in patients with abnormal hemoglobin variants such as hemoglobin M (HbM), or hemoglobin H (HbH), which are not amenable to reduction despite intact enzyme systems.Methemoglobinemia can also arise in patients with pyruvate kinase deficiency due to impaired production of NADH – the essential cofactor for diaphorase I. Similarly, patients with glucose-6-phosphate dehydrogenase deficiency may have impaired production of another co-factor, NADPH. Pathophysiology
The affinity for oxygen of ferric iron is impaired. The binding of oxygen to methemoglobin results in an increased affinity for oxygen in the remaining heme sites that are in ferrous state within the same tetrameric hemoglobin unit. This leads to an overall reduced ability of the red blood cell to release oxygen to tissues, with the associated oxygen–hemoglobin dissociation curve therefore shifted to the left. When methemoglobin concentration is elevated in red blood cells, tissue hypoxia may occur.Normally, methemoglobin levels are <1%, as measured by the CO-oximetry test. | 11
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How well these individuals are able to manage after leaving hospital is not clear.The global rate of people who were able to recover from out-of-hospital cardiac arrest after receiving CPR has been found to be approximately 30%, and the rate of survival to discharge from the hospital has been estimated at 9%. Survival to discharge from the hospital is more likely among people whose cardiac arrest was witnessed by a bystander or emergency medical services, who received bystander CPR and among those living in Europe and North America. Relatively lower survival to hospital discharge rates have been observed in Asian countries. Epidemiology
The risk of cardiac arrest varies with geographical region, age, and gender. The lifetime risk is three times greater in men (12.3%) than women (4.2%) based on analysis of the Framingham Heart Study. However this gender difference disappeared beyond 85 years of age. Around half of these individuals are younger than 65 years of age. North America
Based on death certificates, sudden cardiac death accounts for about 20% of all deaths in the United States. In the United States, approximately 326,000 cases of out-of-hospital and 209,000 cases of in-hospital cardiac arrest occur among adults a year, which works out to be an incidence of approximately 110.8 per 100,000 adults a year. In the United States, during-pregnancy cardiac arrest occurs in about one in twelve-thousand deliveries or 1.8 per 10,000 live births. Rates are lower in Canada. Other regions
Non-Western regions of the world have differing incidences. | Central Nervous System
Megalencephaly
The M in MLC stands for “megalencephaly”, the enlargement of the brain
Ataxia
Slow, progressive and early-onset cerebellar ataxia has been noted in many patients
Spasticity
Patients with MLC often have muscle spasms
Seizures
Delay in motor development
Mild mental retardation
Diffuse swelling of cerebral white matter
Large subcortical cysts in frontal and temporal lobes
Patients develop cysts on the tips of the temporal and subcortical area
Diffuse spongiform leukoencephalopathy
Vacuolizing myelinopathy
The protective myelin sheath on neurons pulls away from their cells forming small holes in nerve fibers – in turn affecting coordination and walking ability. Genetics
It is associated with MLC1. The MLC1 gene is located in chromosome 22q13.33 and is in the genomic coordinates 22:50,059,390 – 50,085874. The gene contains 12 exons and that contain a start codon in exon 2 and an untranslated region in the 3’ end. The MLC1 gene product is a 377 amino acid protein highly expressed in the brain. The disease is caused by a homozygous or compound heterozygous mutation in the gene, MLC1. Previous research indicates that deficiency of cell surface protein expression of the MLC1 gene is the basis for the disorder. The mutant protein is expressed in intracellular compartments reducing the membrane surface expression when compared to the wild type. Diagnosis
Diagnosis of Megalencephalic leukoencephalopathy with subcortical cysts is made with a combination of physical and clinical evaluations. The presence of frontal and temporal subcortical cysts is the main factor when diagnosing a patient with this disease. | 0-1
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Sleep-related hypermotor epilepsy (SHE), previously known as nocturnal frontal lobe epilepsy, is a form of focal epilepsy characterized by seizures which arise during sleep. The seizures are most typically characterized by complex motor behaviors. It is a relatively uncommon form of epilepsy that constitutes approximately 9-13% of cases. This disorder is associated with cognitive impairment in at least half of patients as well as excessive daytime sleepiness due to poor sleep quality. This disorder is sometimes misdiagnosed as a non-epileptic sleep disorder. There are many potential causes of SHE including genetic, acquired injuries and structural abnormalities. History
