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https://www.readbyqxmd.com/read/28776139/catching-the-zebra-clinical-pearls-and-pitfalls-for-the-successful-diagnosis-of-zollinger-ellison-syndrome
#1
REVIEW
Aaron H Mendelson, Mark Donowitz
Zollinger-Ellison syndrome (ZES) results from an ectopic gastrin-secreting tumor leading to peptic ulcer disease, reflux, and chronic diarrhea. While early recognition portends an excellent prognosis with >80% survival at 15 years, symptoms are often nonspecific making the diagnosis difficult to establish. Diagnosis involves a series of tests, including fasting gastrin, gastric pH, chromogranin A, and secretin stimulation. Performing these tests in the correct sequence and at the proper time is essential to avoid inaccurate results...
August 3, 2017: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/28760177/physical-activity-and-diabetes-related-health-beliefs-of-marshallese-adults
#2
Holly Felix, Xiaocong Li, Brett Rowland, Christopher R Long, Karen H K Yeary, Pearl A McElfish
OBJECTIVE: We sought to improve understanding of diabetes-related health beliefs and physical activity behaviors of Marshallese adults with and without type 2 diabetes (T2D). METHODS: We used tests of comparison and regression analyses to examine data from 376 Marshallese adults collected at church-based events. RESULTS: One in 5 (20.2%) respondents had received a T2D diagnosis. About one-fourth of the respondents fell into one of 4 physical activity levels: zero times per week (28...
September 1, 2017: American Journal of Health Behavior
https://www.readbyqxmd.com/read/28754695/eastern-equine-encephalitis
#3
Daniel Berlin, Ahmed I Gilani, Amrit K Grewal, Mary Fowkes
We describe a patient who died from a fulminant presentation of encephalitis. After an exhaustive search, we found no treatable cause. Postmortem PCR analysis of brain tissue led to a diagnosis of eastern equine encephalitis. We have identified several clinical pearls that may assist others in making the diagnosis earlier in the disease course.
July 28, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28749627/acute-kidney-injury-in-pediatric-patients-diagnosis-and-management-in-the-emergency-department-digest
#4
Daniel Mohrer, Melissa Langhan, Pradip Chaudhari
Pediatric acute kidney injury is a condition that is underdiagnosed among children seen in the emergency department, and it has been associated with significant morbidity and mortality, including increased risk for chronic kidney disease. The most common etiologies in pediatric patients are now known to be due to hypovolemia, sepsis, shock, and cardiac dysfunction. This issue compares 3 classification systems for the diagnosis and staging of acute kidney injury and reviews the etiologies that lead to kidney injury in children...
May 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28749625/diphtheria-pertussis-and-tetanus-evidence-based-management-of-pediatric-patients-in-the-emergency-department-digest
#5
Lara Zibners, Pradip Chaudhari
Diphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts...
February 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28749111/syncope-in-pediatric-patients-a-practical-approach-to-differential-diagnosis-and-management-in-the-emergency-department-digest
#6
Colleen Fant, Ari Cohen, Michelle N Vazquez
Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk "red flags," and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope...
April 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745857/altered-level-of-consciousness-evidence-based-management-in-the-emergency-department-digest
#7
Joo Lee Song, Vincent J Wang, Michelle N Vazquez
A child who presents to the emergency department with an altered level of consciousness can be clinically unstable and can pose a great diagnostic challenge. The emergency clinician must quickly develop a wide differential of possible etiologies in order to administer potentially life-saving medications or interventions. The history, physical examination, and appropriate diagnostic tests can aid greatly in rapidly narrowing the differential diagnosis. Once initial stabilization, workup, and first-line interventions are completed, most patients who present with unresolved or unidentified altered level of consciousness should be admitted for further evaluation and close monitoring...
January 22, 2017: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745854/vaccine-preventable-diseases-in-pediatric-patients-a-review-of-measles-mumps-rubella-and-varicella-digest
#8
Deborah A Levine, Kathryn H Pade
Vaccine-preventable diseases such as measles, mumps, rubella, and varicella continue to plague children and adults worldwide. Although public health programs have helped decrease the prevalence and sequelae of these diseases, outbreaks still occur. To limit the spread of these diseases, emergency clinicians must be able to readily identify the characteristic presentations of the rashes associated with measles, rubella, and varicella, as well as the common presenting features associated with mumps. Diagnostic laboratory studies are not usually necessary, as a complete history and physical examination usually lead to an accurate diagnosis...
