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BACKGROUND: We aimed to assess the efficacy and safety of two neutralising monoclonal antibody therapies (sotrovimab [Vir Biotechnology and GlaxoSmithKline] and BRII-196 plus BRII-198 [Brii Biosciences]) for adults admitted to hospital for COVID-19 (hereafter referred to as hospitalised) with COVID-19. METHODS: In this multinational, double-blind, randomised, placebo-controlled, clinical trial (Therapeutics for Inpatients with COVID-19 [TICO]), adults (aged ≥18 years) hospitalised with COVID-19 at 43 hospitals in the USA, Denmark, Switzerland, and Poland were recruited. Patients were eligible if they had laboratory-confirmed SARS-CoV-2 infection and COVID-19 symptoms for up to 12 days. Using a web-based application, participants were randomly assigned (2:1:2:1), stratified by trial site pharmacy, to sotrovimab 500 mg, matching placebo for sotrovimab, BRII-196 1000 mg plus BRII-198 1000 mg, or matching placebo for BRII-196 plus BRII-198, in addition to standard of care. Each study product was administered as a single dose given intravenously over 60 min. The concurrent placebo groups were pooled for analyses. The primary outcome was time to sustained clinical recovery, defined as discharge from the hospital to home and remaining at home for 14 consecutive days, up to day 90 after randomisation. Interim futility analyses were based on two seven-category ordinal outcome scales on day 5 that measured pulmonary status and extrapulmonary complications of COVID-19. The safety outcome was a composite of death, serious adverse events, incident organ failure, and serious coinfection up to day 90 after randomisation. Efficacy and safety outcomes were assessed in the modified intention-to-treat population, defined as all patients randomly assigned to treatment who started the study infusion. This study is registered with ClinicalTrials.gov, NCT04501978. FINDINGS: Between Dec 16, 2020, and March 1, 2021, 546 patients were enrolled and randomly assigned to sotrovimab (n=184), BRII-196 plus BRII-198 (n=183), or placebo (n=179), of whom 536 received part or all of their assigned study drug (sotrovimab n=182, BRII-196 plus BRII-198 n=176, or placebo n=178; median age of 60 years [IQR 50–72], 228 [43%] patients were female and 308 [57%] were male). At this point, enrolment was halted on the basis of the interim futility analysis. At day 5, neither the sotrovimab group nor the BRII-196 plus BRII-198 group had significantly higher odds of more favourable outcomes than the placebo group on either the pulmonary scale (adjusted odds ratio sotrovimab 1·07 [95% CI 0·74–1·56]; BRII-196 plus BRII-198 0·98 [95% CI 0·67–1·43]) or the pulmonary-plus complications scale (sotrovimab 1·08 [0·74–1·58]; BRII-196 plus BRII-198 1·00 [0·68–1·46]). By day 90, sustained clinical recovery was seen in 151 (85%) patients in the placebo group compared with 160 (88%) in the sotrovimab group (adjusted rate ratio 1·12 [95% CI 0·91–1·37]) and 155 (88%) in the BRII-196 plus BRII-198 group (1·08 [0·88–1·32]). The composite safety outcome up to day 90 was met by 48 (27%) patients in the placebo group, 42 (23%) in the sotrovimab group, and 45 (26%) in the BRII-196 plus BRII-198 group. 13 (7%) patients in the placebo group, 14 (8%) in the sotrovimab group, and 15 (9%) in the BRII-196 plus BRII-198 group died up to day 90. INTERPRETATION: Neither sotrovimab nor BRII-196 plus BRII-198 showed efficacy for improving clinical outcomes among adults hospitalised with COVID-19. FUNDING: US National Institutes of Health and Operation Warp Speed
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Williams syndrome Williams-Beuren syndrome Summary Williams syndrome is a rare disorder that can lead to problems with development. Causes Williams syndrome is caused by not having a copy of several genes. It may be passed down in families. Parents may not have any family history of the condition. However, people with Williams syndrome have a 50% chance of passing the disorder on to each of their children. It often occurs randomly. One of the 25 missing genes is the gene that produces elastin, a protein that allows blood vessels and other tissues in the body to stretch. It is likely that missing a copy of this gene results in the narrowing of blood vessels, stretchy skin, and flexible joints seen in this condition. Symptoms Symptoms of Williams syndrome are: Delayed speech that may later turn into strong speaking ability and strong learning by hearing Developmental delay Easily distracted, attention deficit hyperactivity disorder (ADHD) Feeding problems including colic, reflux, and vomiting Inward bend of the small finger Learning disorders Mild to moderate intellectual disability Personality traits including being very friendly, trusting strangers, fearing loud sounds or physical contact, and being interested in music Short, compared to the rest of the person's family Sunken chest The face and mouth of someone with Williams syndrome may show: A flattened nasal bridge with small upturned nose Long ridges in the skin that run from the nose to the upper lip Prominent lips with an open mouth Skin that covers the inner corner of the eye Partially missing teeth, defective tooth enamel, or small, widely spaced teeth Exams and Tests Signs include: Narrowing of some blood vessels Farsightedness High blood calcium level that may cause seizures and rigid muscles High blood pressure Slack joints that may change to stiffness as the person gets older Unusual star-like pattern in iris of the eye Tests for Williams syndrome include: Blood pressure check Blood test for a missing piece of chromosome 7 (FISH test) Echocardiography combined with Doppler ultrasound Kidney ultrasound Treatment There is no cure for Williams syndrome. Avoid taking extra calcium and vitamin D. Treat high blood calcium, if it occurs. Blood vessel narrowing can be a major health problem. It is treated based on how severe it is. Physical therapy is helpful to people with joint stiffness. Developmental and speech therapy can also help. For example, having strong verbal skills can help make up for other weaknesses. Other treatments are based on the person's symptoms. It can help to have treatment coordinated by a geneticist who is experienced with Williams syndrome. Support Groups A support group can be helpful for emotional support and for giving and receiving practical advice. The following organization provides additional information about Williams syndrome: Williams Syndrome Association -- williams-syndrome.org Outlook (Prognosis) About 75% of people with Williams syndrome have some intellectual disability. Most people will not live as long as normal due to the various medical issues and other possible complications. Most people require full-time caregivers and often live in supervised group homes. Possible Complications Complications may include: Calcium deposits in the kidney and other kidney problems Death (in rare cases from anesthesia) Heart failure due to narrowed blood vessels Pain in the abdomen When to Contact a Medical Professional Many of the symptoms and signs of Williams syndrome may not be obvious at birth. Call your health care provider if your child has features similar to those of Williams syndrome. Seek genetic counseling if you have a family history of Williams syndrome. Prevention There is no known way to prevent the genetic problem that causes Williams syndrome. Prenatal testing is available for couples with a family history of Williams syndrome who wish to conceive. Review Date 10/26/2017 Updated by: Anna C. Edens Hurst, MD, MS, Assistant Professor in Medical Genetics, The University of Alabama at Birmingham, Birmingham, AL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Pulmonary hypertension Pulmonary arterial hypertension Sporadic primary pulmonary hypertension Familial primary pulmonary hypertension Idiopathic pulmonary arterial hypertension Primary pulmonary hypertension PPH Secondary pulmonary hypertension Cor pulmonale - pulmonary hypertension Summary Pulmonary hypertension is high blood pressure in the arteries of the lungs. It makes the right side of the heart work harder than normal. Causes The right side of the heart pumps blood through the lungs, where it picks up oxygen. Blood returns to the left side of the heart, where it is pumped to the rest of the body. When the small arteries (blood vessels) of the lungs become narrowed, they cannot carry as much blood. When this happens, pressure builds up. This is called pulmonary hypertension. The heart needs to work harder to force the blood through the vessels against this pressure. Over time, this causes the right side of the heart to become larger. This condition is called right-sided heart failure, or cor pulmonale. Pulmonary hypertension may be caused by: Autoimmune diseases that damage the lungs, such as scleroderma and rheumatoid arthritis Birth defects of the heart Blood clots in the lung (pulmonary embolism) Heart failure Heart valve disease HIV infection Low oxygen levels in the blood for a long time (chronic) Lung disease, such as COPD or pulmonary fibrosis or any other severe chronic lung condition Medicines (for example, certain diet drugs) Obstructive sleep apnea In rare cases, the cause of pulmonary hypertension is unknown. In this case, the condition is called idiopathic pulmonary arterial hypertension (IPAH). Idiopathic means the cause of a disease is not known. IPAH affects more women than men. If pulmonary hypertension is caused by a known medicine or medical condition, it is called secondary pulmonary hypertension. Symptoms Shortness of breath or lightheadedness during activity is often the first symptom. Fast heart rate (palpitations) may be present. Over time, symptoms occur with lighter activity or even while at rest. Other symptoms include: Ankle and leg swelling Bluish color of the lips or skin (cyanosis) Chest pain or pressure, usually in the front of the chest Dizziness or fainting spells Fatigue Increased abdomen size Weakness People with pulmonary hypertension often have symptoms that come and go. They report good days and bad days. Exams and Tests Your health care provider will perform a physical exam and ask about your symptoms. The exam may find: Abnormal heart sounds Feeling of a pulse over the breastbone Heart murmur on the right side of the heart Larger-than-normal veins in the neck Leg swelling Liver and spleen swelling Normal breath sounds if pulmonary hypertension is idiopathic or due to congenital heart disease Abnormal breath sounds if pulmonary hypertension is from other lung disease In the early stages of the disease, the exam may be normal or almost normal. The condition may take several months to diagnose. Asthma and other diseases may cause similar symptoms and must be ruled out. Tests that may be ordered include: Blood tests Cardiac catheterization Chest x-ray CT scan of the chest Echocardiogram ECG Lung function tests Nuclear lung scan Pulmonary arteriogram 6-minute walk test Sleep study Tests to check for autoimmune problems Treatment There is no cure for pulmonary hypertension. The goal of treatment is to control symptoms and prevent more lung damage. It is important to treat medical disorders that cause pulmonary hypertension, such as obstructive sleep apnea, lung conditions, and heart valve problems. Many treatment options for pulmonary arterial hypertension are available. If you are prescribed medicines, they may be taken by mouth (oral), received through the vein (intravenous, or IV), or breathed in (inhaled). Your provider will decide which medicine is best for you. You will be closely monitored during treatment to watch for side effects and to see how well you are responding to the medicine. DO NOT stop taking your medicines without talking to your provider. Other treatments may include: Blood thinners to reduce the risk of blood clots, especially if you have IPAH Oxygen therapy at home Lung, or in some cases, heart-lung transplant, if medicines do not work Other important tips to follow: Avoid pregnancy Avoid heavy physical activities and lifting Avoid traveling to high altitudes Get a yearly flu vaccine, as well as other vaccines such as the pneumonia vaccine Stop smoking Outlook (Prognosis) How well you do depends on what caused the condition. Medicines for IPAH may help slow the disease. As the illness gets worse, you will need to make changes in your home to help you get around the house. When to Contact a Medical Professional Call your provider if: You begin to develop shortness of breath when you are active Shortness of breath gets worse You develop chest pain You develop other symptoms Review Date 2/18/2018 Updated by: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Purpose: Since December 2019, global attention has been drawn to the rapid spread of COVID-19 Corona was discovered in India on 30 January 2020 To date, in India, 178,014 disease cases were reported with 14,011 deaths by the Indian Government In the meantime, with an increasing spread speed, the COVID-19 epidemic occurred in other countries The survival rate for COVID-19 patients who suffer from a critical illness is efficiently and precisely predicted as more fatal cases can be affected in advanced cases However, over 400 laboratories and clinically relevant survival rates of all present critically ill COVID-19 patients are estimated manually The manual diagnosis inevitably results in high misdiagnosis and missed diagnosis owing to a lack of experience and prior knowledge The chapter presents an option for developing a machine-based prognostic model that exactly predicts the survival of individual severe patients with clinical data from different sources such as Kaggle data gov and World Health Organization with greater than 95% accuracy The data set and attributes are shown in detail The reasonableness of such a mere three elements may depend, respectively, on their representativeness in the indices of tissue injury, immunity and inflammation The purpose of this paper is to provide detailed study from the diagnostic aspect of COVID-19, the work updates the cost-effective and prompt criticality classification and prediction of survival before the targeted intervention and diagnosis, in particular the triage of the vast COVID-19 explosive epidemic Design/methodology/approach: Automated machine learning (ML) provides resources and platforms to render ML available to non-ML experts, to boost efficiency in ML and to accelerate research in machine learning H2O AutoML is used to generate the results (Dulhare et al , 2020) ML has achieved major milestones in recent years, and it is on which an increasing range of disciplines depend But this performance is crucially dependent on specialists in human ML to perform the following tasks: preprocess the info and clean it;choose and create the appropriate apps;choose a family that fits the pattern;optimize hyperparameters for layout;and models of computer learning post processes Review of the findings collected is important Findings: These days, the concept of automated ML techniques is being used in every field and domain, for example, in the stock market, education institutions, medical field, etc ML tools play an important role in harnessing the massive amount of data In this paper, the data set relatively holds a huge amount of data, and appropriate analysis and prediction are necessary to track as the numbers of COVID cases are increasing day by day This prediction of COVID-19 will be able to track the cases particularly in India and might help researchers in the future to develop vaccines Researchers across the world are testing different medications to cure COVID;however, it is still being tested in various labs This paper highlights and deploys the concept of AutoML to analyze the data and to find the best algorithm to predict the disease Appropriate tables, figures and explanations are provided Originality/value: As the difficulty of such activities frequently goes beyond non-ML-experts, the exponential growth of ML implementations has generated a market for off-the-shelf ML solutions that can be used quickly and without experience We name the resulting work field which is oriented toward the radical automation of AutoML machine learning The third class is that of the individuals who have illnesses such as diabetes, high BP, asthma, malignant growth, cardiovascular sickness and so forth As their safe frameworks have been undermined effectively because of a common ailment, these individuals become obvious objectives Diseases experienced by the third classification of individuals can be lethal (Shinde et al , 2020) Examining information is fundamental in having the option to comprehend the spread and treatment adequacy The world needs a ot more individuals investigating the information The understanding from worldwide data on the spread of the infection and its conduct will be key in limiting the harm The main contributions of this study are as follows: predicting COVID-19 pandemic in India using AutoML;analyzing the data set predicting the patterns of the virus;and comparative analysis of predictive algorithms The organization of the paper is as follows, Sections I and II describe the introduction and the related work in the field of analyzing the COVID pandemic Section III describes the workflow/framework for AutoML using the components with respect to the data set used to analyze the patterns of COVID-19 patients © 2020, Emerald Publishing Limited
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Staph infections - self-care at home Staphylococcus infections - self care at home Methicillin-resistant staphylococcus aureus infections - self care at home MRSA infections - self care at home Summary Staph (pronounced staff) is short for Staphylococcus. Staph is a type of germ (bacteria) that can cause infections almost anywhere in the body. One type of staph germ, called methicillin-resistant <em>Staphylococcus aureus </em>(MRSA), is harder to treat. This is because MRSA is not killed by certain medicines used to treat other staph germs. How Does Staph Spread? Many healthy people normally have staph on their skin, in their noses, or other body areas. Most of the time, the germ does not cause an infection or symptoms. This is called being colonized with staph. These persons are known as carriers. They can spread staph to others. Some people colonized by staph develop an actual staph infection that makes them sick. Most staph germs are spread by skin-to-skin contact. They can also be spread when you touch something that has the staph germ on it, such as clothing or a towel. Staph germs can then enter a break in the skin, such as cuts, scratches, or pimples. Usually the infection is minor and stays in the skin. But the infection can spread deeper and affect the blood, bones, or joints. Organs such as the lungs, heart, or brain can also be affected. Serious cases can be life-threatening. What are the Risk Factors for Staph Infection? You are more likely to get a staph infection if you: Have an open cut or sore Inject illegal drugs Have a medical tube such as urinary catheter or feeding tube Have a medical device inside your body such as an artificial joint Have a weakened immune system or ongoing (chronic) illness Live with or have close contact with a person who has staph Play contact sports or share athletic equipment Share items such as towels, razors, or cosmetics with others Recently stayed in a hospital or long-term care facility How Do You Know If You Have a Staph Infection? Symptoms depend on where the infection is located. For example, with a skin infection you may have a boil or a painful rash called impetigo. With a serious infection, such as toxic shock syndrome, you may have a high fever, nausea and vomiting, and a sunburn-like rash. The only way to know for sure if you have a staph infection is by seeing a health care provider. A cotton swab is used to collect a sample from an open skin rash or skin sore. A blood, urine, or sputum sample may also be collected. The sample is sent to a lab to test for staph. If staph is found, it will be tested to see which antibiotic should be used to treat your infection. Treatment If test results show you have a staph infection, treatment may include: Taking antibiotics Cleaning and draining the wound Surgery to remove an infected device Preventing Staph Infection Follow these steps to avoid a staph infection and prevent it from spreading. Keep your hands clean by washing them thoroughly with soap and water. Or use an alcohol-based hand sanitizer. Keep cuts and scrapes clean and covered with bandages until they heal. Avoid contact with other people's wounds or bandages. Do not share personal items such as towels, clothing, or cosmetics. Simple steps for athletes include: Cover wounds with a clean bandage. Do not touch other people's bandages. Wash your hands well before and after playing sports. Shower right after exercising. Do not share soap, razors, or towels. If you share sports equipment, clean it first with antiseptic solution or wipes. Use clothing or a towel between your skin and the equipment. Do not use a common whirlpool or sauna if another person with an open sore used it. Always use clothing or a towel as a barrier. Do not share splints, bandages, or braces. Check that shared shower facilities are clean. If they are not clean, shower at home. Review Date 5/21/2017 Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Limb-girdle muscular dystrophy Limb girdle muscular dystrophy LGMD Summary Limb-girdle muscular dystrophy is a group of disorders which affect the voluntary muscles around the hips and shoulders. The conditions are progressive, leading to a loss of muscle strength and bulk over a number of years. Onset may occur in childhood, adolescence, young adulthood, or even later. Males and females are affected in equal numbers. [1] Most forms of limb girdle muscular dystrophy are inherited in an autosomal recessive manner. Several rare forms are inherited in an autosomal dominant pattern. [2] While there are no treatments which directly reverse the muscle weakness associated with this condition, supportive treatment can decrease the complications. [3] There are at least 20 different types of limb-girdle muscular dystrophy. [1] Inheritance Limb-girdle muscular dystrophy (LGMD) is most often inherited in an autosomal recessive manner; less commonly, rare sub-types may be inherited in an autosomal dominant manner. There may be difficulties diagnosing the condition accurately, and often the mode of inheritance cannot be determined. Therefore, it may be challenging to determine the exact recurrence risks for some families. Establishing the type of LGMD in an affected individual can be useful for discussing the clinical course of the disease as well as for determining who else in the family may be at risk for the condition. [4] Diagnosis Making a diagnosis for a genetic or rare disease can often be challenging. Healthcare professionals typically look at a person's medical history, symptoms, physical exam, and laboratory test results in order to make a diagnosis. The following resources provide information relating to diagnosis and testing for this condition. If you have questions about getting a diagnosis, you should contact a healthcare professional. Testing Resources Orphanet lists international laboratories offering diagnostic testing for this condition. Treatment Unfortunately, no definitive treatments for LGMD exist. Management depends on each individual and the specific type of LGMD that the individual has. However, the American Academy of Neurology has developed guidelines for treatment of LGMD including: [5] [6] Weight control to avoid obesity Physical therapy and stretching exercises to promote mobility and prevent contractures (fixed tightening of the muscles) Use of mechanical aids such as canes, walkers, orthotics, and wheelchairs as needed to help ambulation and mobility Monitoring and surgical intervention as needed for orthopedic complications, such as foot deformity and scoliosis cardiomyopathy A team approach to treatment is recommended including a neurologist , pulmonologist , cardiologist , orthopedic surgeon, physiatrist , physical/occupational/ speech therapist , nutritionist , orthopedist , mental health counselors, and geneticist / genetic counselor . [5] [6] While not a currently available treatment option, some studies have shown promising results with the use of gene therapy . More research is needed to prove the safety and efficacy of this treatment approach. [6] Management Guidelines The American Academy of Neurology (AAN), the medical specialty society of neurologists, offers a summary of recommended guidelines for Limb-girdle muscular dystrophy Project OrphanAnesthesia is a project whose aim is to create peer-reviewed, readily accessible guidelines for patients with rare diseases and for the anesthesiologists caring for them. The project is a collaborative effort of the German Society of Anesthesiology and Intensive Care, Orphanet, the European Society of Pediatric Anesthesia, anesthetists and rare disease experts with the aim to contribute to patient safety. Related Diseases Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease. Conditions with similar signs and symptoms from Orphanet The differential diagnosis of LGMD includes facioscapulohumeral muscular dystrophy, Emery-Dreifuss muscular dystrophy, congenital muscular dystrophy, polymyositis, myotonic, myofibrillar, distal and metabolic myopathy, collagen 6-related disorders and dermatomyosistis. Visit the Orphanet disease page for more information.