In 1981, Lugaresi and Cirignotta described a group of 5 patients with paroxysmal attacks of violent movements of the extremities and dystonic-tonic posturing. It was initially uncertain whether these events constituted seizures or something else. However, the patients had a good clinical response to the anti-seizure medication carbamazepine. Ultimately, the epileptic nature of this condition was confirmed with EEG and suggested that they were coming from the frontal lobe. The term “nocturnal frontal lobe epilepsy” was suggested as a name for this condition. Later in 2014, a consensus conference recommended that the name be changed to sleep-related hypermotor epilepsy. There were three main justifications for this change: (1) not all seizures arise from the frontal lobe; (2) seizures do not necessarily occur during the night but rather from sleep; (3) hypermotor describes the most common visible clinical manifestation of the seizures. Symptoms
Seizures in SHE are brief and usually have an abrupt onset and offset. | Post-void dribbling occurs when urine remaining in the urethra after voiding the bladder slowly leaks out after urination. A common and usually benign complaint, it may be a symptom of urethral diverticulum, prostatitis and other medical problems.Some men who experience dribbling, especially after prostate cancer surgery, will choose to wear incontinence pads to stay dry. Also known as guards for men, these incontinence pads conform to the male body. Some of the most popular male guards are from TENA, Depend, and Prevail. Simple ways to prevent dribbling include: strengthening pelvic muscles with Kegel exercises, changing position while urinating, or pressing on the perineum to evacuate the remaining urine from the urethra. Sitting down while urinating is also shown to alleviate complaints: a meta-analysis on the effects of voiding position in elderly males with benign prostate hyperplasia found an improvement of urologic parameters in this position, while in healthy males no such influence was found. References
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Dextromethorphan is a medication most often used as a cough suppressant in over-the-counter cold and cough medicines. It is sold in syrup, tablet, spray, and lozenge forms. It is in the morphinan class of medications with sedative, dissociative, and stimulant properties (at lower doses). Dextromethorphan does not have a significant affinity for the mu-opioid receptor activity typical of morphinan compounds and exerts its therapeutic effects through several other receptors. In its pure form, dextromethorphan occurs as a white powder.Dextromethorphan is also used recreationally. When exceeding approved dosages, dextromethorphan acts as a dissociative hallucinogen. It has multiple mechanisms of action, including actions as a nonselective serotonin reuptake inhibitor and a sigma-1 receptor agonist. Dextromethorphan and its major metabolite, dextrorphan, also block the NMDA receptor at high doses, which produces effects similar to other dissociative anesthetics such as ketamine, nitrous oxide, and phencyclidine. It was patented in 1949 and approved for medical use in 1953. Medical uses
Cough suppression
The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), as well as those resulting from inhaled particle irritants. Pseudobulbar affect
In 2010, the FDA approved the combination drug dextromethorphan/quinidine for the treatment of pseudobulbar affect (uncontrollable laughing/crying). Dextromethorphan is the actual therapeutic agent in the combination; quinidine merely serves to inhibit the enzymatic degradation of dextromethorphan and thereby increase its circulating concentrations via inhibition of CYP2D6. | Some states have restricted the sale of dextromethorphan to adults or put other restrictions on its purchase in place, similar to those for pseudoephedrine. As of January 1, 2012, dextromethorphan is prohibited for sale to minors in the State of California and in the State of Oregon as of January 1, 2018, except with a doctors prescription. Several other states have also begun regulating sales of dextromethorphan to minors. In Indonesia, the National Agency of Drug and Food Control (BPOM-RI) prohibited single-component dextromethorphan drug sales with or without prescription. Indonesia is the only country in the world that makes single-component dextromethorphan illegal even by prescription and violators may be prosecuted by law. National Anti-Narcotics Agency (BNN RI) has even threatened to revoke pharmacies and drug stores licenses if they still stock dextromethorphan, and will notify the police for criminal prosecution. As a result of this regulation, 130 medications have been withdrawn from the market, but those containing multicomponent dextromethorphan can still be sold over the counter. Society and culture
Marketing
It may be used in generic labels and store brands, Benylin DM, Mucinex DM, Camydex-20 tablets, Robitussin, NyQuil, Dimetapp, Vicks, Coricidin, Delsym, TheraFlu, Charcoal D, Cinfatós and others. It has been used in counterfeit medications. Recreational use
Over-the-counter preparations containing dextromethorphan have been used in manners inconsistent with their labeling, often as a recreational drug. | 11
