Science topics: Medicine
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Medicine - Science topic

Explore the latest questions and answers in Medicine, and find Medicine experts.
Questions related to Medicine
How about the H1N1!
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what is the biological molecule of H1N1? And how about the theory to design the medicine?
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concerning H1N1 i want to ask a question , are t6he vaccines nowadays used efficient and what is bettwer than these vaccines if present , thanks for your time
Do you think that the addition of alloxan to white flour participate in high prevalence of diabetes?
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some studies as well as notes in Wikipedia point to the addition of alloxan into white flour for giving the flour its white color. alloxan is used experimentally to induce diabetes type 1. I think this could participate in high prevalence of diabetes especially among population who depend on bread as the main food constituent. what do you think about?
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thanks for your reply. I think if we think of chronic exposure to alloxan, we have to take more precautions.
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Unexplained sensations
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It all depends upon the type of procedures, age, weight and type of pain. Also very important is the area of this pain/Pulsation.
A common syndrome may be what is called, "Meralgia paresthetica", the pain caused when lateral femoral cutaneous nerve in one of your legs is being compressed.
Is that the answer?
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What is the scientific community's opinion on open access journals, which do not have any ISI impact? Recently, many open access journals are coming up. Most of them have no ISI impact, but have good wider circulation. The ISI impact is mainly based on circulation. Therefore, do we need to revisit impact factor policy?
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It's a perplexing question. Open access journals are freely available on the net and are in wider circulation and today net has become an ultimate source of literature searching and when an academician/researcher comes across a journal which is freely available then he is often motivated to cite these journals in his/her research. The basic motivating force being that at least in academics we still fail to cross the conservative approach "big is bountiful" - most of the academic research works have a high proportion of "literature" content available through open access journals.
Now coming onto the other issue regarding the impact of these open access journals - there is this natural rule "you do not get anything for free" - in case of open access journals, this cost is paid by the author, and the reader do not have to pay anything much like the same as you watch the television at home - you watch many entertaining programmes and do not pay anything (except for the cable connection fee just as you pay the internet connection fee). There are useful, there are rubbish, there are not so good and there are too good programmes on the television - but involuntarily we watch all of them - sometimes even while not agreeing or liking the content being aired. But the set top box calculates it as the popularity of the programme.
There is obviously a need to control, monitor and rate the open access journals not on the basis of circulation or hits they get, yet an independent quality assessment is required. If you visit my page, you will find a lot of letters to editors - and most of them are to the editors of open access journals (even pubmed indexed ones) regarding the research design, interpretation and statistical errors in scientific material - when such research containing erroneous information is published in an open access journal, it has a multiplier regressive effect for the scientific community - people set up their subsequent researches on the basis of erroneous information in these journals, they get confused when their results do not match with the results cited in these journals and moreover they get a wrong inference of the magnitude of problem itself.
It is unfortunate that you get a domain name registered for as low as $5 and can start a website within $100, you need not have an office, you can have virtual editors, virtual staff and you can run an open access journal without even having scientific knowledge about the subjects. There are groups such as Hindawi, OJST, et al. which publish articles after charging a hefty fee - more unfortunate is the fact that they are pubmed indexed, hence having an "creditation value" for many incompetent professionals who seek their promotional avenues through these publications. And despite having a "C" grade content might have a high impact too owing to their easy availability.
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Cutting the ET tube a few centimeters (the part protruding out of mouth) reduces the dead space. And this may decrease the time for oxygen to reach the lungs.and this will improve patient outcomes. What are your thoughts?
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0.78-3.14ml dead space for adults. For preterm neonates if we cut the tube 1 cm piece, dead space willl be reduce jsut 0.3-0.6 mL. This volume is not important to reduce dead space volume even a 500 gr pretem. Moreover compliance of new anesthesia circuits and endotracheal tubes are very love. Additionaly we can observe dead space increase withETco2 and we can eliminate two ways: CO2 absorbants or high flow anesthesia. Risk of extubation with shorten tube is more important in a 500 gr neonate.
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In UK, NHS medical emergencies calls are often answered by nurses or call advisers who have completed a brief training course. They are used to help reduce cost, visits to hospitals and family practice. Today, various newspapers have criticized NHS emergency because a study found the number of calls to ambulance service and visits to hospital has increased. I find this is unethical because the service will offer false reassurance, delay in diagnosis that result in complications and also increase avoidable anxiety for referring common medical symptoms.
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With regards to call centres the advice given will always tend to err on the side of caution. This may well increase the referrals / attendances at local hospitals and GP practices. From my experience working in Yorkshire for five years after the introduction of NHS direct did not lead to and reduction in inappropriate attendances. If anything they seem to increase. I would much rather that hospitals are adequately resourced including placing a senior doctor in Triage with the triage nurse. A lot of conditions can be managed extremely efficiently in this manner, fractures can be excluded, inappropriate attenders can be turned around with minimal impact on the health service and they can be educated on this. When I worked in West Yorkshire we showed that the average waiting time for all patients was reduced by at least one hour by placing a senior doctor in Triage to deal with the minor cases. Of course the minor patients benefitted the most but even major cased benefitted by one hour. Regards Richard
Is it feasible to retain raw data, materials after publishing a paper? If so, for how long?
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How is your experience with retaining raw data, materials, etc. After the paper has been published. Does anyone within your academic medium revise your published article?
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thanks Antonino, i think your last point is highly valuable
How do you see the role of science in the future?
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Science has led humanity into a long pervade pathways. Humanity has witnessed magic improvements in all fields of life. What is more to come? How do you imagine changes in future?
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Dear Surekha Praveen, thank you for your nice participation. you are still young researcher, i wish you and others long living and to remember in near future this discussion and how science will jump as never before. i agree with you about nanotechnology. let me imagine microsurgery for positive thinking or anticrime surgery!!!!!!!!!! so strange but could be????
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There are only few variables which are considered as vital, i.e. consciousness, nutritional status, body temperature, heart rate, blood pressure and respiratory rate. In most EBM at least one of these vital signs is permanently omitted. The most frequently ignored is respiratory rate. Thus, is it actually clinically valid?
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Respiratory rate is essential but it must be done properly! If a patient is deteriorating, the resp rate can be a key sign of something happening. From some of our preliminary auditing of observation charts, we found that resp rates were often not done but when they were, any changes highlighted a physiological problem. I think with Medical Emergency Teams - resp rate will soon become an important physiological marker but clinicians must record it accurately.
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The patient is 70 years old and health state is very good.
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As other colleagues have written, age, stage are very important.
Follicular lymphoma is rare in children.
I will like to get the opinion of experts in the field.
A 5,5 year old male child had had frequent upper respiratory tract infections, acute otitis media attacts for the last two years and was followed up by a professor of otolaryngology, who decided to perform a tonsillectomy. Clinical examination revealed symmetrical enlargement of the tonsils. Routine tonsillectomy was performed and the specimen was sent for histopathological examination. On left tonsil, reactive lymphoid hyperplasia was reported. On right tonsil, around a crypt, in 25 % of the total material, a neoplasm consisting of big lymphoid cells with prominent nuclei , was seen. Immunocytochemistry results were as follows:
CD20 +, CD5 -, CD10 -, bcl-6 +, MUM1 +, bcl 2 -, EBV -, Ki 67 80% only in big cells.
The diagnosis of follicular lymphoma grade 3 B on left tonsil was made on histopathological examination.
CBC, biochemistry was normal. PET-CT performed postoperatively revealed no pathology.
The pathology was further consulted with 3 other professors of hematopathology. Two of them did not think it was a follicular lymphoma, but lymphoid hyperplasia.
The third reported that there was a B cell clonality, and suggested an insitu diagnosis of follicular lymphoma.
The patient was consulted during a hematology meeting, with some very experienced adult hematologists from Istanbul who see more follicular lymphomas than us pediatric hematologist-oncologists, and by Prof Marcus from London who was in the meeting, since this was a pediatric case detected in situ, they suggested a “watch-and-wait” policy. (even with no bone marrow examination) .
In the literature, in 14/21 patients <40 years old with stage I, only excision, none had relapsed (Blood 2012).
In the BFM series, 25pediatric patients with excellent outcome have been reported all treated as other B cell lymphomas (Hematologica 2010)
Since follicular lymphomas are rare in children, I will like to get your expert opinion on how to proceed with this child?
1. Watch and wait
2. 2 courses of chemotherapy as in BFM or COPAB (with i.t. or no i.t.?)
Thanks a lot
Best regards
Prof.Dr Rejin Kebudi
Istanbul University
Pediatric Hematology-Oncology
What do you think about using RG as a platform for unpublished data?
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I am sure that every member at RG has unpublished data.Unpublished data could have as significant values as published ones. What do you think about sharing your data with other members. publication needs processing and fees which implies always having unpublished data that could be significant for others. So sharing data will satisfy the scientific purposes and research ethics.
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Unpublished data is not peer reviewed and once you "publish" it here, a journal might not accept it as new data.
Can simulation programs induce changes in our thinking and philosophy about diseases?
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Simulation programs or software have various applications especially in medical field. Do you think applications of these programs could offer predictions such as for cancer detection at an early stage or the prognosis of the diseases?
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I think so, recently I read an article about "real-time chemistry". The idea is that you can get input parameters for your programs at the time you are conducting experiments. In this case you wouldn't need to perform ab-initio calculations but you would get precise parameters from experiments. The last will be very helpful when you try to model a system consisting of damaged DNA for instance (which is believed to be a cause of cancer) or misfolding of proteins.
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Antibiotic resistance among common pathogens is becoming quite frequent these days. Such infections have begun to pose a serious threat to human health. I would like to know the current situation with respect to our preparation to deal with such serious issues of human health.
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I think the most challenging problem is the emergence and spread of resistances in Gram negatives, such as Escherichia coli (cephalosporins, quinolones), Klebsiella pneumoniae (cephalosporins, quinolones, carbapenems) and non fermenters, such as A. baumannii (carbapenems). These are endemic in hospitals of most countries or in some areas of developed countries (e.g. Greece and Italy, in Europe). A more serious problem is their spread in LTCF or nursing homes, where surveillance is lacking at all and epidemiological data are unavailable. This could be a large reservoir of resistances, where they spill-out easily from towards the hospitals along with their old and co-morbid hosts.
In Palermo, Italy, where I am working since many years about this issue, we have seen the spread of such MDR or XDR organisms first in high risk wards, then in all wards and, recently, in some NICUs also, that is a very worrying development.
Antibiotic stewardship is indispensable, but I think there is a widespread under-appreciation of this problem by many healthcare workers. I agree also with D. Graham about the gross under-appreciation of "hygiene" and logistic/management issues, especially by the medical directions of the healthcare structures. A further problem arises from the need to approach the problem at a (at least) regional level.
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The subject is a female 41 years, she has complained on swollen and pain in both eyes since 1 moth ago. this pain has started when she went swimming in her private pool. the ophthalmologist prescribed a few antibiotics and asked her to do ANA,ACE,HLAB5,51 and 27.
she has already ITP.she went to the lab before starting antibiotic therapy. Her laboratory results are HLAB 5 and 51 positive.ANA is 0.8,ACE is 40 (6-54) and HLA b27 negative. Can we suspect to behcet disease,if yes what is the confirmation tests?if no what would you think about she?