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Prostate cancer treatment Summary Treatment for your prostate cancer is chosen after a thorough evaluation. Your health care provider will discuss the benefits and risks of each treatment. Sometimes your provider may recommend one treatment for you because of your type of cancer and risk factors. Other times, there may be two or more treatments that could be good for you. Factors you and your provider must think about include: Your age and other medical problems you may have Side effects that occur with each type of treatment How much the prostate cancer has spread Your Gleason score, which tells how likely it is that cancer has already spread Your prostate-specific antigen (PSA) test result Ask your provider to explain these things following about your treatment choices: Which choices offer the best chance of curing your cancer or controlling its spread? How likely is it that you will have different side effects, and how they will affect your life? Radical Prostatectomy (Prostate Removal) Radical prostatectomy is a surgery to remove the prostate and some of the surrounding tissue. It is an option when the cancer has not spread beyond the prostate gland. Healthy men who will likely live 10 or more years after being diagnosed with prostate cancer often have this procedure. Be aware that it is not always possible to know for certain, before surgery, if the cancer has spread beyond the prostate gland. Possible problems after surgery include difficulty controlling urine and erection problems. Also, some men need further treatments after this surgery. Radiation Therapy Radiation therapy works best for treating prostate cancer that has not spread outside of the prostate. It may also be used after surgery if there is a risk that cancer cells are still present. Radiation is sometimes used for pain relief when cancer has spread to the bone. External beam radiation therapy uses high-powered x-rays pointed at the prostate gland: Before treatment, the radiation therapist uses a special pen to mark the part of the body that is to be treated. Radiation is delivered to the prostate gland using a machine similar to a regular x-ray machine. The treatment itself is usually painless. Treatment is done in a radiation oncology center that is usually connected to a hospital. Treatment is usually done 5 days a week for 6 to 8 weeks. Side effects may include: Appetite loss Diarrhea Erection problems Fatigue Rectal burning or injury Skin reactions Urinary incontinence, the feeling of needing to urinate urgently, or blood in the urine There are reports of secondary cancers arising from the radiation as well. Proton therapy is another kind of radiation therapy used to treat prostate cancer. Proton beams target the tumor precisely, so there is less damage to the surrounding tissue. This therapy is not widely accepted or used. Prostate Brachytherapy Brachytherapy is often used for small prostate cancers that are found early and are slow-growing. Brachytherapy may be combined with external beam radiation therapy for more advanced cancers. Brachytherapy involves placing radioactive seeds inside the prostate gland. A surgeon inserts small needles through the skin beneath your scrotum to inject the seeds. The seeds are so small that you do not feel them. The seeds are left in place permanently. Side effects may include: Pain, swelling, or bruising in the penis or scrotum Red-brown urine or semen Impotence Incontinence Urinary retention Diarrhea Hormonal Therapy Testosterone is the main male hormone. Prostate tumors need testosterone to grow. Hormonal therapy is treatment that decreases the effect of testosterone on prostate cancer. Hormone therapy is mainly used for cancer that has spread beyond the prostate. The treatment can help relieve symptoms and prevent further growth and spread of cancer. But it does not cure the cancer. The main type of hormone therapy is called a luteinizing hormone-releasing hormones (LH-RH) agonist: The medicine blocks the testicles from making testosterone. The drugs must be given by injection, usually every 3 to 6 months. Possible side effects include nausea and vomiting, hot flashes, anemia, fatigue, thinning bones (osteoporosis), reduced sexual desire, decreased muscle mass, weight gain, and impotence. The other type of hormone medicine is called an androgen-blocking drug: It is often given along with LH-RH drugs to block the effect of testosterone produced by the adrenal glands, which make a small amount of testosterone. Possible side effects include erection problems, reduced sexual desire, liver problems, diarrhea, and enlarged breasts. Much of the body's testosterone is made by the testes. As a result, surgery to remove the testes (called orchiectomy) can also be used as a hormonal treatment. Chemotherapy Chemotherapy and immunotherapy (medicine that helps the body's immune system fight the cancer) may be used to treat prostate cancer that no longer responds to hormone treatment. Usually a single drug or a combination of drugs is recommended. Cryotherapy Cryotherapy uses very cold temperatures to freeze and kill prostate cancer cells. The goal of cryosurgery is to destroy the entire prostate gland and possibly surrounding tissue. Cryosurgery is generally not used as a first treatment for prostate cancer. Review Date 10/10/2017 Updated by: Jennifer Sobol, DO, Urologist with the Michigan Institute of Urology, West Bloomfield, MI. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Benefits of quitting tobacco (Summary): If you smoke, you should quit. But quitting can be hard. Most people who have quit smoking have tried at least once, without success, in the past. View any past attempts to quit as a learning experience, not a failure. There are many reasons to quit using tobacco. Long-term use of tobacco can increase your risk of many serious health problems. THE BENEFITS OF QUITTING You may enjoy the following when you quit smoking. - Your breath, clothes, and hair will smell better. - Your sense of smell will return. Food will taste better. - Your fingers and fingernails will slowly appear less yellow. - Your stained teeth may slowly become whiter. - Your children will be healthier and will be less likely to start smoking. - It will be easier and cheaper to find an apartment or hotel room. - You may have an easier time getting a job. - Friends may be more willing to be in your car or home. - It may be easier to find a date. Many people do not smoke and do not like to be around people who smoke. - You will save money. If you smoke a pack a day, you spend about $2,000 a year on cigarettes. HEALTH BENEFITS Some health benefits begin almost immediately. Every week, month, and year without tobacco further improves your health. - Within 20 minutes of quitting: Your blood pressure and pulse rate drop to normal and the temperature of your hands and feet increases to normal. - Within 8 hours of quitting: Your blood carbon monoxide levels drop and your blood oxygen levels increase to normal levels. - Within 24 hours of quitting: Your risk of a sudden heart attack goes down. - Within 48 hours of quitting: Your nerve endings begin to regrow. Your senses of smell and taste begin to return to normal. - Within 2 weeks to 3 months of quitting: Your circulation improves. Walking becomes easier. Your lungs work better. Wounds heal more quickly. - Within 1 to 9 months of quitting: You have more energy. Smoking-related symptoms, such as coughing, nasal congestion, fatigue, and shortness of breath improve. You will have fewer illnesses, colds, and asthma attacks. You will gradually no longer be short of breath with everyday activities. - Within 1 year of quitting: Your risk of coronary heart disease is half that of someone still using tobacco. - Within 5 years of quitting: Your risk of mouth, throat, esophagus, and bladder cancers are reduced by half. - Within 10 years of quitting: Your risk of dying from lung cancer is about one half that of a person who still smokes. Other health benefits of quitting smoking include: - Lower chance of blood clots in the legs, which may travel to the lungs - Lower risk of erectile dysfunction - Fewer problems during pregnancy, such as babies born at low birth weight, premature labor, miscarriage, and cleft lip - Lower risk of infertility due to damaged sperm - Healthier teeth, gums, and skin Infants and children who you live with will have: - Asthma that is easier to control - Fewer visits to the emergency room - Fewer colds, ear infections, and pneumonia - Reduced risk of sudden infant death syndrome (SIDS) MAKING THE DECISION Like any addiction, quitting tobacco is difficult, especially if you do it alone. There are a lot of ways to quit smoking and many resources to help you. Talk to your health care provider about nicotine replacement therapy and smoking cessation medications. If you join smoking cessation programs, you have a much better chance of success. Such programs are offered by hospitals, health departments, community centers, and work sites.
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BACKGROUND: In children, SARS-CoV-2 infection is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, one of the largest UK citizen participatory epidemiological studies to date. METHODS: In this prospective cohort study, data from UK school-aged children (age 5–17 years) were reported by an adult proxy. Participants were voluntary, and used a mobile application (app) launched jointly by Zoe Limited and King's College London. Illness duration and symptom prevalence, duration, and burden were analysed for children testing positive for SARS-CoV-2 for whom illness duration could be determined, and were assessed overall and for younger (age 5–11 years) and older (age 12–17 years) groups. Children with longer than 1 week between symptomatic reports on the app were excluded from analysis. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed. FINDINGS: 258 790 children aged 5–17 years were reported by an adult proxy between March 24, 2020, and Feb 22, 2021, of whom 75 529 had valid test results for SARS-CoV-2. 1734 children (588 younger and 1146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study timeframe (illness onset between Sept 1, 2020, and Jan 24, 2021). The most common symptoms were headache (1079 [62·2%] of 1734 children), and fatigue (954 [55·0%] of 1734 children). Median illness duration was 6 days (IQR 3–11) versus 3 days (2–7) in children testing negative, and was positively associated with age (Spearman's rank-order r(s) 0·19, p<0·0001). Median illness duration was longer for older children (7 days, IQR 3–12) than younger children (5 days, 2–9). 77 (4·4%) of 1734 children had illness duration of at least 28 days, more commonly in older than younger children (59 [5·1%] of 1146 older children vs 18 [3·1%] of 588 younger children; p=0·046). The commonest symptoms experienced by these children during the first 4 weeks of illness were fatigue (65 [84·4%] of 77), headache (60 [77·9%] of 77), and anosmia (60 [77·9%] of 77); however, after day 28 the symptom burden was low (median 2 symptoms, IQR 1–4) compared with the first week of illness (median 6 symptoms, 4–8). Only 25 (1·8%) of 1379 children experienced symptoms for at least 56 days. Few children (15 children, 0·9%) in the negatively tested cohort had symptoms for at least 28 days; however, these children experienced greater symptom burden throughout their illness (9 symptoms, IQR 7·7–11·0 vs 8, 6–9) and after day 28 (5 symptoms, IQR 1·5–6·5 vs 2, 1–4) than did children who tested positive for SARS-CoV-2. INTERPRETATION: Although COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate. FUNDING: Zoe Limited, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, and Alzheimer's Society.
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Kartagener syndrome Dextrocardia bronchiectasis and sinusitis Siewert syndrome Immotile cilia syndrome, Kartagener type Dextrocardia bronchiectasis and sinusitis Siewert syndrome Immotile cilia syndrome, Kartagener type Primary ciliary dyskinesia, Kartagener type Dextrocardia-bronchiectasis-sinusitis syndrome Primary ciliary dyskinesia and situs inversus See More Summary Kartagener syndrome is a type of p that is also characterized by situs inversus totalis (mirror-image reversal of internal organs ). The signs and symptoms vary but may include neonatal respiratory distress; frequent lung, sinus and middle ear infections beginning in early childhood; and infertility. [1] [2] [3] It can be cause by changes ( mutations ) in many different genes that are inherited in an autosomal recessive manner. Although scientists have identified many of the genes associated with Kartagener syndrome, the genetic cause of some cases is unknown. [4] [2] There is no cure for Kartagener syndrome. Treatment varies based on the signs and symptoms present in each person but may include airway clearance therapy and antibiotics . [1] [2] [3] Symptoms Kartagener syndrome is characterized by p and situs inversus totalis. In people affected by situs inversus totalis, the internal organs including the heart, liver, spleen and intestine are on the opposite side of the body. Although the internal organs are abnormally placed, this condition typically does not cause any health problems. [1] [2] The signs and symptoms of primary ciliary dyskinesia vary, but may include: [1] [2] [3] Neonatal respiratory distress Frequent respiratory infections that can lead to severe lung damage Chronic nasal congestion Frequent sinus infections Recurrent middle ear infections, particularly in early childhood Hearing loss Hydrocephalus Infertility Cause Kartagener syndrome can be caused by changes ( mutations ) in many different genes . These genes encode proteins that are important to the structure and function of cilia. Cilia are tiny, hair-like structures that are found on the surface of cells in various parts of the body such as the lining of the airway, the reproductive system, and other organs . The coordinated movement of cilia in wave-like motions is important to the normal functioning of certain organs and tissues throughout the body and ensures the proper placement of organs in the developing embryo. Mutations in these genes cause the cilia to be either immotile (unable to move) or dysmotile (they move incorrectly), which leads to the many signs and symptoms of Kartagener syndrome. [1] [4] [3] Scientists have identified several different genes that are associated with Kartagener syndrome; however, the genetic cause is unknown in some cases. [1] [4] [3] Inheritance Kartagener syndrome is inherited in an autosomal recessive manner. [4] This means that to be affected, a person must have a mutation in both copies of the responsible gene in each cell . The parents of an affected person usually each carry one mutated copy of the gene and are referred to as carriers . Carriers typically do not show signs or symptoms of the condition. When two carriers of an autosomal recessive condition have children, each child has a 25% (1 in 4) risk to have the condition, a 50% (1 in 2) risk to be a carrier like each of the parents, and a 25% chance to not have the condition and not be a carrier. Diagnosis Kartagener syndrome is typically suspected based on the presence of characteristic signs and symptoms. A diagnosis can be confirmed by examining a small sample of tissue ( biopsy ) from an area of the body known to have cilia such as the sinus cavities or the airway. Abnormalities in the structure of cilia, as seen in people affected by Kartagener syndrome, can be observed under a special microscope (called an electron microscope). If the disease-causing change ( mutation ) is known, genetic testing can also be used to confirm the diagnosis. [1] [2] [3] Testing Resources The Genetic Testing Registry (GTR) provides information about the genetic tests for this condition. The intended audience for the GTR is health care providers and researchers. Patients and consumers with specific questions about a genetic test should contact a health care provider or a genetics professional. Treatment There is currently no cure for Kartagener syndrome . Treatment varies based on the signs and symptoms present in each person. Airway clearance therapy, similar to that used in cystic fibrosis, can loosen thick, sticky mucus so it can be cleared away. Antibiotics may be prescribed to treat respiratory, sinus, and middle ear infections and may be given on a long-term basis in people with chronic or frequent infections. Surgery to insert ear tubes may be recommended in children with chronic ear infections that are resistant to antibiotics. In people with severe lung disease, lung transplantation may be an option. [1] [2] [3] For more information on the treatment and management of Kartagener syndrome, please click here. Prognosis The long-term outlook for people with Kartagener syndrome varies widely and largely depends on timely diagnosis and treatment. Chronic childhood infections can be very debilitating. However, with appropriate treatment, the progression of lung disease can be slowed and other complications such as hearing loss can be avoided. [3] [2] [5]
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BACKGROUND: The invasive species Aedes albopictus, commonly known as the Asian tiger mosquito, has undergone extreme range expansion by means of steady introductions as blind passengers in vehicles traveling from the Mediterranean to south-west Germany. The more than 25 established populations in the State of Baden-Württemberg, Palatine and Hesse (south-west Germany) have become a major nuisance and public health threat. Aedes albopictus deserves special attention as a vector of arboviruses, including dengue, chikungunya and Zika viruses. In Germany, Ae. albopictus control programs are implemented by local communities under the auspices of health departments and regulatory offices. METHODS: The control strategy comprised three pillars: (i) community participation (CP) based on the elimination of breeding sites or improved environmental sanitation, using fizzy tablets based on Bacillus thuringiensis israelensis (fizzy Bti tablets; Culinex® Tab plus); (ii) door-to-door (DtD) control by trained staff through the application of high doses of a water-dispersible Bti granular formulation (Vectobac® WG) aimed at achieving a long-lasting killing effect; and (iii) implementation of the sterile insect technique (SIT) to eliminate remaining Ae. albopictus populations. Prior to initiating large-scale city-wide treatments on a routine basis, the efficacy of the three elements was evaluated in laboratory and semi-field trials. Special emphasis was given to the mass release of sterile Ae. albopictus males. RESULTS: More than 60% of the local residents actively participated in the first pillar (CP) of the large-scale control program. The most effective element of the program was found to be the DtD intervention, including the application of Vectobac® WG (3000 ITU/mg) to potential breeding sites (10 g per rainwater container, maximum of 200 l = maximum of approx. 150,000 ITU/l, and 2.5 g per container < 50 l) with a persistence of at least 3 weeks. In Ludwigshafen, larval source management resulted in a Container Index for Ae. albopictus of < 1% in 2020 compared to 10.9% in 2019. The mean number of Aedes eggs per ovitrap per 2 weeks was 4.4 in Ludwigshafen, 18.2 in Metzgergrün (Freiburg) (SIT area) and 22.4 in the control area in Gartenstadt (Freiburg). The strong reduction of the Ae. albopictus population by Bti application was followed by weekly releases of 1013 (Ludwigshafen) and 2320 (Freiburg) sterile Ae. albopictus males per hectare from May until October, resulting in a high percentage of sterile eggs. In the trial areas of Ludwigshafen and Frieburg, egg sterility reached 84.7 ± 12.5% and 62.7 ± 25.8%, respectively; in comparison, the natural sterility in the control area was 14.6 ± 7.3%. The field results were in line with data obtained in cage tests under laboratory conditions where sterility rates were 87.5 ± 9.2% after wild females mated with sterile males; in comparison, the sterility of eggs laid by females mated with unirradiated males was only 3.3 ± 2.8%. The overall egg sterility of about 84% in Ludwigshafen indicates that our goal to almost eradicate the Ae. albopictus population could be achieved. The time for inspection and treatment of a single property ranged from 19 to 26 min depending on the experience of the team and costs 6–8 euros per property. CONCLUSIONS: It is shown that an integrated control program based on a strict monitoring scheme can be most effective when it comprises three components, namely CP, DtD intervention that includes long-lasting Bti-larviciding to strongly reduce Ae. albopictus populations and SIT to reduce the remaining Ae. albopictus population to a minimum or even to eradicate it. The combined use of Bti and SIT is the most effective and selective tool against Ae. albopictus, one of the most dangerous mosquito vector species. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13071-021-05112-7.
