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The rational clinical exam

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https://www.readbyqxmd.com/read/29204954/chronic-fluoxetine-induces-activity-changes-in-recovery-from-poststroke-anxiety-depression-and-cognitive-impairment
#1
Faranak Vahid-Ansari, Paul R Albert
Poststroke depression (PSD) is a common outcome of stroke that limits recovery and is only partially responsive to chronic antidepressant treatment. In order to elucidate changes in the cortical-limbic circuitry associated with PSD and its treatment, we examined a novel mouse model of persistent PSD. Focal endothelin-1-induced ischemia of the left medial prefrontal cortex (mPFC) in male C57BL6 mice resulted in a chronic anxiety and depression phenotype. Here, we show severe cognitive impairment in spatial learning and memory in the stroke mice...
December 4, 2017: Neurotherapeutics: the Journal of the American Society for Experimental NeuroTherapeutics
https://www.readbyqxmd.com/read/29202449/clonal-relationships-of-csf-b-cells-in-treatment-naive-multiple-sclerosis-patients
#2
Erica L Eggers, Brady A Michel, Hao Wu, Sheng-Zhi Wang, Carolyn J Bevan, Aya Abounasr, Natalie S Pierson, Antje Bischof, Max Kazer, Elizabeth Leitner, Ariele L Greenfield, Stanislas Demuth, Michael R Wilson, Roland G Henry, Bruce Ac Cree, Stephen L Hauser, H-Christian von Büdingen
A role of B cells in multiple sclerosis (MS) is well established, but there is limited understanding of their involvement during active disease. Here, we examined cerebrospinal fluid (CSF) and peripheral blood (PB) B cells in treatment-naive patients with MS or high-risk clinically isolated syndrome. Using flow cytometry, we found increased CSF lymphocytes with a disproportionate increase of B cells compared with T cells in patients with gadolinium-enhancing (Gd+) lesions on brain MRI. Ig gene heavy chain variable region (Ig-VH) repertoire sequencing of CSF and PB B cells revealed clonal relationships between intrathecal and peripheral B cell populations, which could be consistent with migration of B cells to and activation in the CNS in active MS...
November 16, 2017: JCI Insight
https://www.readbyqxmd.com/read/29189822/-cognitive-traps-and-clinical-decisions
#3
Matteo Motterlini
We are fallible, we have limited computational capabilities, limited access to information, little memory. Moreover, in everyday life, we feel joy, fear, anger, and other emotions that influence our decisions in a little, "calculated" way. Not everyone, however, is also aware that the mistakes we make are often systematic and therefore, in particular circumstances, are foreseeable. Doctors and patients are constantly called upon to make decisions. They need to identify relevant information (for example, the symptoms or outcome of an examination), formulate a judgment (for example a diagnosis), choose an action course among the various possible ones based on one's own preferences (e...
December 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29188854/short-term-impact-of-a-combined-nutraceutical-on-cognitive-function-perceived-stress-and-depression-in-young-elderly-with-cognitive-impairment-a-pilot-double-blind-randomized-clinical-trial
#4
A F Cicero, M Bove, A Colletti, M Rizzo, F Fogacci, M Giovannini, C Borghi
BACKGROUND: The prevalence of senile dementia is increasing worldwide, especially in the developed countries. Nevertheless, drug therapy isn't often enough to treat this condition. Researchers are evaluating the possible impact of a preventive approach, based on an improvement of lifestyle and the intake of micronutrients. Moreover, there is an increasing interest for combined nutraceuticals that can act as memory and learning enhancers, with a significant and beneficial potential on the cognitive disorders...
2017: Journal of Prevention of Alzheimer's Disease
https://www.readbyqxmd.com/read/29184361/phenotypic-and-genotypic-characterization-of-antimicrobial-susceptibility-of-avian-pathogenic-escherichia-coli-isolated-from-broiler-chickens
#5
Gamal Younis, Amal Awad, Nada Mohamed
Aim: Avian pathogenic Escherichia coli (APEC) is pathogenic strains of E. coli that are responsible for one of the most common bacterial diseases affecting poultry worldwide. This study was designed to determine the occurrence, antibiotic resistance profile, and antibiotic resistance genes of E. coli isolated from diseased and freshly dead broilers. Materials and Methods: In that context, a total of 200 broilers samples were examined by standard microbiological techniques for isolation of E...