Her eyes pain and inflammation in her eyes were improved after starting antibiotics.
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1. A report from the ophtalmologist is mandatory. We are not given here what he said. Other MDs are not qualified to diagnose eye problems, even rheumatologists who are responsible for the treatment of arthritis-related eye problems.
2. The description fits conjunctivitis. Behcet presents differently: uveitis of anterior and/or posterior chambers. There are criteria for Behcet, and this patient does not fulfill them, at least with the data provided, which is insufficient.
3. HLA typing is never used to diagnose rheumatic conditions (in joints or eyes or...). Even if the patient is HLA B5 positive, no diagnosis must be derived from this.
HLA Typing for rheumatic diseases is useful in cohort and epidemiological studies.
4. The data presented is not sufficient for a diagnosis. But the description of the condition seems to direct to conjunctivitis, to be treated by an ophtalmologist
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All guides for hypertension make efforts to limit salt intake, but really do we know how much they daily take?
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A great success to decrease salt from 12 grams to 5 grams daily by minimizing processed foods. Changing lifestyles is a journey. Congratulate the patient. With each encounter ask for a food recall. From there suggest culinary changess. I recommend increasing flavorful herbs such as sage, rosemary, and spices . Of course changing taste bud affinity for salt is difficult but possible. I have discovered that rapid changes in salt lowering is not sustainable. The patient has to have a buy on that can only come from education. I even encourage cooking classes and use of social media.
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Polymyositis
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Yes, there are some cutting edge approaches. No outright cures yet.
A recent phase 1 study showed use of an interferon alpha blocker sifalimumab reduced the attack nearly 50%. Reference is Ann Rheum Dis doi:10.1136/annrheumdis-2012-202794.
WF10 shows promise, hMSC stem cells have some positive results, and there are others. IVIG is not new but is often of help. Matthew
What is the best treatment for fibromyalgia?
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Pregabaline treatment, tramadol and NSAIDs have not been sufficient to reduce pain.
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I was involved in both research and treating patients with FMS in the past. From a clinical standpoint there were 2 groups that had to be approached very differently. About 2/3 of patients who met the ACR definition for FMS had no serious psychopathology (and were often being treated as if they had some variant of major depression that caused the pain -a universally ineffective approach in my experience). In this group a multidisciplinary/polymodal program almost always helped as long as it was individualized to the patients needs, abilities etc. However, sleep pattern had to be significantly improved to get the best results (i.e. addressing non-restorative sleep was always a first priority and I thought and still think that those who treat FMS need to have a good understanding of circadian rhythms to treat the sleep problems effectively). Also, in my experience patients who reported some type of "spiritual growth" did better. The other group is much more challenging and psychiatric care plays a greater role, but unfortunately at least in my experience is not nearly as successful. One could argue that the only difference is that the second group has a more severe form of FMS that leads to serious psychopathology, but I suspect that is not the case.
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I'm looking for the advantages and disadvantages of CEM to apply on health-seeking behavior of breast cancer patients. They are more likely to choose traditional treatment compared to modern treatment. Any ideas, comments and suggestions on appropriate books or articles.
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thank you Dwight Barry...i will try that. do you know about psychic surgery?
Urinary diversion in patient with bladder cancer and Crohn's disease: what is the best possible course of action?
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Patient with Crohn's disease and who has previously had a right colectomy 10 years ago for the same pathology. The patient is 57 years old and in good performance status. He has a pT2G3 bladder cancer. Crohn disease is now silent, but of course is a clear contraindication for an ortotopic neobladder. Can we avoid a bilateral uretero-cutaneostomy?
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In response to your question, I would say that patients with >T1 stage should undergo a later re-resection if the tumorous cells re-appear.Later, radical cystectomie with a formation of ureterocutaneostomy at both sides should be the therapeutic approach.
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What dose and for how long should this supplementation occur? Should it be a part of everyday life?
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Personally I wouldn't for the following reason.
Firstly, there is a tendency to ‘inappropriately’ prescribe iron tablets when haemoglobin (hb) is low prior to surgery. (personal observation) In the event a person is experiencing a clinical situation whereby surgery is required it is more likely that the anaemia is due to anaemia of chronic disease (AOCD). I am aware that there may be situation whereby iron deficiency anaemia (IDA) may occur together. We should give due respect to our body adaptation to adverse situation. AOCD primarily aim to reduce circulating iron and hoards iron into intracellular ferritin reserve. This leads to functional iron deficiency state. Why? Circulating iron is sought after by entities that is detrimental to our well being. As part of the same mechanism elevated serum hepcidin reduces iron transfer from the gut into the blood. Hence why are we purposely introducing measures (giving iron supplements) to violate this very measure that our body is toiling to preserve. Besides how much of the swallowed iron will be absorbed. Even in normal situation when hepcidin level is favourable, the non-heme iron absorption is below 10%.
Secondly, patient’s undergoing surgery is at risk of stress ulcer. There has been situation whereby the caregiver is being alerted of a possibility of upper gastrointestinal (UGIT) bleeding because the stool has turned dark. This is more so in an era when anticoagulation is more widely used for post surgical DVT chemoprophylaxis. In several situations, I noticed this confusion came about because the patients has been prescribed hematinics. I am sure there are those who will argue that our hem-occult test could easily differential non-heme (supplement iron) from heme iron (UGIT bleed). My argument is, why create additional stress for ourselves if the iron supplements are not a necessity in the first place.
Leaving in a multiethnic community, I notice there is ethic variation in the risk of UGIT bleed, higher among the Chinese and lowest among the Indians. Hence, I assume, that those living in the Indian Subcontinent may not be concern with this issue. I am not sure of other regions.
Thirdly, we should be aware that there is a large buffer between what we accept as normal value based on 95th-centile population variation and level that interferes with bodily function. We all accept that the normal platelet level is 150,000 – 140,000/microliter but spontaneous bleeding is not expected until below 10,000/microliter. A marginally low haemoglobin should not lead to alarm unless if the patient has other co-morbidity of concern.
Based on the above reasons and perhaps also defined by my personal philosophy of minimal intervention, I will not provide iron supplements unless there is clear indication of iron defiency anaemia.
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Today, sequencing of whole genome (exome or transcriptome or full) is possible in reasonable cost and time. Why personalized medicine is not implemented so far in real life. I believe it will be implemented in future, its just matter of time. May I know in your view how long it will take.
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To put it bluntly, making it, personalized medicine, work. Studies to date are generally small and or narrow in scope. Interplatform variability is also a big issue.
I think what is needed is for an encyclopedia of data covering a broad range of -omic markers covering a broad range of diseases to be compiled. Then we need the help of good statisticians and bioinformaticists to understand what it all means.
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Female patient in her 50s. Since she turned 18 she's has multiple episodes of cholangitis and colic. cholangiolithiasis (pronounced) and choledocholithiasis. The gallbladder was removed 30 years ago and has had ERCP three times.
I have met her this week and I found it very interesting that she has diarrhea since many years (3x per day, fluid, light-colored). I do not think it is a secondary problem, as the urine eis normal.
She also has no CED.
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What did the ERCP/ MRCP show? Any features of PSC or "oriental" cholangitis. What's her LFTs? How did you characterise her diarrhoea - steatorrhoea? Any features of chronic pancreatitis - risk factors or features on imaging including EUS? Any ductal strictures to suggest IgG4 disease - including pancreatic duct involvement? Diarrhoea may or may not be associated with cholangitis but consider also UC if PSC identified. Is CED coeliac disease and you've done the duodenal biopsies? Most common cause of diarrhoea following cholecystectomy would be bile salt irritation and improves on cholestyramine.
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A link or document outlining the basics and necessary data needed for the calculation would be very useful.
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Dear Caryn,
I am attaching here a Excel file which I received from Helmut Schutz. It will provide you assistance in estimation of sample size for a clinical study.
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Drotrecogin alpha an Activated Protein C, Inactivates clotting factors that limiting the generation of thrombin and inhibits production of inflammatory cytokines.
Mechanism of action: anti thrombotic, anti inflammatory, profibrinolytic.
In 2001, FDA approved the use of drotrecogin alfa (activated protein C ) for the treatment of severe Sepsis.
Drotrecogin alpha produced the largest benefit in the sickest subgroups, with an absolute mortality reduction of 7.4% in patients with more than one organ dysfunction and 13% (P = 0.0002) in patients with APACHE II scores totaling more than 24.
The treatment was effective regardless of age, severity of illness, the number of dysfunctional organs or systems, the site of infection (pulmonary or extrapulmonary), and the type of infecting organism (gram-positive, gram-negative, or mixed.
Caution is advised in:-
INR>3.0
Platelets count <30000/cumm
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hmmm... the Eli Lily company has removed xigris off the shelves due to safety concern and the so called benefit was likened to compare apple to an orange, as the "benefit" data was concluded by comparing a prospective data on treatment with APC to retrospective data aged years ago without it. Thus one of the BIG conclusion was the mortality benefit was largely drive by the improvement in ICU care in recent years rather than APC itself
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The software would for example model the effects of changes in blood pressure, heart rate and rhythm, skin colour change, in response to various interventions such a drug administration, change in posture, blood loss etc...
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We have a great software solution that has been integrated into both software and hardware at http://pulse.kitware.com/
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Traditionally, NAFLD has been conceptualized as a histological disease spectrum which progresses from pure fatty liver (simple steatosis) through non-alcoholic steatohepatitis (NASH) to liver fibrosis, cirrhosis and eventually hepatocellular carcinoma.
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Indeed, a high number of simple steatosis just remains simple without evolving towards steatohepatitis (NASH). This supports the idea that a number of factors determine the appreance of the inflammatory form, and that this occurs only in some cases.
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Status epilepticus is a severe neurologic emergency. In 10-40% of status epilepticus patients, seizure activity cannot be controlled with antiepileptic drugs and mortality in this context is ~40%. The definition of treatment refractory status epilepticus as a state where first- and second-line antiepileptic drugs fail has been questioned (Bleck TP. Curr Opin Crit Care 2005). Many opinion leaders require failure of two antiepileptic drugs before deeming status epilepticus "refractory", but this may produce delays in treatment escalation and in using definitive therapies. In the veterans affair trial, the likelihood that a second conventional agent would succeed after the first one had failed was unacceptably small (Treiman DM, et al. N Engl J Med. 1998). Therefore it has been proposed that failure of any one of the first administered regimens should constitute treatment refractory status epilepticus (Bleck TP. Curr Opin Crit Care 2005). However, this ongoing debate and these conflicting definitions are critical as they may hamper future studies in this field. Therefore, I would like to open the discussion and invite you to reveal your individual opinion.