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Résumé Objectif Le présent document résume notre expérience limitée quant à la présence du SRAS pendant la grossesse et suggère des lignes directrices quant à sa prise en charge. Issues Les exposés de cas issus d’Asie laissent entendre que les issues maternelles et fœtales sont aggravées par la présence du SRAS pendant la grossesse. Résultats Des recherches ont été menées dans Medline afin d’en tirer les articles pertinents publiés en anglais entre 2000 et 2007. Des exposés de cas ont été analysés et nous avons sollicité l’opinion de spécialistes. Valeurs Les recommandations ont été formulées conformément aux lignes directrices élaborées par le Groupe d’étude canadien sur les soins de santé préventifs. Commanditaire La Société des obstétriciens et gynécologues du Canada. Recommandations 1. Tous les hôpitaux devraient mettre en œuvre des systèmes de prévention des infections, afin de s’assurer que des alertes au sujet des modifications que connaissent les facteurs de risque d’exposition au SRAS ou à d’autres maladies transmissibles potentiellement graves sont communiquées sans tarder aux unités cliniques, y compris l’unité de travail et d’accouchement (III-C). 2. En présence d’une éclosion de SRAS, toutes les patientes enceintes évaluées ou admises à l’hôpital devraient faire l’objet d’un dépistage des symptômes et des facteurs de risque du SRAS (III-C). 3. À leur arrivée au sein de l’unité de triage quant au travail, les patientes enceintes chez lesquelles la présence du SRAS est soupçonnée et probable devraient être placées dans une salle d’isolement dotée d’un système de ventilation à pression négative comptant au moins six renouvellements d’air à l’heure. Toutes les unités de travail et d’accouchement offrant des soins à des patientes chez lesquelles la présence du SRAS est soupçonnée et probable devraient disposer d’au moins une salle dans laquelle ces patientes peuvent connaître leur travail et leur accouchement en toute sûreté, et ce, malgré la nécessité d’assurer un isolement aérogène (III-C). 4. Dans la mesure du possible, le travail et l’accouchement (y compris l’accouchement opératoire ou la césarienne) devraient être pris en charge, dans une salle d’isolement désignée dotée d’un système de ventilation à pression négative, par du personnel désigné disposant d’une tenue de protection et d’une formation spécialisée en prévention des infections (III-C). 5. Tant l’anesthésie régionale que générale peuvent s’avérer adéquates pour l’accouchement des patientes atteintes du SRAS (III-C). 6. Les nouveau-nés issus de mères atteintes du SRAS devraient être isolés au sein d’une unité désignée jusqu’à ce que leur état ait été satisfaisant pendant 10 jours ou jusqu’à ce que la période d’isolement de la mère ait pris fin. La mère ne devrait pas allaiter pendant cette période (III-C). 7. Une équipe multidisciplinaire (comprenant des obstétriciens, des infirmières, des pédiatres, des spécialistes de la prévention des infections, des inhalothérapeutes et des anesthésiologistes) devrait être nommée au sein de chaque unité et être responsable de l’organisation et de la mise en œuvre des protocoles de prise en charge du SRAS de l’unité (III-C). 8. Le personnel offrant des soins aux patientes enceintes atteintes du SRAS ne devraient pas offrir leurs services aux autres patientes enceintes. Le personnel offrant des soins aux patientes enceintes atteintes du SRAS devraient activement faire l’objet d’une surveillance visant la fièvre et d’autres symptômes du SRAS. Ces personnes ne devraient pas travailler en présence de tout symptôme du SRAS se manifestant dans les 10 jours suivant une exposition à un patient atteint du SRAS (III-C). 9. Tous les professionnels des soins de santé, les résidents et les membres du personnel de soutien devraient bénéficier d’une formation sur la prise en charge et le confinement des infections afin de prévenir la propagation du virus du SRAS (III-A). 10. Les autorités sanitaires régionales, conjointement avec le personnel hospitalier, devraient envisager la désignation d’établissements ou d’unités de soins de santé particulières (y compris des centres de soins primaires, secondaires ou tertiaires) en ce qui concerne l’offre de soins aux patients atteints du SRAS ou de maladies semblables (III-A).
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Tetanus Lockjaw Trismus Summary Tetanus is an infection of the nervous system with a type of bacteria that is potentially deadly, called <em>Clostridium tetani (C tetani)</em>. Causes Spores of the bacterium <em>C tetani</em> are found in the soil, and in animal feces and mouth (gastrointestinal tract). In the spore form, <em>C tetani</em> can remain inactive in the soil. But it can remain infectious for more than 40 years. You can get tetanus infection when the spores enter your body through an injury or wound. The spores become active bacteria that spread in the body and make a poison called tetanus toxin (also known as tetanospasmin). This poison blocks nerve signals from your spinal cord to your muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fractures of the spine. The time between infection and the first sign of symptoms is about 7 to 21 days. Most cases of tetanus in the United States occur in those who have not been properly vaccinated against the disease. Symptoms Tetanus often begins with mild spasms in the jaw muscles (lockjaw). The spasms can also affect your chest, neck, back, and abdominal muscles. Back muscle spasms often cause arching, called opisthotonos. Sometimes, the spasms affect muscles that help with breathing, which can lead to breathing problems. Prolonged muscular action causes sudden, powerful, and painful contractions of muscle groups. This is called tetany. These are the episodes that can cause fractures and muscle tears. Other symptoms include: Drooling Excessive sweating Fever Hand or foot spasms Irritability Swallowing difficulty Uncontrolled urination or defecation Exams and Tests Your doctor will perform a physical exam and ask about your medical history. No specific lab test is available to diagnose tetanus. Tests may be used to rule out meningitis, rabies, strychnine poisoning, and other diseases with similar symptoms. Treatment Treatment may include: Antibiotics Bedrest with a calm environment (dim light, reduced noise, and stable temperature) Medicine to reverse the poison (tetanus immune globulin) Muscle relaxers, such as diazepam Sedatives Surgery to clean the wound and remove the source of the poison (debridement) Breathing support with oxygen, a breathing tube, and a breathing machine may be necessary. Outlook (Prognosis) Without treatment, 1 out of 4 infected people die. The death rate for newborns with untreated tetanus is even higher. With proper treatment, less than 15% of infected people die. Wounds on the head or face seem to be more dangerous than those on other parts of the body. If the person survives the acute illness, recovery is generally complete. Uncorrected episodes of hypoxia (lack of oxygen) caused by muscle spasms in the throat may lead to irreversible brain damage. Possible Complications Complications that may result from tetanus include: Airway obstruction Respiratory arrest Heart failure Pneumonia Damage to muscles Fractures Brain damage due to lack of oxygen during spasms When to Contact a Medical Professional Call your health care provider right away if you have an open wound, particularly if: You are injured outdoors. The wound has been in contact with soil. You have not received a tetanus booster (vaccine) within 10 years or you are not sure of your vaccination status. Call for an appointment with your provider if you have never been immunized against tetanus as an adult or child. Also call if your children have not been immunized, or if you are unsure of your tetanus immunization (vaccine) status. Prevention IMMUNIZATION Tetanus is completely preventable by being immunized (vaccinated). Immunization usually protects against tetanus infection for 10 years. In the United States, immunizations begin in infancy with the DTaP series of shots. The DTaP vaccine is a 3-in-1 vaccine that protects against diphtheria, pertussis, and tetanus. Td vaccine or Tdap vaccine is used to maintain immunity in people age 7 and older. Tdap vaccine should be given once, before age 65, as a substitute for Td for those who have not had Tdap. Td boosters are recommended every 10 years starting at age 19. Older teenagers and adults who get injuries, especially puncture-type wounds, should get a tetanus booster if it has been more than 10 years since the last booster. If you have been injured outside or in any way that makes contact with soil likely, contact your provider about your risk of getting a tetanus infection. Injuries and wounds should be thoroughly cleaned right away. If the tissue of the wound is dying, a doctor will need to remove the tissue. You may have heard that you can get tetanus if you are injured by a rusty nail. This is true only if the nail is dirty and has the tetanus bacteria on it. It is the dirt on the nail, not the rust that carries the risk for tetanus. Review Date 12/13/2017 Updated by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Pancreatic cysts: Pancreatic cysts are saclike pockets of fluid on or in your pancreas, a large organ behind the stomach that produces hormones and enzymes that help digest food. Most pancreatic cysts aren't cancerous, and many don't cause symptoms. They're typically found during imaging testing for another problem. Some are actually noncancerous (benign) pockets of fluids lined with scar or inflammatory tissue, not the type of cells found in true cysts (pseudocysts). But some pancreatic cysts can be or can become cancerous. Your doctor might take a sample of the pancreatic cyst fluid to determine if cancer cells are present. Or your doctor might recommend monitoring a cyst over time for changes that indicate cancer. You may not have symptoms from pancreatic cysts, which are often found when imaging tests of the abdomen are done for another reason. When signs or symptoms of pancreatic cysts do occur, they typically include: - Persistent abdominal pain, which may radiate to your back - A mass you can feel in your upper abdomen - Nausea and vomiting When to see a doctor Rarely, cysts can become infected. See a doctor if you have a fever and persistent abdominal pain. A ruptured pseudocyst can be a medical emergency, but fortunately is rare. Fluid released by the pseudocyst can damage nearby blood vessels and cause massive bleeding. A ruptured pseudocyst can also cause infection of the abdominal cavity (peritonitis). Seek emergency medical treatment if you have signs or symptoms of internal bleeding and shock, including: - Fainting - Severe abdominal pain - Decreased consciousness - Weak and rapid heartbeat - Vomiting of blood The cause of most pancreatic cysts is unknown. Some cysts are associated with rare illnesses including von Hippel-Lindau disease, a genetic disorder that can affect the pancreas and other organs. Pseudocysts often follow a bout of a painful condition in which digestive enzymes become prematurely active and irritate the pancreas (pancreatitis). Pseudocysts can also result from injury to the abdomen, such as from a car accident. Heavy alcohol use and gallstones are risk factors for pancreatitis, and pancreatitis is a risk factor for pseudocysts. Abdominal injury is also a risk factor for pseudocysts. Pancreatic cysts are diagnosed more often than in the past because improved imaging technology finds them more readily. Many pancreatic cysts are found during abdominal scans for other problems. The main challenge in diagnosis is to determine whether the cyst might become cancerous. These procedures are often used to help with diagnosis and treatment planning: - Medical history. Previous abdominal injury or pancreatitis might indicate a pseudocyst. - CT scan. This imaging test can provide detailed information about the size and structure of a pancreatic cyst. - MRI scan. This imaging test can highlight subtle details of a pancreatic cyst, including whether it has any components that suggest a higher risk of cancer. - Endoscopic ultrasound. This test, like MRI, can provide a detailed image of the cyst. Also, fluid can be collected from the cyst for analysis in a laboratory for possible signs of cancer. The characteristics and location of the pancreatic cyst, with your age and sex, can help doctors pinpoint the type of cyst you have: - Serous cystadenoma can become large enough to displace nearby organs, causing abdominal pain and a feeling of fullness. Serous cystadenomas occur most frequently in women older than 60 and only rarely become cancerous. - Mucinous cystadenoma is usually situated in the body or tail of the pancreas and occurs most often in middle-aged women. Mucinous cystadenoma is precancerous, which means it might become cancer if left untreated. Larger cysts might already be cancerous when found. - Intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. It occurs most often in men and women older than 50. Depending on its location and other factors, IPMN may require surgical removal. - Papillary cystic tumor is usually situated in the body or tail of the pancreas and occurs most often in women younger than 35. Also known as papillary cystic neoplasm, it's rare and usually cancerous. - Cystic islet cell tumor is mostly solid but can have cystlike components. Cystic islet cell tumors are rare. They can be confused with other pancreatic cysts and may be precancerous or cancerous. Watchful waiting or treatment depends on the type of cyst you have, its size, its characteristics and whether it's causing symptoms. Watchful waiting A benign pseudocyst, even a large one, can be left alone as long as it isn't bothering you. Serous cystadenoma rarely becomes cancerous, so it also can be left alone unless it causes symptoms or grows. But all pancreatic cysts should be monitored. Drainage A pseudocyst that is causing bothersome symptoms or growing larger can be drained. A small flexible tube (endoscope) is passed through your mouth to your stomach and small intestine. The endoscope is equipped with an ultrasound probe (endoscopic ultrasound) and a needle to drain the cyst. Sometimes drainage through the skin is necessary. Surgery Surgery might be needed to remove an enlarged pseudocyst or a serous cystadenoma that's causing pain or other symptoms. Other types of pancreatic cysts generally require surgical removal because of the risk of cancer. A pseudocyst may recur if you have ongoing pancreatitis.
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Lung cancer - small cell Cancer - lung - small cell Small cell lung cancer SCLC Summary Small cell lung cancer (SCLC) is a fast-growing type of lung cancer. It spreads much more quickly than non-small cell lung cancer. There are two types of SCLC: Small cell carcinoma (oat cell cancer) Combined small cell carcinoma Most SCLCs are of the oat cell type. Causes About 15% of all lung cancer cases are SCLC. Small cell lung cancer is slightly more common in men than women. Almost all cases of SCLC are due to cigarette smoking. SCLC is very rare in people who have never smoked. SCLC is the most aggressive form of lung cancer. It usually starts in the breathing tubes (bronchi) in the center of the chest. Although the cancer cells are small, they grow very quickly and create large tumors. These tumors often spread rapidly (metastasize) to other parts of the body, including the brain, liver, and bone. Symptoms Symptoms of SCLC include: Bloody sputum (phlegm) Chest pain Cough Loss of appetite Shortness of breath Weight loss Wheezing Other symptoms that may occur with this disease, especially in the late stages, include: Facial swelling Fever Hoarseness or changing voice Swallowing difficulty Weakness Exams and Tests The health care provider will perform a physical exam and ask about your medical history. You will be asked whether you smoke, and if so, how much and for how long. When listening to your chest with a stethoscope, the provider may hear fluid around the lungs or areas where the lung has partially collapsed. Each of these findings may suggest cancer. SCLC has usually spread to other parts of your body by the time it is diagnosed. Tests that may be performed include: Bone scan Chest x-ray Complete blood count (CBC) CT scan Liver function tests MRI scan Positron emission tomography (PET) scan Sputum test (to look for cancer cells) Thoracentesis (removal of fluid from the chest cavity around the lungs) In most cases, a piece of tissue is removed from your lungs or other areas to be examined under a microscope. This is called a biopsy. There are several ways to do a biopsy: Bronchoscopy combined with biopsy CT scan-directed needle biopsy Endoscopic esophageal or bronchial ultrasound with biopsy Mediastinoscopy with biopsy Open lung biopsy Pleural biopsy Video-assisted thoracoscopy Usually, if a biopsy shows cancer, more imaging tests are done to find out the stage of the cancer. Stage means how big the tumor is and how far it has spread. SCLC is classified as either: Limited: cancer is only in the chest and can be treated with radiation therapy. Extensive: cancer has spread outside the area that can be covered by radiation. Treatment Because SCLC spreads quickly throughout the body, treatment will include cancer-killing drugs (chemotherapy), which are usually given through a vein (by IV). Treatment with chemotherapy and radiation may be done for people with SCLC that has spread throughout the body (most cases). In this case, the treatment only helps relieve symptoms and prolongs life, but does not cure the disease. Radiation therapy can be used with chemotherapy if surgery is not possible. Radiation therapy uses powerful x-rays or other forms of radiation to kill cancer cells. Radiation may be used to: Treat the cancer, along with chemotherapy, if surgery is not possible. Help relieve symptoms caused by the cancer, such as breathing problems and swelling. Help relieve cancer pain when the cancer has spread to the bones. Often, SCLC may have already spread to the brain. This can occur even when there are no symptoms or other signs of cancer in the brain. As a result, some people with smaller cancers, or who had a good response in their first round of chemotherapy may receive radiation therapy to the brain. This therapy is done to prevent spread of the cancer to the brain. Surgery helps very few people with SCLC because the disease has often spread by the time it is diagnosed. Surgery may be done when there is only one tumor that has not spread. If surgery is done, chemotherapy or radiation therapy is still needed. Support Groups You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone. Outlook (Prognosis) How well you do depends on how much the lung cancer has spread. SCLC is very deadly. Not many people with this type of cancer are still alive 5 years after diagnosis. Treatment can often prolong life for 6 to 12 months, even when the cancer has spread. In rare cases, if SCLC is diagnosed early, treatment may result in a long-term cure. When to Contact a Medical Professional Call your provider if you have symptoms of lung cancer, particularly if you smoke. Prevention If you smoke, now is the time to quit. If you are having trouble quitting, talk with your provider. There are many methods to help you quit, from support groups to prescription medicines. Also try to avoid secondhand smoke. If you smoke or used to smoke, talk with your provider about getting screened for lung cancer. To get screened, you need to have a CT scan of the chest. Review Date 8/14/2017 Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/12/2018.
