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Medically unexplained

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https://www.readbyqxmd.com/read/28328837/atypical-presentation-of-paroxysmal-nocturnal-hemoglobinuria-treated-by-eculizumab-a-case-report
#1
Anne Quinquenel, Quentin Maestraggi, Carinne Lecoq-Lafon, Peffault de Latour Régis, Alain Delmer, Amélie Servettaz
RATIONALE: Paroxysmal nocturnal hemoglobinuria (PNH) is a nonmalignant acquired hematopoietic stem cell disease, which can be revealed by hemolytic anemia, thromboembolism, or bonemarrow failure. Thrombosis can occur at any site, but coronary thrombosis is extremely rare. Controlled trials have demonstrated that eculizimab, an inhibitor of the terminal complement cascade, was able to reduce both hemolysis and thrombosis, but its efficacy in cases of PNH with coronary thrombosis is unknown...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28326802/the-relationship-between-beliefs-about-emotions-and-quality-of-life-in-irritable-bowel-syndrome
#2
Hannah Bowers, Abigail Wroe, Tamar Pincus
Suppression of undesirable emotions, as well as beliefs about the unacceptability of experiencing and expressing emotions, have both been shown to be related to poorer health-related outcomes in several clinical groups. Potential models through which these variables relate have yet to be tested in those with irritable bowel syndrome (IBS) and are therefore examined in the current article. Online questionnaires were administered to people with IBS (n = 84) to test a mediation model in which beliefs about the unacceptability of emotions are associated with greater emotional suppression, which in turn relates to increased affective distress and consequently poorer quality of life...
March 22, 2017: Psychology, Health & Medicine
https://www.readbyqxmd.com/read/28295826/prevalence-types-and-associations-of-medically-unexplained-symptoms-and-signs-a-cross-sectional-study-of-1023-adults-with-intellectual-disabilities
#3
M Osugo, J Morrison, L Allan, D Kinnear, S-A Cooper
BACKGROUND: Medically unexplained symptoms and signs are common in the general population and can respond to appropriate managements. We aimed to quantify the types and prevalence of unexplained symptoms and signs experienced by adults with ID and to determine the associated factors. METHOD: In a population-based study, 1023 adults with ID aged 16 and over had a detailed health assessment, which systematically considered symptoms and signs. Descriptive data were generated on their symptoms and signs...
March 9, 2017: Journal of Intellectual Disability Research: JIDR
https://www.readbyqxmd.com/read/28295128/medically-unexplained-physical-symptoms-mups-among-adults-in-canada-comorbidity-health-care-use-and-employment
#4
Jungwee Park, Heather Gilmour
Based on data from the 2014 Canadian Community Health Survey and the 2012 Canadian Community Health Survey-Mental Health, this study provides estimates of the prevalence of medically unexplained physical symptoms (MUPS) in the household population aged 25 or older. MUPS are examined in relation to sociodemographic characteristics, physical and mental comorbidity, health care use and unmet needs, labour force participation and productivity. In 2014, 5.5% of Canadian adults-an estimated 1.3 million - reported having chronic fatigue syndrome (1...
March 15, 2017: Health Reports
https://www.readbyqxmd.com/read/28291576/evaluating-challenges-for-improving-medically-unexplained-symptoms-in-us-military-veterans-via-provider-communication
#5
L Alison Phillips, Lisa McAndrew, Benjamin Laman-Maharg, Katharine Bloeser
OBJECTIVES: Medically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans' MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement...
March 6, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28290948/mortality-surveillance-for-infectious-diseases-in-the-u-s-department-of-defense-1998-2013
#6
Robert N Potter, Ladd A Tremaine, Joel C Gaydos
INTRODUCTION: The Mortality Surveillance Division (MSD) of the U.S. Armed Forces Medical Examiner System was established in 1998 to improve surveillance for all military deaths although emphasizing deaths from infectious diseases. Establishment of the MSD was part of the 1997 Department of Defense initiative to improve surveillance and response for emerging infectious diseases. Before 1998, mortality surveillance was limited to compiling information from death certificates, a system that provided limited useful information and lacked the timeliness needed to take meaningful action to address emerging infectious disease threats...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290647/syncope-evaluation-and-differential-diagnosis
#7
Lloyd A Runser, Robert L Gauer, Alex Houser
Syncope is an abrupt and transient loss of consciousness caused by cerebral hypoperfusion. It accounts for 1% to 1.5% of emergency department visits, resulting in high hospital admission rates and significant medical costs. Syncope is classified as neurally mediated, cardiac, and orthostatic hypotension. Neurally mediated syncope is the most common type and has a benign course, whereas cardiac syncope is associated with increased morbidity and mortality. Patients with presyncope have similar prognoses to those with syncope and should undergo a similar evaluation...