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Thank you all - especially Raoul - for the exciting questions and discussion. Hoping that my answer is not too late, I will add some lines. Refractory status epilepticus (RSE) and refractory epilepsy - in my opinion - are rather worthless terms. Epileptologists prefer to speak about best treatment of epilepsies and the treatment of all variants of status epiletipcus (SE), not only to mention epileptic seizures control.
The incidence of grand-mal-status ranges from 18 – 28/100 000 inhabitants/year. I agree with Francois: The US-statistic number of mortality (40 %) is probably a bit too high. In Europe “mortality” of SE ranges from 3 (!) -33 % (Holtkamp et al. 2003; Meierkord et al. 2010). However, we prefer the term "lethality" to discribe the fatality of SE regarding clinical statistics and no definite numbers concerning the prevalence of SE in a certain European population. I think this could help to avoid the term “refractory”:
Important for any treatment of SE is the time factor, not wasting the time (I agree with Raoul and Anthony), not beginning with thinking over some known and sometimes unexplained fatal results - regardless of any interesting pospective or restrospective discussion - but to describe the very beginning of SE (convulsive or non-convulsive) and Video-EEG-Monitoring of each single epileptic seizure (focal, partial or generalized). That ist not new, but always important, I suppose.
Doubtless there is a rare “malignant variant” of SE (Holtkamp et al. 2005). In such subtle SE i.v. anaesthesia is required. On the other hand many types of generalized and some types of nonconvulsive SE cause little permanent neurologic sequelae (Kaplan, 2000). Anaesthesia is not required in the most cases.
SE as result of intoxication, encephalitis, brain tumor, stroke - or the beginning with early focal postraumatic fits - is not very difficult to treat (with benzodiazepine and phenytoine), if there is not (yet) a big progress of brain edema. The lethality, due mainly to the causing illness and comorbidity is 20 % (higher in the elderly, especially in some cases of nonconvulsive SE). RSE is not the leading cause of death. In this point I agree with Francois, too.
According to literature and our experience SE in chonical epilepsies has an overall lethality of only 4 % !
In most cases of noncompliance, drug - or alcohol and sleep withdrawal and in all cases of status pseudo-epilepticus we have not to use the questionable term “refractory”. Why in the rest of it? What is the sense and purpose? Even when the end will be fatal in 3 - 33 % of severe SE, who will think of RSE, when seizures, epilepsies and status begin?
Kaplan PW. No, some types of nonconvulsive status epilepticus
cause little permanent neurologic sequelae (or:
‘‘the cure may be worse than the disease’’). Clin Neurophysiol
2000; 30: 377–382.
Holtkamp M, Masuhr F, Harms L, Einhaupl KM, Meierkord
H, Buchheim K. The management of refractory
generalised convulsive and complex partial status epilepticus
in three European countries: a survey among epileptologists
and critical care neurologists. J Neurol
Neurosurg Psychiatry 2003; 74: 1095–1099.
Holtkamp M, Othman J, Buchheim K, Masuhr F, Schielke
E, Meierkord H. A ‘‘malignant’’ variant of status
epilepticus. Arch Neurol 2005; 62: 1428–1431.
Meierkord H, Boon P, Engelsen, B, K. Gocke,
S. Shorvonf, S Tinuper P, Holtkamp M:
EFNS guideline on the management
of status epilepticus in adults. Eur J Neurol 17(2010) 348-355.
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Delayed referral and hence delayed diagnosis are two main factors that worsen the prognosis of oral cancer. How does being a non-smoker female contribute to this fact?
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There's an article by Kourelis K, et al. in J BUON, 2013, that states that, even when it has a worse prognosis, Oral Ca in young patients exhibits just around 8% ER. Another by Zuguchi M et al in Cancer Sci 2012 points that the presence of ER beta in Squamous H&N Ca Cells is a bad prognosis factor. Shatalova EG et al, in Cancer Prev Res (Phil) 2011, indicated that Estrogen and Cytochrome P450 1B1 contribute to both early and end stage H&N Carcinogenesis, and that by IHC, ER and CYP1B1 were elevated in HNSCC relative to normal epithelium, Estrogens had no influence in apoptosis of SCH&NCa, but Fulvestrant had an apoptosis promoting effect in Leukemia cells. For Chandanos E, Eur J Cancer 2009, Estrogens are protective against Esophageal SCCa, and Goulioumis AK et al, in Oncol Rep 2009, remarked that the presence of ER-beta could protect tumor cell from acquiring Epithelial-Mesenchimal Transition features.
I had a 40 y.o. female patient, wife of a man suffering from hemophilia and with an history of Blood products transfussions, that had a side tongue carcinoma in an early stage, that was apparently cured by surgery. She had a mild lymphocitosis, that finally was identified as a Chronic T-Cell Lymphocytic Leukemia, or monoclonal T lymphocites; HTLV-1 and 2 testing was negative, but as the region you're living may be considered has having a higher prevalence of HTLV-1 and 2 infection than Spain, it may be considered is it's worth checking for this or another cause of blunted immunity that may have had an influence in the develpment of the Oral Cancer in your patient; as a matter of curiosity, Tackacs D et al, in Oral Oncol 2011 signal a decreased Oral Ca Risk by moderate alcohol consumption in non-smoker postmenopausal women.
Srivastava VK et al, in Biochem Biophys Res Commun 2011, published that Centochroman (Ormeloxifene) , a non-steroidal anti-estrogen used for birth regulation purposes in India, had an anti-prolipherative effect in H&NSCC by modulating PI3K / mTOR pathway,and also STAT3, and they suggest testing CC as a therapy mean in this type of Cancer.
Park SJ et al, in cancer Lett 2010, signaled an additive anti-cancer effect on Oral Squamous Cell Carcinoma by Combined Cetuximab and Genistein. Egloff AM et al, in Clin Can Res 2009, published about Cross-Talk between ER and EGFR in H&N SCC.
CHU ST et al, in J Recept Signal Transduct Res 2007, reported about Tamoxifen induced Cell Death in human Oral Cancer Cells, all of this may open ways for therapy, but in this field, you easily find yourself having too many data.
Regarding Cancer epidemiological and therapy outcome data gathering, it must be considered that, as the process of data collection and analysis takes time, when you've finished having an image about the ethiology and best therapy approaches in your environment, the actual situation may have changed, and the info you collected with great effort no longer being useful.
Carcinogenesis is a process that takes some time, and when you discover the Cancer, the causes that promoted it or stimulated the malignization of the cells in the tumor you're facing may no longer be there, or be totally different, for example, COPD is a know factor for Dementia, and a factor that may be surprisingly present in high frequency both in Dementia and Cancer in never-smoker women, as old time kitchens were an environment plenty of smoke, that induces both Lung Function impairments and Cancer; when the patient comes to your office, she may have ceased using coal or other smoke producing cooking procedures from decades ago, but the harm done is still there. Do we have enough time and ways precise enough for obtaining a selective history on disease promoting events or environmental causes not present wehn the patient comes in? Who knows? Salud †
What do you think about the co-expression of iNOS and HSP90 in the skeletal muscle of rats with Parkinso's Disease?
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According to the literature, the expression of both should come in the same direction. However, we found some differences, in which the expression of HSP90 increases where that of iNOS decreases.
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Hsp90 has been found necessary for iNOS induction in cultured cells exposed to inflammatory mediators. However, Hsp90 is the main component of the cytosolic molecular chaperone complex that has been implicated in the negative regulation of the heat shock factor 1 (HSF1). HSF1 is responsible for the transcriptional activation of the heat shock genes including Hsp40, Hsp70, and Hsp90, suggesting a regulatory role in Hsp90 synthesis at the transcriptional level. Hsp90 forms a multichaperone complex with Hsp70 and Hsp40 to regulate several regulatory proteins, such as steroid hormone receptors and transcription factors, and to modulate the protein translocation from peroxisomal to organelle. The interplay between these chaperones is of crucial importance for cell function and survival. Recently, Uryu et al. demonstrated that Hsp90 was predominantly increased in PD brains, which was in correlation with the elevated level of insoluble αSN. These alterations of Hsp90 in PD brain were recapitulated by neuropathological findings in αSN mutant transgenic mouse model of PD. Furthermore, exposure of cells to proteasome inhibitors resulted in increased levels of Hsp90. Microglia, which plays a principal role of inflammation in brain express high levels of Hsp90 following excitotoxic lesion in the mouse hippocampus. The protective function of Hsp90 can be very important since inflammation evoked by microglia may increase the risk of PD. Hsp90 is also a chaperone for maintaining an appropriate ligand-binding conformation for steroid receptors, but it also participates in the nuclear-cytoplasmic shuttling of steroid receptors. The role of heat shock protein 90 (hsp90) extends to agonist-dependent eNOS activation. Hsp90 binding stimulates eNOS activity by cooperatively enhancing the affinity of eNOS for binding calmodulin, balancing output of nitric oxide versus superoxide, and possibly facilitating heme binding. Synergistic activation of eNOS can be seen following formation of a ternary complex containing hsp90, Akt, and calmodulin-bound eNOS. NO itself may negatively modulate hsp90 by S-nitrosylation of a cysteine residue that inhibits the hsp90 ATPase function and may disrupt eNOS–hsp90 binding; this mechanism might provide negative feedback to regulate the amount of NO generation and/or facilitate cyclic eNOS activity. So, getting back to iNOS: Hsp90 is required in iNOS induction. Inhibiting Hsp90 function with geldanamycin or radicicol prevented iNOS expression in cells stimulated by both LPS and IFN-γ. HOever, it is not Hsp90 alone, but in conjuction with albumin, LPS, IFN- γ, TNF-alpha, endotoxins and many other cytokines. Taking into cosideration the other roles of Hsp90, it is not surprising that iNOS does not increase in all experimental situations even when Hsp90 is increased, especially in the absence of LPS for example.
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This indeed is a difficult situation to manage.
First and foremost, the patient may need resuscitation. Oxygen, IV fluids, protection of remaining lung from intrabronchial blood. Patient is at risk of asphyxiation.
It is important to identify the cause of haemoptysis.(eg: If it is an AV malformation, it can be embolised. If pulmonary embolism has caused lung infraction which in turn has caused haemoptysis, the lung segment will need excision... and so on).
Similarly, it is also important to classify Pulmonary embolism. Massive acute PE is when there is haemodynamic/ cardiorespiratory collapse. In the setting of massive haemoptysis, you clearly cannot thrombolyse/ heparinise the patient. Therefore, an inflow occlusion (off pump) pulmonary embolectomy might be indicated. This procedure can be further aided with an IVC filter to prevent further emboli.
Once the patient is stabilised, and cause of haemoptysis dealt with, you may be able to anticoagulate this patient.
In case of Chronic PEs, patient may develop pulmonary hypertension. In such patients, pulmonary endarterectomy may be indicated which should be undertaken only in very specialised centres.
Last but not the least, a cause of thromboembolism needs to be identified. The patient should be referred to haemotology for thrombophilia screening.
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A HIV negative patient with severe pulmonary MAC diseases is not improved with therapy including clarithromycin, ethambutol, moxifloxacin, rifampin.
MAC was resistant to clarithromycin, ethambutol, moxifloxacin, rifampin, amikacin, streptomycin.