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Irritable bowel syndrome - aftercare IBS Mucus colitis IBS-D IBS-C Summary Irritable bowel syndrome (IBS) is a disorder that leads to abdominal pain and bowel changes. Your health care provider will talk about things you can do at home to manage your condition. What to Expect at Home Irritable bowel syndrome (IBS) may be a lifelong condition. You may be suffering from cramping and loose stools, diarrhea, constipation, or some combination of these symptoms. For some people, IBS symptoms may interfere with work, travel, and attending social events. But taking medicines and making lifestyle changes can help you manage your symptoms. Diet Changes in your diet may be helpful. However, IBS varies from person to person. So the same changes may not work for everyone. Keep track of your symptoms and the foods you are eating. This will help you look for a pattern of foods that may make your symptoms worse. Avoid foods that cause symptoms. These may include fatty or fried foods, dairy products, caffeine, sodas, alcohol, chocolate, and grains such as wheat, rye, and barley. Eat 4 to 5 smaller meals a day, rather than 3 larger ones. Increase the fiber in your diet to relieve symptoms of constipation. Fiber is found in whole grain breads and cereals, beans, fruits, and vegetables. Since fiber may cause gas, it is best to add these foods to your diet slowly. Medicines No one drug will work for everyone. Medicines your provider may have you try include: Antispasmodic medicines that you take before eating to control colon muscle spasms and abdominal cramping Antidiarrheal medicines such as loperamide Laxatives, such as lubiprostone, bisacodyl , and other ones bought without a prescription Antidepressants to help relieve pain or discomfort Rifaximin, an antibiotic that is not absorbed from your intestines It is very important to follow your provider's instructions when using medicines for IBS. Taking different medicines or not taking medicines the way you have been advised can lead to more problems. Stress Stress may cause your intestines to be more sensitive and contract more. Many things can cause stress, including: Not being able to do activities because of your pain Changes or problems at work or at home A busy schedule Spending too much time alone Having other medical problems A first step toward reducing your stress is to figure out what makes you feel stressed. Look at the things in your life that cause you the most worry. Keep a diary of the experiences and thoughts that seem to be related to your anxiety and see if you can make changes to these situations. Reach out to other people. Find someone you trust (such as a friend, family member, neighbor, or clergy member) who will listen to you. Often, just talking to someone helps relieve anxiety and stress. When to Call the Doctor Call your provider if: You develop a fever You have gastrointestinal bleeding You have bad pain that does not go away You lose over 5 to 10 pounds (2 to 4.5 kilograms) when you are not trying to lose weight Review Date 4/24/2017 Updated by: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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hello my name is ryan. I believe i may have seratonin syndrome . I was put on an anitdepressant called paxil for my anxiety. i started taking 5 mg for one week then i increased to 10 mg about two days after switching to the 10 i started to notice having a weird feeling i have never experienced before. i was feeling agitatied irrated depressed and very anxious and my nerves were on edge. i believed that it might be a side effect of the drug i tryied to push through it hearing that the side effects do go away after 4 days of this it became unbareable and i was so afraid that i quit taking it. the physical side effects went away within 2 days but i still felt aggition and depression and my anxiety was worse than before the medicine. i stopped taking it last tuesday. i told me doctor about this and he prescribed me a new antidepressant zoloft . both of the medications were generic brand. i took my first pill 25mg on this tuesday around noon. i did feel a little optimistic after taking it hoping it may help me. around 7 oclock that evening i started to feel this rush of fear and thoughts about all the bad things going on in my life. i started to panic and pace around my room crying and feeling like im going crazy. I ran outside to see if it would help but it didnt. I really wanted to go to the hospital but instead to calm me down i drank 2 glasses of whiskey in 20 mins. Ever since then i have become extremely aggitated and very anxious worse than before when i expeienced these symtoms on paxil. i wake up in the morning around 5 or 6 every day very anxious and racing thoughts. i fall asleep ok around midnight after being awake around 18 hours. In the past month me and my girlfriend broke up after being together for 2 years and i know it was because of my anxiety that our relationship failed. my car broke down so me and my dad are fixing it in his garage. ive been having problems at work because of my anxiety. Ive been smoking weed everyday for my anxiety over the past 2 years and just recently about a month ago decided to quit to get healthy and in shape. just everything pilling up it very overwhelming and depressing. i read online that seratonin syndrome can occur when you increase a dose in a ssri anitdepressant. Im wondering if my taking the zoloft agitated this and made my symtoms worse. I saw the doctor on thursday to tell him about this. he seemed he like he didnt know too much about mental health so he called a psychiatrist to fit me into an appointment on monday morning. in the mean time he prescribed me antivan to calm me down. i took the first pill thursday around 2 it was .5 mg. I didnt experience any change in my anxiety and mabye a less slightly aggitated but not enought to calm me down. i decided to up the dose to 1 mg too see if it would be any different i took that at 7 pm thursday evening after 2 hours of waiting for anything i didnt experience any change either. i became very upset and panicky becuase i thought something was seriously mentally wrong with me for this not to work. I had to resort to smoking marijuana just to calm my nerves and its my only option right now or going to the emergency room. im trying to hold on to seeing the psychiatrist on monday but im afraid it may effect my work this weekend i work at a resaurant and it really busy on the weekends. Any thoughts on what i am going throught would be greatly appriciated.
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A unified treatment of the renewable portfolio standards is given concerning direct methanol fuel. The current mechanism of electrocatalysis of methanol oxidation on platinum and non-platinum-containing alloys is summarized for the systematic improvement of the rate of electro-oxidation of methanol are discussed. Policy realignment under the five-year plan is discussed in length to demonstrate how policy, markets, and engineering designs contribute towards the development of model direct methanol fuel cells operational enhancement, and factors that affect critical performance parameters for commercial exploitation are summarized for catalytic formulations and cell design within the context of why this investment in technology, education, and finances is required within the global context of sustainable energy and energy independence as exposed by thirteenth the five-year plan. The prolog focuses on the way, whereas the section on methanol fuel cells on the how and the post log on what is expected post-COVID-19 era in science and technology as China pivots to a post-fossil fuel economy. China's industrial growth has been through internal market reforms and supplies side economics from the Chinese markets for fossil fuels except for petroleum. The latest renewable portfolio standards adopted have common elements as adopted from North American and the United Kingdom in terms of adaptation of obligation in terms of renewable portfolio standards as well as a realization that the necessity for renewables standards for the thirteen five year plan (from 2016 to 2020) need to less rigorously implemented due to performance targets that were met during the eleventh (06–10) and twelfth five-year plans (11–15) in terms of utilization of small coal-ire power plants, development of newer standards, led to an improvement of energy efficiency of 15 %, reduction of SO(x)/NO(x) by an average of 90 % and PM2.5 by 96 % over the last two five-year plans. The current phase of the plan has a focus on energy generation from coal and a slowing down of renewables or Renewable energy curtailment of approximately 400 T Wh renewables including 300 T Wh of non-hydro power, principally from Guangdong, and Jiangsu for transfer of hydropower and Zhejiang, Tianjin, Henan for non-hydro power transfer with Beijing and Shanghai playing important roles in renewables energy curtailment and realignment using an integrated approach to optimize each provinces energy portfolio. The realignment of the renewable energy portfolio indicates that the newly installed capacity in Sichuan, Yunnan, Inner Mongolia, and Zhejiang will account for less than 20 % of the current renewable energy portfolio but with the NO(x) SO(x) and PM(2.5) savings already accrued. The catalytic reduction of carbon dioxide to methanol (70 / 110 million metric tons from all sources in 2019 for China/world) is one technological approach to reduce global carbon dioxide emissions and suggests that catalytic methanol synthesis by CO(2) hydrogenation may be a plausible approach, even if it is more expensive economically than methanol synthesis by the syngas approach. This is because the CO(2) emissions of the synthesis are lower than other synthesis methodologies. The Chinese government has placed a premium on cleaner air and water and may view such an approach as solving the dual issues of fuel substitution and reduction of CO(2). Thus, the coupling of hydrogen generation from sustainable energies sources (Solar 175 / 509 GW) or wind (211/591.5 GW in 2019) may be an attractive approach, as this requires slightly less water than coal gasification. Due to the thermodynamic requirement of lower operating pressure and higher operating pressure, currently, there is no single operational approach, although some practice approaches (220 °C at 48 atm using copper) and zinc oxide/alumina are suggested for optimal performance.
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A pandemia da COVID-19 é um problema de saúde pública global que imprimiu uma nova dinâmica à economia mundial A rápida propagação da doença e o uso do distanciamento como forma de prevenção expuseram as desigualdades sociais e urbanas das cidades capitalistas No Brasil, como em outros países, o isolamento social promoveu rápidas mudanças no mercado de trabalho, com impactos mais severos para 37,3 milhões de pessoas que vivem na informalidade, já que elas não têm direitos como Fundo de Garantia por Tempo de Serviço (FGTS) e seguro-desemprego Para a Organização Internacional do Trabalho (OIT), as primeiras demissões estão ocorrendo entre aqueles que vivem do trabalho precário, como terceirizados, balconistas, garçons, funcionários de cozinha, diaristas, manipuladores de bagagem e produtos de limpeza Assim, faremos uma breve síntese das consequências que a crise sanitária vem promovendo para os trabalhadores brasileiros, bem como proporemos medidas de enfrentamento que não se limitem aos auxílios emergenciais A recuperação e a criação de ocupações dependerão, entre outros fatores, da retomada dos gastos com programas sociais e econômicos que reduziram as desigualdades sociais no início deste século, como o Programa de Aceleração do Crescimento em Favelas (PAC-Favelas);o Programa Minha Casa, Minha Vida;o Programa Bolsa Família (PBF);e o Programa de Geração de Emprego e Renda (Proger) com recursos do Fundo de Amparo ao Trabalhador (FAT) Esses programas podem e devem ser ampliados a fim de fazer com a que a economia retome o crescimento em longo prazo Alternate abstract: The COVID-19 pandemic is a global public health problem that has given new dynamics to the world economy The rapid spread of the disease and the use of social distancing as a form of prevention exposed the social and urban inequalities of capitalist cities In Brazil, as in other countries, social distancing has promoted rapid changes in the labor market with more severe impacts for 37 3 million people living in the informal sector, as they do not have rights to, for example, the severance pay indemnity fund (FGTS) and unemployment benefit According to the International Labour Organization, the first layoffs are occurring among those who live off precarious work, such as: outsourced workers, clerks, waiters, kitchen workers, day laborers, baggage handlers, and cleaners We show a brief synthesis of the consequences that the health crisis has brought to Brazilian workers and propose coping measures that are not limited to emergency aid The recovery and creation of occupations will depend, among other factors, on the resumption of spending on social and economic programs that were able to reduce social inequalities at the beginning of this century, such as PAC-favelas;Minha Casa, Minha Vida Program;Bolsa Família Program and the FAT Employment and Income Generation Program These programs can and must be expanded to bring the economy back to growth in the long run Alternate abstract: La pandemia de COVID-19 es un problema de salud pública global que ha dado una nueva dinámica a la economía mundial La rápida propagación de la enfermedad y el uso de la distancia como un medio de prevención expusieron las desigualdades sociales y urbanas de las ciudades capitalistas En Brasil, como en otros países, el aislamiento social promovió cambios rápidos en el mercado laboral con impactos más severos para 37,3 millones de personas que viven en la informalidad, ya que no tienen derechos como el Fondo de Garantía por Tiempo de Trabajo y seguro de desempleo Para la Organización Internacional del Trabajo, los primeros despidos ocurren entre quienes viven del trabajo precario, tales como: trabajadores subcontratados, vendedores de mostrador, camareros, personal de cocina, jornaleros, manipuladores de equipaje y productos de limpieza Por lo tanto, haremos una breve síntesis de las consecuencias que la crisis sanitaria está promoviendo para los trabajadores brasileños, y propondremos medidas de af on amiento que no se limiten a las ayudas de emergencia La recuperación y la creación de ocupaciones dependerán, entre otros factores, de la reanudación de los gastos en programas sociales y económicos que redujeron las desigualdades sociales a principios de este siglo, como el Programa de Aceleración del Crecimiento (PAC Favelas);el “Programa Minha Casa, Minha Vida”;el “Programa Bolsa Família” y el Programa Fondo de Amparo al Trabajador (FAT) Esos programas pueden y deben expandirse para que la economía vuelva a crecer a largo plazo
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Breath odor Bad breath Halitosis Malodor Summary Breath odor is the scent of the air you breathe out of your mouth. Unpleasant breath odor is commonly called bad breath. Considerations Bad breath is usually related to poor dental hygiene. Not brushing and flossing regularly causes sulfur compounds to be released by bacteria in the mouth. Some disorders will produce distinct breath odors. Some examples are: A fruity odor to the breath is a sign of ketoacidosis, which may occur in diabetes. It is a potentially life-threatening condition. Breath that smells like feces can occur with prolonged vomiting, especially when there is a bowel obstruction. It may also occur temporarily if a person has a tube placed through the nose or mouth to drain their stomach. The breath may have an ammonia-like odor (also described as urine-like or "fishy") in people with chronic kidney failure. Causes Bad breath may be caused by: Abscessed tooth Gum surgery Alcoholism Cavities Dentures Eating certain foods, such as cabbage, garlic, or raw onions Coffee and poorly pH-balanced diet Object stuck in the nose (usually happens in kids); often a white, yellow, or bloody discharge from one nostril Gum disease (gingivitis, gingivostomatitis, ANUG) Impacted tooth Poor dental hygiene Tonsils with deep crypts and sulfur granules Sinus infection Throat infection Tobacco smoking Vitamin supplements (especially in large doses) Some medicines, including insulin shots, triamterene, and paraldehyde Some diseases that may cause breath odor are: Acute necrotizing ulcerative gingivitis (ANUG) Acute necrotizing ulcerative mucositis Gastroesophageal reflux disease (GERD) Acute renal failure Bowel obstruction Bronchiectasis Chronic kidney failure Esophageal cancer Gastric carcinoma Gastrojejunocolic fistula Hepatic encephalopathy Diabetic ketoacidosis Lung infection or abscess Ozena, or atrophic rhinitis Periodontal disease Pharyngitis Zenker diverticulum Home Care Use proper dental hygiene, especially flossing. Remember that mouthwashes are not effective in treating the underlying problem. Fresh parsley or a strong mint is often an effective way to fight temporary bad breath. Avoid smoking. Otherwise, follow your health care provider's instructions to treat any underlying cause of bad breath. When to Contact a Medical Professional Contact your provider if: Breath odor does not go away and there is not an obvious cause (such as smoking or eating foods that cause the odor). You have breath odor and signs of a respiratory infection, such as fever, cough, or face pain with discharge from your nose. What to Expect at Your Office Visit Your provider will take a medical history and perform a physical exam. You may be asked the following medical history questions: Is there a specific odor (such as fish, ammonia, fruit, feces, or alcohol)? Have you recently eaten a spicy meal, garlic, cabbage, or other "odorous" food? Do you take vitamin supplements? Do you smoke? What home care and oral hygiene measures have you tried? How effective are they? Have you had a recent sore throat, sinus infection, tooth abscess, or other illness? What other symptoms do you have? The physical exam will include a thorough inspection of your mouth and nose. A throat culture may be taken if you have a sore throat or mouth sores. In rare cases, tests that may be performed include: Blood tests to screen for diabetes or kidney failure Endoscopy (EGD) X-ray of the abdomen X-ray of the chest Antibiotics may be prescribed for some conditions. For an object in the nose, your provider will use an instrument to remove it. Review Date 2/5/2018 Updated by: Ilona Fotek, DMD, MS, Dental Healing Arts, Jupiter, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Background:COVID-19 is an emerging infectious disease caused by SARS-CoV-2. Risk factors for the worst outcome in COVID-19 are pre-existing pulmonary and cardiovascular disease, while the impact of chronic immunosuppression has not yet completely been clarified (1).Currently, there is no clinical evidence that chronically immunosuppressed rheumatic patients under biologic agent or a small molecule may have a higher risk of COVID-19 or a worse prognosis(2). However, the anti-CD20 antibody monoclonal rituximab may contribute to severe consequences, inhibiting the humoral response to SARS-CoV-2 and capacity to produce efficient antibodies against it (3,4). Rituximab is widely use in the treatment of ANCA-associated vasculitis (AAV). Nowadays, the incidence and impact of COVID-19 in AAV-patients are still unknown and, in particular, in AAV-patients who have been exposed to rituximab since the outbreak (5).Objectives:Herein we evaluate the incidence and outcome of SARS-CoV-2 infection in our cohort of AAV-patients who had at least one visit in the year 2020.Methods:We collected clinical data of 100 AAV-patients who had at least one visit in our Centre from February 2020 to December 2020, and we described cases of COVID-19 infection among them. The COVID-19 was proved by detection of SARS-CoV-2 RNA in nose-pharyngeal swabs. In case of infection, anti-SARS-CoV-2 IgM or IgG production was then investigated.Results:Among 100 patients (53 females;47 males) regularly followed, the median age was 65, and the mean (SD) duration of disease was 8.8 (6.8) years. The most frequent diagnosis was granulomatosis with polyangiitis (GPA) (56%), followed by granulomatosis eosinophilic with polyangiitis (EGPA) (31%), and microscopic polyangiitis (MPA) (13%). The mean (SD) BVASv3 at the onset of disease was 12.6 (5.6). More than half of the patients (59%) have had lung and/or ENT involvement at the onset of disease. Overall, 84% of our patients received immunosuppressive agents and 45% also received glucocorticoids (GC). Rituximab was administered in 15% of patients during the pandemic. COVID-19 was diagnosed in 2 cases (2%). Both patients have received rituximab as maintenance: the last rituximab infusion was on November 9, 2020 for patient 1 (female, 73 years old, GPA ANCA-PR3+) and was on August 17, 2020 for patient 2 (female, 74 years old, MPA ANCA-MPO+). Both patients had a BVAS 0 and negative ANCA antibodies at the time of the first positive nose-pharyngeal swab RT-PCR test, on December 24 and on November 25, respectively. Both patients were B-cell depleted and IgG levels were 455 mg/dL and 866 mg/dL, respectively. While patient 1 died due to critically ill COVID-19 pneumonia 25 days after the COVID-19 disease onset, patient 2 remained asymptomatic with nose-pharyngeal swab still positive on day 56 after the first detection. Anti-SARS-CoV-2 IgM or IgG antibodies above the cut-off (cut-off value 10 AU/mL) were absent in patient 1, while in patient 2 a low level of anti-SARS-CoV-2 IgG (39 AU/mL, cut-off value 10 AU/mL) was documented.Conclusion:Prevalence of COVID-19 in AAV seems lower than in general population (prevalence of 29582/466700, 6.3%, in the same geographical area). Rituximab compromises the B-cells function and can lead to humoral immunodeficiency, causing the inability to produce anti-SARS-CoV-2 IgG antibodies. The timing of the last rituximab infusion and the levels of IgG can greatly affect the outcome. Patients who underwent anti-CD20 therapy are at higher risk of severe outcome in case of infection (3), and require prioritization for SARS-CoV-2 vaccination.References:[1]Guilpain P, et al. Ann Rheum Dis. 2021;80(1):e10.[2]Quartuccio L, et al. Joint Bone Spine. 2020;87(5):439–43.[3]Benucci M, et al. Ann Rheum Dis. 2020;Aug 4:annrheumdis-2020-218590.[4]Tepasse P-R, et al. Br J Haematol. 2020;190(2):185–8.[5]Kant S, et al. J Nephrol. 2020;J Nephrol. 2020 Oct 8:1-6.Disclosure of Interests:None declared.
