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Medically unexplained symptoms

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https://www.readbyqxmd.com/read/28188168/metformin-associated-lactic-acidosis-treated-with-continuous-renal-replacement-therapy
#1
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/28173764/-medically-unexplained-symptoms-and-symptom-disorders-in-primary-care-prognosis-based-recognition-and-classification
#2
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
#3
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/28162191/-the-chinese-expert-consensus-on-clinical-practice-of-medically-unexplained-symptoms
#4
(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/28138200/a-review-of-psychopharmacological-interventions-post-disaster-to-prevent-psychiatric-sequelae
#5
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/28129956/-medically-unexplained-symptoms-care-in-internal-medicine-a-paradigm-of-doctor-patient-relationship-in-situation-of-uncertainty
#6
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
#7
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/28122926/negotiating-explanations-doctor-patient-communication-with-patients-with-medically-unexplained-symptoms-a-qualitative-analysis
#8
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
#9
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
https://www.readbyqxmd.com/read/28122842/medically-unexplained-symptoms-the-person-the-symptoms-and-the-dialogue
#10
Juul Houwen, Peter L B J Lucassen, Hugo W Stappers, Pim J J Assendelft, Sandra van Dulmen, Tim C Olde Hartman
BACKGROUND: Many general practitioners (GPs) find the care for patients with medically unexplained symptoms (MUS) challenging. The patients themselves are often not satisfied with the care they receive. OBJECTIVES: The aim of this study is to explore what patients with MUS expect from their GP by looking at relevant communication elements in consultations as identified by patients. METHODS: We video-recorded everyday consultations with GPs and asked the GPs immediately after the consultation whether MUS were presented...
January 24, 2017: Family Practice
https://www.readbyqxmd.com/read/28117245/the-medical-value-and-cost-effectiveness-of-an-exercise-test-for-sport-preparticipation-evaluation-in-asymptomatic-middle-aged-white-male-and-female-athletes
#11
Laurent Chevalier, Gaelle Kervio, Stephane Doutreleau, Jean-Philippe Mathieu, Jean-Michel Guy, Aude Mignot, Luc Corneloup, François Passard, Thierry Laporte, Aude Girard-Girod, Olivier Hennebert, Philippe Bernadet, Marie-Pierre Vincent-Chevalier, Laurent Gencel, François Carré
BACKGROUND: Cardiovascular events related to high-intensity sport practice are rare but dramatic. Coronary artery disease (CAD) is the leading cause of these events after the age of 35 years. The value of a maximal exercise test (ET) for detection of athletes at risk remains a matter of debate. AIM: The aim of this prospective multicentre study was to clarify the medical value and cost-effectiveness of an ET in middle-aged white asymptomatic athletes who participate in high-intensity sport...
January 20, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28108416/symptoms-and-the-body-taking-the-inferential-leap
#12
REVIEW
Omer Van den Bergh, Michael Witthöft, Sibylle Petersen, Richard J Brown
The relationship between the conscious experience of physical symptoms and indicators of objective physiological dysfunction is highly variable and depends on characteristics of the person, the context and their interaction. This relationship often breaks down entirely in the case of "medically unexplained" or functional somatic symptoms, violating the basic assumption in medicine that physical symptoms have physiological causes. In this paper, we describe the prevailing theoretical approach to this problem and review the evidence pertaining to it...
January 17, 2017: Neuroscience and Biobehavioral Reviews
https://www.readbyqxmd.com/read/28003283/clinical-practitioners-views-on-the-management-of-patients-with-medically-unexplained-physical-symptoms-mups-a-qualitative-study
#13
A Keith W Brownell, Chloe Atkins, Andrea Whiteley, Robert F Woollard, Jude Kornelsen
OBJECTIVES: By identifying strategies that practicing physicians use in managing patients with medically unexplained physical symptoms (MUPS), we present an interim practical management guide (IPMG) that clinical practitioners may find useful in their clinical practices and that may help guide future research. DESIGN: A qualitative research study based on interview data from practicing physicians with experience in dealing with MUPS and known to the physician members of the research team...
December 21, 2016: BMJ Open
https://www.readbyqxmd.com/read/27996317/cardiac-arrest-with-clozapine-and-olanzapine-revealing-long-qt-syndrome
#14
Edward Woloszyn, Nishant Whig, Eileen Trigoboff, Jeffery J Grace
The authors describe a rare case of "concealed" congenital Long QT Syndrome (LQTS) Type 3 in a patient with treatment resistant schizophrenia and no known personal or family history of cardiac disease. The patient in this Case Report had a hidden genetic condition revealed only following the essential administration of antipsychotics. As a result, this patient experienced an aborted cardiac arrest and a total of five episodes of ventricular tachycardia (VT) requiring cardioversion. Successful control of the VT occurred with an Automatic Internal Defibrillator (AID), judicious use of antipsychotic medications, and anti-arrhythmic medications...