December 22, 2016: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745849/pelvic-inflammatory-disease-diagnosis-and-treatment-in-the-emergency-department-digest
#9
Charles Walter Bugg, Taku Taira, Milana Zaurova
Pelvic inflammatory disease is a common disease that is associated with significant complications including infertility, chronic pelvic pain, ruptured tubo-ovarian abscess, and ectopic pregnancy. The diagnosis may be delayed when the presentation has nonspecific signs and symptoms. Even when it is properly identified, pelvic inflammatory disease is often treated suboptimally. This review provides evidence-based recommendations for the diagnosis, treatment, disposition, and follow-up of patients with pelvic inflammatory disease...
December 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745847/transient-global-amnesia-emergency-department-evaluation-and-management-digest
#10
Jeremy Samuel Faust, Andreea Nemes, Milana Zaurova
Transient global amnesia is a clinically distinct syndrome characterized by the acute inability to form new memories. It can last up to 24 hours. The diagnosis is dependent on eliminating other more serious etiologies including toxic ingestions, acute strokes, complex partial seizures, and central nervous system infections. Transient global amnesia confers no known long-term risks; however, when abnormal signs or symptoms are present, they take precedence and guide the formulation of a differential diagnosis and investigation...
August 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745844/emergency-department-management-of-priapism-digest
#11
Gregory S Podolej, Christine Babcock, Jeremy Kim
Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. There are 3 types of priapism: ischemic, nonischemic, and recurrent ischemic priapism; ischemic priapism accounts for 95% of cases. Ischemic priapism must be treated within 4 to 6 hours to minimize morbidity, including impotence. The diagnosis of ischemic priapism relies heavily on the history and physical examination and may be facilitated by penile blood gas analysis and penile ultrasound. This issue reviews current evidence regarding emergency department treatment of ischemic priapism using a stepwise approach that begins with aspiration of cavernosal blood, cold saline irrigation, and penile injection with sympathomimetic agents...
January 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745843/evidence-based-management-of-potassium-disorders-in-the-emergency-department-digest
#12
John Ashurst, Shane R Sergent, Benjamin J Wagner, Jeremy Kim
Hypokalemia and hyperkalemia are the most common electrolyte disorders managed in the emergency department. The diagnosis of these potentially life-threatening disorders is challenging due to the often vague symptomatology a patient may express, and treatment options may be based upon very little data due to the time it may take for laboratory values to return. This review examines the most current evidence with regard to the pathophysiology, diagnosis, and management of potassium disorders. In this review, classic paradigms, such as the use of sodium polystyrene and the routine measurement of serum magnesium, are tested, and an algorithm for the treatment of potassium disorders is discussed...
November 22, 2016: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28745570/soft-tissue-tumor-immunohistochemistry-update-illustrative-examples-of-diagnostic-pearls-to-avoid-pitfalls
#13
Shi Wei, Evita Henderson-Jackson, Xiaohua Qian, Marilyn M Bui
CONTEXT: - Current 2013 World Health Organization classification of tumors of soft tissue arranges these tumors into 12 groups according to their histogenesis. Tumor behavior is classified as benign, intermediate (locally aggressive), intermediate (rarely metastasizing), and malignant. In our practice, a general approach to reaching a definitive diagnosis of soft tissue tumors is to first evaluate clinicoradiologic, histomorphologic, and cytomorphologic features of the tumor to generate some pertinent differential diagnoses...
August 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28743791/imaging-in-acute-ischaemic-stroke-pearls-and-pitfalls
#14
REVIEW
James Caldwell, Manraj K S Heran, Ben McGuinness, P Alan Barber
Prompt and accurate diagnosis is the foundation of acute ischaemic stroke care. Multiple positive endovascular thrombectomy trials in ischaemic stroke patients with large vessel occlusions have further emphasised this but also added complexity to treatment decisions. CT angiography is now routine for patients who present with an acute stroke syndrome around the world. Members of the neurology and stroke teams (rather than radiologists) are often the first doctors to lay eyes on the CT images and are best equipped to integrate the clinical picture with the imaging findings...