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Therapy of MAC infections of non-HIV patients is difficult (1). When you have across the board resistance as your question indicates, any current therapy is probably ineffective. When all else has failed and there is nothing available, one can treat the patient under compassionate basis that will improve quality of life and perhaps, bring about some relieve, if not a cure. We have shown that the use the old neuroleotic thiordazine will improve the quality of life of XDR TB patients and has been recommended as a salvage drug (2). In vitro, small quantities of thioridazine will render MAC strains susceptible to many second line drugs to which the strain was initially resistant (3). The positive in vitro responses are opined to be the result of inhibition of over-expressed efflux pumps which extrude the antibiotics before they reach their intended target (4). I suggest these cited papers for more complete info.
1. Ramirez J, Mason C, Ali J, Lopez FA. Mycobacterium avium complex pulmonary
disease: management options in HIV-negative patients. J La State Med Soc. 2008
Sep-Oct;160(5):248-54; quiz 254, 293. PubMed PMID: 19048978.
2a. Amaral L, Udwadia Z, Abbate E, van Soolingen D. The added effect of
thioridazine in the treatment of drug-resistant tuberculosis. Int J Tuberc Lung
Dis. 2012 Dec;16(12):1706-8; author reply 1708-9. doi: 10.5588/ijtld.12.0616.
PubMed PMID: 23131273.
2b. Amaral L, Boeree MJ, Gillespie SH, Udwadia ZF, van Soolingen D. Thioridazine
cures extensively drug-resistant tuberculosis (XDR-TB) and the need for global
trials is now! Int J Antimicrob Agents. 2010 Jun;35(6):524-6. doi:
10.1016/j.ijantimicag.2009.12.019. Epub 2010 Feb 25. Review. PubMed PMID:
20188526.
3. Viveiros M, Martins M, Couto I, Kristiansen JE, Molnar J, Amaral L. The in
vitro activity of phenothiazines against Mycobacterium avium: potential of
thioridazine for therapy of the co-infected AIDS patient. In Vivo. 2005
Jul-Aug;19(4):733-6. PubMed PMID: 15999542.
4a. Viveiros M, Martins M, Rodrigues L, Machado D, Couto I, Ainsa J, Amaral L.
Inhibitors of mycobacterial efflux pumps as potential boosters for
anti-tubercular drugs. Expert Rev Anti Infect Ther. 2012 Sep;10(9):983-98. doi:
10.1586/eri.12.89. Review. PubMed PMID: 23106274.
4b. Machado D, Couto I, Perdigão J, Rodrigues L, Portugal I, Baptista P, Veigas B,
Amaral L, Viveiros M. Contribution of efflux to the emergence of isoniazid and
multidrug resistance in Mycobacterium tuberculosis. PLoS One. 2012;7(4):e34538.
doi: 10.1371/journal.pone.0034538. Epub 2012 Apr 6. PubMed PMID: 22493700; PubMed Central PMCID: PMC3321020.
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This is a frequent clinical scenario in terminal heart failure patients. There are no generally accepted recommendations at this point.
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This situation needs to be discussed with the patient and his family on an individual basis. With ongoing ICD-therapy we probably only replace one mode of death by another. This needs to be understood. Two papers by Buxton (2007) and Goldberg (2008) adress this topic nicely, because they help to identifiy modes of death in individual patietns. This is nicely summarized in the Seattle heart failure score (Levy 2006). These may give a more rational approach to the problem. However, these are only data form retrospective analysios and prospective data are lacking.
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The role of social media in building scientific and medical knowledge has been changing rapidly, and seems to be increasingly reliable, usable, and accepted within the field. How do you use Wikipedia in your medical work and how do you recommend others (especially students) use this resource. Also, does anyone have experience writing medial articles for Wikipedia? If so, do you have any advice to offer on the process?
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You also have to take into account the risk that it might contain obsolete, controvesial or unverified information, as any service of the kind. While in research this is easibly verifiable, there are many people who simply follow articles in wikipedia to treat themselves and do so without any critical thinking. So I would advise the students to think critically and try to verify the information before even considering any real application of wikipedia knowledge. An article on the wikipedia, however, might be a good starting point, provided one does read all the references and follows up on his investigation. As for writing -- try to make each information you put into your article well documented and easily verifiable, which is (or should be) no different than in a proper scientific paper.
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Wanted information about future research scope in the field of data mining in areas like anomaly detection in medical images and cancer detection
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While you can tweak the anomaly detection algorithms for better performance, the biggest challenge is in making sure that the data itself is accurate, complete, and consistent.
Why is carcinogenesis not a reversible process?
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Why carcinogenesis remains an ongoining process?
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One of the reasons might be that chromosomal instability is very often associated to cancer, at least in solid tumors. Hence, to revert cancer you would have to put back every piece of DNA at its original place!
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Dental pulp cells, periodontal ligament, cells from exfoliated deciduous teeth, cells from apical papilla, cells from periostium are common sources for obtaining stem cells to generate new bone and possibly teeth. Oral mucous is a rich source of induced pluripotent cells, these cells can be obtained from the biopsy of buccal mucosa. It would be beneficial if more simpler methods of obtaining pluripotent cells from a brush biopsy or a pap smear from healthy buccal mucosa.
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Dear Dr Ravi.
It is well established that multiplication of cells as they enter G0 phase of cell cycle takes place in St germinivatum (St Basale + lower layer of St Spinosum) layer of oral mucosa. Hence I second Dr Andi that in order to have active cells (unless tumerous) we require a deeper punch so as to get stem cells.Again all this can be established by experimental studies further 
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Stress that doctors face related to unhealthy competition
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Resilience in my humble opinion will help to reduce stress. That might mean to change some attitude towards life, but I think it is worth it. The seven pillars of resilience are: acceptance, to leave the situation of victomhood, result orientated, taking responsibility, optimistic, future orientated, network orientated.
If you look at these pillars and realise which have to be stressed, I think the stress will reduce, because you decide which way things will go.
In addition it might help to have a look at the five pillars of wellness. Those are: emotional wellness, physical wellness, spiritual wellness, social wellness and familiy wellness.
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Nasal polyposis is a fundamental problem for patients and also physicians.
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Chronic rhinosinusitis with nasal polyps is a condition classically defined as a subtype of chronic rhinosinusitis; however, experience and contemporary evidence suggest that this may eventually prove to be a condition on its own. (attached is an excellent review of CRS)
There are numerous theories put forth that seeks to explain the etiology of CRSwNP, from genetic predisposition, to fungi, to staph superantigen, however, there is no consensus at present.
The natural history is one of recurrence, regardless of the method by which you treat it, either by medical polypectomy or surgical polypectomy. Since it is just a matter of time before it recurs, you have to qualify what you mean by BEST treatment? Do you mean a decrease in SNOT scores? Shrinkage or total absence of the polyps? Non-recurrence (and for how long?)? Decreased need for intranasal steroid spray (no maintenance medication)? Resolution of nasal obstruction? Return of sense of smell?
I subscribe to the EPOS guidelines released this 2012, however, my region of the world (South East Asia) may have different kinds of polyps compared to Western countries, so the recommendations may not be spot on all the time.
Personally, especially for grade 3 polyps, I start them off on concurrent oral and intranasal steroids and augmented penicillins for 2 weeks, re-assess the patient's status and SNOT score, proceed with PNS CT and FESS if with poor response, or if with patient-reported satisfactory response and undecided on surgery, discontinue oral meds and just continue with intranasal steroids, with the caveat that symptoms may recur.
In terms of extent of surgery, I never do just a polypectomy (unless if it is just an antrochoanal polyp, a different story altogether), but, rather, remove the uncinate, open up the ethmoid bulla, make sure the ostiomeatal unit is patent. If there is still gross polyps, I will open up the ground lamella and posterior ethmoids, but if it is just diseased mucosa, I will let my post-operative intranasal steroid spray do the work.
Antihistamines for me are only given in the presence of systemic allergy, otherwise, I don't routinely prescribe them. There are some studies supporting the use of anti-leukotrienes for recurrent nasal polyps, but the evidence is not consistent, and the studies are not robust.
Control of other conditions should also be undertaken, since non-allergic asthma also correlates with nasal polyps. Patients with aspirin sensitivity should be considered as special cases and treated appropriately.
What are the indications and implications of having red blood cells in routine urine analysis?
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Sometimes, routine urine analysis is associated with reporting the presence of red blood cells in urine. The interpretation of the results varies among clinicians from infection to cancer. How do you share your experience in this regard. Furthermore, do you think this can be valid to form a database to predict prospective carcinogenicity?
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Dear Ahed Thanks a lot.Although it's true that high urinary level of some minerals such as Ca, uric acid and oxalate potentially can induce to microscopic hematuria with or without stone formation, but the role of dietary content is the focus of arguments.Because your interest on oxalate and oxalate containing foods,I emphesize on this mineral.We have to consider some points about dietary oxalate and its role on stone formation and hematuria :1/ only 10-15% of urinary oxalate is from diet and the rest is endogenous. 2/ excretion of oxalate in urine depends on bioavailability of oxalate.Spinach and rhubarb are examples for high availability oxalate containing foods.Interestingly ,tea and coffee are not in this group. 3/Oxalate in foods is in complex with other mineral such as calcium,So effect of oxalate ingestion on urinary oxalate excretion is a complicated concept.In conclusion, it is not completely clear that dietary oxalate manipulation can induce in change in urinary oxalate excretion and it dosen't worth to recommend to patients with stone and/or hamaturia.
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Patient safety is high on the agenda both nationally and internationally.
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Unfortunately, errors will occur. We can minimise this by training, the use of checklists and having a good supportive team structure. What is key is if we do make mistakes we are honest enough to admit to it and not to compound the error.
Incompetence is really a term used to assign blame, fortunately most errors are not due to surgeons who either lack the necessary ability or insight to prevent an error. But we all make mistakes, the key thing is how we react to these errors and aim to correct them or at least don't make things worse.
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There is a wealth of research and information in relation to waste medication in primary care but appears to be limited when related to secondary care (hospitals). I am interested in how health professionals view medication waste and the impact this has upon health services. Additionally I wish to look at the root causes of medication waste within secondary care.
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Very interesting question. Of the 2 types of medication waste, I deal more with liquid medication waste (unused IV medications). Cytotoxic meds go in an RCRA container, and there are other containers for non-cytotoxic IV meds. Some meds are more expensive than others (Fentanyl is likely more expensive than Dilaudid). I have seen similar situations to Urmila Patel's scenario of patients being admitted to the hospital with bags chock full of meds. If the meds are not formulary, pharmacy will have us administer from patient supply. If the meds are formulary, then the hospital will use hospital stock and send the patient supply home with family or hold it in pharmacy until discharge. I believe that much waste happens under the guise of "better safe than sorry". I don't see this as a bad policy per se, but I also believe that this policy requires closer scrutiny. Part of the reason that healthcare is so expensive is because there is so much waste. I look forward to seeing how this topic develops.