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Less frequently, the whole brachial plexus lesion occurs;
most infrequently, sudden upward pulling on an abducted arm (as when someone breaks a fall by grasping a tree branch) produces a lower brachial plexus lesion, in which the eighth cervical (C8) and first thoracic (T1) nerves are injured "either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand and the flexors of the wrist and fingers". This results in a form of paralysis known as Klumpkes paralysis.Backpack palsy is caused by much use of a heavy backpack whose pack-straps chronically press on the brachial plexus. Mechanism
Injury to the brachial plexus can happen in numerous environments. These may include contact sports, motor vehicle accidents, and birth. Although these are but a common few events, there is one of two mechanisms of injury that remain constant during the point of injury. The two mechanisms that can occur are traction and heavy impact. Anatomy
The brachial plexus is made up of spinal nerves that are part of the peripheral nervous system. It includes sensory and motor nerves that innervate the upper limbs. The brachial plexus includes the last four cervical nerves (C5-C8) and the 1st thoracic nerve (T1). Each of those nerves splits into smaller trunks, divisions, and cords. The lateral cord includes the musculocutaneous nerve and lateral branch of the median nerve. The medial cord includes the medial branch of the median nerve and the ulnar nerve. The posterior cord includes the axillary nerve and radial nerve. | The epineurium of the nerve is contiguous with the dura mater, providing extra support to the nerve.Brachial plexus lesions typically result from excessive stretching; from rupture injury where the nerve is torn but not at the spinal cord; or from avulsion injuries, where the nerve is torn from its attachment at the spinal cord. A bony fragment, pseudoaneurysm, hematoma, or callus formation of fractured clavicle can also put pressure on the injured nerve, disrupting innervation of the muscles. A trauma directly on the shoulder and neck region can crush the brachial plexus between the clavicle and the first rib.Although injuries can occur at any time, many brachial plexus injuries happen during birth: the babys shoulders may become impacted during the birth process causing the brachial plexus nerves to stretch or tear. Obstetric injuries may occur from mechanical injury involving shoulder dystocia during difficult childbirth, the most common of which result from injurious stretching of the childs brachial plexus during birth, most often during vaginal birth, but occasionally Caesarean section. The excessive stretch results in incomplete sensory and/or motor function of the injured nerve.Injuries to the brachial plexus result from excessive stretching or tearing of the C5-T1 nerve fibers. These injuries can be located in front of or behind the clavicle, nerve disruptions, or root avulsions from the spinal cord. These injuries are diagnosed based on clinical exams, axon reflex testing, and electrophysiological testing. Brachial plexus injuries require quick treatment in order for the patient to make a full functional recovery (Tung, 2003). | 11
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Diagnosed as definite or possible but limited to one limb or ≤5 contiguous segments of spine.Another set of criteria are:
Two or more nonintradermal (cutaneous) schwannomas
No evidence of vestibular tumor
No known NF-2 mutationor
One pathologically confirmed nonvestibular schwannoma plus a first degree relative who meets the above criteria. Treatment
Schwannomatosis patients represent 2.4% to 5% of patients undergoing surgical resection of their schwannomas. In isolated regions of the body schwannomas are small and difficult to locate. Intraoperative sonography offers invaluable assistance in such cases by localizing small schwannomas and decreasing operative time and extent of the surgical incision. If feasible, the schwannomas can be surgically removed. Any tumor-associated pain usually subsides after tumor removal. Damaged nerves and scar tissue can be a result of surgery and pain can be an ongoing problem. Sometimes, a tumor will reappear at the same site after surgery. If surgery is unfeasible, then pain management will have to be used. Schwannomatosis can sometimes cause severe, untreatable pain over time. Other than surgery and/or pain management, there are no other medical treatments available. There are no drugs available to treat Schwannomatosis. Gamma knife radiosurgery can be performed on head tumors to help stop growth of a tumor, although there is no guarantee that it will work. The University of Pittsburgh published their experience with over 829 cases and reported 97% of patients had long term tumor control (defined as requiring no further treatment) with Gamma knife radiosurgery. Recently, many advances are being made in the treatment of schwannomas. Of interest is CyberKnife, manufactured by Accuray. | However, molecular analysis of the NF2 gene in schwannomatosis patients has shown the presence of inactivating mutations in the tumor cells, but no evidence of the germline