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Irritable Bowel Syndrome (IBS) (Treatment): Though irritable bowel syndrome (IBS) doesn’t have a cure, your doctor can manage the symptoms with a combination of diet, medicines, probiotics, and therapies for mental health problems. You may have to try a few treatments to see what works best for you. Your doctor can help you find the right treatment plan.Changes in eating, diet, and nutrition, such as following a FODMAP diet, can help treat your symptoms.Your doctor may recommend medicine to relieve your symptoms.Fiber supplements to relieve constipation when increasing fiber in your diet doesn’t help. Laxatives to help with constipation. Laxatives work in different ways, and your doctor can recommend a laxative that’s right for you. Loperamide to reduce diarrhea by slowing the movement of stool through your colon. Loperamide is an antidiarrheal that reduces diarrhea in people with IBS, though it doesn’t reduce pain, bloating, or other symptoms. Antispasmodics, such as hyoscine, cimetropium, and pinaverium, help to control colon muscle spasms and reduce pain in your abdomen. Antidepressants, such as low doses of tricyclic antidepressants and selective serotonin reuptake inhibitors, to relieve IBS symptoms, including abdominal pain. In theory, because of their effect on colon transit, tricyclic antidepressants should be better for people with IBS with diarrhea, or IBS-D, and selective serotonin reuptake inhibitors should be better for people with IBS with constipation, or IBS-C, although studies haven’t confirmed this theory. Tricyclic antidepressants work in people with IBS by reducing their sensitivity to pain in the gastrointestinal (GI) tract as well as normalizing their GI motility and secretion. Lubiprostone (Amitiza) for people who have IBS-C to improve abdominal pain or discomfort and constipation symptoms. Linaclotide (Linzess) for people who have IBS-C to relieve abdominal pain and increase how often you have bowel movements. The antibiotic rifaximin to reduce bloating by treating small intestinal bacterial overgrowth. However, experts are still debating and researching the use of antibiotics to treat IBS. Coated peppermint oil capsules to reduce IBS symptoms.Follow your doctor’s instructions when you use medicine to treat IBS. Talk with your doctor about possible side effects and what to do if you have them.Some medicines can cause side effects. Ask your doctor and your pharmacist about side effects before taking any medicine. MedlinePlus maintains the latest information about side effects and drug warnings.Your doctor may also recommend probiotics. Probiotics are live microorganisms—tiny organisms that can be seen only with a microscope. These microorganisms, most often bacteria, are like the microorganisms that are normally present in your GI tract. Studies have found that taking large enough amounts of probiotics, specifically Bifidobacteria and certain probiotic combinations, can improve symptoms of IBS. However, researchers are still studying the use of probiotics to treat IBS.You can find probiotics in dietary supplements, such as capsules, tablets, and powders, and in some foods, such as yogurt.Discuss your use of complementary and alternative medical practices, including probiotics and dietary supplements, with your doctor.Psychological therapies may improve your IBS symptoms.Managing StressLearning to reduce stress can help improve IBS. With less stress, you may find you have less cramping and pain. You may also find it easier to manage your symptoms.Some options for managing stress includetaking part in stress reduction and relaxation therapies such as meditation getting counseling and support taking part in regular exercise such as walking or yoga reducing stressful life situations as much as possible getting enough sleepTalk TherapyTalk therapy may reduce stress and improve your IBS symptoms. Two types of talk therapy that health care professionals use to treat IBS are cognitive behavioral therapy and psychodynamic, or interpersonal, therapy. Cognitive behavioral therapy focuses on your thoughts and actions. Psychodynamic therapy focuses on how your emotions affect your IBS symptoms. This type of therapy often involves relaxation and stress management techniques.Gut-Directed HypnotherapyIn gut-directed hypnotherapy, a therapist uses hypnosis to help you relax the muscles in the colon.Mindfulness TrainingMindfulness training can teach you to focus your attention on sensations occurring at the moment and to avoid catastrophizing, or worrying about the meaning of those sensations.
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BEFORE MY MOTHER DIED. WE TOOK HER TO ER FOR LEFT LEG PAIN WHICH HAD BOTHERED HER FOR A WEEK. THINKING IT WAS JUST A CRAMP. I MASSAGED HER LEG AT ALL HOURS. AFTER TALKING WITH FAMILY DOCTOR. HE TOLD US TO TAKE HER TO ER. AT ER THEY FOUND THAT HER BLOOD COUNT WAS LOW 5 AND THAT HER PLATELETT LEVELS WERE CRITICALLY LOW ALSO. SO THE HOSPITAL ADMITTED HER. A FEW DAYS LATER I WAS CALLED TO THE HOSPITAL. THE HOSPITAL STAFF HAD GIVEN MY MOTHER TOO MUCH FLUIDS IN HER IV AND SHE WAS COMPLETELY SWOLLEN AND STRUGGLING TO BREATH. THEY SAID SHE HAD ASPIRATED PNEUMONIA. EVEN HER EYES HAD A FILM ACROSS IT FROM THE SWELLING. SHE WAS NOW ON OXYGEN, DIURETICS AND ANTIBIOTICS. PRIOR TO ENTERING HOSPITAL. MY MOTHER COULD TALK, LAUGH, SIT UP, SING, MOVE HER ARMS AND LEGS AND WAS TOTALLY AWARE. AFTER THE ASPIRATED PNEUMONIA, SHE NO LONGER COULD DO THESE THINGS. SHE WENT DOWN HILL FROM THERE. THEY TRIED BLOOD AND PLATELETT TRANSFUSIONS NUMEROUS TIMES AND SUBJECTED HER TO NUMEROUS SCANS. AT ONE POINT KNOWING OF HER RADIATION TREATMENT PASS. I ASKED DOCTOR IF SHE HAD LEUKEMIA. HE SAID NO. ABOUT ALMOST A MONTH IN THE HOSPITAL, THEY COULD NOT LOCATE PROBLEM, WOULD NOT TRANSFER HER, WOULD NOT CALL IN OTHER DOCTORS, TOLD ME, IT DOES NOT MATTER IF SHE HAD 5 MILLION DOLLARS WE STILL WOULD NOT DO THESE THINGS. THEY SENT HER HOME AFTER NOT BEING ABLE TO LOCATE PROBLEM. SHE WAS SENT HOME IN HOSPICE. WITH INSTRUCTIONS, NOT TO PROLONG LIFE AND NOT TO FEED HER. I WAS NOT TOLD THIS TILL RIGHT BEFORE SHE DIED. BY THEN IT WAS TOO LATE. SHE DIED 4 DAYS AFTER COMING HOME. THE DAY BEFORE SHE DIED, I FAILED TO RECOGNIZE THE SYMPTOMS OF DEHYDRATION. THE DOCTOR DID NOT ORDER A CHECK TO SEE IF THERE WAS BLOOD IN MY MOTHERS STOOL, EVEN THO SHE WAS APPARENTLY BLEEDING INTERNALLY FOR 3 WEEKS. THE DOCTORS WITH NO ANSWER SAID THAT ALL SYMPTOMS POINTED TO LEUKEMIA. THE SAME ILLNESS THE DOCTOR HAD SAID MY MOTHER DID NOT HAVE 2 WEEKS EARLIER. IN FACT WAS DEFINATELY SURE SHE DID NOT HAVE. HE REFUSED TO DO PROCEDURES ON MY MOTHER BECAUSE SHE IN HIS WORDS WAS THAT SHE WAS TOO OLD AT THE TIME 76 YRS AND THAT HER LOW PLATELETT COUNT MADE ANY INVASIVE PROCEDURES DANGEROUS.NEVEN THO IN CHECKING I HD FOUND SURGERY ON A PATIENT AS OLD AS 84 AND THE PATIENT IS OKAY NOW. I AM LEFT WITH SO MANY QUESTIONS. I NO LONGER TRUST THE DOCTORS OR THE HOSPITAL. I AM LEFT WITHOUT A MOTHER AND MANY UNANSWERED QUESTIONS. ( that is okay, no need to answer question. don`t have credit card ) $15.00 is a cheap price for advice from a doctor, but it does not matter. my mother will still be dead, no matter what you say. the question was for me, because I was not sure I did everything possible. I have been depressed and am contemplating punishing myself by killing myself. I failed to protect my mother. therefore I need to be punish. I just needed to know, if I did everything possible. sorry to have bothered you. )
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Endometriosis (What are the symptoms of endometriosis?): The primary symptoms of endometriosis are pain and infertility.- Among women with pelvic pain, endometriosis may occur in about 75%.1,2 - Among women with fertility problems, endometriosis may occur in as many as 50%.1Other common symptoms of endometriosis include:- Painful, even debilitating, menstrual cramps, which may get worse over time - Pain during or after sex - Pain in the intestine or lower abdomen - Painful bowel movements or painful urination during menstrual periods - Heavy menstrual periods - Premenstrual spotting or bleeding between periodsIn addition, women who are diagnosed with endometriosis may have painful bladder syndrome, digestive or gastrointestinal symptoms similar to a bowel disorder, as well as fatigue, tiredness, or lack of energy.2For some women, the pain symptoms associated with endometriosis get milder after menopause, but this is not always the case. Hormone therapy such as estrogen or birth control pills, given to reduce menopausal symptoms, may cause these endometriosis symptoms to continue.Researchers know that pain is a primary symptom of endometriosis, but it is not known how pain arises in women with endometriosis.The severity of pain does not correspond with the number, location, or extent of endometriosis lesions. Some women with only a few small lesions experience severe pain; other women may have very large patches of endometriosis, but only experience little pain.3,4Current evidence suggests several possible explanations for pain associated with endometriosis, including (but not limited to):3,4- Patches of endometriosis respond to hormones in a similar way as the lining of the uterus. These tissues may bleed or have evidence of inflammation every month, similar to a regular menstrual period. However, the blood and tissue shed from endometriosis patches stay in the body and are irritants, which can cause pain. - In some cases, inflammation and chemicals produced by the endometriosis areas can cause the pelvic organs to adhere, or stick together, causing scar tissue. This makes the uterus, ovaries, and fallopian tubes, as well as the bladder and rectum, appear as one large organ. - Hormones and chemicals released by endometriosis tissue also may irritate nearby tissue and cause the release of other chemicals known to cause pain. - Over time, some endometriosis areas may form nodules or bumps as they create lesions on the surface of pelvic organs or can become cysts (fluid-filled sacs) on the ovaries. - Some endometriosis lesions have nerves in them, tying the patches directly into the central nervous system. These nerves may be more sensitive to pain-causing chemicals released in the lesions and surrounding areas. Over time, they may be more easily activated by the chemicals than normal nerve cells are. - Patches of endometriosis might also press against nearby nerve cells to cause pain. - Some women report less endometriosis pain after pregnancy, but the reason for this is unclear. Researchers are trying to determine if the reduction results from the hormones released by the body during pregnancy, or from changes in the cervix, uterus, or endometrium that occur during pregnancy and delivery.Pain from endometriosis can be severe, interfering with day-to-day activities. Understanding how endometriosis is related to pain is a very active area of research because it could allow for more effective treatments for this specific type of pain.
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Recently, I have been having Heart Palputations at night. I could finally be drifting off to sleep, then suddenly my Heart gives off a hard pump and wakes me up for a while. I have also been having pain in the area of my ribs, and deal with this daily. I have Winter Asthma, and recently I ve had to take the larger solution two to three times a day, and its usually because I ve been feeling weaker and numb in worrying areas, like the back of my skull, over my face, and in parts of my body. I ve delt with Acute Bronchitis recently and Acute Sinusitis, and those seemed to have gone, but my condition has gotten worse. Like, how yesterday, there was a large numbness all over most of my skull/brain, but after taking the solution, it went away and my body felt better, somewhat. This all started around a month ago, when we though it was just a cold or the flu. Then in the second week, I got Bronchitis and all those other things, the third week Ibwas getting better then had to go to the ER, and now its the fourth week and Im getting worse... I think my body isn t generating enough blood, and my body makes me take the solution to help my heart pump and send out more blood throughout my body. I have been taking 2 peptobismo chewbles a day, one in the morning, one at night, to help with acid reflux, and three Bayer s chewable asprins everynight, to help with rib and heart pain, and it worked for a while, but now its just nothing. I have also been getting ice cold on the inside, but hot on the outside. Breathing is so-so but its alright, but the pain in my ribs and heart hurt horribly everyday multiple times a day. I have also been somewhat stressing and may be gaining anxiety recently from all this, as I have never been sick this badly, so it s all new to me, and I had to go to the ER from an allergic reaction to a type of penicillin a week and two days ago, and this severe pain only started recently, on Jan. 29. The ER had given me Benadryl and a Cortiosteriod (May have miss spelt that) when I was there, and gave me more benadryl Take for 10 days as needed for allergy symptoms and I don t know if it meant I had to take them for 10 days, or when I had allergy symptoms. They gave me some more cortiosteroids to take two days after on Jan. 28. I did, and had a horrible pain attack that night, so I set up an appointment with my doctor on the 29. I went, and he ignored basically everything pain wise and didn t know about anything that was happening. In the car, the entire roof of my mouth was blue. Its been getting better from that, but its still slightly blue down the middle. I did a few errands, and by the time I got home, I was in so much pain, and then proceeded to have an asthma attack. Then ever since then, I had to take the solution once everyday, and the last 2-3 days I have had to take it more than one, ranging from twice to three times. I have tried exercising the past three/four days, where I go outside for a few minutes (5-10, really) and that really makes me feel better, but it always causes me to need the solution an hour or two afterwards. I also believe I am loosing large amounts of weight, which is slightly terrifying to me. I weighed myself early and as my normal weight was 180lbs before all this (The sickness has been going on for over a month now.) and I was 165lbs. I drink around 2-3 bottles of water a day, eat soup, a turkey and cheese sandwhich, some eggs and swiss cheese scrambled together with a tortillia and then bananas. Since I ve been having acid reflux, I stop eating large solid foods at 7pm, and stop eating in general and getting ready for bed around 10pm, but if I do feel extremely hungry (Which I ve been having problems with recently aswell) I eat a banana or some crackers. (Very few though, as I had a horrible reaction with acid reflux recently (When the heart palputations started, really) and thats also when I started getting really sicker and was pale yesterday,and in so much pain I almost fainted. I am going to go to the Doctor s in a few minutes today actually, and we re going to see what he says, maybe do an x-ray to see if I broke a rib, a blood test, to see if I have anything, like cancer, or low blood sugar/ High blood pressure/ anemia. So, If you nees to know anything more, tell me in the email or whatever you are going to send me, and I ll tell you and what the doctor will say.
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BACKGROUND: During the period of the coronavirus disease 2019 (COVID-19) outbreak, strong intervention measures, such as lockdown, travel restriction, and suspension of work and production, may have curbed the spread of other infectious diseases, including natural focal diseases. In this study, we aimed to study the impact of COVID-19 prevention and control measures on the reported incidence of natural focal diseases (brucellosis, malaria, hemorrhagic fever with renal syndrome [HFRS], dengue, severe fever with thrombocytopenia syndrome [SFTS], rabies, tsutsugamushi and Japanese encephalitis [JE]). METHODS: The data on daily COVID-19 confirmed cases and natural focal disease cases were collected from Jiangsu Provincial Center for Disease Control and Prevention (Jiangsu Provincial CDC). We described and compared the difference between the incidence in 2020 and the incidence in 2015–2019 in four aspects: trend in reported incidence, age, sex, and urban and rural distribution. An autoregressive integrated moving average (ARIMA) (p, d, q) × (P, D, Q)(s) model was adopted for natural focal diseases, malaria and severe fever with thrombocytopenia syndrome (SFTS), and an ARIMA (p, d, q) model was adopted for dengue. Nonparametric tests were used to compare the reported and the predicted incidence in 2020, the incidence in 2020 and the previous 4 years, and the difference between the duration from illness onset date to diagnosed date (DID) in 2020 and in the previous 4 years. The determination coefficient (R(2)) was used to evaluate the goodness of fit of the model simulation. RESULTS: Natural focal diseases in Jiangsu Province showed a long-term seasonal trend. The reported incidence of natural focal diseases, malaria and dengue in 2020 was lower than the predicted incidence, and the difference was statistically significant (P < 0.05). The reported incidence of brucellosis in July, August, October and November 2020, and SFTS in May to November 2020 was higher than that in the same period in the previous 4 years (P < 0.05). The reported incidence of malaria in April to December 2020, HFRS in March, May and December 2020, and dengue in July to November 2020 was lower than that in the same period in the previous 4 years (P < 0.05). In males, the reported incidence of malaria in 2020 was lower than that in the previous 4 years, and the reported incidence of dengue in 2020 was lower than that in 2017–2019. The reported incidence of malaria in the 20–60-year age group was lower than that in the previous 4 years; the reported incidence of dengue in the 40–60-year age group was lower than that in 2016–2018. The reported cases of malaria in both urban and rural areas were lower than in the previous 4 years. The DID of brucellosis and SFTS in 2020 was shorter than that in 2015–2018; the DID of tsutsugamushi in 2020 was shorter than that in the previous 4 years. CONCLUSIONS: Interventions for COVID-19 may help control the epidemics of natural focal diseases in Jiangsu Province. The reported incidence of natural focal diseases, especially malaria and dengue, decreased during the outbreak of COVID-19 in 2020. COVID-19 prevention and control measures had the greatest impact on the reported incidence of natural focal diseases in males and people in the 20–60-year age group. GRAPHICAL ABSTRACT: [Image: see text]
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Gonorrhea Overview Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.1 Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant. What is gonorrhea? Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs. Who gets gonorrhea? In 2014, gonorrhea affected more than 162,000 women in the United States.1 Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.1 How do you get gonorrhea? Gonorrhea is spread through: What are the signs and symptoms of gonorrhea? Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection. Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria. Signs and symptoms in the genital area can include: Signs and symptoms in other parts of the body include: Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms. Do I need to get tested for gonorrhea? You also need to get tested if you have any symptoms of gonorrhea. Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV. How is gonorrhea diagnosed? There are two ways that a doctor or nurse tests for gonorrhea: A Pap test is not used to detect gonorrhea. How is gonorrhea treated? Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow. Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible. For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated. What can happen if gonorrhea is not treated? Gonorrhea that is not treated can cause serious health problems in women:3 What should I do if I have gonorrhea? Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible. If you have gonorrhea: How does gonorrhea affect pregnancy? For pregnant women, untreated gonorrhea raises the risk of: Babies born to infected mothers are at risk for: Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection. How can I prevent gonorrhea? The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex. If you do have sex, lower your risk of getting an STI with the following steps: The steps work best when used together. No single step can protect you from every single type of STI. Can women who have sex with women get gonorrhea? Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women. Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea. Did we answer your question about gonorrhea? For more information about gonorrhea, call the OWH Helpline at 1-800-994-9662 or contact the following organizations: Sources
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Diet for rapid weight loss Very low-calorie diet VLCD Low-calorie diet LCD Very low energy diet Weight loss - rapid weight loss Overweight - rapid weight loss Obesity - rapid weight loss Diet - rapid weight loss Summary Rapid weight loss diet is a type of diet in which you lose more than 2 pounds (1 kilogram, kg) a week over several weeks. To lose weight this quickly you eat very few calories. How It Works These diets are most often chosen by obese people who want to lose weight quickly. These diets are rarely recommended by health care providers. People on these diets should be followed closely by a provider. Rapid weight loss is not safe for most people to do on their own. These diets are only to be used for a short time and are not recommended for more than several weeks. The types of rapid weight loss diets are described below. People who lose weight very quickly are much more likely to regain the weight over time than people who lose weight slowly through less drastic diet changes and physical activity. Very Low-Calorie Diet (VLCD) On a VLCD, you may have as few as 800 calories a day and may lose up to 3 to 5 pounds (1.5 to 2 kg) week. Most VLCDs use meal replacements, such as formulas, soups, shakes, and bars instead of regular meals. This helps ensure that you get all of the nutrients you need each day. A VLCD is only recommended for adults who are obese and need to lose weight for health reasons. These diets are often used before weight-loss surgery. You should only use a VLCD with the help of your provider. Most experts DO NOT recommend using a VLCD for more than 12 weeks. Low-Calorie Diet (LCD) These diets usually allow about 1,000 to 1,200 calories a day for women and 1,200 to 1,600 calories a day for men. An LCD is a better choice than a VLCD for most people who want to lose weight quickly. But you should still be supervised by a provider. You will not lose weight as fast with an LCD, but you can lose just as much weight with a VLCD. An LCD may use a mix of meal replacements and regular food. This makes it easier to follow than a VLCD. Fad Diets Some fad diets also severely limit calories to achieve rapid weight loss. In many cases, these diets are not safe. Once you stop the diet, you are at risk for regaining the weight if you return to your old eating habits. For most people, it is safest to choose a diet in which you lose a 1/2 pound to 1 pound (225 grams to 500 grams) a week. The Role of Exercise Rapid weight loss is more about cutting calories than exercising. Talk with your provider about what type of exercise you should do while you are on this type of diet. Your provider may suggest waiting until you are on a more long-term diet to start exercising. Health Benefits Rapid weight loss diet is usually for people who have health problems because of obesity. For these people, losing a lot of weight quickly can help improve: Diabetes High cholesterol High blood pressure Possible Health Concerns You should only follow one of these diets with the help of your provider. Losing more than 1 or 2 pounds (0.5 to 1 kg) a week is not safe for most people. It can cause you to lose muscle, water, and bone density. Rapid weight loss can also cause some side effects including: Gallstones Gout Fatigue Constipation Diarrhea Nausea People who lose weight quickly are also more likely to gain back the weight quickly. This can lead to other health problems. In general, a rapid weight loss diet is not safe for children. It may also not be safe for teens, pregnant women or older adults unless a provider recommends it. If you have a health condition, it is a good idea to talk with your provider before starting this or any diet plan to lose weight. Review Date 5/17/2018 Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Scoliosis in Children and Adolescents (How is it treated?): Your doctor may recommend the following treatments: - Observation. If the curve is mild and you are still growing, your doctor will re-examine you every few months. - Bracing. If the curve is moderate and you are still growing, your doctor may recommend a brace to keep the curve from getting worse. Braces are selected for the specific curve problem and fitted to each patient. Braces must be worn every day for the full number of hours prescribed by the doctor. - Surgery. If you are still growing and have a severe curve that is getting worse, your doctor may suggest surgery. This often involves fusing together two or more bones in the spine. The doctor may also put in a metal rod or other device to help keep the spine straight after surgery. You should seek the advice of at least two experts, and ask about the benefits and risks of the surgery. The following treatments have not been shown to keep curves from getting worse in scoliosis: - Chiropractic treatment. - Electrical stimulation. - Nutritional supplements. Your doctor may recommend the following treatments: - Observation. If the curve is mild and you are still growing, your doctor will re-examine you every few months. - Bracing. If the curve is moderate and you are still growing, your doctor may recommend a brace to keep the curve from getting worse. Braces are selected for the specific curve problem and fitted to each patient. Braces must be worn every day for the full number of hours prescribed by the doctor. - Surgery. If you are still growing and have a severe curve that is getting worse, your doctor may suggest surgery. This often involves fusing together two or more bones in the spine. The doctor may also put in a metal rod or other device to help keep the spine straight after surgery. You should seek the advice of at least two experts, and ask about the benefits and risks of the surgery. The following treatments have not been shown to keep curves from getting worse in scoliosis: - Chiropractic treatment. - Electrical stimulation. - Nutritional supplements. Your doctor may recommend the following treatments: - Observation. If the curve is mild and you are still growing, your doctor will re-examine you every few months. - Bracing. If the curve is moderate and you are still growing, your doctor may recommend a brace to keep the curve from getting worse. Braces are selected for the specific curve problem and fitted to each patient. Braces must be worn every day for the full number of hours prescribed by the doctor. - Surgery. If you are still growing and have a severe curve that is getting worse, your doctor may suggest surgery. This often involves fusing together two or more bones in the spine. The doctor may also put in a metal rod or other device to help keep the spine straight after surgery. You should seek the advice of at least two experts, and ask about the benefits and risks of the surgery. The following treatments have not been shown to keep curves from getting worse in scoliosis: - Chiropractic treatment. - Electrical stimulation. - Nutritional supplements.