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The answer to this question depends on both geographical, cultural, legal and time-related conditions. Many methods used in alternative medicine, in the Nordic countries, today may be accepted in other countries (for example, homeopathy (Germany), acupuncture (China), and Ayurvedic medicine (India)). Many methods once considered "alternative", are many places accepted today (for example, diet therapy and acupuncture).
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As a researcher I am also an educator in EBM (evidence-based medicine), including both eb-CAM (evidence-based CAM) and eb-IM (evidence-based integrative medicine), so I will provide here first the five most authoritative official definitions of CAM (complementary and alternative medicine) in current use, and offer some brief commentary, then finally offer a Working Definition of CAM based on a distillation of the best of these definitions and from decades of professional experience.
There are currently five authoritative definitions of CAM in widespread use:
NCCAM (National Center for Complementary and Alternative Medicine)
“Complementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine; that is, medicine as practiced by holders of MD (medical doctor) or DO (doctor of osteopathy) degrees and their allied health professionals, such as physical therapists, psychologists, and registered nurses.” [1]
The Cochrane Collaboration (Cochrane)
“A broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period.” [2] Note that the Cochrane Definition has been adopted by the CAMDoc Alliance, constituted by The European Committee for Homeopathy (ECH), the European Council of Doctors for Plurality in Medicine (ECPM), the International Council of Medical Acupuncture and Related Techniques (ICMART) and the International Federation of Anthroposophic Medical Associations (IVAA), now representing 132 European associations of medical doctors actively practicing CAM.[7] See also their Model Guidelines for the Practice of Complementary Therapies (CAM) by Medical Doctors in the European Union [8].
British Medical Association (BMA)
“Those forms of treatment which are not widely used by the conventional healthcare professions, and the skills of which are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses.” [3]
CAMbrella
CAMbrella is a pan-European research project on CAM that has completed a comprehensive study of the nature and definition of CAM, and has just (2012) published its definition:
"Complementary and Alternative Medicine (CAM) utilised by European citizens represents a variety of different medical systems and therapies based on the knowledge, skills and practices derived from theories, philosophies and experiences used to maintain and improve health, as well as to prevent, diagnose, relieve or treat physical and mental illnesses. CAM has been mainly used outside conventional health care, but in some countries certain treatments are being adopted or adapted by conventional health care." [4]
CAM-Expert Definition / Zollman/Vickers
From acknowledged CAM experts Catherine Zollman and Andrew Vickers, Research Council for Complementary Medicine, London, and now (Vickers) with Memorial Sloan-Kettering:
‘Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed." [5]
Commentary:
1. In general, complementary medicine refers to therapies used in combination with conventional medicine, while alternative medicine is used in place of conventional medicine, but what constitutes alternative or complementary when seen from a conventional medicine perspective may be, or become, traditional or mainstream for some ethno-cultural groups and/or at various points in history: thus use of Traditional Chinese Medicine (TCM) by the Chinese community within which it is conventional not alternative.
2. It should also be noted that the complementary versus alternative subcategories are contextual, not absolute: thus acupuncture therapy is complementary in one context as for analgesia w/wo traditional analgesics, but is alternative in another, where acupuncture is used instead of physiotherapy for muscular pain.
3. In addition, boundaries within CAM, and borders between the CAM domain and that of conventional medicine, are neither consistently clear nor constant, and these boundaries and borders change and are shaped over time across a continuum of gradually increasing acceptance and integration with conventional medicine.
4. The BMA definition is an especially poor one in claiming that CAM skills "are not taught as part of the undergraduate curriculum of conventional medical and paramedical healthcare courses." Even as of a 1989 survey [6], 64% of USA medical schools surveyed offered 1 or more courses in CAM, or these topics were covered in required courses, and 37% of the medical schools surveyed offered 2 or more courses. Since 1989, both the number of medical schools, and the number of courses on CAM within those schools, has increased dramatically.
5. Nonetheless both significant resistance and sometimes manifest hostility to, as well as ignorance about, CAM remains even today.
So based on experience and research, I will offer the following more constructive definition of CAM that has served well in instruction and in professional interaction:
WORKING DEFINITION OF CAM
An umbrella term for a collection of diverse approaches outside of the narrower framework of conventional medicine for the maintenance and improvement of health, for disease prevention and treatment, and for various associated supportive functions. In addition, when CAM is subject, as it must be, to the same methodological rigors of review and appraisal as any evaluable conventional modality using the protocols and constructs of EBM (evidence-based medicine), we term that eb-CAM (evidence-based CAM). Furthermore when CAM is integrated with conventional medicine, we term that Integrative Medicine and when that in turn is subject to EBM constraints and requirements, we term that eb-IM (evidence-based Integrative Medicine).
Forward Statement:
In systematic reviews and critical appraisals of CAM and its sister disciplines, eb-CAM, IM, and eb-IM, the weight of the evidence supports a finding of "probable efficacy" (Level I and Level II) for dozens of CAM modalities, supported by systematic review, meta-analysis, and critical appraisals, at the level of RCT (randomized controlled trial) [as, with melatonin, ginger, acupuncture, and numerous others evidenced within eb-CAM], and of course the judgment of only "possible efficacy" or "lack of (demonstrable) efficacy" for many more. As CAM, especially eb-CA matures, it is to be expected that significant bodies of CAM modalities, interventions and agents will be winnowed out by critical appraisal and failure in human clinical RCTs, but that nonetheless a significant albeit smaller body will achieve probably efficacy and be ultimately integrated into conventional medicine, a progress we are already beginning to witness.
References
1. National Center for Complementary and Alternative Medicine (NCCAM). The Use of Complementary and Alternative Medicine in the United States. Available at http://nccam.nih.gov/news/camsurvey_fs1.
2. Wieland LS, Manheimer E, Berman BM. Development and classification of an operational definition of complementary and alternative medicine for the Cochrane collaboration. Altern Ther Health Med 2011 Mar-Apr; 17(2):50-9.
3. British Medical Association (BMA). Complementary Medicine—New Approaches to Good Practice. Available at http://www.bma.org.uk/ap.nsf/content/publicpetitioncam.
4. Falkenberg T, Lewith G, di Sarsina PR, et al. Towards a Pan-European Definition of Complementary and Alternative Medicine – a Realistic Ambition?. Forsch Komplementmed 2012;19(suppl 2):6–8.
5. Zollman C, Vickers A. What is complementary medicine? Br Med J 1999; 319: 693–696.
6. Wetzel MS, Eisenberg DM, Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical schools. JAMA 1998 Sep 2; 280(9):784-7.
7. CAMDoc. The CAMDoc Alliance. Available at: http://www.camdoc.eu/index.html.
8. CAMDoc. The CAMDoc Alliance. Model Guidelines for the Practice of Complementary Therapies (CAM) by Medical Doctors in the European Union. Available at: http://www.camdoc.eu/Pdf/Model%20Guidelines%20CAM%20Practice.pdf.
Constantine Kaniklidis
Director of Medical Research,
No Surrender Breast Cancer Foundation (NSBCF)
European Association for Cancer Research (EACR)
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In particular he is a 48 year old male with DM type II. Our treatment after biopsy first to eliminate all areas of dysplasia (buccal mucosal areas) with carbon dioxide laser application and lesions recurred within 2 months. Short term systemic corticosteroid therapy (for 3 weeks) was excellent but only for 1 month and then lesions arose.
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Dysplasia on the basis of licheniod tissues are local expressions of systemic disease.
Dear Heinz, what is the nature of that systemic disease, and how do you treat it?
What if you could differentiate a haemorrhagic from an ischemic stroke 'in the field' ?
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If there would be a portable device which allows you to differentiate an ischemic from a haemorrhagic stroke at that the site of the emergency or during patient transport - how would you rate this information on a scale between: 1 - not relevant 2 - poor 3 - potentially useful 4 - useful 5 - very useful 6 - critical What is the key argument supporting your score?
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Being able to differentiate ischemic from a hemorrhagic stroke is very critical. The question is how reliable is the test. What are its specificity and sensitivity indices?. What is the precision? Once we know that it is a reliable test, then in patients with ischemic stroke, it enables neurologists to decide whether or not to administer tPA. Firstly, one has to know whether or not the patient has any contraindications to fibrinolytic therapy. If the patient has no contraindications, then with all due precautions fibrinolytic therapy may be safely administered. Even if you have that fantastic test at your disposal it does not mean that if the test shows ischemic stroke, one jumps to administer fibrinolytic therapy. Patients have to be evaluated on an individual basis and then consider to administer fibrinolytic therapy. If the test shows hemorrhagic stroke, then again based on the reliability and precision of the test, neurologists can administer recombinant Factor VIIa (Novoseven) in a site-directed delivery system. Again caution should be exercised that if the rFVIIa is not safely administered in a site-directed delivery system, there could be thrombotic complications as a result of this.
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Parametric or non parametric analysis.
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If you aim to analyze hear rate variability you can use e.g. the freeware Kubios (http://kubios.uef.fi). Or what you are aming at?
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Vocal cord paralysis.
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To determine the time for intervention or if any intervention is required. Depending on the etiology, intervention may be temporary or permanent.
When can anti-epileptic treatment for West syndrome be safely discontinued?
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The patient is a three year old girl with symptomatic West syndrome, diagnosed at 7 months and epileptic control attained within one week after onset. She has been siezure free now for 2.5 years but the parents are reluctant to discontinue treatment. EEG follow-up has been normal. She has moderate quadroplegic cerebral palsy though she continues to make developmental gains. Cognitive development is appropriate. Speech development is delayed. She is treated with Sultiam 45mg twice a day. How to proceed? What are the risks/benefits?
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Typically, if treatment for infantile spasms is successful in causing cessation of spasms and resolution of hypssarrhythmia (the typical EEG of West Syndrome), treatment is short term for first line agents(weeks to months for ACTH or oral steroids, 6 months for Vigabatrin). That said, there are reports of relapse after VGB discontinuation (in children with cortical dysplasia) (Krolle-Seger et all Epilepsia 2007). With other types of epilepsy, discontinuation of antiepileptic medication is considered after 2 years of seizure freedom, and the majority of patients will not have a relapse though those with a symptomatic etiology (as your patient has) and those with epileptiform abnormalities on EEG (which your patient does not have) tend to have a higher relapse rate(see papers by Shlomo Shinnar, and by Ann Berg, also by Peter and Carol Camfield). Because we do not have Sulthiame in the US and rarely use it, I am not familiar with its specific long term risks. There is considerable debate and not very much data about the long term neurodevelopmental effects of AEDs. All in all, if the child does not have a malformation of cortical development, has a normal EEG and has been seizure free for more than 2 years, I would advise discontinuation of the antiepielptic medication.
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Exparel is a medication used in surgery. It is the liposomal version of bupivacaine. The company did 3 "pivotal" trials for its approval (www.fda.gov). 2 of these were against placebo and 1 was against bupivacaine. Exparel did better than placebo, but not better than bupivacaine. The exparel versus bupivacaine study was never published. The 2 placebo trials are heavily marketed.
Exparel is $300 versus $2 for bupivacaine.