mutations that are found in NF2 patients.A mechanism involving both the SMARCB1 and NF2 genes may be responsible for the development of the disease because tumor analysis of schwannomas indicates the presence of inactivating mutations in both the SMARCB1 and NF2 genes. However, there is speculation about the involvement of an unidentified schwannomatosis gene(s) in most cases. This is because one study found no SMARCB1 germinal mutations in patients with familial schwannomatosis. Some schwannomatosis patients do not have SMARCB1 or NF2 mutations. Furthermore, many patients exhibit somatic mosaicism for mutations in the NF2 or SMARCB1 gene, which means that some somatic cells have the mutation and some do not in the same patient. Ultimately, the tumorigenesis of schwannomas is not solely dependent on one gene locus alone. In regards to the SMARCB1 and NF2 genes, it is important to understand constitutional mutations and somatic mutations. Constitutional mutations are the first inactivation events that are often small mutations, such as point mutations and deletion/insertion of single base pairs. Somatic mutations are the second mutations that occur and may also be another small mutation or the loss of the remaining allele of the gene. Schwannomas from one patient share the same constitutional mutations but have distinct somatic mutations. In addition, the constitutional mutation may be present in non-tumor.SMARCB1 is also known as INI1, hSNF5, or BAF47. | 11
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He begins his thesis with an introduction to the complex history of the word:
My argument, then, is that the fetish could originate only in conjunction with the emergent articulation of the ideology of the commodity form that defined itself within and against the social values and religious ideologies of two radically different types of noncapitalist society, as they encountered each other in an ongoing cross-cultural situation. This process is indicated in the history of the word itself as it developed from the late medieval Portuguese feitiço, to the sixteenth-century pidgin Fetisso on the African coast, to various northern European versions of the word via the 1602 text of the Dutchman Pieter de Marees... The fetish, then, not only originated from, but remains specific to, the problem of the social value of material objects as revealed in situations formed by the encounter of radically heterogeneous social systems, and a study of the history of the idea of the fetish may be guided by identifying those themes that persist throughout the various discourses and disciplines that have appropriated the term. Stallybrass concludes that "Pietz shows that the fetish as a concept was elaborated to demonize the supposedly arbitrary attachment of West Africans to material objects. The European subject was constituted in opposition to a demonized fetishism, through the disavowal of the object." History
Initially, the Portuguese developed the concept of the fetish to refer to the objects used in religious practices by West African natives. | Management
Monteggia fractures may be managed conservatively in children with closed reduction (resetting and casting), but due to high risk of displacement causing malunion, open reduction internal fixation is typically performed.Osteosynthesis (open reduction and internal fixation) of the ulnar shaft is considered the standard of care in adults. It promotes stability of the radial head dislocation and allows very early mobilisation to prevent stiffness. The elbow joint is particularly susceptible to loss of motion. Prognosis
In children, the results of early treatment are always good, typically normal or nearly so. If diagnosis is delayed, reconstructive surgery is needed and complications are much more common and results poorer. In adults, the healing is slower and results usually not as good.Complications of ORIF surgery for Monteggia fractures can include non-union, malunion, nerve palsy and damage, muscle damage, arthritis, tendonitis, infection, stiffness and loss of range of motion, compartment syndrome, audible popping or snapping, deformity, and chronic pain associated with surgical hardware such as pins, screws, and plates. Several surgeries may be needed to correct this type of fracture as it is almost always a very complex fracture that requires a skilled orthopedic surgeon, usually a specialist familiar with this type of injury. See also
Galeazzi fracture
Hume fracture
Essex-Lopresti fracture
References