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autosomal recessive congenital stationary night blindness: Autosomal recessive congenital stationary night blindness is a disorder of the retina, which is the specialized tissue at the back of the eye that detects light and color. People with this condition typically have difficulty seeing and distinguishing objects in low light (night blindness). For example, they may not be able to identify road signs at night or see stars in the night sky. They also often have other vision problems, including loss of sharpness (reduced acuity), nearsightedness (myopia), involuntary movements of the eyes (nystagmus), and eyes that do not look in the same direction (strabismus). The vision problems associated with this condition are congenital, which means they are present from birth. They tend to remain stable (stationary) over time. Autosomal recessive congenital stationary night blindness is likely a rare disease; however, its prevalence is unknown. Mutations in several genes can cause autosomal recessive congenital stationary night blindness. Each of these genes provide instructions for making proteins that are found in the retina. These proteins are involved in sending (transmitting) visual signals from cells called rods, which are specialized for vision in low light, to cells called bipolar cells, which relay the signals to other retinal cells. This signaling is an essential step in the transmission of visual information from the eyes to the brain. Mutations in two genes, GRM6 and TRPM1, cause most cases of this condition. These genes provide instructions for making proteins that are necessary for bipolar cells to receive and relay signals. Mutations in other genes involved in the same bipolar cell signaling pathway are likely responsible for a small percentage of cases of autosomal recessive congenital stationary night blindness. Gene mutations that cause autosomal recessive congenital stationary night blindness disrupt the transmission of visual signals between rod cells and bipolar cells or interfere with the bipolar cells' ability to pass on these signals. As a result, visual information received by rod cells cannot be effectively transmitted to the brain, leading to difficulty seeing in low light. The cause of the other vision problems associated with this condition is unclear. It has been suggested that the mechanisms that underlie night blindness can interfere with other visual systems, causing myopia, reduced visual acuity, and other impairments. Some people with autosomal recessive congenital stationary night blindness have no identified mutation in any of the known genes. The cause of the disorder in these individuals is unknown. This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition. Audo I, Bujakowska K, Orhan E, Poloschek CM, Defoort-Dhellemmes S, Drumare I, Kohl S, Luu TD, Lecompte O, Zrenner E, Lancelot ME, Antonio A, Germain A, Michiels C, Audier C, Letexier M, Saraiva JP, Leroy BP, Munier FL, Mohand-Saïd S, Lorenz B, Friedburg C, Preising M, Kellner U, Renner AB, Moskova-Doumanova V, Berger W, Wissinger B, Hamel CP, Schorderet DF, De Baere E, Sharon D, Banin E, Jacobson SG, Bonneau D, Zanlonghi X, Le Meur G, Casteels I, Koenekoop R, Long VW, Meire F, Prescott K, de Ravel T, Simmons I, Nguyen H, Dollfus H, Poch O, Léveillard T, Nguyen-Ba-Charvet K, Sahel JA, Bhattacharya SS, Zeitz C. Whole-exome sequencing identifies mutations in GPR179 leading to autosomal-recessive complete congenital stationary night blindness. Am J Hum Genet. 2012 Feb 10;90(2):321-30. doi: 10.1016/j.ajhg.2011.12.007. Erratum in: Am J Hum Genet. 2012 Jul 13;91(1):209.
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Frozen shoulder - aftercare: A frozen shoulder is shoulder pain that leads to stiffness of your shoulder. Often the pain and stiffness are present all the time. The capsule of the shoulder joint is made of strong tissue (ligaments) that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones cannot move freely in the joint. This condition is called frozen shoulder. Frozen shoulder may develop with no known cause. It can also occur in people who: - Have thyroid disease, diabetes, or are going through menopause - Have a shoulder injury - Have had a stroke that makes them unable to use their arm - Have a cast on their arm that holds their arm in one position Symptoms of frozen shoulder often follow this pattern: - At first, you have a lot of pain, or a freezing feeling that prevents you from moving your arm. - Then your shoulder becomes very stiff and hard to move, but the pain lessens. It becomes hard to reach over your head or behind you. - Finally, the pain goes away and you can use your arm again. This is the thawing phase and can take months to end. It can take a few months to go through these stages of frozen shoulder. The shoulder can get very painful and stiff before it starts to loosen. It can take as long as 18 to 24 months for complete healing. To help speed healing, your health care provider will likely do the following: - Teach you exercises to restore motion in your shoulder joint. - Refer you to a physical therapist. - Prescribe medicines for you to take by mouth. These include drugs to reduce pain and inflammation in the shoulder joint. You may also receive a shot of anti-inflammatory drug directly into the joint. Most people have a full recovery with full range of motion without surgery. Using moist heat on your shoulder 3 to 4 times a day may help relieve some pain and stiffness. For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store. - Talk with your provider before using these medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. - DO NOT take more than the amount recommended on the bottle or by your provider. Get help setting up your home so that you can get to everything you need without reaching above your shoulders or behind your back. - Keep the clothes that you wear most often in drawers and shelves that are between your waist and shoulder level. - Store food in cupboards, drawers, and refrigerator shelves that are between your waist and shoulder level. Get help with house cleaning, taking out the garbage, gardening, and other household tasks. DO NOT lift heavy things or do activities that require a lot of shoulder and arm strength. You will learn some simple exercises and stretches for your shoulder. - At first, try to do these exercises once every hour, or at least 4 times a day. - It is more important to do the exercises often than to do them for a long time each time you do them. - Use moist heat before the exercises to help lessen pain and increase movement. - The exercises should focus on stretching of the shoulder and range of motion. - Avoid exercises to strengthen your shoulder until the range of motion has returned. Some of the exercises are: - Shoulder stretches - Pendulum - Wall crawl - Rope and pulley stretches - Movements to help with internal and external rotation, such as hand behind back Your provider or physical therapist will show you how to do these exercises. Call your doctor if: - The pain in your shoulder is getting worse - You re-injure your arm or shoulder - Your frozen shoulder is making you feel sad or depressed Updated by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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I had my gallbladder out four months ago. I am only 31 yrs old. I have had diarrhea since. I am now being treated for it with Colestid. I have now been in pain for two months which started as a squeezing type feeling in my chest. Right shoulder blade pain (deep inside around trigger point), spinal pain (deep), neck pain (sharp like nerves and strained muscles/pings). Pain occasionally wraps around my right ribs and around incisions. Pain in upper back is terrible. Doctors are not listening since I had an MRI which which reveled a reverse Lordis curve and a bulge at c5 c6, also some minor bone spurs in Thoracic. I have been to many doctors, Neuro who said to take Gabapitin, which I do an night, physical therapy , Ortho doctor who said that the MRI in writing was not accurate to what he saw when I brought him the images. Acupuncturist (who is also a former gallbladder and liver surgeon) thinks that the doctors need to listen to me because he thinks something is wrong that no one is looking at. I am in chronic pain and I get light headed and feel like I m being crushed and strangled (literally, I don t know any other way to describe it, it feels like I m not getting enough blood in my head), it is very prominent and makes me feel like I m going to pass out. Had heart checked at ER (said it was fine), Thyroid (normal), barium swallow (normal), stool sample was normal after treating C-diff infection following surgery w/ Flagyl. It is so bad now to start and getting worse. I feel like my back is breaking, my neck and ribs are in the wrong place, and now my lower back is hurting and shooting pain goes into my right leg and right arm. I have to say that I was (besides the gallbladder issue) normal before, five months ago. I am not being taken seriously because they cannot find anything wrong in my blood (with the exception of a Vitamin D- low- which may be because of the diarrhea or the Colestid, or both) and the MRI. I have been labeled depressed as of yesterday which is a big-cop out I feel. I am not depressed for any other reason that I am in pain each day, 24/7. I have my head together, I am a hard working student, and an overall happy person, but am concerned greatly that I have something very wrong and I have not been treated well. I am very sick (in pain) now and I need someone to help me that will listen, that is all I ask. I have only had an x-ray done of the top of my right shoulder even though I said the pain was near my shoulder blade. My lungs were fine last time they checked with chest x ray. I had two CT scans since surgery (both gave me hives on face), no stones were found. Appetite fine just lots of sever pain. Almost like my back is broken right at the spine. Have an ovarian cyst that is 3.4 cm. On birth control for the last three years. Really, I m in enough agony right now to go to the ER, but that has yielded no answers and either. Thank you so much for reading.
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Very Low-calorie Diets How is obesity treated? Obesity is treated using one or more of these strategies:a diet low in calories increased physical activity behavior therapy prescription medications weight-loss surgery What is a VLCD? A VLCD is a special diet that provides up to 800 calories per day. VLCDs use commercial formulas, usually liquid shakes, soups, or bars, which replace all your regular meals. These formulas are not the same as the meal replacements you can find at grocerystores or pharmacies, which are meant to replace one or two meals a day.Depending on a number of factors, healthy adults need different amounts of calories to meet their daily energy needs. A standard amount is about 2,000 calories. VLCDs provide far fewer calories than most people need to maintain a healthy weight. This type of diet is used to promote quick weight loss, often as a way to jump-start an obesity treatment program.VLCD formulas are designed to provide all of the nutrients you need while helping you lose weight quickly. However, this type of diet should only be used for a short time—usually about 12 weeks.The Low-calorie Diet (LCD)An LCD limits calories, but not as much as a VLCD. A typical LCD may provide1,000–1,200 calories/day for a woman 1,200–1,600 calories/day for a manThe number of calories may be adjusted based on your age, weight, and how active you are. An LCD usually consists of regular foods, but could also include meal replacements. As a result, you may find this type of diet much easier to follow than a VLCD. In the long term, LCDs have been found to lead to the same amount of weight loss as VLCDs. Should I use a VLCD to lose weight? Most people who need to lose weight should not use a VLCD. For many of them, a low-calorie diet (LCD) may work better (see The Low-calorie Diet (LCD)).VLCDs may be used to promote rapid weight loss among adults who have obesity. Health care providers must review risks and benefits on a case-by-case basis.In general, VLCDs are not appropriate for children. In a few cases, they may be used with some adolescents who are being treated for obesity.Not much is known about the use of VLCDs to promote weight loss among older adults. Some people over age 50 may have medical issues that may not make them good candidates for this type of diet. What are the health benefits of a VLCD? A VLCD may allow you to lose about 3 to 5 pounds per week. This may lead to an average total weight loss of 44 pounds over 12 weeks. Such a weight loss can rapidly improve medical conditions linked to obesity, including diabetes, high blood pressure, and high cholesterol.The rapid weight loss experienced by most people on a VLCD can be very motivating. Patients who participate in a VLCD program that also includes lifestyle changes may lose about 15 to 25 percent of their initial weight during the first 3 to 6 months. They may maintain a 5 percent weight loss after 4 years if they adopt a healthy eating plan and physical activity habits. What are the health risks of a VLCD? Doctors must monitor all VLCD patients regularly—ideally every 2 weeks in the initial period of rapid weight loss—to be sure patients are not experiencing serious side effects.Many patients on a VLCD for 4 to 16 weeks report minor side effects such as fatigue, constipation, nausea, or diarrhea. These conditions usually improve within a few weeks and rarely prevent patients from completing the program.The most common serious side effect is gallstones. Gallstones, which often develop in people who are obese, especially women, may be even more commonly developed during rapid weight loss. Some medicines can prevent gallstones from forming during rapid weight loss. Your health care provider can determine if these medicines are appropriate for you. For more information, see the WIN fact sheet on dieting and gallstones, listed under Additional Links. Will I regain the weight? Although the long-term results of VLCDs vary widely, weight regain is common. To prevent weight regain, the VLCD should always be combined with other ways to lose weight and with an active follow-up program.For most people who have obesity, the condition is long term and requires a lifetime of attention even after formal methods to treat the obesity end. You may need to commit to permanent changes of healthier eating, regular physical activity, and an improved outlook about food. Very Low-calorie Diets The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.What are clinical trials, and are they right for you?Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.What clinical trials are open?Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.