December 20, 2016: Clinical Schizophrenia & related Psychoses
https://www.readbyqxmd.com/read/27995604/exercise-therapy-for-chronic-fatigue-syndrome
#15
REVIEW
Lillebeth Larun, Kjetil G Brurberg, Jan Odgaard-Jensen, Jonathan R Price
BACKGROUND: Chronic fatigue syndrome (CFS) is characterised by persistent, medically unexplained fatigue, as well as symptoms such as musculoskeletal pain, sleep disturbance, headaches and impaired concentration and short-term memory. CFS presents as a common, debilitating and serious health problem. Treatment may include physical interventions, such as exercise therapy, which was last reviewed in 2004. OBJECTIVES: The objective of this review was to determine the effects of exercise therapy (ET) for patients with CFS as compared with any other intervention or control...
20, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27984257/preliminary-predictors-of-initial-attendance-symptom-burden-and-motor-subtype-in-a-us-functional-neurological-disorders-clinic-population
#16
David L Perez, Sigrid S Young, Julie N King, Anthony J Guarino, Barbara A Dworetzky, Alice Flaherty, Zeina Chemali, David Caplan, Bradford C Dickerson
BACKGROUND AND OBJECTIVE: Although many patients present with functional neurological symptoms (FNS), few US clinics offer specialized FNS care, and data on clinic attendees remain limited. We determined predictors of initial attendance, symptom burden, and FNS subtype in the first patients referred to our Functional Neurological Disorders Clinic for suspected FNS. METHODS: We reviewed the charts of 62 consecutive patients (46 women, 16 men). Regression analyses investigated predictors of keeping the first scheduled clinic appointment...
December 2016: Cognitive and Behavioral Neurology: Official Journal of the Society for Behavioral and Cognitive Neurology
https://www.readbyqxmd.com/read/27977289/somatic-symptoms-deserve-our-attention
#17
Kurt Kroenke
This commentary focuses on two articles in this issue which provide important insights regarding the diagnosis and management of medically unexplained symptoms (MUS). Up to half of all outpatient visits are prompted by a physical/somatic complaint of which at least a third are MUS. Analyzing data from the National Ambulatory Care Medical Survey, Gates, Petterson, Wingrove, Miller, and Klink (2016) confirmed the common finding that depression and anxiety in patients presenting with somatic symptoms are underrecognized...
December 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/27977288/our-continuing-exploration-of-medically-unexplained-symptoms
#18
Larry B Mauksch, Colleen T Fogarty
In this issue, the reader will find three articles examining different but converging perspectives on medically unexplained symptoms (MUS). In the first article, Gates, Petterson, Wingrove, Miller, and Klink (2016) examined 110,000 office visits to primary care providers between 2002 and 2010. In the second article, Clarke (2016), an internist and gastroenterologist, presents a model for diagnosing and treating MUS. The person most referenced in the first two articles and author of the landmark study-Kroenke (2016) writes the third article, an invited commentary...
December 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/27973580/a-small-molecule-inhibitor-of-sarcomere-contractility-acutely-relieves-left-ventricular-outflow-tract-obstruction-in-feline-hypertrophic-cardiomyopathy
#19
Joshua A Stern, Svetlana Markova, Yu Ueda, Jae B Kim, Peter J Pascoe, Marc J Evanchik, Eric M Green, Samantha P Harris
Hypertrophic cardiomyopathy (HCM) is an inherited disease of the heart muscle characterized by otherwise unexplained thickening of the left ventricle. Left ventricular outflow tract (LVOT) obstruction is present in approximately two-thirds of patients and substantially increases the risk of disease complications. Invasive treatment with septal myectomy or alcohol septal ablation can improve symptoms and functional status, but currently available drugs for reducing obstruction have pleiotropic effects and variable therapeutic responses...
2016: PloS One
https://www.readbyqxmd.com/read/27957879/lead-intoxication-due-to-ayurvedic-medications-as-a-cause-of-abdominal-pain-in-adults
#20
Varun Mehta, Vandana Midha, Ramit Mahajan, Vikram Narang, Praneet Wander, Ridhi Sood, Ajit Sood
BACKGROUND: Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. METHODOLOGY: This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed...
February 2017: Clinical Toxicology
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