I have put together an article with above details as well as other information that shows similar outcomes with exparel and bupivacaine and just submitted to pharmacy journal. However, seems like I should do more.
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Thanks, interesting about the DSM.
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Lets take the hypotension or hypertension in the same anxiety disorder in different patients. The disease its the same for the both patients psychiatrically, but the cardiovascular is different. Is there an endocrinal explanation, or is it more like the signaling of the spectrum of apparatus joined with the somatical design of the act ?
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Excuse me but dianetics isn't related to scientology or something like that?
Anyway i will search for a better knowledge of the materials you gave and hope to find a good answer
let me rephrase names like lishman or frany alexander are sure related to psycho somatics and i guess the point .
Thanx and a lot of respect for what you do im very atracted on this domain whom i think it will transform what we do with psychiatry in the future.
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Historically, pivotal changes in the practice of medicine, pharmacy, dentistry, or nursing have occurred in response to the misery of the human condition. Health conditions such as the Black Plague, the polio epidemic, HIV/AIDS, and war are examples of how human suffering that affected large populations spurred advances in infection control, immunization, pharmacologic therapies, and survival after life-threatening injury.
When poverty or cruelty finally rises to the level of social awareness, political action is taken through Acts of the U.S. Congress. The 1935 Social Security Act, 1946 Mental Health Act, 1964 Civil Rights Act, 1965 Medicare Act, 1990 Americans with Disabilities Act, and the 2010 Affordable Care Act are the moments in history when human suffering rose to a level of social consciousness that there was political action. (Source: NIH Almanac Legislative Chronology http://www.nih.gov/about/almanac/historical/legislative_chronology.htm)
Today, evidence that we generate from our NIH, NSF, and Foundation grants does not translate to the public good because of regulatory control that blocks licenses health professionals from providing care to people who need it or because the reimbursement rates for professional services is too low; especially for those of us who work for public, not-for-profit health care systems. It is time for us to act as health scientists and health professionals to return to the practice of health and the ethical dissemination and sharing of research data that highlights health disparity.
Those of us who are clinical research scientists have demonstrated efficacy and effectiveness of basic health behaviors such as physical activity, immunizations, good nutrition, chronic health management, and prenatal care. The major problem is a health care system where all the resources are skimmed off the top and nothing is left for the people and health practitioners who struggle each day to provide care. As professionals, when we put on our white coats we took an oath to protect the health of society and to provide health care to those that need it.
For all of us in the medical health professions, we need to come together and seek support from our colleagues in business, health policy, and health sciences to solve the social problems that are creating 3rd world poverty, sickness, and suffering that rivals the time of the Great Depression.
Image of public health service areas in Los Angeles County; SPA6; pop 1.1 million people, green area is an economically distressed Medically Underserved Area and medical, dental, and mental Health Professional Shortage Area:
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There are some very good essays written recently on this circumstance, especially by the the likes of Chris Hedges (see his "Life is Sacred"). The best book I've read on the subject is Not-Two IS Peace, by Adi Da. My sense is that this book may be the most important read in these precipitous times. Absolutely YES, we must cooperate to bring about peace and harmony---in WORLD society, not just locally. As Hedges has pointed out, "We now live in a nation where doctors destroy health, lawyers destroy justice, universities destroy knowledge, governments destroy freedom, the press destroys information, religion destroys morals, and our banks destroy the economy." It doesn't take a genius to see the truth in these words.
This world is being destroyed by heartless corporate interests that don't give a damn about anything but profits and power.
Revolution across-the-board is greatly needed and surely coming. But a revolution in consciousness: understanding the world (with all of its life) as a unity, honoring and fostering life, ending war as a means of settling disputes, teaching peace, tolerance and cooperation. This all starts right with us as individuals---communicating this life-positive energy to everyone every day in every way we can.
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Hi there, I just wanted to let you know of a site I have set up called Memorable Medicine. It's a free revision and social networking site for medical students and junior doctors. Here's a link to the internal medicine section: http://www.memorablemedicine.com/course/view.php?id=7
Please get in touch if you would like to be more involved in its evolution!
Regards,
Nick
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Nick
It is extremely difficult to gain access to your website - end up with Japanese writing, but despite translating it does not appear to give access to your website.
Howard.
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Retinal detachment in lung carcinoma as a presenting sign
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Secondary retinal detachment due to metastatic lesion into choroid could be a presenting sign for lung adenocarcinoma . It will be confirmed by ultrasound examination
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Necsito saber sobre los propiedades de los mejores materiales para impresiones dentales enfocados al adulto mayor como son todos los tipos de protesis
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Yo recomiendo tomar impresiones con silicon o con hule cuando se trata de protesis fija ya que habra una minima distorsion, ademas de que la impresion no sufre modificaciones por un buen tiempo, al contrario que las impresiones con alginato las cuales son de valor en casos de protesis removible,parcial o total. Hay Dentistas  de generacion anterior que les gusta tomar una impresion final con pasta sinquenolica aplicada a la cucharilla individual para protesis total.
Cada material tiene el lado positivo y el lado no tan positivo, lo importante es saber como manejar cada uno de acuerdo a las instrucciones del fabricante.
Yo me acuerdo que en la Facultad tomaba impresiones hasta con modelina(ya ni se conoce) ya sea de alta o baja.
pero esto es otra clase de platica
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Is it not a relevant topic or alcohol industry manipulates the researchers? I would like to have some figures of Portugal.
Thank you.
Aires Gameiro
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Very good question Aires. Contact at www.eufasd.org for some facts and figures. Currently operating a prevention campaign in 22 countries of Europe seeking mandatory labelling on alcohol products to warn of the dangers of alcohol in pregnancy.. There is only estimated figures in europe due to lack of diagnostic services. Here in Ireland our estimated number of FASD Births per year is 900.
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Is Coxofemoral tendino-bursitis same thing as periarthritis of the hip?
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I think that "Coxofemoral tendino-bursitis" is an incorrect term. They probably mean an ilio-psoas bursitis which is anterior to the coxo-femoral joint. Even "periarthritis" is now an outdated term as the new term is "GTPS" - greater trochanteric pain syndrome (which includes tendinitis +/- rupture of the gluteus medius and minimus tendons as well as trochanteric bursitis).
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I am a medical student and I would like to learn more about the statistics involved in medical researches such as the chi square, p value, t test, confidence interval, odds ratio etc. Can anyone guide me as to where to learn that? Or are there any softwares that can help me calculate these?
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Hi, for standard statistics I would try PSPP, it´s free and has a SPSS-like interface
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Why not bilateral? Why first was good joints( in 2 years) and in 6 years dislocation?etc Dr Marek
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Dear Okonski
Cerebral palsy is characterized by a change in posture and movement due to an injury to the immature brain. Such injuries can happen from the beginning of the formation of the central nervous system myelination by the end of. Depending on the location of neurological injury, has been the predominant clinical type , such as spastic cerebral cortex , basal atetosico based , ataxic cerebellar .
The changes that occur in a child 's cerebral palsy interfere with normal gait . Deformities at the hip , for example , are very frequent in spastic patients because spasticity leads to muscular imbalance and one of the changes that affect the hip joint are: contractors of adductor and flexor muscles(mainly iliac psoas) with progressive deformity in adduction and flexion. With these contractures the femoral head loses the normal acetabulum relationship (medial and anterior) and the femoral head with this abnormal position (posterior and lateral ) if orthopedic procedure is not done to correct the deformity , the hip will progressively dislocate .
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Medicine
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Are the alloys unstable in the body?
Why not use grapheme?
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Nowdays fast dissolving tablet is common, so to do a new reaserch on this topic what are the aspects needed , on which class of new drug it can be performed.
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Analgesics. In order to get a rapid pharmacological action.you can perform in vitrue dissolution testing as a measure.
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What is the latest medicine used to treat sarcoidisis?
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Baljeet Grewal wrote:
> What is the latest medicine used to treat sarcoidisis?
According to this article NOD2 inhibitors. Disclaimer: I'm not a medic.
Further:
Regards,
Joachim
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I got low levels of beta amyloid in plasma of Saudi autistic patients and I discussed this to high rate of influx to the brain but it was not accepted as hypothesis during the publication of my work
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how did you know there is a high influx rate from blood to brain? What was your rationale? Did you evaluate it somehow? Is there any published evidence?
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Intralesional methotrexate
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Small lesions of psoriasis vulgaris are a good indication for intralesional methotrexate and also some cases of keloids.
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That used to augementation of soft tissues
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Abdul Arami wrote:
> That used to augementation of soft tissues
Recently new methods to grow synthetic collagen were devised.
Regards,
Joachim
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How about the feasibility of thermal ablation of brain tumors?
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Laser thermal ablation is feasible and is FDA approved. MR guided focused ultrasound (MRgFUS) is another modality that can thermally ablate tumors. One of the advantage of MRgFUS in this regard is that it is non-invasive. This is a good review that we wrote recently: http://shootingcupoche.com/publication/45649328_Future_Potential_of_MRI-Guided_Focused_Ultrasound_Brain_Surgery
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There are many complaints in women of the transition age to menopuse.i have dought that if there is any relationship between the environment in which they live and age of onset of menopause.
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I think that even the entire life has an impact of hormonal system, with addition of stress, happiness or not, the existence or not, of a normal sex life, and also the genetic legacy ,..and so on
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we have one case presnted with pneumonia, CXR showed medistinal mass,
bronchoscopy showed endobronchial lesion& biopsy showed aspiration pneumonia
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If aspirated material is big enough and left for time ,it can present as mediastinal mass with calcification
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Leprosy reaction is very hard to control and prednison has many side effects,who can give me any good suggestion in control it?
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Firstly ,we must figure out the other infections ,that would be the precipitating causes. For another drug was used in lepra reaction ,from my experience is dapsone or clozimine.
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I have a patient with the right main bronchi occluded caused by Wegener´s disease. I´m planning to open it with electrocautery and maybe deliver a dumon stent.
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Actually i ve got no experience in that
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Female patients: 43 age,weight 46 kg, height 165 cm, 86 pulses per minute, body temperature is constantly 38°C, normal lab tests, with high stress work environment, physical activity of moderate, persistent feelings of fatigue and sleep, without sugar and fat, blood pressure slightly lower than normal, with mild rheumatoid arthritis,any history of TB and other chronic infection.
At the age of 17 due to nausea and vomiting, seek medical attention and underwent surgery with the diagnosis of small bowel adhesions and a very small part of the small intestine is removed.
With dexamethasone for a period of six months after taking the patient's increased appetite and weight were normal.
What would you recommend for this patient?
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From her BMI , can be defined as malnourished that would cause by many conditions such as hyperthyroidism, dm,malignancy, connective tissue disease such as sle ,mctd and chronic infection such as TB , AIDS.IN addition the major problem is incomplete history and physical examination in this patient can make us jump to the psycotic or mal nutrition cause.