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Acute bronchitis Summary Acute bronchitis is swelling and inflamed tissue in the main passages that carry air to the lungs. This swelling narrows the airways, which makes it harder to breathe. Other symptoms of bronchitis are a cough and coughing up mucus. Acute means the symptoms have been present only for a short time. Causes When acute bronchitis occurs, it almost always comes after having a cold or flu-like illness. The bronchitis infection is caused by a virus. At first, it affects your nose, sinuses, and throat. Then it spreads to the airways that lead to your lungs. Sometimes, bacteria also infect your airways. This is more common in people with COPD. Chronic bronchitis is a long-term condition. To be diagnosed with chronic bronchitis, you must have a cough with mucus on most days for at least 3 months. Symptoms Some symptoms of acute bronchitis are: Chest discomfort Cough that produces mucus -- the mucus may be clear or yellow-green Fatigue Fever -- usually low-grade Shortness of breath that gets worse with activity Wheezing, in people with asthma Even after acute bronchitis has cleared, you may have a dry, nagging cough that lasts for 1 to 4 weeks. Sometimes it can be hard to know if you have pneumonia or bronchitis. If you have pneumonia, you are more likely to have a high fever and chills, feel sicker, or be more short of breath. Exams and Tests Your health care provider will listen to the breathing sounds in your lungs with a stethoscope. Your breathing may sound abnormal or rough. Tests may include: Chest x-ray, if your provider suspects pneumonia Pulse oximetry, a painless test that helps determine the amount of oxygen in your blood by using a device placed on the end of your finger Treatment Most people DO NOT need antibiotics for acute bronchitis caused by a virus. The infection will almost always go away on its own within 1 week. Doing these things may help you feel better: Drink plenty of fluids. If you have asthma or another chronic lung condition, use your inhaler. Get plenty of rest. Take aspirin or acetaminophen if you have a fever. DO NOT give aspirin to children. Breathe moist air by using a humidifier or steaming up the bathroom. Certain medicines that you can buy without a prescription can help break up or loosen mucus. Look for the word "guaifenesin" on the label. Ask the pharmacist for help finding it. If your symptoms do not improve or if you are wheezing, your provider may prescribe an inhaler to open your airways. If your provider thinks you also have bacteria in your airways, they may prescribe antibiotics. This medicine will only get rid of bacteria, not viruses. Your provider may also prescribe corticosteroid medicine to reduce swelling in your lungs. If you have the flu and it is caught in the first 48 hours after getting sick, your provider might also prescribe antiviral medicine. Other tips include: DO NOT smoke. Avoid secondhand smoke and air pollution. Wash your hands (and your children's hands) often to avoid spreading viruses and other germs. Outlook (Prognosis) Except for the cough, symptoms usually go away in 7 to 10 days if you do not have a lung disorder. When to Contact a Medical Professional Call your provider if you: Have a cough on most days, or have a cough that keeps returning Are coughing up blood Have a high fever or shaking chills Have a low-grade fever for 3 or more days Have thick, yellow-green mucus, especially if it has a bad smell Feel short of breath or have chest pain Have a chronic illness, like heart or lung disease Review Date 2/18/2018 Updated by: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Generalized anxiety disorder GAD Anxiety disorder Summary Generalized anxiety disorder (GAD) is a mental disorder in which a person is often worried or anxious about many things and finds it hard to control this anxiety. Causes The cause of GAD is unknown. Genes may play a role. Stress may also contribute to the development of GAD. GAD is a common condition. Anyone can develop this disorder, even children. GAD occurs more often in women than in men. Symptoms The main symptom is frequent worry or tension for at least 6 months, even when there is little or no clear cause. Worries seem to float from one problem to another. Problems may involve family, other relationships, work, school, money, and health. Even when aware that worries or fears are stronger than appropriate for the situation, a person with GAD still has difficulty controlling them. Other symptoms of GAD include: Problems concentrating Fatigue Irritability Problems falling or staying asleep, or sleep that is restless and unsatisfying Restlessness when awake The person may also have other physical symptoms. These can include muscle tension, upset stomach, sweating, or difficulty breathing. Exams and Tests There is no test that can make a diagnosis of GAD. The diagnosis is based on your answers to questions about the symptoms of GAD. Your health care provider will ask about these symptoms. You will also be asked about other aspects of your mental and physical health. A physical exam or lab tests may be done to rule out other conditions that cause similar symptoms. Treatment The goal of treatment is to help you feel better and function well in daily life. Talk therapy or medicine alone can be helpful. Sometimes, a combination of these may work best. TALK THERAPY Many types of talk therapy may be helpful for GAD. One common and effective talk therapy is cognitive-behavioral therapy (CBT). CBT can help you understand the relationship between your thoughts, behaviors, and symptoms. Often CBT involves a set number of visits. During CBT you can learn how to: Understand and gain control of distorted views of stressors, such as other people's behavior or life events. Recognize and replace panic-causing thoughts to help you feel more in control. Manage stress and relax when symptoms occur. Avoid thinking that minor problems will develop into terrible ones. Other types of talk therapy may also be helpful in managing symptoms of an anxiety disorder. MEDICINES Certain medicines, usually used to treat depression, may be very helpful for this disorder. They work by preventing your symptoms or making them less severe. You must take these medicines every day. DO NOT stop taking them without talking with your provider. Medicines called sedatives or hypnotics may also be prescribed. These medicines should only be taken under a doctor's direction. Your doctor will prescribe a limited amount of these drugs. They should not to be used everyday. They may be used when symptoms become very severe or when you are about to be exposed to something that always brings on your symptoms. If you are prescribed a sedative, do not drink alcohol while on this medicine. SELF-CARE Other than taking medicine and going to therapy, you can help yourself get better by: Reducing caffeine Not using street drugs or large amounts of alcohol Exercising, getting enough rest, and eating healthy foods Support Groups You can ease the stress of having GAD by joining a support group. Sharing with others who have common experiences and problems can help you not feel alone. Support groups are usually not a good substitute for talk therapy or taking medicine, but can be a helpful addition. Resources for more information include: Anxiety and Depression Association of America -- adaa.org National Institute of Mental Health -- www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml Outlook (Prognosis) How well a person does depends on how severe the condition is. In some cases, GAD is long-term and is difficult to treat. Most people, though, get better with medicine and/or talk therapy. Possible Complications Depression and substance abuse may occur with an anxiety disorder. When to Contact a Medical Professional Call your provider if you frequently worry or feel anxious, especially if it interferes with your daily activities. Review Date 3/26/2018 Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Ingrown toenail Onychocryptosis Unguis incarnates Surgical nail avulsion Matrix excision Ingrown toenail removal Summary An ingrown toenail occurs when the edge of the nail grows into the skin of the toe. Causes An ingrown toenail can result from a number of things. Poorly fitting shoes and toenails that are not properly trimmed are the most common causes. The skin along the edge of a toenail may become red and infected. The great toe is affected most often, but any toenail can become ingrown. An ingrown toenail may occur when extra pressure is placed on your toe. This pressure is caused by shoes that are too tight or fit poorly. If you walk often or play sports, a shoe that is even a little tight can cause this problem. Deformities of the foot or toes can also place extra pressure on the toe. Nails that are not trimmed properly can also cause ingrown toenails: Toenails that are trimmed too short, or if the edges are rounded rather than cut straight across may cause the nail to curl and grow into the skin. Poor eyesight, inability to reach the toes easily, or having thick nails can make it hard to properly trim nails. Picking or tearing at the corners of the nails can also cause an ingrown toenail. Some people are born with nails that are curved and grow into the skin. Others have toenails that are too large for their toes. Stubbing your toe or other injuries can also lead to an ingrown toenail. Symptoms There may be pain, redness and swelling around the nail. Exams and Tests Your health care provider will examine your toenail and ask about your symptoms. Tests or x-rays aren't usually needed. Treatment If you have diabetes, nerve problem in the leg or foot, poor blood circulation to your foot, or an infection around the nail, see a provider right away. Don't try to treat an ingrown nail at home. Otherwise, to treat an ingrown nail at home: Soak the foot in warm water 3 to 4 times a day if possible. After soaking, keep the toe dry. Gently massage over the inflamed skin. Place a small piece of cotton or dental floss under the nail. Wet the cotton or floss with water or antiseptic. When trimming your toenails: Briefly soak your foot in warm water to soften the nails. Use a clean, sharp trimmer. Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not try to cut out the ingrown portion of the nail yourself. This will only make the problem worse. Consider wearing sandals until the problem goes away. Over-the-counter medicine that is applied to the ingrown toenail may help with the pain, but it does not treat the problem. If this doesn't work and the ingrown nail gets worse, see your family doctor, a foot specialist (podiatrist), or a skin specialist (dermatologist). If the ingrown nail doesn't heal or keeps coming back, your provider may remove part of the nail: Numbing medicine is first injected into the toe. The ingrown part of the nail is removed. This procedure is called a partial nail avulsion. It takes 2 to 4 months for the nail to regrow. If the toe is infected, your doctor may prescribe antibiotics. After the procedure, follow any instructions for helping your nail heal. Outlook (Prognosis) Treatment usually controls the infection and relieves pain. The condition is likely to return if you don't practice good foot care. This condition may become serious in people with diabetes, poor blood circulation, and nerve problems. Possible Complications In severe cases, the infection can spread through the toe and into the bone. When to Contact a Medical Professional Call your provider if you: Are not able to treat an ingrown toenail at home Have severe pain, redness, swelling, or fever Have diabetes, nerve damage in the leg or foot, poor circulation to your foot, or an infection around the nail Prevention Wear shoes that fit properly. Shoes that you wear every day should have plenty of room around your toes. Shoes that you wear for walking briskly or for playing sports should also have plenty of room, but not be too loose. When trimming your toenails: Briefly soak your foot in warm water to soften the nail. Use a clean, sharp nail trimmer. Trim toenails straight across the top. Do not taper or round the corners or trim too short. Do not pick or tear at the nails. Keep your feet clean and dry. People with diabetes should have routine foot exams and nail care. Review Date 4/12/2017 Updated by: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, Subspecialty Foot and Ankle, Camden Bone and Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Epidemics are among the most costly and destructive natural hazards globally. To reduce the impacts of infectious disease outbreaks, the development of a risk index for infectious diseases can be effective, by shifting infectious disease control from emergency response to early detection and prevention. In this study, we introduce a methodology to construct and validate an epidemic risk index using only open data, with a specific focus on scalability. The external validation of our risk index makes use of distance sampling to correct for underreporting of infections, which is often a major source of biases, based on geographical accessibility to health facilities. We apply this methodology to assess the risk of dengue in the Philippines. The results show that the computed dengue risk correlates well with standard epidemiological metrics, i.e. dengue incidence (p = 0.002). Here, dengue risk constitutes of the two dimensions susceptibility and exposure. Susceptibility was particularly associated with dengue incidence (p = 0.047) and dengue case fatality rate (CFR) (p = 0.029). Exposure had lower correlations to dengue incidence (p = 0.211) and CFR (p = 0.163). Highest risk indices were seen in the south of the country, mainly among regions with relatively high susceptibility to dengue outbreaks. Our findings reflect that the modelled epidemic risk index is a strong indication of sub-national dengue disease patterns and has therefore proven suitability for disease risk assessments in the absence of timely epidemiological data. The presented methodology enables the construction of a practical, evidence-based tool to support public health and humanitarian decision-making processes with simple, understandable metrics. The index overcomes the main limitations of existing indices in terms of construction and actionability. Author summary Why Was This Study Done? – Epidemics are among the most costly and destructive natural hazards occurring globally; currently, the response to epidemics is still focused on reaction rather than prevention or preparedness. – The development of an epidemic risk index can support identifying high-risk areas and can guide prioritization of preventive action and humanitarian response. – While several frameworks for epidemic risk assessment exist, they suffer from several limitations, which resulted in limited uptake by local health actors - such as governments and humanitarian relief workers - in their decision-making processes What Did the Researchers Do and Find? – In this study, we present a methodology to develop epidemic risk indices, which overcomes the major limitations of previous work: strict data requirements, insufficient geographical granularity, validation against epidemiological data. – We take as a case study dengue in the Philippines and develop an epidemic risk index; we correct dengue incidence for underreporting based on accessibility to healthcare and show that it correlates well with the risk index (Pearson correlation coefficient 0.69, p-value 0.002). What Do These Findings Mean? – Our methodology enables the development of disease-specific epidemic risk indices at a sub-national level, even in countries with limited data availability; these indices can guide local actors in programming prevention and response activities. – Our findings on the case study show that the epidemic risk index is a strong indicator of sub-national dengue disease patterns and is therefore suitable for disease risk assessments in the absence of timely and complete epidemiological data.
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hi im 20 years old gave birth to my first child august 2010 after goin 11 days over my due date. so the hospital induced me they gave me a tablet to rippen the cervix but nothing happened so my partner went home leaving me at the hospital on my own as they sed they wud ring him if they wer to do anything else or if sumat happened well bowt 9pm they came an sed they wer goin to pop my waters so i agreed. when they did my waters where green. i was in labour 2 hours and it was fine i only felt like i needed to go for a poo then i started to bleed i am still not sure why but at the time i thought it was normal so i was rushed to a room of my own and got given a needle to numb my vagina and then they cut me they sed they needed to pull my baby out with a ventose so i agreed not really knowing what was happening. my daughter finally arrived at 12.07am and she was beautiful and healthy. after she was born they asked if i wanted to hold her and i refused because i felt weak numb and my arms wer like jelly i was scared of dropping her . then a doctor came to stitch me back up and to see if my utrus was returning to its normal size but it wasnt and he said i had clots in my belly so i started to panic as i know that blood clots can travel and kill you instantly .the doctor was trying his hardest to remove the blood clots from my belly through my vagina. after he did that he stitched me back up and i was made some toast and some tea and mentioned to one of the midwifes that i felt dizzy and faint . the next thing i remember was waking up laying down on a bed with people rushing around me. i asked what had happened and know one replied i though i had died and they had brought me back to life but apparently i didnt i had just fainted. they put me on drips inserted a catatear and kept an eye on me until my partner arrived i was so terrified i brushed it off at the time as i was so exhausted but then when i came home from hospital i felt constantly ill i was over protective with my daughter but didnt really want to bother i love her to bits and im not as bad anymore but i get panic attacks i constantly feel ill i get headaches then worry ther e brain tumours, i get belly ache and think i have stomach cancer . i even feel faint and dizzy but i have had this since i was about 14 and my eyes would be open but every thing would go black nothing has been diagnosed and my doctors is rubbish to be honest. i have suffered with minor depression but i think its back bigger and stronger and its here to stay i dunno what happened since i gave birth to my daughter but i have not felt right i dont even go out with my friend i worry to much and if i leave my daughter with my partner or a family member i feel guilty. i dont enjoy what i used to and feel this is taking over my life i have been told by a councillor i have ocd , and health anxiety but i need to get rid of it for my daughters sake, to save my relationship with my partner and because i am pregnant again i am terrified it will all happen again or i will get worse and have my babys taken off me or be commited i have come to the point where im that scared of dying i have thought about ending it myself so i dont upset others along with myself . i wouldnt do it because i have nt got the guts but im worried it could get that bad that i dont think of the consiquences of leaving every one i love . i need to know what medications the best and whats best to take whilst you are pregnant. please help me i have know one else to turn to
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How should Ibuprofen be used and what is the dosage?: Prescription ibuprofen comes as a tablet to take by mouth. It is usually taken three or four times a day for arthritis or every 4 to 6 hours as needed for pain. Nonprescription ibuprofen comes as a tablet, chewable tablet, suspension (liquid), and drops (concentrated liquid). Adults and children older than 12 years of age may usually take nonprescription ibuprofen every 4 to 6 hours as needed for pain or fever. Children and infants may usually be given nonprescription ibuprofen every 6 to 8 hours as needed for pain or fever, but should not be given more than 4 doses in 24 hours. Ibuprofen may be taken with food or milk to prevent stomach upset. If you are taking ibuprofen on a regular basis, you should take it at the same time(s) every day. Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ibuprofen exactly as directed. Do not take more or less of it or take it more often than directed by the package label or prescribed by your doctor. Ibuprofen comes alone and in combination with other medications. Some of these combination products are available by prescription only, and some of these combination products are available without a prescription and are used to treat cough and cold symptoms and other conditions. If your doctor has prescribed a medication that contains ibuprofen, you should be careful not to take any nonprescription medications that also contain ibuprofen. If you are selecting a product to treat cough or cold symptoms, ask your doctor or pharmacist for advice on which product is best for you. Check nonprescription product labels carefully before using two or more products at the same time. These products may contain the same active ingredient(s) and taking them together could cause you to receive an overdose. This is especially important if you will be giving cough and cold medications to a child. Nonprescription cough and cold combination products, including products that contain ibuprofen, can cause serious side effects or death in young children. Do not give these products to children younger than 4 years of age. If you give these products to children 4 to 11 years of age, use caution and follow the package directions carefully. If you are giving ibuprofen or a combination product that contains ibuprofen to a child, read the package label carefully to be sure that it is the right product for a child of that age. Do not give ibuprofen products that are made for adults to children. Before you give an ibuprofen product to a child, check the package label to find out how much medication the child should receive. Give the dose that matches the child's age on the chart. Ask the child's doctor if you don't know how much medication to give the child. Shake the suspension and drops well before each use to mix the medication evenly. Use the measuring cup provided to measure each dose of the suspension, and use the dosing device provided to measure each dose of the drops. The chewable tablets may cause a burning feeling in the mouth or throat. Take the chewable tablets with food or water. Stop taking nonprescription ibuprofen and call your doctor if your symptoms get worse, you develop new or unexpected symptoms, the part of your body that was painful becomes red or swollen, your pain lasts for more than 10 days, or your fever lasts more than 3 days. Stop giving nonprescription ibuprofen to your child and call your child's doctor if your child does not start to feel better during the first 24 hours of treatment. Also stop giving nonprescription ibuprofen to your child and call your child's doctor if your child develops new symptoms, including redness or swelling on the painful part of his body, or if your child's pain or fever get worse or lasts longer than 3 days. Do not give nonprescription ibuprofen to a child who has a sore throat that is severe or does not go away, or that comes along with fever, headache, nausea, or vomiting. Call the child's doctor right away, because these symptoms may be signs of a more serious condition.
