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Medically unexplained symptoms

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https://www.readbyqxmd.com/read/27905341/heidenhain-variant-of-creutzfeldt-jakob-disease-in-a-patient-who-had-bovine-bioprosthetic-valve-implantation
#1
Jehard Hashoul, Waleed Saliba, Irina Bloch, Haneen Jabaly-Habib
Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disorder characterized by rapidly progressing dementia, general neurologic deterioration, and death. When the leading symptoms are visual disturbances, it is termed as the Heidenhain variant of CJD (HvCJD). CJD was reported following prion-contaminated pericardium transplants but never after bovine bioprosthetic cardiac valve. In this case report, we describe HvCJD in a patient who had a bovine bioprosthetic cardiac valve implant. An 82-year-old-woman was referred to neuro-ophthalmology clinic for unexplained visual loss that started 1 month previously...
October 2016: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/27905001/guidelines-for-diagnosis-and-management-of-the-cobalamin-related-remethylation-disorders-cblc-cbld-cble-cblf-cblg-cblj-and-mthfr-deficiency
#2
Martina Huemer, Daria Diodato, Bernd Schwahn, Manuel Schiff, Anabela Bandeira, Jean-Francois Benoist, Alberto Burlina, Roberto Cerone, Maria L Couce, Angeles Garcia-Cazorla, Giancarlo la Marca, Elisabetta Pasquini, Laura Vilarinho, James D Weisfeld-Adams, Viktor Kožich, Henk Blom, Matthias R Baumgartner, Carlo Dionisi-Vici
BACKGROUND: Remethylation defects are rare inherited disorders in which impaired remethylation of homocysteine to methionine leads to accumulation of homocysteine and perturbation of numerous methylation reactions. OBJECTIVE: To summarise clinical and biochemical characteristics of these severe disorders and to provide guidelines on diagnosis and management. DATA SOURCES: Review, evaluation and discussion of the medical literature (Medline, Cochrane databases) by a panel of experts on these rare diseases following the GRADE approach...
November 30, 2016: Journal of Inherited Metabolic Disease
https://www.readbyqxmd.com/read/27898081/understanding-unspecific-complaints-through-genetics
#3
Eli Sprecher
Unspecific and unexplained medical complaints can be frustrating to both patients and clinicians. A cause for these complex symptoms and signs may now have been identified.
November 29, 2016: Nature Genetics
https://www.readbyqxmd.com/read/27894609/what-is-the-problem-with-medically-unexplained-symptoms-for-gps-a-meta-synthesis-of-qualitative-studies
#4
REVIEW
May-Lill Johansen, Mette Bech Risor
OBJECTIVE: To gain a deeper understanding of challenges faced by GPs when managing patients with MUS. METHODS: We used meta-ethnography to synthesize qualitative studies on GPs' perception and management of MUS. RESULTS: The problem with MUS for GPs is the epistemological incongruence between dominant disease models and the reality of meeting patients suffering from persistent illness. GPs have used flexible approaches to manage the situation, yet patients and doctors have had parallel negative experiences of being stuck, untrustworthy and helpless...
November 21, 2016: Patient Education and Counseling
https://www.readbyqxmd.com/read/27894463/what-should-we-say-to-patients-with-unexplained-neurological-symptoms-how-explanation-affects-offence
#5
Juen Mei Ding, Richard A A Kanaan
OBJECTIVES: Unexplained neurological symptoms (UNS) are common presentations in neurology but there is no consensus as to what they should be called. This is important, as patient acceptance is a predictor of outcome and there is evidence that patients are unhappy with the terms used. Patient understanding of these terms may be limited, however, and, once explained, the terms may seem more or less offensive. We sought to elicit patients' views of 7 frequently used terms for UNS, and whether these changed once definitions were provided...
December 2016: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/27894448/the-intersection-of-medical-child-abuse-and-medical-complexity
#6
REVIEW
Hillary W Petska, John B Gordon, Debra Jablonski, Lynn K Sheets
Children with medical complexity and victims of medical child abuse may have similar clinical presentations. Atypical or unexplained signs and symptoms due to rare diseases may lead providers to suspect medical child abuse when not present. Conversely, medical child abuse may be the cause of or coexist with medical complexity. Careful consideration of whether or not medical child abuse is present is essential when assessing a child with medical complexity since either diagnosis has significant consequences for children and families...