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A 70 years old women with suspected pulmonary-biliary fistula. She had bilious sputum and developed recurrent pulmonary infection, with E.coli- yeild sputum culture. Bronchoscopy showed bile coming from the right lower lobe. Complicated post-operative hepatobiliary surgery was the culprit. MRCP did not show fitula .ERCP could show a small fistula that is not shown with MRCP. definitive surgical correction needed if no spontaneous closure happened especialy if persistant infection occur.
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We have treated bilio pulmonary fistulae secondary to complicated hidtydic cyst by a bronchoscopic approach. We identified the compromised bronchial subsegment and inject alicuots of 0.1 cc 95% ethanol into various points of mucosa and after that, we instilled a fibrin glue (platelets enriched plasma) after which no dranege of bilis throgh respiratory tract has been observed. ·3 cases with follow up of 6, 9 and 12 months.
There are 2 publication of endobronchial treatement with cyanoacrilate 2007 and 2008
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I would like to contribute an article
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I would like to send an article
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Does somebody know more about a rupture of the pes anserinus tendon? How should it be treated?
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Probably after Cortisone Injection? Pes anserinus ( Sartorius/ Gracilis/ Semitendinosus insertion at the medial tibia head) acts mainly as secondary medial joint stabilizer. So- if no stabilization problem is evident, the treatment remains conservative, according sport trauma therapy (RICE). Tests include Vlagus stress test in zero and 30 ° flexion as well as Lachmann Test, anterior drawer in neutral and in ext. rotation with knee in 90° flexion. Ultimate measure for functional stabilisation is gait analysis. If there is instability, than treatment depends- proper eccentric exercises, Galileo, skipping rope..., I haven´t seen instability due to pes anserinus tendon insufficiency, so surgery remains pretty rare, if at all.  
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good day for you all , i am mostafa mahran a demonstrator of anatomy in college of medicine , cairo , egypt , i am new to research gate and dont know where to star or what to do , if someone can help me i will be more than thankful for that help , thank you all , god bless u
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Welcome Mostafa,
At the first glance I would say please read your questions and answers carefully before sending. why? to avoid spelling mistakes and misunderstanding of your questions. To increase your score in research gate try to answer as many as questions in your field.
Good Luck
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NRHM is a program implemented by Gov. of India on April 2005 for 7 years. Now it is about to complete the term. In this program lots of funds were spent to decrease the maternal mortality, child mortality etc (all indicators of health) but after 5 year it is not looking fruitful the goals were not achieved as expected).
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NRHM has given a lot of power to the local bodies. But, as you have said that, it's not looking fruitful. So, like the other things, the use of power depends upon the king, if we use it morally things definitely will go right. One more thing, it was/is the thing that has increased the burden of PHC medical officer who is already exhausted because after all being a doctor he remains engaged in fulfilling the targets of tubectomies, vasectomies, sputum collection, peripheral smear etc. Because under NRHM govt sends the money to PHC medical officer and he has to use it and have to give feedback and it is must. In the peripheries there are lot of vacancies for the post of medical officer and even i’ve heard that work goes only on papers. Again new medical officers, sometimes get the inchargeship within few months because of lack of medical officers. And this inchargeship is being given to these graduation completed fellows without any prior administrative training. As well as many medical officers despite of in-charge medical officer works on yearly contracts basis predisposes them to frustration. Any new enthusiastic medical officer will became helpless within the period of six months.
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I am an Indian medical student and searching for some interesting and rare case reports in extreme medicine like in deserts, mountains, jungle, underwater, etc.
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Decompression sickness, high altitude cerebral oedema, high-altitude pulmonary oedema, immersion hypothermia, frost bite, rescue collapse (During the Second World War, an estimated 25–30,000 sailors died shortly after being rescued from cold water. After the sinking of the Titanic there were numerous reports that described the almost immediate death of people who seemed otherwise well after being pulled onto lifeboats several hours after being immersed in the sea) are few examples of cases from extreme environmental medicine. Case reports regarding these cases can be search from internet. As well as case can be framed as per interest.
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See attached paper, and response to the question.
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One at time of first vitals, and then again after initation of medications. Patients initially diagnosed with STEMI, after medications such as ASA and TNG, can have a non diagnostic ECG later, particularly medications that have the possibility of correcting myocardial oxygen supply and demand. I have attached 2 prints, the first (ECG 1) is at time of VS, and then second (ECG 2) is after medications, about 4 minutes later
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Can we remove it with sinus endoscopy?
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Hello! I think, at first you have to do CT ck an. If the foreign body in maxillary sinus, you can. If not, in my point of view, it will be better to do with external approach by incision superiorly of zygomatic arch.
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79 year old male, healthy, fit, active. Dx Lyme disease (borreliosis) in 2005 following a trip to France.
Acute presentation one month after exposure, hospitalised 2 months, IV ABs once diagnosed.
Some peripheral neuropathy secondary to the borreliosis, lymphoplasmacytic lymphoma (Waldenstrom macroglobulinaemia) diagnosed this year in one node. No medications.
2 year history of transient pain around rib cage described as being like an 'electrical shock'. Progressive lethargy, weakening and atrophy of hip flexors, adductors and quadriceps to the point where he is now incapable of standing. Upper body, hamstrings, plantarflexors, dorsiflexors are all very strong.
This has occurred over 4 months. 2 years ago, pt cycled 100km over 2 days whilst on holidays, 4 months ago was able to independently catch public transport and walk around a capital city CBD. Hospitalised 2 months for investigations after 2 consecutive falls within a week, with no positive result to Lyme serology, immunohistology, blood panel (low Na), muscle biopsy, nerve biopsy, lumbar puncture, electroneurography.
Any ideas?
I wonder whether neuralgic amyotrophy might explain the presentation.
Many thanks for your time and expertise.
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not in my perspective
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I am at present engaged in quality research about death in Hospitals (Norway). Last year it was claimed that errors or adverse events is linked to nearly 1/3 of deaths in Norwegian hospitals in 2010 (see attachment, there is a short summary in English in the text). Currently we review all deaths in our own hospital (Haukeland University Hospital), and we strive to find good definitions for what we could define as a sudden and/or unexpected death. Suggestions?
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There are only two organs which are implicated in sudden death : the brain and the heart. Concerning the heart, acute cardiac arrest may be caused by myocardial infarction or by ventricular tachycardia. The brain mechanisms of sudden death, most of time, implicate a brutal increase in the intracranial pressure by either subarachnoid or cerebral lobar haemorrhage, or induced by large swelling cerebral infarction.
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A 2 year old child was put under general anesthesia by plastic surgeon for skin grafting. Just after surgery during recovery she became unconscious, unable to recover and was brought to general ICU where she was resuscitated using ventilators and didn't recover recover for 5 days. She also had a seizure and an MRI was done showing basal ganglion abnormal signaling.
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Thanks Hans and swati ..Hans 'sir i also thin like that'.thanks a lot,and that hypoxic brain injury i think occur at resucitation.thanks a lot for contribution
and dr swati is also correct that explain the depth of mechanism.
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How can one get retinal pigment epithelium progenitor cells to clinical application? I have a patient with total RPE damage with perception of light and probable etiology of HIV. I thought of injecting RPE progenitor cells into superb space of the patient eye.
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Dear Srirama, I'm based in the Dep Eye and Vision Science in Liverpool University. My colleagues are working on RPE transplantation, but I'm not a clinician and RPE are not my first aim of study. I will suggest you to read papers from Williams R, Kearns V, Mason S and/or Sheridan C (such as "Plasma polymer coatings to aid retinal pigment epithelial growth for transplantation in the treatment of age related macular degeneration" Kearns V et al 2012 J Mater Sci, PubMedID:22618272).
Best regards
Valentina Barrera
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Today, the Supreme Court upheld the Affordable Care Act which is the most important legislation since the Civil Rights Act. In 1943, the United States (U.S.) public health service expanded to create the Office of the Surgeon General (i.e., Centers for Disease Control, CDC), the National Institutes of Health (NIH), and the Centers for Medicare and Medicaid Services (CMS) responsible for public health policy, research and training, and health services and payment, respectively.
The separation of public health, research and education, and medical health services was intended to spur advancement in health science and practice; however, today, the U.S. health system has produced high cost and poor health. The challenges we face today in the 21st century are to strengthen the interconnection, not the separation, of our institutions that link evidence with practice, practice with public health, and the training of health scientists with health professionals. It is our duty as health scientists and professionals to bring better health and better health care to society. To do this, we must change our priorities from the business of health care, whether it is within the health care delivery system or the research enterprise, to the practice of health.
Image from: Los Angeles Memorial Sports Arena free clinic; today 30% of the population under 65 years is uninsured and is in poor health due to lack of access to affordable, preventive and early intervention care.
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This last comment is a clear reflection of how misinformed many Americans are. Once we get away from objective, data-driven sources of information, we end up doing a terrible disservice to the country and to ourselves. Cheaper rates than universal care for people with "no money" (whatever that means)? An allegedly "evil government" who will use EHS to deny care? (??) This is beyond ridiculous. We know (if you read scientific journals) that EHS makes healthcare, more efficient and effective and helps improve the quality and safety of medical care, when used and implemented appropriately. Also, people come to the US to receive excellent specialty care, but when it comes to primary care we fail miserably in this country. Furthermore, the US healthcare system is far from being superior; we are 37th in the world, behind France, Japan, Andorra, Malta, Ireland, Colombia and Costa Rica (just to name a few)! I think we all understand and value differences in opinion as long as they are informed.
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How do you know that medical devices are reliable, accurate, and safe?
I would like to evaluate several medical devices (for example: therapeutic ultrasound unit, interferential unit, cardiac defibrillator, laser therapy unit, etc.). The evaluation would include the reliability, accuracy, and safety of the medical devices. This would be important contributing to best practice procedures.
For example, I looked at AED (Automated Electronic Defibrillator) info by checking the FDA site: http://www.fda.gov/default.htm
There are numerous defibrillators that are not approved/registered by the FDA. And several approved/registered units, have been recalled by the FDA, due to serious problems. Therefore, I thought the FDA is a very credible site to obtain an independent evaluation of medical devices.
I believe that approval ratings that include: 'CE', 'UL', and 'GS' are only electrical safety ratings, and do not evaluate the reliability and validity (accuracy) of a medical device. I believe that ISO certification generally refers that a manufacturer "has introduced and applies a Quality Management System"; "demonstrated compliance of the Quality Management System" related to a particular area/code/regulation/policy. This information does not readily show reliability, accuracy, safety of a product. And, any claims by the manufacturer could be prone to internal bias. This is where independent evaluations by the FDA provides strong, credible evidence. And, I noticed that several medical devices state that they are FDA approved/registered. However, medical devices are regularly sold without FDA approval/ registration.
Please let me know if I am mistaken with any information, and provide further advice.
Why would a manufacturer of a medical device not obtain FDA approval/registration? I believe that FDA approval would be an exceptional selling feature.
Is it best to choose a medical advice on the basis of FDA approval and registration?
Or are there other regulatory bodies that provide a recognised standard of approval?
I hope that this information would be helpful to share with all health/medical practitioners.