March 1, 2017: American Family Physician
https://www.readbyqxmd.com/read/28289468/the-effect-of-an-educational-intervention-in-family-phisicians-on-self-rated-quality-of-life-in-patients-with-medically-unexplained-symptoms
#8
Vojislav Ivetić, Klemen Pašić, Polona Selič
INTRODUCTION: Medically unexplained symptoms (MUS) are very common in family medicine, despite being a poorly-defined clinical entity. This study aimed to evaluate the effect of an educational intervention (EI) on self-rated quality of life, treatment satisfaction, and the family physician-patient relationship in patients with MUS. METHODS: In a multi-centre longitudinal intervention study, which was performed between 2012 and 2014, patients were asked to rate their quality of life, assess their depression, anxiety, stress and somatisation, complete the Hypochondriasis Index, the Medical Interview Satisfaction Scale and the Patient Enablement Instrument for assessing the physician-patient relationship, before and after the EI...
June 1, 2017: Zdravstveno Varstvo
https://www.readbyqxmd.com/read/28287345/the-role-of-emotion-in-psychotherapeutic-change-for-medically-unexplained-symptoms
#9
Joel M Town, Victoria Lomax, Allan A Abbass, Gillian Hardy
OBJECTIVES: Evidence of the contribution of emotional processes to the emergence, maintenance, and experience of medically unexplained symptoms (MUS) suggests that clinical approaches which target these processes could be beneficial. In this study, qualitative methods were used to examine patients' perspectives and subjective experiences of emotional processes in the context of a psychotherapy assessment and treatment service for MUS provided in a hospital emergency department (ED). METHODS: Seven semi-structured interviews were conducted with ED patients presenting with MUS who received a course of intensive short-term dynamic psychotherapy treatment...
March 13, 2017: Psychotherapy Research: Journal of the Society for Psychotherapy Research
https://www.readbyqxmd.com/read/28282066/medically-unexplained-visual-loss-in-children-and-young-people-an-observational-single-site-study-of-incidence-and-outcomes
#10
M C Daniel, A Coughtrey, I Heyman, A H Dahlmann-Noor
PurposeTo determine the incidence of medically unexplained visual loss (MUVL) in children in an open access children's eye casualty.Patients and methodsWe collated demographic and clinical data of consecutive patients younger than 16 years who presented to the children's eye casualty at Moorfields Eye Hospital over a 12-month period and were diagnosed with MUVL or suspected MUVL. We reviewed the clinical records at least 3 months after initial presentation. We calculated the incidence using the number of 'new patient' attendances over the same period as denominator (n=2397)...
March 10, 2017: Eye
https://www.readbyqxmd.com/read/28279495/psychotherapy-for-medically-unexplained-pain-a-randomized-clinical-trial-comparing-intensive-short-term-dynamic-psychotherapy-and-cognitive-behavior-therapy
#11
Behzad Chavooshi, Mehdi Saberi, Seyed Abbas Tavallaie, Hedayat Sahraei
BACKGROUND: The efficacy of intensive short-term dynamic psychotherapy (ISTDP) for medically unexplained pain remains open to debate because of a paucity of high-quality studies. OBJECTIVES: This study sought to evaluate ISTDP as a treatment for medically unexplained pain in outpatients by comparing it with the established evidence-based cognitive-behavioral therapy (CBT) in a randomized clinical trial. METHODS: A total of 341 adults with medically unexplained pain were randomly assigned to 16 sessions of individual manualized CBT (N = 164) or ISTDP (N = 177)...
January 11, 2017: Psychosomatics
https://www.readbyqxmd.com/read/28266237/frozen-embryo-transfer-cycles-in-women-with-deep-endometriosis
#12
George Queiroz Vaz, Alessandra Viviane Evangelista, Maria Cecilia Almeida Cardoso, Paulo Gallo, Maria Cecilia Erthal, Marco Aurelio Pinho Oliveira
OBJECTIVE: To compare the transfer pregnancy rates with frozen embryos from patients with deep endometriosis and non-endometriosis patients. METHODS: We conducted a retrospective cohort study of review of medical records of 181 women aged 18-40 years, undergoing transfer of frozen embryos into a fertility center. The data collected was from January 2007 to December 2013. RESULTS: Regarding the patients with endometriosis, there was no statistical difference in proportion to compare polycystic ovarian syndrome, male factor, tubal factor and unexplained infertility...
March 7, 2017: Gynecological Endocrinology
https://www.readbyqxmd.com/read/28259551/diagnostic-yield-of-device-interrogation-in-the-evaluation-of-syncope-in-an-elderly-population
#13
Robert N D'Angelo, Christopher C Pickett
BACKGROUND: Device interrogation has become a standard part of the syncope evaluation for patients admitted with permanent pacemakers (PPM) or implantable cardiac defibrillators (ICD), although few studies have shown interrogation yields clinically useful data. The purpose of this study is to determine the diagnostic yield of device interrogation as well as other commonly performed tests in the workup of unexplained syncope in patients with previously implanted PPMs or ICDs. METHODS: We retrospectively reviewed records of 88 patients admitted to our medical center for syncope with previously implanted pacemakers between January 1, 2005 and January 1, 2015 using ICD-9 billing data...