February 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/27888403/the-predictor-of-mortality-outcome-in-adult-patients-with-ebola-virus-disease-during-the-2014-2015-outbreak-in-guinea
#7
M S Cherif, N Koonrungsesomboon, M P Diallo, E Le Gall, D Kassé, F Cherif, A Koné, M Diakité, F Camara, N Magassouba
The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68...
November 25, 2016: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/27886517/organic-vs-functional-neurological-disorders-the-role-of-childhood-psychological-trauma
#8
Thanos Karatzias, Ruth Howard, Kevin Power, Florentina Socherel, Craig Heath, Alison Livingstone
Although the relationship between psychological trauma and medically unexplained symptoms (MUS) is well established, this relationship is less well understood in people with medically unexplained neurological symptoms. In the present study, we set out to compare people with functional neurological disorders, and organic neurological disorders, in terms of childhood and adulthood traumatic events, traumatic stress, emotional dysregulation and symptoms of depression and anxiety. We have hypothesised that those with functional neurological disorders would be more likely to report childhood and adulthood traumatic life events, traumatic symptomatology, emotional dysregulation and symptoms of anxiety and depression, compared to those with organic neurological disorders...
November 22, 2016: Child Abuse & Neglect
https://www.readbyqxmd.com/read/27825568/osteoarticular-manifestations-of-celiac-disease-and-non-celiac-gluten-hypersensitivity
#9
Stéphanie Dos Santos, Frédéric Lioté
Celiac disease is a chronic inflammatory autoimmune enteropathy based disorder that is triggered by the ingestion of gluten in genetically susceptible individuals. The global prevalence of 1% to 2% represents only the tip of the iceberg. The diagnosis is confirmed by positive specific antibody, anti-transglutaminase or anti-endomysium, specific lesions of the small intestine and a response to strict gluten-free diet. The diagnosis is difficult and often delayed because the clinical variability is very large, ranging from digestive clinical presentation "classic" to "atypical" symptoms, often extra-intestinal, that are sometimes attributed to a concomitant disease or a complication...
November 4, 2016: Joint, Bone, Spine: Revue du Rhumatisme
https://www.readbyqxmd.com/read/27821895/health-care-utilization-of-mexican-patients-with-medically-unexplained-physical-symptoms
#10
Azucena Maribel Rodriguez González, José Manuel Ramírez Aranda, Homero de Los Santos Reséndiz, María Yolanda Lara Duarte, Santiago Oscar Pazaran Zanella, Jafet Felipe Méndez López, Issa Gil Alfaro, Félix Gilberto Islas Ruz, Gloria Navarrete Floriano, Edith Guillen Salomón, Obdulia Texon Fernández, Silvia Cruz Duarte, Juan Carlos Romo Salazar, Claudia Elsa Pérez Ruiz, Sara de Jesús López Salas, Lizbeth Benítez Amaya, Javier Nahum Zapata Gallardo
OBJECTIVE: To determine the prevalence of medically unexplained physical symptoms and the characteristics and use of health services in a group of patients with medically unexplained physical symptoms and a group of patients with other illnesses. METHODS: This was a cross-sectional, retrospective and multicenter study. We included 1,043 patients over 18 years of age from 30 primary care units of a government health institution, in 11 states of Mexico, attended by 39 family physicians...
September 30, 2016: Colombia Médica: CM
https://www.readbyqxmd.com/read/27772554/what-s-difficult-a-multi-stage-qualitative-analysis-of-secondary-care-specialists-experiences-with-medically-unexplained-symptoms
#11
Anke Maatz, Megan Wainwright, Andrew J Russell, Jane Macnaughton, Yan Yiannakou
BACKGROUND: The term 'difficult' is pervasively used in relation to medically unexplained symptoms (MUS) and patients with MUS. This article scrutinises the use of the term by analysing interview data from a study of secondary care specialists' experiences with and attitudes towards patients suffering from MUS. DESIGN: Qualitative design employing semi-structured open-ended interviews systematically analysed in three stages: first, data were analysed according to the principles of content analysis...