October 2017: Veterinary World
https://www.readbyqxmd.com/read/29183293/prescribing-patterns-of-rural-family-physicians-a-study-in-kermanshah-province-iran
#6
Fariba Ahmadi, Ehsan Zarei
BACKGROUND: The inappropriate use of drugs due to irrational prescriptions is a common problem in Iran, but there is little evidence of prescription patterns in rural family physicians. This study aimed to explore the prescribing pattern and rational drug use indicators for family physicians using Index of Rational Drug Prescribing (IRDP) in Kermanshah Province, Iran. METHODS: In this retrospective study, 352,399 prescriptions from 184 family physicians in 103 primary health care (PHC) centers were examined...
November 28, 2017: BMC Public Health
https://www.readbyqxmd.com/read/29178420/drooling-is-no-early-sign-of-dysphagia-in-parkinson-s-disease
#7
J C Nienstedt, C Buhmann, M Bihler, A Niessen, R Plaetke, C Gerloff, C Pflug
BACKGROUND: Dysphagia is frequent and clinically highly relevant in Parkinson's disease (PD). For a rational dysphagia screening predictors are required. Previous investigations suggested that drooling correlates with dysphagia and may serve as its early sign. The aim of this study was to clarify the interrelationship of drooling and dysphagia. METHODS: In a controlled, cross-sectional, observational study, a total of 119 Parkinson outpatients and 32 controls were examined clinically and by flexible-endoscopic evaluation of swallowing (FEES)...
November 27, 2017: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
https://www.readbyqxmd.com/read/29155409/biomaterial-strategies-for-limiting-the-impact-of-secondary-events-following-spinal-cord-injury
#8
Trevor R Ham, Nic D Leipzig
The nature of traumatic spinal cord injury (SCI) often involves limited recovery and long-term quality of life complications. The initial injury sets off a variety of secondary cascades, which result in an expanded lesion area. Ultimately, the native tissue fails to regenerate. As treatments are developed in the laboratory, the management of this secondary cascade is an important first step in achieving recovery of normal function. Current literature identifies four broad targets for intervention: inflammation, oxidative stress, disruption of the blood-spinal cord barrier, and formation of an inhibitory glial scar...
November 20, 2017: Biomedical Materials
https://www.readbyqxmd.com/read/29139062/tools-in-asthma-evaluation-and-management-when-and-how-to-use-them
#9
REVIEW
Anna Mulholland, Alana Ainsworth, Naveen Pillarisetti
The goals of asthma management are accurate diagnosis, prompt initiation of treatment and monitoring of disease progression to limit potential morbidity and mortality. While the diagnosis and management is largely based on history taking and clinical examination, there are an increasing number of tools available that could be used to aid diagnosis, define phenotypes, monitor progress and assess response to treatment. Tools such as the Asthma Predictive Index could help in making predictions about the possibility of asthma in childhood based on certain clinical parameters in pre-schoolers...
November 15, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/29138883/hallmarks-of-bone-metastasis
#10
REVIEW
Rachelle W Johnson, Larry J Suva
Breast cancer bone metastasis develops as the result of a series of complex interactions between tumor cells, bone marrow cells, and resident bone cells. The net effect of these interactions are the disruption of normal bone homeostasis, often with significantly increased osteoclast and osteoblast activity, which has provided a rational target for controlling tumor progression, with little or no emphasis on tumor eradication. Indeed, the clinical course of metastatic breast cancer is relatively long, with patients likely to experience sequential skeletal-related events (SREs), often over lengthy periods of time, even up to decades...