July 25, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28727248/vascular-anomaly-cases-for-the-pediatric-hematologist-oncologists-an-interdisciplinary-review
#15
REVIEW
Denise M Adams, Leonardo R Brandão, Caitlin M Peterman, Anita Gupta, Manish Patel, Steven Fishman, Cameron C Trenor
Vascular anomalies (VAs) are classified as tumors or malformations depending on their clinical characteristics, pathological diagnosis, and genomic information. Diagnosis can be challenging because of the heterogeneity of clinical presentation; thus, the best diagnosis and care are provided by an interdisciplinary team of specialists. Over the past 10 years, an increasing number of pediatric hematologist/oncologists are caring for patients with VAs secondary to new medical therapy options and clinical trials...
July 20, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28712694/imaging-pearls-of-pediatric-beh%C3%A3-et-s-disease
#16
REVIEW
Osman Melih Topcuoglu, Elif Dilara Topcuoglu, Cetin Murat Altay, Sinan Genc
OBJECTIVE: To emphasize the diverse diagnostic imaging findings of pediatric Behçet's disease and to define the fundamental imaging clues for pulmonary, vascular, gastrointestinal and central nervous system involvements of Behçet's disease in pediatric age group. We also aim to list the major imaging differences of Behçet's disease in childhood and adulthood. CONCLUSION: The diagnosis of pediatric Behçet's disease is challenging. Imaging can narrow the differential diagnosis by using some substantial clues and prevent diagnostic delays...
June 28, 2017: European Journal of Radiology
https://www.readbyqxmd.com/read/28694045/myelitis-in-systemic-lupus-erythematosus
#17
REVIEW
Xiang-Yang Li, Hai-Bing Xiao, Pearl Pai
SLE-associated acute transverse myelitis (ATM) is a rare, but potentially severe complication of Systemic lupus erythematosus (SLE), and may lead to significant motor, sensory and autonomic dysfunctions in the central nervous system resulting in marked neurological deficits. It is important to recognize its clinical feature to allow timely diagnosis and management of this condition. In this review, we aimed to provide the reader with the understanding of its clinical presentation and classification, the underlying pathological, MRI (magnetic resonance imaging) appearance, and current status of management, with an emphasis on recent discoveries and advancements...
July 7, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28686783/schnitzler-syndrome-with-delirium-and-vertigo-the-utility-of-neurologic-manifestations-in-diagnosis
#18
Stanislav N Tolkachjov, David A Wetter
<p>Schnitzler syndrome (SS) is an autoinflammatory dermatosis that often goes undiagnosed for 5-6 years. Patients typically carry a diagnosis of urticaria; however, their cutaneous symptoms fail to respond to typical urticaria therapies and lack symptoms such as pruritus. Additionally, patients with SS may see multiple providers for nonspecific complaints of fever, lymphadenopathy, arthralgias, and bone pain. A correct diagnosis is paramount, as close to 20% of patients may develop a lymphoproliferative disorder and appropriate treatment may ameliorate all symptoms...
June 1, 2017: Journal of Drugs in Dermatology: JDD
https://www.readbyqxmd.com/read/28668112/pearls-and-pitfalls-autoimmune-lymphoproliferative-syndrome-and-autoimmune-lymphoproliferative-syndrome-like-disease
#19
Anne K Bartels, Taylor A Banks, Jeannie L Bay
A case of autoimmune lymphoproliferative syndrome (ALPS) was presented, followed by a discussion of the clinical characteristics, pathophysiology, diagnosis, and management of this disease. Clinical pearls and pitfalls are emphasized for the use of the practicing allergist and the fellow in-training. The diagnosis of ALPS was guided by published criteria. A careful history and workup were needed to exclude other possible etiologies for the patient's symptoms and physical findings. ALPS often carries significant morbidity and is best managed through a multidisciplinary approach...
July 1, 2017: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/28661116/dental-emergencies-management-strategies-that-improve-outcomes-digest
#20
Ryan Anthony Pedigo, Milana Zaurova
Points & Pearls is a digest of Emergency Medicine Practice. Acute dental emergencies are a common chief complaint presenting to emergency departments, and they are increasing substantially in frequency. The diagnosis and management of dental emergencies is a core competency of the emergency clinician, and proper therapeutic strategies can significantly improve cosmetic and functional outcomes for patients. This issue provides a systematic review of the literature on common acute traumatic and atraumatic dental emergencies with a focus on the historical and physical examination findings that must be understood to identify life-threatening infections, relieve pain, salvage natural teeth, and communicate with specialists in the further management of patients after emergency treatment...
June 22, 2017: Emergency Medicine Practice
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