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Oleander poisoning Rosebay poisoning Yellow oleander poisoning Thevetia peruviana poisoning Summary Oleander poisoning occurs when someone eats the flowers or chews the leaves or stems of the oleander plant (<em>Nerium oleander</em>), or its relative, the yellow oleander (<em>Cascabela thevetia</em>). This article is for information only. DO NOT use it to treat or manage an actual poison exposure. If you or someone you are with has an exposure, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. Poisonous Ingredient Poisonous ingredients include: Digitoxigenin Neriin Oleandrin Oleondroside <strong>Note:</strong> This list may not include all poisonous ingredients. Where Found The poisonous substances are found in all parts of the oleander plant: Flowers Leaves Stems Twigs Symptoms Oleander poisoning can affect many parts of the body. HEART AND BLOOD Irregular or slow heartbeat Low blood pressure Weakness EYES, EARS, NOSE, MOUTH, AND THROAT Blurred vision Vision disturbances, including halos STOMACH AND INTESTINES Diarrhea Loss of appetite Nausea and vomiting Stomach pain NERVOUS SYSTEM Confusion Death Depression Disorientation Dizziness Drowsiness Fainting Headache Lethargy SKIN Hives Rash <strong>Note:</strong> Depression, loss of appetite, and halos are most often seen in chronic overdose cases. Home Care Seek immediate medical help. DO NOT make a person throw up unless told to do so by poison control or a health care provider. Before Calling Emergency Get the following information: Person's age, weight, and condition Name and part of the plant swallowed, if known Time it was swallowed Amount swallowed Poison Control Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This hotline number will let you talk to experts in poisoning. They will give you further instructions. This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does not need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week. What to Expect at the Emergency Room The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive: Activated charcoal Blood and urine tests Breathing support Chest x-ray ECG (electrocardiogram, or heart tracing) Fluids through a vein (IV) Medicines to treat symptoms including an antidote to reverse the effects of the poison Tube through the mouth into the stomach to wash out the stomach (gastric lavage) Outlook (Prognosis) How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery. Symptoms last for 1 to 3 days and may require a hospital stay. Death is unlikely. DO NOT touch or eat any plant with which you are not familiar. Wash your hands after working in the garden or walking in the woods. Review Date 10/16/2017 Updated by: Jesse Borke, MD, FACEP, FAAEM, Attending Physician at FDR Medical Services/Millard Fillmore Suburban Hospital, Buffalo, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Headache (Causes): The most common type of headache is tension headache. It is likely caused by tight muscles in your shoulders, neck, scalp, and jaw. A tension headache: - May be related to stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal position. - Tends to be on both sides of your head. It often starts at the back of the head and spreads forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight or sore. A migraine headache involves severe pain. It usually occurs with other symptoms, such as vision changes, sensitivity to sound or light, or nausea. With a migraine: - The pain may be throbbing, pounding, or pulsating. It tends to begin on one side of your head. It may spread to both sides. - The headache may be associated with an aura. This is a group of warning symptoms that start before your headache. The pain usually gets worse as you try to move around. - Migraines may be triggered by foods, such as chocolate, certain cheeses, or monosodium glutamate (MSG). Caffeine withdrawal, lack of sleep, and alcohol may also be triggers. Rebound headaches are headaches that keep coming back. They often occur from overuse of pain medicines. For this reason, these headaches are also called medicine overuse headaches. People who take pain medicine more than 3 days a week on a regular basis can develop this type of headache. Other types of headaches: - Cluster headache is a sharp, very painful headache that occurs daily, sometimes up to several times a day for months. It then goes away for weeks to months. In some people, the headaches never come back. The headache usually lasts less than an hour. It tends to occur at the same times every day. - Sinus headache causes pain in the front of the head and face. It is due to swelling in the sinus passages behind the cheeks, nose, and eyes. The pain is worse when you bend forward and when you first wake up in the morning. - Headaches may occur if you have a cold, the flu, a fever, or premenstrual syndrome. - Headache due to a disorder called temporal arteritis. This is a swollen, inflamed artery that supplies blood to part of the head, temple, and neck area. In rare cases, a headache can be a sign of something more serious, such as: - Bleeding in the area between the brain and the thin tissue that covers the brain (subarachnoid hemorrhage) - Blood pressure that is very high - Brain infection, such as meningitis or encephalitis, or abscess - Brain tumor - Buildup of fluid inside the skull that leads to brain swelling (hydrocephalus) - Buildup of pressure inside the skull that appears to be, but is not a tumor (pseudotumor cerebri) - Carbon monoxide poisoning - Lack of oxygen during sleep (sleep apnea) - Problems with the blood vessels and bleeding in the brain, such as arteriovenous malformation (AVM), brain aneurysm, or stroke
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Introduction: While the COVID-19 pandemic has affected many aspects of clinical care, research, and medical training, its impact on hematology-oncology trainees and professional development has not been described. The American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO) sought to assess the impact of COVID-19 on fellows enrolled in hematology-oncology programs. Methods: In spring 2020, ASH and ASCO developed and administered a survey by e-mail to active hematology-oncology fellow members. Response formats used both a semi-Likert scale and open-ended text. Questions focused on fellow experiences and how changes in their programs have impacted their personal and professional lives across several domains. Multiple-choice responses were analyzed using descriptive statistics, and NVivo software was used for qualitative analysis of open-ended questions. Results: Respondent demographics are described in Table 1. Of 2,306 trainees, 620 (27%) responded to the survey. Most respondents continued patient care responsibilities during the pandemic (80%). Almost half of all trainees (47%) reported that they felt less productive than usual. Stress and/or anxiety about the current situation was the most cited factor affecting productivity in the overall cohort (Figure 1). One-third (33%) of respondents had volunteered or were assigned to clinical/non-clinical COVID-19-related efforts. Of the 90 visa holders in our cohort, 30% (N=27) reported experiencing issues with their visa/immigration status. Eight percent of respondents stated their career plans had changed due to COVID-19. Of those who said their plans had changed, 30 respondents were considering careers in academia pre-pandemic and 11 were considering private practice. However, only 14 respondents were considering academia post-pandemic while 19 were interested in private practice. Overall, most respondents had concerns about at least one of the following: salary reductions, availability of networking events, family well-being, mental health and obtaining a job (Figure 2). The prevalence of burnout increased from 22% (N=105) before the pandemic to 33% (N=161) during (p<.001). Of the respondents who did not report burnout before COVID-19, 22% noted new-onset burnout during the pandemic. New-onset burnout prevalence varied based on the type of work respondents performed: no COVID-related work (17%), COVID-related non-clinical work (26%), and COVID-related clinical work (34%) (p<0.01). The open-ended responses yielded several consistent themes. Clinical and educational constraints were enumerated: lost learning opportunities due to low patient volumes, unavailability of colleagues to discuss cases, and overall low perceived quality of virtual learning. Trainees also reported reduced motivation to complete work within a stipulated time frame due to lack of robust discussions in the virtual environment and technological challenges in navigating educational resources. Trainee research was also severely impacted as laboratories closed, experimental animal colonies were lost, and many research activities ceased. Respondents also expressed concern that cuts in research training initiatives and budgets would jeopardize faculty positions for graduating fellows and that funding for travel and conferences was suspended. Fellows' recommendations for ASH and ASCO included improved online education, virtual research training and networking opportunities, practical guidance on caring for immune-compromised patients during the pandemic, increased funding resources for trainees, mental health resources, and advocating on behalf of trainee visa holders. Conclusions: Hematology-oncology trainees reported their training experiences have been deeply impacted by the COVID-19 pandemic. A majority of trainees are concerned about the negative impact on career opportunities, research funding, financial well-being, and mental health. Burnout increased during COVID-19, especially in trainees who were assigned to specific COVID-related efforts. Training programs and professional societies can support trainees by increasing trainee research funding, online networking and learning opportunities, mental health resources and, support for international trainees. Disclosures Velazquez Manana: Corbus Pharmaceuticals: Other: Immediate family member stock ownership; Portola Pharmaceuticals: Other: Immediate family member stock ownership; Midatech: Other: Immediate family member stock ownership. Wun: Glycomimetics, Inc.: Consultancy.
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The coronavirus pandemic has changed the way individuals work and live, with an ever increasing reliance on technology to carry out daily life. Like schools and business, physicians and physician offices around the country not tasked with treating patients suffering from COVID-19 shuttered their doors and turned to technology, through telehealth, to render necessary healthcare services. Telehealth services, generally defined as being able to diagnose and/or treat a patient via technology as opposed to in-person, have been around for some time, but there have been significant barriers that have hindered widespread growth. Despite this, telehealth advocates have been doggedly and slowly pushing for expansion and trying to break through the known obstacles for decades in an effort to hopefully achieve the touted gains from telehealth, such as enhanced health care services to rural and medically underserved populations, more integrated care across platforms to coordinated providers all treating the same episode of care, and greater convenience and efficiency for the patients and providers for some of the more basics health care needs. Now, the global pandemic has pushed telehealth services into the mainstream and, like a set of dominoes, various federal and state restrictions and limitations that have been built up over the years around telehealth were suddenly waived in order to allow patients to continue to seek necessary medical care. Unlike before, however, patients now found themselves able to access such services from their homes or other places of residence. While some of the restrictions previously in place are likely to return, many are speculating that the pandemic has finally been telehealth’s “tipping point” and could usher in more robust and widespread use of telehealth even after the pandemic has passed or at least waned. As telehealth services have become more widely available and proven to be useful, it now seems unlikely there will be a return to the previous status quo for the industry, but this still leaves the industry, regulators, and enforcers to contemplate what the telehealth industry should look like in a post-pandemic environment. This is a unique time to be able to observe the use of telehealth in an unfettered state and, through that lens, provide legislators and policymakers with valuable data to reconsider the delivery of telehealth and its regulatory structure with the goal of enacting practical and workable regulations that advance efficient and effective health care delivery. To this end, Part I of this Article will examine the history of telehealth, from its early origins, and define what telehealth means today in all of its various forms. Part I will further explain the restrictions and regulatory structure, both federal and state, that applied to telehealth prior to the coronavirus pandemic and the then-current enforcement trends. Next, Part II will describe all of the various waivers and regulatory changes that went into effect in response to the coronavirus pandemic and examine how the pandemic has fueled increased telehealth growth. Part II will also analyze trends realized during the pandemic and other usage data to consider the impact and effect of the waivers and loosening of restrictions on telehealth services. This Article will then argue in Part III that legislators and regulators should avoid either a return to status quo or a permanent adoption of all of the waivers in effect and should instead utilize data and evidence gathered during this time period when restrictions were largely lifted to understand the true concerns raised by telehealth usage and consider a revised regime that focuses its attention and efforts on those aspects of the regulatory structure that are most detrimental to the health and safety of patients and consumers. It will further provide some general recommendations for reconsidering the telehealth regulatory regime once the public health emergency has subsided in order to promote the use of telehealth in a way that enhances and enriches the benefits of telehealth, without harming patients and consumers. Finally, Part IV will conclude with some final thoughts regarding the importance of reimaging the telehealth infrastructure for a sustained and successful future.
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Schizophrenia Psychosis - schizophrenia Psychotic disorders - schizophrenia Summary Schizophrenia is a mental disorder that makes it hard to tell the difference between what is real and not real. It also makes it hard to think clearly, have normal emotional responses, and act normally in social situations. Causes Schizophrenia is a complex illness. Mental health experts are not sure what causes it. Genes may play a role. Schizophrenia occurs in just as many men as women. It usually begins in the teen or young adult years, but it may begin later in life. In women, it tends to begin later and is a milder condition. Schizophrenia in children usually begins after age 5. Childhood schizophrenia is rare and can be hard to tell apart from other developmental problems, such as autism spectrum disorder. Symptoms Symptoms usually develop slowly over months or years. The person may have many symptoms, or only a few. People with schizophrenia may have trouble keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors. Early symptoms may include: Irritable or tense feelings Trouble concentrating Trouble sleeping As the illness continues, the person may have problems with thinking, emotions, and behavior, including: Hearing or seeing things that are not there (hallucinations) Isolation Reduced emotions in tone of voice or expression of face Problems with understanding and making decisions Problems paying attention and following through with activities Strongly held beliefs that are not real (delusions) Talking in a way that does not make sense Thoughts that "jump" between different topics (loose associations) Exams and Tests There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the person and make the diagnosis. The diagnosis is made based on an interview of the person and family members. The psychiatrist will ask about the following: How long symptoms have lasted How the person's ability to function has changed What the person's developmental background was like About the person's genetic and family history How well medicines have worked Whether the person has problems with substance abuse Other medical conditions the person has Brain scans (such as CT or MRI) and blood tests may help rule out other conditions that have similar symptoms. Treatment During an episode of schizophrenia, the person may need to stay in the hospital for safety reasons. MEDICINES Antipsychotic drugs are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms. These drugs can cause side effects, but many side effects can be managed. Side effects should not prevent the person from getting treated for this serious condition. Common side effects from antipsychotics may include: Dizziness Feelings of restlessness or jitteriness Sleepiness (sedation) Slowed movements Tremor Weight gain Long-term use of antipsychotics may increase the risk of a movement disorder called tardive dyskinesia. This condition causes repeated movements that the person cannot control. Call the health care provider right away if you think you or your family member may have this condition due to the medicine. When schizophrenia does not improve with antipsychotics, other medicines may be tried. Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotics for life. SUPPORT PROGRAMS AND THERAPIES Support therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can help the person function better in social and work situations. Job training and relationship-building classes are also important. Family members and caregivers are very important during treatment. Therapy can teach important skills, such as: Coping with symptoms that continue, even while taking medicines Following a healthy lifestyle, including getting enough sleep and staying away from recreational drugs Taking medicines correctly and managing side effects Watching for the return of symptoms, and knowing what to do when they return Getting the right support services Outlook (Prognosis) Outlook is hard to predict. Most of the time, symptoms improve with medicines. But many people may have trouble functioning. They are at risk of repeated episodes, especially during the early stages of the illness. People with schizophrenia may need housing, job training, and other community support programs. Those with the most severe forms of this disorder may not be able to live alone. They may need to live in group homes or other long-term, structured residences. Symptoms are very likely to return when medicine is stopped. Possible Complications Having schizophrenia increases the risk of: Developing a problem with alcohol or drugs. Using these substances increases the chances that symptoms will return. Physical illness. This is due to an inactive lifestyle and side effects of medicines. Suicide. When to Contact a Medical Professional Call your provider if you (or a family member): Hear voices telling you to hurt yourself or others Have the urge to hurt yourself or others Feel scared or overwhelmed See things that are not really there Feel that you cannot leave the house Feel that you are not able to care for yourself Prevention Schizophrenia cannot be prevented. Symptoms may be prevented by taking medicine exactly as the doctor instructed. Symptoms are likely to return if medicine is stopped. Changing or stopping medicines should only be done by the doctor who prescribed them. Review Date 8/14/2017 Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Internal review and update on 11/06/2018 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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BACKGROUND: A state of emergency was declared in the United States (US) on March 13, 2020 in response to the SARS-CoV-2 pandemic. Healthcare providers had to alter practice patterns and research priorities. We assessed the frequency of acute respiratory illnesses (ARI) in children, notably those due to respiratory syncytial virus (RSV) and influenza, before and during the pandemic. METHODS: We conducted multi-center active prospective ARI surveillance in children as part of the New Vaccine Surveillance Network. Children < 18 years with fever and/or respiratory symptoms were enrolled in emergency department and inpatient settings at seven US medical centers over four respiratory seasons during 2016–2020 (Fig 1). Pandemic-related restrictions to patient access limited enrollment in some sites beginning March 2020. Respiratory specimens were collected and tested at each site for RSV and influenza by qRT-PCR. Data were analyzed by calendar weeks. We compared the cumulative proportions of RSV and influenza detection after week 13 in 2020 to the previous seasons using Fisher’s exact test. Figure 1. Numbers of Eligible and Enrolled Acute Respiratory Illness Cases, and Proportions of RSV and Influenza Detection by Week, Stratified by Study Season [Image: see text] RESULTS: Of 44,247 eligible children, 25,375 (57%) were enrolled and tested for RSV and/or influenza. A total of 6351/25375 (25%) and 3446/25372 (14%) children were RSV and influenza-positive over the four seasons, respectively. In 2020, we noted a rapid drop in eligible and enrolled ARI subjects after weeks 11–13 (Fig 1). During weeks 13–18 in 2016–2019, the three-year average of eligible and enrolled subjects was 1802 and 978, respectively. However, over the same period in 2020, there were 675 eligible and 278 enrolled subjects, representing declines of 62.5% and 71.6% respectively (Fig 1). In 2020, there were no RSV or influenza cases detected in weeks 15–18, and the cumulative proportions of RSV and influenza detection after week 13 were lower compared to previous seasons (p< 0.001) (Figs 1 and 2). Figure 2. Cumulative Proportions of Weekly RSV and Influenza Detection by Study Season [Image: see text] CONCLUSION: There was a considerable decline in ARI visits and the proportion of RSV and influenza detection across seven distinct geographic sites during the pandemic compared with previous seasons. These findings might be attributable to social distancing measures to lessen the spread of SARS-CoV-2, changes in healthcare-seeking behaviors, and limited access to medical care. DISCLOSURES: Zaid Haddadin, MD, CDC (Grant/Research Support, Research Grant or Support)Quidel Corporation (Grant/Research Support, Research Grant or Support)sanofi pasteur (Grant/Research Support, Research Grant or Support) John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member)IDConnect (Advisor or Review Panel member)Quidel (Advisor or Review Panel member) Christopher J. Harrison, MD, GSK (Grant/Research Support, Infant menigiciccal B conjugate vaccine trial)Merck (Research Grant or Support, Infant pneumococcal conjugate vaccine trial) Janet A. Englund, MD, AstraZeneca (Scientific Research Study Investigator)GSK group of companies (Scientific Research Study Investigator)Meissa vaccines (Consultant)Merck (Scientific Research Study Investigator)Sanofi Pasteur (Consultant) Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Karius (Consultant)Moderna (Consultant)Quidel (Grant/Research Support, Research Grant or Support)Sanofi (Grant/Research Support, Research Grant or Support)
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Hello doctor,I am 30 years old male. Weight is 107 kg, and height is 5\\9. Not under any medications. (Not been on any medication for over a year previous medications include numerous mental health medications, various SSRIs, Clomipramine, and several anti-psychotics, most recently Olanzapine). I tried Lymecycline a couple of years ago and multiple creams for acne in the past.I have a history of mental health problems. I have a diagnosis of Asperger syndrome, OCD, anxiety, and depression. My anxiety levels have been chronic for many years due to the severity of my obsessive thoughts and compulsions etc. I think that my poor mental state has impacted on my health. I have had severe skin problems since I was about 17 or so. I get huge cysts that often recur in the same place with large boils. I have some large permanent cysts. I seem to break out at certain times.I also have a condition known as a functional neurological disorder. I will be seeing a neurologist here in the at a movement disorders clinic to deal with this in the near future. I also developed eyelash ptosis, where my eyelash in my right eye keeps growing long. My Ophthalmologist told me that it needs to be trimmed regularly with scissors or that I have to use curlers, as it can impair my visual field. The neurological or psychological aspects may be affecting my other conditions.I have had athlete\\s foot for the past year. Due to my mental or neurological problems and depression, I have been housebound for most of the last year. I tend not to shower much or brush my teeth due to this (but I am trying to change my life with the help and change this). I walk around in my bare feet in the house most of the time, and when I do go out, I tend to wear crocs.The athlete\\s foot has become more itchy or burning recently. Also, for the past year or two, I have two fungal nails. My big toes on both feet are very yellow looking at the front of the pins (I have ingrown nails in the past). What I am concerned about is my fingernail.I do not know how I did this? About two weeks ago, I noticed that my middle finger on my right hand was very painful when I touched it. I cannot remember if I pulled the nail, and this has caused some infection, or if it is related in some way to the fungal nail infections on my toes or my athlete\\s foot.I will show you some pictures, and I would like your advice on what to do next. Due to my mental state, I have not taken good care of my body, but I am trying to address this.My athlete\\s foot is entirely wrong. If I start treating this with cream, I am likely to see an improvement. Also, what can I do about the fungal nails? I also have a pilonidal cyst on my tailbone. It was initially very painful to sit down (I am overweight, spend a lot of time sitting at my desk, etc.). This cyst is intermittent, but there are times when it can be very itchy. As you can see, I am not in the best shape, but I am trying to address both my mental health and my physical health by starting to take better care of myself, eat better, exercise, etc.The main concern is the fingernail. Do I have an infection? Can it be serious to blood flow/losing limbs, or is this my anxiety and the things I\\ve read on Google. I am quite concerned. I cannot see a doctor for another week or two. I have had this fingernail problem for about two weeks, and it is very sore and very red.
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in Data Studio
Medium 512-1K Tokens Prompts Dataset
Created by Aipresso LIMITED, London, UK
⚠️ By using this dataset you agree to our Terms of Use.
Overview
703 high-quality English prompts whose length lies between 512 and 1 000 tokens.
Every prompt has been de-duplicated, cleaned and token-counted with the GPT-2 tokenizer.
Statistics
| Rows | Token range | File size | Format |
|---|---|---|---|
| 703 | 512 – 1 000 | 2.9 MB | CSV |
Use-cases
- Medium-context language-model fine-tuning
- Research on optimal context-length trade-offs
- Enterprise systems that need more than “short” prompts but less than full documents
File layout
data/ └── medium_512_1k_tokens_prompts.csv Copy
Columns
Prompt(str): the cleaned prompt textToken_count(int64): exact GPT-2 token count (512-1 000)
Quick start
from datasets import load_dataset
ds = load_dataset("Aipresso/medium_512_1k_tokens_prompts", split="train")
print(ds[0])
Citation
bibtex
Copy
@dataset{aipresso_medium_prompts_2024,
title={Medium 512-1K Tokens Prompts Dataset},
author={Aipresso LIMITED},
year={2024},
publisher={Hugging Face},
url={https://huggingface.co/datasets/Aipresso/medium_512_1k_tokens_prompts}
}
Related datasets
MEGA Cleaned Prompts – 2.7 M rows
10K Cleaned Prompts – mixed lengths
<512 Tokens – short prompts
>1K Tokens – long prompts
Maintained by Aipresso LIMITED, London, UK.
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