November 14, 2017: Calcified Tissue International
https://www.readbyqxmd.com/read/29136449/does-this-patient-have-acute-mountain-sickness-the-rational-clinical-examination-systematic-review
#11
REVIEW
David Meier, Tinh-Hai Collet, Isabella Locatelli, Jacques Cornuz, Bengt Kayser, David L Simel, Claudio Sartori
Importance: Acute mountain sickness (AMS) affects more than 25% of individuals ascending to 3500 m (11 500 ft) and more than 50% of those above 6000 m (19 700 ft). AMS may progress from nonspecific symptoms to life-threatening high-altitude cerebral edema in less than 1% of patients. It is not clear how to best diagnose AMS. Objective: To systematically review studies assessing the accuracy of AMS diagnostic instruments, including the visual analog scale (VAS) score, which quantifies the overall feeling of sickness at altitude (VAS[O]; various thresholds), Acute Mountain Sickness-Cerebral score (AMS-C; ≥0...
November 14, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29135105/impact-of-abcb1-and-cyp2d6-polymorphisms-on-tamoxifen-treatment-outcomes-and-adverse-events-in-breast-cancer-patients
#12
Sona Argalacsova, Ondrej Slanar, Hana Bakhouche, Lubos Pertuzelka
PURPOSE: This study was designed to evaluate the effect of CYP2D6 and ABCB1 polymorphisms and co-medication on the outcomes and adverse events (AEs) of tamoxifen therapy. METHODS: In total, 258 women (187 postmenopausal and 71 premenopausal) with hormone positive breast carcinoma were retrospectively evaluated. CYP2D6 polymorphisms were evaluated with AmpliChip (Roche), and polymorphisms of ATP-binding cassettes B1 (P-glycoprotein) (ABCB1) rs2032582 and rs1045642 with restriction fragment length polymorphisms polymerase chain reaction (RFLP-PCR)...
September 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29110579/effects-of-glyphosate-residues-and-different-concentrate-feed-proportions-on-performance-energy-metabolism-and-health-characteristics-in-lactating-dairy-cows
#13
Karina Schnabel, Rolf Schmitz, Dirk von Soosten, Jana Frahm, Susanne Kersten, Ulrich Meyer, Gerhard Breves, Rudolf Hackenberg, Madeleine Spitzke, Sven Dänicke
The aim of this study was to examine the influence of glyphosate (GL) residues in feedstuffs on performance, energy balance and health-related characteristics of lactating dairy cows fed diets with different concentrate feed proportions. After an adaption period, 64 German Holstein cows (207 ± 49 d in milk; mean ± SD) were assigned to either groups receiving a GL contaminated total mixed ration (TMR) (GL groups) or an uncontaminated TMR (CON groups) during a 16 weeks trial. Contaminated feedstuffs used were legally GL-treated peas and wheat (straw and grain)...
December 2017: Archives of Animal Nutrition
https://www.readbyqxmd.com/read/29076171/randomised-clinical-trial-yoga-vs-a-low-fodmap-diet-in-patients-with-irritable-bowel-syndrome
#14
D Schumann, J Langhorst, G Dobos, H Cramer
BACKGROUND: Irritable bowel syndrome is the most frequent gastrointestinal disorder. It is assumed that lifestyle interventions might be a rational treatment approach. AIM: To examine the effect of a yoga-based intervention vs a low-FODMAP diet on patients with irritable bowel syndrome. METHODS: Fifty-nine patients with irritable bowel syndrome undertook a single-blind, randomised controlled trial involving yoga or a low-FODMAP diet for 12 weeks...
October 27, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29059071/a-rational-approach-to-the-patient-with-hematochezia
#15
Jason D Eckmann, Victor G Chedid, Conor G Loftus
PURPOSE OF REVIEW: Hematochezia is a common clinical presentation, with significant morbidity and economic burden. These patients often require costly interventions including hospitalization, blood transfusions, and radiologic or endoscopic procedures. The purpose of this review is to give a rational, concise approach to the patient with hematochezia, with special consideration of recent advances in the literature. RECENT FINDINGS: Recent studies pertaining to hematochezia have evaluated risk stratification, endoscopic intervention, evaluation of small bowel bleeding, and management of anticoagulation...