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For example, in the U.S., a single 65 g dose of Gamunex brand in 2010 might be billed at the rate of $8,000 just for the immunoglobulin—not including other charges such as nurse administration.Immunosuppressive drugs are often of the cytotoxic (chemotherapy) class, including rituximab (Rituxan) which targets B cells, and cyclophosphamide, a drug which reduces the function of the immune system. Ciclosporin has also been used in CIDP but with less frequency as it is a newer approach. Ciclosporin is thought to bind to immunocompetent lymphocytes, especially T-lymphocytes.Non-cytotoxic immunosuppressive treatments usually include the anti-rejection transplant drugs azathioprine (Imuran/Azoran) and mycophenolate mofetil (Cellcept). In the U.S., these drugs are used "off-label", meaning that they do not have an indication for the treatment of CIDP in their package inserts. Before azathioprine is used, the patient should first have a blood test that ensures that azathioprine can safely be used.Anti-thymocyte globulin, an immunosuppressive agent that selectively destroys T lymphocytes is being studied for use in CIDP. Anti-thymocyte globulin is the gamma globulin fraction of antiserum from animals that have been immunized against human thymocytes. It is a polyclonal antibody. Although chemotherapeutic and immunosuppressive agents have shown to be effective in treating CIDP, significant evidence is lacking, mostly due to the heterogeneous nature of the disease in the patient population in addition to the lack of controlled trials.A review of several treatments found that azathioprine, interferon alpha and methotrexate were not effective. Cyclophosphamide and rituximab seem to have some response. Mycophenolate mofetil may be of use in milder cases. | Ganirelix prevents ovulation until it is triggered by injecting human chorionic gonadotrophin (hCG).Ganirelix is administered by a subcutaneous injection of 250 µg once per day during the mid to late follicular phase of a patients menstrual cycle. Treatment should start on the 5th or 6th day after the start of ovarian stimulation, and the mean duration for its use is five days. Preferably, the subcutaneous injections are delivered in the upper leg, and the patient can be trained to do this themself. Continued use of the drug should take place until the administration of hCG begins. hCG administration is begun when a sufficient number of follicles have developed due to the effects of endogenous and or exogenously administered follicle stimulating hormone. Contraindications
Ganirelix should not be used in women who are already pregnant, and because of this the onset of pregnancy must be ruled out before it is administered. Women using ganirelix should not breast feed, as it is not known whether ganirelix is excreted in breast milk. Side effects
Clinical studies have shown that the most common side effect is a slight reaction at the site of injection in the form of redness, and sometimes swelling. Clinical studies have shown that, one hour after injection, the incidence of at least one moderate or severe local skin reaction per treatment cycle was 12% in 4 patients treated with ganirelix and 25% in patients treated subcutaneously with a GnRH agonist. The local reactions generally disappear within 4 hours after administration. | 0-1
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While the treated patients still showed progressive neurological decline, and while none of them survived longer than expected from the normal course of the disease, the scientists at University College London who conducted the study see these early-stage results as encouraging and suggest to conduct a larger study, ideally at the earliest possible intervention. See also
Chronic traumatic encephalopathy
Chronic wasting disease
Kuru
References
External links
Creutzfeldt–Jakob disease at Curlie | Lomustine (INN); abbreviated as CCNU; original brand name CeeNU, now marketed as Gleostine) is an alkylating nitrosourea compound used in chemotherapy. It is closely related to semustine and is in the same family as streptozotocin. It is a highly lipid-soluble drug, thus it crosses the blood-brain barrier. This property makes it ideal for treating brain tumors, which is its primary use, although it is also used to treat Hodgkin lymphoma as a second-line option. Lomustine has a long time to nadir (the time when white blood cells reach their lowest number). Unlike carmustine, lomustine is administered orally. It is a bifunctional alkylating agent, alkylates both DNA and RNA, has the ability to created interstrand cross-links (ICLs) in DNA. As with other nitrosoureas, it may also inhibit several key enzymatic processes by carbamoylation of amino acids in proteins. Lomustine is cell-cycle nonspecific. It has also been used in veterinary practice as a treatment for mast cell tumors in dogs. Price increase
In the U.S., the patent for lomustine has expired, but only one company manufactures it. In 2013, Bristol-Myers Squibb Co. sold its CeeNU brand of lomustine to CordenPharma, a subsidiary of International Chemical Investors S.E., which markets it as Gleostine through NextSource Biotechnology. In 2013, BMS charged $50 a capsule. In 2018, NextSource charged $768 a capsule. Some doctors said the price increase made it unaffordable, and one doctor called it "price gouging." | 0-1