February 27, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28254164/short-term-olfactory-sensitization-involves-brain-networks-relevant-for-pain-and-indicates-chemical-intolerance
#14
Linus Andersson, Anna-Sara Claeson, Lars Nyberg, Steven Nordin
Chemical intolerance is a medically unexplained affliction that implies deleterious reactions to non-toxic everyday chemical exposure. Sensitization (i.e. increased reactivity to repeated, invariant stimulation) to odorous stimulation is an important component in theoretical explanations of chemical intolerance, but empirical evidence is scarce. We hypothesized that (1) individuals who sensitize to repeated olfactory stimulation, compared with those who habituate, would express a lower blood oxygenated level dependent (BOLD) response in key inhibitory areas such as the rACC, and higher signal in pain/saliency detection regions, as well as primary and/or secondary olfactory projection areas; and (2) olfactory sensitization, compared with habituation, would be associated with greater self-reported chemical intolerance...
February 14, 2017: International Journal of Hygiene and Environmental Health
https://www.readbyqxmd.com/read/28251632/predictors-of-autopsy-following-stillbirth-in-queensland-australia-a-population-based-study
#15
Ibinabo Ibiebele, Frances M Boyle, Dell Horey, Rohan Lourie, Patricia Wilson, Michael Coory, Vicki Flenady
BACKGROUND: Accurate determination of causes of stillbirth is critical to effective prevention. Autopsy remains the gold standard investigation for stillbirth; however, with low autopsy rates many stillbirths are likely to be 'unexplored' rather than 'unexplained'. AIM: To determine factors associated with autopsy following stillbirth. MATERIALS AND METHODS: Routinely collected population-based data on all singleton stillbirths of at least 400 g birthweight or 20 weeks gestation in Queensland between July 2000 and December 2011 were examined...
February 2017: Australian & New Zealand Journal of Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28250013/time-variant-genetic-effects-as-a-cause-for-preterm-birth-insights-from-a-population-of-maternal-cousins-in-sweden
#16
Julius Juodakis, Jonas Bacelis, Ge Zhang, Louis J Muglia, Bo Jacobsson
Preterm delivery is the leading cause of neonatal mortality worldwide, yet its etiology remains largely unexplained. We propose that the genetic factors controlling this trait could act in a non-uniform manner during pregnancy, with each factor having a unique 'window of sensitivity.' We test this hypothesis by modeling the distribution of gestational ages observed in maternal cousins from the Swedish Medical Birth Register (n=35,541 pairs). The models were built using a time-to-event framework, with simulated genetic factors that increase the hazard of birth either uniformly across the pregnancy (constant effect) or only in particular windows (varying effect)...
March 1, 2017: G3: Genes—Genomes—Genetics
https://www.readbyqxmd.com/read/28246082/survivorship-of-severe-medically-unexplained-symptoms-in-palliative-care
#17
Justin Dwyer, Keryn Taylor, Mark Boughey
OBJECTIVES: Patients who articulate their psychological distress primarily through physical symptoms (referred to as medically unexplained symptoms (MUS)) pose a challenge to the skills of most clinicians, including palliative care physicians. The philosophical underpinnings of palliative care with a stated focus on symptom management and care of the person in their psychosociospiritual context lend itself to the care of these patients. The aim of this study was to investigate the characteristics to improve identification of this patient group within palliative care...
February 28, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28241237/association-of-testosterone-levels-with-anemia-in-older-men-a-controlled-clinical-trial
#18
Cindy N Roy, Peter J Snyder, Alisa J Stephens-Shields, Andrew S Artz, Shalender Bhasin, Harvey J Cohen, John T Farrar, Thomas M Gill, Bret Zeldow, David Cella, Elizabeth Barrett-Connor, Jane A Cauley, Jill P Crandall, Glenn R Cunningham, Kristine E Ensrud, Cora E Lewis, Alvin M Matsumoto, Mark E Molitch, Marco Pahor, Ronald S Swerdloff, Denise Cifelli, Xiaoling Hou, Susan M Resnick, Jeremy D Walston, Stephen Anton, Shehzad Basaria, Susan J Diem, Christina Wang, Stanley L Schrier, Susan S Ellenberg
Importance: In one-third of older men with anemia, no recognized cause can be found. Objective: To determine if testosterone treatment of men 65 years or older with unequivocally low testosterone levels and unexplained anemia would increase their hemoglobin concentration. Design, Setting, and Participants: A double-blinded, placebo-controlled trial with treatment allocation by minimization using 788 men 65 years or older who have average testosterone levels of less than 275 ng/dL...
February 21, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28220638/a-novel-clinical-framework-the-use-of-dispositions-in-clinical-practice-a-person-centred-approach
#19
Matthew Low
This paper explores a novel clinical framework that is underpinned by a specific philosophical perspective of causation and its utility in clinical practice. A dispositional theory of causation may overcome challenges that clinicians face in complex clinical presentations including those that are medically unexplained. Dispositionalism identifies causes not as regular events necessitating an effect but rather phenomena, which are highly complex, context-sensitive, and which tend toward an effect. Diagnostic uncertainty and causal explanation are significant challenges in terms of clinical reasoning, communication, and the overall therapeutic outcome...
February 21, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28210361/estimating-the-cost-of-care-for-emergency-department-syncope-patients-comparison-of-three-models
#20
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
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