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https://www.readbyqxmd.com/read/28210361/estimating-the-cost-of-care-for-emergency-department-syncope-patients-comparison-of-three-models
#1
Marc A Probst, John K McConnell, Robert E Weiss, Amber L Laurie, Annick N Yagapen, Michelle P Lin, Jeffrey M Caterino, Manish N Shah, Benjamin C Sun
INTRODUCTION: We sought to compare three hospital cost-estimation models for patients undergoing evaluation for unexplained syncope using hospital cost data. Developing such a model would allow researchers to assess the value of novel clinical algorithms for syncope management. METHODS: We collected complete health services data, including disposition, testing, and length of stay (LOS), on 67 adult patients (age 60 years and older) who presented to the emergency department (ED) with syncope at a single hospital...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28203222/unexpected-death-of-a-child-with-complex-febrile-seizures-pathophysiology-similar-to-sudden-unexpected-death-in-epilepsy
#2
Brian J Dlouhy, Michael A Ciliberto, Christina L Cifra, Patricia A Kirby, Devin L Shrock, Marcus Nashelsky, George B Richerson
Febrile seizures are usually considered relatively benign. Although some cases of sudden unexplained death in childhood have a history of febrile seizures, no documented case of febrile seizure-induced death has been reported. Here, we describe a child with complex febrile seizures who died suddenly and unexpectedly after a suspected seizure while in bed at night during the beginning phases of sleep. She was resuscitated and pronounced brain dead 2 days later at our regional medical center. Autopsy revealed multiorgan effects of hypoperfusion and did not reveal an underlying (precipitating) disease, injury, or toxicological cause of death...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28192236/diagnosis-of-primary-antibody-and-complement-immunodeficiencies-in-young-adults-after-a-first-invasive-bacterial-infection
#3
Sébastien Sanges, Frédéric Wallet, Nicolas Blondiaux, Didier Theis, Isabelle Verin, Anne Vachée, Rodrigue Dessein, Karine Faure, Nathalie Viget, Eric Senneville, Olivier Leroy, Fleur Maury, Nicolas Just, Julien Poissy, Daniel Mathieu, Anne Prévotat, Cécile Chenivesse, Arnaud Scherpereel, Grégoire Smith, Benjamin Lopez, Jérémie Rosain, Véronique Fremeaux-Bacchi, Eric Hachulla, Pierre-Yves Hatron, Mathilde Bahuaud, Frédéric Batteux, David Launay, Myriam Labalette, Guillaume Lefèvre
OBJECTIVES: Screening for primary immunodeficiencies (PIDs) in adults is recommended after two severe bacterial infections. We aimed to evaluate if screening should be performed after the first invasive infection in young adults. METHODS: Eligible patients were retrospectively identified using hospital discharge and bacteriology databases in 3 centers during a 3-year period. Eighteen to forty year-old patients were included if they had experienced an invasive infection with encapsulated bacteria commonly encountered in PIDs (Streptococcus pneumoniae (SP), Neisseria meningitidis (NM), Neisseria gonorrhoeae (NG), Haemophilus influenzae (HI) or group A Streptococcus (GAS))...
February 10, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28188168/metformin-associated-lactic-acidosis-treated-with-continuous-renal-replacement-therapy
#4
Akihide Nakamura, Kei Suzuki, Hiroshi Imai, Naoyuki Katayama
Metformin-associated lactic acidosis (MALA) is a rare but life-threatening complication. We report a case of MALA in a man aged 71 years who was treated with continuous renal replacement therapy (CRRT). The patient was brought to the hospital for prolonged and gradual worsening gastrointestinal symptoms. Although he received intravenous treatment, he developed catecholamine-resistant shock, and blood gas analysis revealed lactic acidosis. Bicarbonate and antibiotics for possible sepsis were initiated, but with no clear benefit...
February 10, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28183560/anesthesia-and-brugada-syndrome-a-12-year-case-series
#5
Mélanie Duque, Luís Santos, Sandy Ribeiro, Dora Catré
STUDY OBJECTIVE: The aim of this 12-year case series was to review the drugs used during anesthetic management of patients with diagnosis of or risk criteria for Brugada syndrome (BrS), and to document any possible association between these drugs and arrhythmogenic activity or unexplained hemodynamic instability. DESIGN: A retrospective clinical observational study. SETTING: Tertiary hospital. PATIENTS: Thirty-one patients met our inclusion criteria: 20 belonging to group D (diagnosed BrS) and 11 to group R (risk of BrS)...
February 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28173764/-medically-unexplained-symptoms-and-symptom-disorders-in-primary-care-prognosis-based-recognition-and-classification
#6
EDITORIAL
Marianne Rosendal, Tim C Olde Hartman, Aase Aamland, Henriette van der Horst, Peter Lucassen, Anna Budtz-Lilly, Christopher Burton
BACKGROUND: Many patients consult their GP because they experience bodily symptoms. In a substantial proportion of cases, the clinical picture does not meet the existing diagnostic criteria for diseases or disorders. This may be because symptoms are recent and evolving or because symptoms are persistent but, either by their character or the negative results of clinical investigation cannot be attributed to disease: so-called "medically unexplained symptoms" (MUS). MUS are inconsistently recognised, diagnosed and managed in primary care...