November 2016: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/27768649/long-term-outcome-of-bodily-distress-syndrome-in-primary-care-a-follow-up-study-on-health-care-costs-work-disability-and-self-rated-health
#12
Mette Trollund Rask, Eva Ørnbøl, Marianne Rosendal, Per Fink
OBJECTIVE: The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health. METHODS: Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785)...
October 20, 2016: Psychosomatic Medicine
https://www.readbyqxmd.com/read/27761689/limitations-to-work-related-functioning-of-people-with-persistent-medically-unexplained-physical-symptoms-a-modified-delphi-study-among-physicians
#13
K H N Weerdesteijn, F G Schaafsma, A J van der Beek, J R Anema
Purpose The purpose of this study was to obtain consensus among physicians of several medical specialties on the level of limitations to work-related functioning of people with persistent "medically unexplained" physical symptoms (PPS). Methods A modified Delphi study was conducted with 15 physicians of five different medical specialties. The study involved two email rounds and one meeting. In each round, the physicians prioritized the level of limitations in 78 work-related functioning items for four different PPS cases...
October 19, 2016: Journal of Occupational Rehabilitation
https://www.readbyqxmd.com/read/27759751/fever-delirium-and-incontinence-not-always-a-uti
#14
Emily McNicholas, Ahmed H Abdelhafiz
Unexplained fever and confusion is a common reason for emergency medical admission. When this occurs in the context of new urinary incontinence, a urinary tract infection may be considered to be the most likely cause. However it is also important to consider spinal pathology when this combination of symptoms arises. We present a case of a retropharygeal collection presenting in a patient with this combination of symptoms.
2016: Acute Medicine
https://www.readbyqxmd.com/read/27758724/-recognizing-signs-of-sexual-abuse
#15
T A M Teunissen, S H Lo Fong Wong, A L M Lagro-Janssen
Sexual abuse is very common. In the Netherlands 42% of women and 13% of men aged over 25 years have experienced unacceptable sexual behaviour. Most victims do not seek professional help nor do they report the abuse to the police, and most of the victims who do seek medical help do not mention the abuse. Doctors often do not recognize the signs of sexual abuse. Most victims of rape have symptoms that may develop into posttraumatic stress disorder (PTSD) if they persist for more than 4 weeks, such as sleep problems or panic attacks...
2016: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/27726068/newest-drugs-for-chronic-unexplained-nausea-and-vomiting
#16
William L Hasler
Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g., gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates...
October 10, 2016: Current Treatment Options in Gastroenterology
https://www.readbyqxmd.com/read/27703758/protocol-investigating-the-clinical-outcomes-and-cost-effectiveness-of-cognitive-behavioural-therapy-delivered-remotely-for-unscheduled-care-users-with-health-anxiety-randomised-controlled-trial
#17
Shireen Patel, Sam Malins, Boliang Guo, Marilyn James, Joe Kai, Catherine Kaylor-Hughes, Emma Rowley, Jayne Simpson, David Smart, Michelle Stubley, Helen Tyrer, Richard Morriss
BACKGROUND: Health anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable...
January 2016: BJPsych Open
https://www.readbyqxmd.com/read/27703533/solving-medical-mysteries-hidden-stresses-and-unexplained-symptoms
#18
David D Clarke
Medically unexplained symptoms and chronic functional syndromes are common but few healthcare professionals have had formal training about their connection to psychosocial issues. A systematic approach to diagnosis and treatment based on experience with over 7000 of these patients is described. Outcomes improve with assessment for and treatment of current life stresses, the prolonged impact of adversity in childhood and somatic presentations of depression, post-traumatic stress, and anxiety disorders.
September 1, 2016: Zdravstveno Varstvo
https://www.readbyqxmd.com/read/27697802/stroke-mimic-diagnoses-presenting-to-a-hyperacute-stroke-unit
#19
Ang Dawson, Geoffrey C Cloud, Anthony C Pereira, Barry J Moynihan
Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27678506/gastric-electrical-stimulation-for-gastroparesis-and-chronic-unexplained-nausea-and-vomiting
#20
REVIEW
John M Wo, Thomas V Nowak, Shamaila Waseem, Matthew P Ward
Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting...
December 2016: Current Treatment Options in Gastroenterology
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