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These miners were trapped underground for 14 days, during which six of the miners died of suffocation. After their rescue, ten of the miners were studied for ten years. All but one were greatly affected by the experience, and six developed phobias to "confining or limiting situations". The only miner who did not develop any noticeable symptoms was the one who acted as leader.Another factor that could cause the onset of claustrophobia is "information received". As Aureau Walding states in "Causes of Claustrophobia", many people, especially children, learn who and what to fear by watching parents or peers. This method does not only apply to observing a teacher, but also observing victims. Vicarious classical conditioning also includes when a person sees another person exposed directly to an especially unpleasant situation. This would be analogous to observing someone getting stuck in a tight space, suffocated, or any of the other examples that were listed above. Prepared phobia
There is research that suggests that claustrophobia is not entirely a classically conditioned or learned phobia. It is not necessarily an inborn fear, but it is very likely what is called a prepared phobia. As Erin Gersley says in "Phobias: Causes and Treatments", humans are genetically predisposed to become afraid of things that are dangerous to them. Claustrophobia may fall under this category because of its "wide distribution… early onset and seeming easy acquisition, and its non-cognitive features." | Claustrophobia is the fear of confined spaces. It can be triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala and classical conditioning. One study indicates that 5–10% of the world population is affected by severe claustrophobia, but only a small percentage of these people receive some kind of treatment for the disorder. The term claustrophobia comes from Latin claustrum "a shut in place" and Greek φόβος, phóbos, "fear". Signs and symptoms
Claustrophobia is classified as a mental and behavioral disorder, specifically an anxiety disorder. Symptoms generally develop during childhood or adolescence. Claustrophobia is typically thought to have one key symptom: fear of suffocation. In at least one, if not several, of the following areas: small rooms, MRI or CAT scan apparatus, cars, buses, airplanes, trains, tunnels, underwater caves, cellars, elevators and caves. Being enclosed or thinking about being enclosed in a confined space can trigger fears of not being able to breathe properly, and running out of oxygen. | 11
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Disease-associated variants of either subunit of KATP, KCNJ11 and ABCC8, can result in a channel that is "stuck open", rendering the β cell unable to secrete insulin in response to high blood glucose. Children born with disease-associated KATP variants often have intrauterine growth restriction and resulting low birthweight. Similarly, the second most common cause of permanent neonatal diabetes is alterations to the gene that encodes insulin. Mutations associated with neonatal diabetes tend to cause misfolding of the insulin protein; misfolded insulin accumulates in the endoplasmic reticulum (ER), leading to ER stress and β-cell death.Most transient neonatal diabetes is caused by the over-expression of a cluster of genes on chromosome 6, a region called 6q24. Over-expression of 6q24 is often caused by anomylous epigenetic regulation of the locus. The copy of 6q24 inherited from ones father normally has much higher gene expression than the copy inherited from ones mother. Therefore, inheriting two copies of the gene region from ones father (either through uniparental disomy, or receiving two copies from ones father in addition to the copy from ones mother) commonly results in over-expression of the locus. Alternatively, inheriting a maternal copy of 6q24 with defective DNA methylation can result in similar over-expression of the locus.Variants in several other genes can cause neonatal diabetes, though these cases are much rarer. Genetic changes that disable the transcription factors CNOT1, GATA4, GATA6, PDX1, PTF1A, or RFX6 – all involved in the development of the pancreas – result in a shrunken or missing pancreas. | Thyrotoxicosis factitia (alimentary thyrotoxicosis, exogenous thyrotoxicosis) refers to a condition of thyrotoxicosis caused by the ingestion of exogenous thyroid hormone. It can be the result of mistaken ingestion of excess drug, such as levothyroxine and triiodothyronine, or as a symptom of Munchausen syndrome. It is an uncommon form of hyperthyroidism. Patients present with hyperthyroidism and may be mistaken for Graves’ disease, if TSH receptor positive, or thyroiditis because of absent uptake on a thyroid radionuclide uptake scan due to suppression of thyroid function by exogenous thyroid hormones. Ingestion of thyroid hormone also suppresses thyroglobulin levels helping to differentiate thyrotoxicosis factitia from other causes of hyperthyroidism, in which serum thyroglobulin is elevated. Caution, however, should be exercised in interpreting thyroglobulin results without thyroglobulin antibodies, since thyroglobulin antibodies commonly interfere in thyroglobulin immunoassays causing false positive and negative results which may lead to clinical misdirection. In such cases, increased faecal thyroxine levels in thyrotoxicosis factitia may help differentiate it from other causes of hyperthyroidism. See also
Foodborne illness
Liothyronine
References
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