February 7, 2017: BMC Family Practice
https://www.readbyqxmd.com/read/28169588/how-do-hospital-doctors-manage-patients-with-medically-unexplained-symptoms-a-qualitative-study-of-physicians
#7
Alex Warner, Kate Walters, Kethakie Lamahewa, Marta Buszewicz
Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis...
February 2017: Journal of the Royal Society of Medicine
https://www.readbyqxmd.com/read/28164685/declined-natural-killer-cells-emerging-in-women-with-unexplained-recurrent-spontaneous-abortion-and-further-reducing-after-medical-therapy
#8
Xianghua Lin, Dijin Lin, Jiao Liu, Yunwen Bao, Zhaofan Luo, Junyue Fang, Ying Wang, Mingpeng Zhao, Chaohui Duan
BACKGROUND: As focus grows on reproduction, the issue of Recurrent Spontaneous Abortion (RSA), especially for unexplained reasons (URSA), is grabbing more and more attention in gynecological immunology. We investigated the changes of peripheral lymphocyte subsets focusing on whether they had some relationship with development of URSA. METHODS: The percentage and absolute count of lymphocyte subsets (T cells, Th cells, Ts cells, B cells, NK cells) were simultaneously evaluated by flow cytometry in URSA patients (n = 48) and healthy controls (HC, n = 22)...
November 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28162737/-488-intensive-stress-and-emotion-interview-for-primary-care-patients-with-medically-unexplained-pain-disorders-a-randomized-trial
#9
M Ziadni, M Lumley, H Doherty, J Porcerelli, L Rapport, H Schubiner
No abstract text is available yet for this article.
April 2016: Journal of Pain: Official Journal of the American Pain Society
https://www.readbyqxmd.com/read/28162191/-the-chinese-expert-consensus-on-clinical-practice-of-medically-unexplained-symptoms
#10
(no author information available yet)
"Medically unexplained symptoms" (MUS) are commonly seen in all clinical specialties. The preliminary investigations in China show a prevalence of MUS in 4.15%-18.2% of clinical patients. Based on international and national guidelines and the most advanced studies, a Chinese expert consensus on clinical practice of MUS is reached through three rounds of discussion seminars by 25 experts from various specialties including psychiatry, internal medicine, surgery, gynecology-obstetrics, otorhinolar-yngology and traditional Chinese medicine...
February 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/28158885/breaking-bad-delirium-methamphetamine-and-boric-acid-toxicity-with-hallucinations-and-pseudosepsis
#11
Kayla Johnson, Joanna L Stollings, E Wesley Ely
OBJECTIVES: A 30-year-old patient presented with hallucinations and profound shock. He was initially misdiagnosed as having severe sepsis; once ingestions were considered, he was diagnosed as potentially having arsenic toxicity. SUMMARY: The clinical story reveals many instructional lessons that could aid in the evaluation and management of future patients. This man presented with large amounts of blue crystals around his nose and lips from inhaling and eating boric acid (an ant poison) so he could, as he put it, kill the ants "pouring into my mouth and nose and up into my brain...
February 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28157788/a-medical-mystery-unexplained-renal-failure-in-burn-patients
#12
Harrison M Lands, David B Drake
The objective of this study was to review the investigation that uncovered the medical mystery of burn patients developing unexpected renal failure. The authors examined published and unpublished manuscripts and case reports, as well as conducted personal interviews with primary sources. In the late 1970s, emergence of resistant bacterial strains to the topical antimicrobial silver sulfadiazine occurred at the University of Virginia Medical Center. In the search for an alternative topical antimicrobial with known coverage of Pseudomonas aeruginosa, Furacin Soluble Dressing was substituted...
January 31, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28153527/anemia-prevalence-and-hemoglobin-levels-are-associated-with-long-term-exposure-to-air-pollution-in-an-older-population
#13
Trenton Honda, Vivian C Pun, Justin Manjourides, Helen Suh
BACKGROUND: Anemia, a highly prevalent disorder in elderly populations, is associated with numerous adverse health outcomes, including increased mortality, impaired functional status and cognitive disorders. Approximately two-thirds of anemia in American elderly is caused by chronic inflammation or is unexplained. A potential contributing factor may include air pollution exposures, which have been shown to increase systemic inflammation and affect erythropoiesis. Few studies, however, have investigated the associations of air pollution on hemoglobin levels and anemia...