January 2018: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/29058481/effects-of-antiretroviral-treatment-and-nadir-cd4-count-in-progression-to-cardiovascular-events-and-related-comorbidities-in-a-hiv-brazilian-cohort-a-multi-stage-approach
#16
Raquel de Vasconcellos Carvalhaes de Oliveira, Silvia Emiko Shimakura, Dayse Pereira Campos, Yara Hahr Marques Hökerberg, Flaviana Pavan Victoriano, Sayonara Ribeiro, Valdiléa G Veloso, Beatriz Grinsztejn, Marilia Sá Carvalho
The use of highly active antiretroviral therapy has resulted in changes of comorbidity profile in people living with HIV (PLHIV), increasing non-AIDS-related events. The occurrence of cardiovascular events is greater in PLHIV, but the mechanism responsible for it is still controversial. This article aimed to investigate factors associated with the progression to cardiovascular events in PLHIV using HAART. A 15-years cohort study with 1135 PLHIV was conducted in Rio de Janeiro-Brazil. Clinical progression was stratified in five states: No comorbidities (s1), arterial hypertension (s2), lipid abnormalities (s3), hypertension and lipid abnormalities (s4) and major cardiovascular events (stroke, coronary artery disease, thrombosis or death) (s5)...
October 23, 2017: AIDS Care
https://www.readbyqxmd.com/read/29035729/pre-clinical-in-vitro-infection-models
#17
REVIEW
George L Drusano
Given the current magnitude of the problem of antimicrobial resistance, particularly in the hospital setting, getting new agents to patients at the right dose and schedule is incredibly important. In vitro systems such as the 1-compartment model and the hollow fiber infection model (HFIM) can provide valuable information that allows rational decisions to be made which will drive the best choices of dose and schedule. Studies identifying the dynamically-linked index (dose fractionation studies) and the size of the index to obtain a specific amount of bacterial kill can be performed in both systems...
October 13, 2017: Current Opinion in Pharmacology
https://www.readbyqxmd.com/read/29029694/prescriber-response-to-computerized-drug-alerts-for-electronic-prescriptions-among-hospitalized-patients
#18
Yael Zenziper Straichman, Daniel Kurnik, Ilan Matok, Hillel Halkin, Noa Markovits, Amitai Ziv, Ari Shamiss, Ronen Loebstein
BACKGROUND: Clinical decision support systems (CDSS) reduce prescription errors, but their effectiveness is reduced by high alert rates, "alert fatigue", and indiscriminate rejection. OBJECTIVES: To compare acceptance rates of alerts generated by the SafeRx(®) prescription CDSS among different alert types and departments in a tertiary care hospital, identify factors associated with alert acceptance, and determine whether alert overrides were justified. METHODS: In a retrospective study, we compared acceptance rates of all prescription alerts generated in 2013 in 18 departments of Israel's largest tertiary care center...
November 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29027409/-developing-traditional-chinese-medicine-injection-is-the-need-for-curing-sickness-to-save-patients
#19
Ping He, Feng-Jie Li, Lian-da Li, Yi-Kui Li
Safety issues of traditional Chinese medicine injections has been heated debate. There are two diametrically opposed views: it should be used reasonable and developed healthily or be forbidden to use. Some people have many misunderstandings and prejudices about the safety of traditional Chinese medicine injections. Compared with western medicine,traditional Chinese medicine has its own particularity. Traditional Chinese medicine has complex components. Its research and clinical application is different from western medicine...
March 2017: Zhongguo Zhong Yao za Zhi, Zhongguo Zhongyao Zazhi, China Journal of Chinese Materia Medica
https://www.readbyqxmd.com/read/29019349/do-workers-health-surveillance-examinations-fulfill-their-occupational-preventive-objective-analysis-of-the-medical-practice-of-occupational-physicians-in-catalonia-spain
#20
Mari Cruz Rodríguez-Jareño, Emilia Molinero, Jaume de Montserrat, Antoni Vallès, Marta Aymerich
OBJECTIVES: Although routine workers' health examinations are extensively performed worldwide with important resource allocation, few studies have analyzed their quality. The objective of this study has been to analyze the medical practice of workers' health examinations in Catalonia (Spain) in terms of its occupational preventive aim. MATERIAL AND METHODS: A cross-sectional study was carried out by means of an online survey addressed to occupational physicians who were members of the Catalan Society of Safety and Occupational Medicine...
October 6, 2017: International Journal of Occupational Medicine and Environmental Health
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