Cheers, Phil
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There is the fundamental problem in classification of medical device.Current classification is risk based-which is more of an engineering concept applied to medical field.This makes the device assessment more confusing.There are more than 100,000 medical devices on market compared to around 10,000 medicinal product.The current regulatory system is not is a position to assess each and every medical device placed on the market.There is a need for development of regulatory system which can evaluate medical device for its efficiancy and effectiveness.
What's a biophoton? Is it possible to cure diseases by biophotonics?
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http://www.news-medical.net/news/20100327/Biophotonics-Light-to-cure-disease.aspx
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A unit of light that interacts with a biological system. This is a very new area of study, and there are a number of resources on upcoming research and experimentation in this field. Check out Omenetto's work : http://ase.tufts.edu/biomedical/unolab/home.html
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As prosthetist, would you use a bamboo fabric instead of fibre glass if there is research to support it? Or would you continue with the materials you are used to? Keep in mind, the same processes (lamination) and same outcome will be achieved
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No problem. I figure the more we learn, the better we'll be able to discuss both the positives and the negatives. My question is, how big of an industry is bamboo (since I don't use it here in the states that often) and is there a threat to the bamboo crops in overusing it? Yes, it's always nice to see efforts made in using other materials for all items, but not at the risk of wiping out what bamboo we have. Since I'm more naive to this particular product, I'd want more details prior to saying, "Oh yes, it's absolutely a wonderful idea!"
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Most of the diseases strike when in forties, diabetes, hypertension, cancer, rheumatism and of course psychological disorders. What makes forties vulnerable?
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I am assuming you are talking about a certain country or region (India?) where only 8% of the population is 45+. This means that the average life expectancy is relatively low (compare that to North America or Western Europe) and 45 years is a fairly advanced age. If you've reached advanced age for your country/region, there is a high probability (on average) that you'll die fairly soon. Since mitosis does not stop until about 115 years of age, only a serious disease can end your life, meanwhile you'll consume a large chunk of medicare fighting it. So there is nothing vulnerable about forties; 45+ is just an average number for this country/region. And people in the 45+ category consume a large chunk of medicare simply because in this country/region anyone who is 45+ is (on average) already rather old and prone to sickness.
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I am looking for modern medical original articles published in good medical journals with no references. I am interested in this because I want to study if its possible to create new information without previous knowledge. So if you find an article without references could you please inform me.
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I agree that new knowledge only can come about by questioning previous ideals and knowledge. Although many researchers would like to have something brandnew and ground breaking atributed to them, the vast majority of good solid research and creation of new knowledge, comes from questioning what we already know, asking new questions and hopefully testing the hypothesis and in doing so provide another small piece of the puzzle as to what is.
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I am doing a final year biomedical engg. I am designing hardware to find blood flow rate using IR detector. I want to know normal blood flow rate so that I can detect abnormal rate.
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I will try and tell you
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Human Papillomavirus also known as HPV is a virus that can affect both males and females of any race. In the United States, it is estimated that HPV is the most common sexually transmitted disease. HPV infections occur due to transmissions from one infected individual to another through direct skin to skin contact. Many studies have shown that HPV has a correlation to cervical cancer. Gardasil and Cervarix are two vaccines that are currently on the market to help prevent HPV infections. Women of African descent have higher rates of cervical cancer compared to women of European ancestry. A previous study in the Caribbean (Tobago) showed that when women without cancer were tested for the presence of cervical HPV infections, HPV-45 was the most common type detected rather than HPV-16 or HPV-18 (Ragin 2007). It is therefore important to determine the type of impact that the HPV vaccine may have in women of African decent since cancer-causing types of HPV other then HPV-16 and HPV-18 are more prevalent. The main goal of my project was to generate preliminary results from a subset of the overall study population of black women only by calculating the prevalence of each HPV type and then comparing the frequencies between African-American and African-Caribbean women (those living in the US and those living in the Caribbean). To complete this project it was necessary to perform DNA Extraction in order to obtain genetic information in order to perform HPV testing. Next, a Nested PCR had to be done in order to indentify which DNA samples were HPV positive or negative. Lastly, a Linear Array HPV Genotyping Test was used which allowed me to identify which specific HPV type each sample had. After completing the project I was able to conclude that the prevalence of HPV-type 16 and/or 18 had the highest distribution in U.S. women. On the other hand, HPV-type 45 was most prevalent in women from the Caribbean. Also, I was able to conclude that when one ethnicity (Caribbean immigrants) assimilates with another ethnicity (U.S. women), the Caribbean women had similar HPV distributions to the U.S. women rather than the Caribbean natives. It is not yet clear why this is; therefore more research will have to be done in order to find out the cause of this. This is an important experiment because it will allow us to figure out which HPV types are most common in each ethnicity and to determine whether a vaccine for other cancer-causing HPV types may need to be developed in the future for these specific ethnic groups.
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Hi Kaila,
I believe your question has a fairly straightforward response: For your purposes, human geographical location and human culture are nearly the same thing. Culture is a powerful force when it comes to shaping human behavior. And cultural variation correlates most strongly with geographic variation. So African women in the Caribbean and African women in the US live under different cultures and hence can be expected to display different sexual behavior. Your results may indicate that the sexual behavior of African-Caribbean women is highly conductive to the contraction of HPV-45 by them, but a lot less so for the contraction of HPV-16/18. On the other hand, the sexual behavior of African-American women may be highly conductive to the contraction of HPV-16/18 by them, but a lot less so for the contraction of HPV-45. So, in light of all this it should not be surprising that when African-Caribbean women assimilate into American society (and hence adopt American culture) the prevalence of various strains of HPV among them starts to mimic that among native-born African –American women. If you think about it, through the process of cultural assimilation in the US, African-Caribbean women adopt the culture of African- American women (due to shared lines of descent, shared history of discrimination, and other shared factors, African-Caribbean women are much more likely to trust and interact with African –American women, rather than Euro-American women), and inevitably, their sexual behavior; and in the process become nearly indistinguishable from other African-American women. So I would argue that in order to successfully take on the HPV epidemic among African –American and African-Caribbean women, it is also necessary to do a detailed study of the sexual behavior of both groups, and based on that, develop intervention strategies, for each group separately.
Also, do you mind posting a link to the full text of the research paper that resulted from this project of yours? Me, and probably many other people here, would be very interested in looking at the details of this project.
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Cardiorenal syndrome is as a newly discovered syndrome including anemia, intractable congestive heart failure and end-stage kidney disease. Unfortunately, reaching this diagnosis can happen later.
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May be in the very early stages so,the mandatory needs of innovating new classifications of newly discovered entity of cardiorenal disease long before the emergence of this very complex preplexing syndrome where all moda;ities also fail to treat the failure
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When paracetamol tablet is not having any other active ingredient
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Hi! Paracetamol - aniline derivate. Do you remember aniline dyes? If the liver besides paracetamol receives something - it will be "double shock"
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Girl 22 years old , father had pneumosklerosis ,
she have anaimia ,fotodermatittis,arthritis.
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Eliminate the caffeine from her diet and she will improve.
More details on e-book "Fluids Hypertension Syndromes", available free at www.izecksohn.com/leonardo/ .
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Currently working with a 38 year old diagnosed with IgA nephropathy 8 years ago and sarcoidosis 1 1/2 years ago: now in renal failure, stating dialysis and evaluation for kidney transplant. He has worked as a welder his entire career. Does any one have experience with these conditions, and/or aware of occupational exposures that results in these conditions? If so, what are the specific toxins that could be responsible?
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A large percentage of people with IGA Nephropathy or Sarcoidosis have non-celiac gluten intolerance. The gluten
creating autoimmune reactions in both conditions. Try giving up gluten for a month.
How well-known is the field of medical illustration?
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As a medical illustrator, I'm certain that almost everyone has seen a medical or scientific illustration. They appear on textbooks, patient education brochures, websites, journal articles etc. Most researchers assume they appear "magically" and not think of the actual medical illustrators behind the scenes. What are some of your experiences with medical & scientific illustrations or illustrators? Do you have a medical illustrator on staff?
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We also have a Department for medical illustrations, actualy I have made good use of it in the past. Regarding classic illustrations I do think most of them are out of context now days just for the fact that in that time they didn´t have digital software to do this images and when I compare a classic image to a "new" (digital version) one, the difference is astonishing, so in conclusion I do suggest all old images should be brought to the actual form.
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I am trying to gather data about job satisfaction among PHC nurses in Oman. But I found only one published article...so if I can get help to get previous studies done in Oman about nurse’s job satisfaction in Oman?
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Walukom salam, thank you Dr Mohammed, it will be a great help if she can help me. Moreover, i am also trying to get some ideal framework for developing mentoring system for nurses in general and primary health care in particular. if you have any idea please?
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Effects
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Para acetaminophen is metabolized by both phase 1 & phase 2 hepatic elimination pathways, in phase 2 it can either be glucuronated or sulphonated, the products of these reactions are eliminated easily. this occurs 70% of the times compared to phase 1 which produce a toxic chemical called N-acetyl-p-benoquinoneimine (NAPQi) this is the possibity of acting as a radical damaging cell membranes setting up a cascade leading to possible hepatocellular necrosis. Over doses of P-acetaminophen is the main causes of the problem because it exhausted the hepatic phase !! and GSH pathways which reduce levels of NAPQi, when constitutively produced.
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There is a high incidence of stress urinary incontinence among young female athletes due to repeated physical activity. Due to frequent changes in abdominal activity resulting weakness of pelvic floor muscles cause the above said problem.
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Look quiet extrange to me "young female athletes" because usually the athlets have strong muscles ....however, discard infection diseases, non-good hygiene behaviour, etc, etc....I suggest add "pelvic exercises" in regular training. (similar to perform after post-partum ). See link above - WHO-
However, check nutritional status...specially VIT C.
WHO | Pelvic floor muscle training for prevention and ...
Is anyone aware of new procedures to deal with long term inguinal pain syndrome? This issue is due to an inguinal hernia repair.
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This patient has had numinous doctors that have come to the same conclusion that there is nothing to be done with him. There have been numerous papers that have been written on this matter and I can not believe that there is no one to help with this problem. Thank you for all your comments.
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The Lichtenstein repair was done 6 years ago the 52 year old male is in chronic pain after only 1 month out of surgery. All mentions of this were ignored by both the surgeon and pain management Dr's in Reno NV. We are finally getting help outside of the region and going to the Lichtenstein Amid Institute in southern California at UCLA. A triple neurectomy of the Ilioinguinal, Iliohypogastric, and genitofemoral nerves look to be promising. Please if anyone is preforming this Operation in the future please be very aware of these nerves, as it can become a very debilitating problem. There are many reports on the subject matter on line.
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The causes of eosiniphilic epitheloid cells
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Cgd is not commonly with eosinophil in lesion consider eosinophilia granuloma
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A patient with deep vein thrombosis under oral anticoagulants and INR of 2.9 wants to travel. How soon can he fly after a DVT?
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I believe they can travel as long as there is no visible thrombus by Doppler or USG. It is the immobility during the flight that should be avoided, plus dehydration. compression stockings may be worn too. Another option is to have an IVC filter inserted...