January 30, 2017: Environment International
https://www.readbyqxmd.com/read/28138200/a-review-of-psychopharmacological-interventions-post-disaster-to-prevent-psychiatric-sequelae
#14
REVIEW
Badari Birur, Suresh Bada Math, Rachel E Fargason
BACKGROUND: Disasters are mega-scale catastrophic events which cause trauma and mental health sequelae. A review of early pharmacological interventions for the prevention of psychiatric disorders following disasters is sorely needed. METHODS: A literature search of "Psychiatric Sequelae AND Disasters", "Disaster mental health/Disaster psychiatry", "Psychotropics AND Disasters", and "Drug therapy AND Disasters" yielded 213 articles, 38 of which were included in the review...
January 26, 2017: Psychopharmacology Bulletin
https://www.readbyqxmd.com/read/28130470/predictors-of-incident-epilepsy-in-older-adults-the-cardiovascular-health-study
#15
Hyunmi Choi, Alison Pack, Mitchell S V Elkind, W T Longstreth, Thanh G N Ton, Frankline Onchiri
OBJECTIVE: To determine the prevalence, incidence, and predictors of epilepsy among older adults in the Cardiovascular Health Study (CHS). METHODS: We analyzed data prospectively collected in CHS and merged with data from outpatient Medicare administrative claims. We identified cases with epilepsy using self-report, antiepileptic medication, hospitalization discharge ICD-9 codes, and outpatient Medicare ICD-9 codes. We used Cox proportional hazards regression to identify factors independently associated with incident epilepsy...
January 27, 2017: Neurology
https://www.readbyqxmd.com/read/28129956/-medically-unexplained-symptoms-care-in-internal-medicine-a-paradigm-of-doctor-patient-relationship-in-situation-of-uncertainty
#16
B Ranque, O Nardon
Medically unexplained symptoms (MUS) are extremely common in general practice as in all medical specialties, but their designation is not unambiguous and the approaches to take care of the patients differ from conventional therapeutic approaches. The difficulty is not to confirm the diagnosis, which is rapidly obvious with some experience, but to establish a genuinely human therapeutic relationship, without any technical help, which pushes the doctor to the edge of his empathy and communication skills. The discomfort or even distress regularly encountered by physicians in front of a patient with MUS shows that the foundations of the doctor-patient relationship under uncertainty are poorly mastered...
January 24, 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/28129738/a-novel-case-of-renal-pathergy-reaction-in-a-beh%C3%A3-et-s-disease-patient-complicated-by-iga-vasculitis
#17
Takaaki Higashihara, Akira Okada, Taiko Kusano, Kazuyoshi Ishigaki, Akira Shimizu, Hideki Takano
BACKGROUND: A pathergy reaction is defined as a hyperreactivity of the skin in response to minimal trauma, which is important in the diagnosis of Behçet's disease (BD). However, a pathergy reaction may not be restricted to the skin, and little is known about whether an invasive medical procedure can induce the reaction. Here we present a pathergy reaction induced by renal biopsy, an invasive procedure. CASE PRESENTATION: A 46-year-old man who was diagnosed with IgA vasculitis (IgAV) at the age of 38 was treated with prednisolone and mizoribine...
January 28, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28126017/ruptured-aortic-aneurysm-due-to-mycobacterium-bovis-bcg-with-a-delayed-bacteriological-diagnosis-due-to-false-negative-result-of-the-mpb-64-immunochromatographic-assay
#18
J Simar, L Belkhir, B Tombal, E André
BACKGROUND: Adjuvant therapy with bacillus Calmette-Guerin (BCG), a live attenuated strain of Mycobacterium bovis, has become the treatment of choice for low-risk superficial bladder carcinoma following transurethral resection of the bladder. Complications following vesical BCG instillations are uncommon but, in some cases, severe side-effects can occur such as sepsis or mycotic aneurysm. Besides usual laboratory techniques used for the diagnosis of Mycobacterium tuberculosis complex (MTBC) infections (smear microscopy and cultures), commercial immunochromatographic assays detecting MBP64, a 24 kDa M...
January 26, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28122926/negotiating-explanations-doctor-patient-communication-with-patients-with-medically-unexplained-symptoms-a-qualitative-analysis
#19
Madelon den Boeft, Daniëlle Huisman, LaKrista Morton, Peter Lucassen, Johannes C van der Wouden, Marjan J Westerman, Henriëtte E van der Horst, Christopher D Burton
BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations. OBJECTIVE: To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes...
February 2017: Family Practice
https://www.readbyqxmd.com/read/28122844/medically-unexplained-symptoms-and-general-practitioners-a-comprehensive-survey-about-their-attitudes-experiences-and-management-strategies
#20
Laura Sirri, Silvana Grandi, Eliana Tossani
BACKGROUND: Medically unexplained symptoms (MUS) are common in primary care and are one of the most challenging clinical encounters for general practitioners (GPs). OBJECTIVE: To assess GPs' clinical experience with MUS and its relationship with their gender, age and length of practice. METHODS: Four hundred and thirty-three Italian GPs were invited to complete a questionnaire encompassing the following MUS-related features: workload, cognitive and emotional responses, management strategies, attitudes towards psychological interventions, sources of education and educational needs...
January 24, 2017: Family Practice
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