Best Doctors Experts Dr. Martin Samuels, Dr. Harris McIlwain and Dr. Michael Morse discuss their own mistakes in diagnosing patients presenting with fatigue. The panel will discuss pitfalls when diagnosing symptoms of fatigue and offer tips for identifying conditions related to fatigue such as:
Symptoms of hypercalcemia:
- polyuria, polydipsia, anorexia, nausea, constipation, include weakness, confusion, coma
Causes of hypercalcemia:
- primary hyperparathyroidism and malignancy (bone metastases, humeral hypercalcemia of malignancy, myeloma) are the most common;
- others: thyrotoxicosis, hypervitaminosis D, Milk alkali syndrome, adrenal insufficiency, thiazides, immobilization, sarcoidosis
Chronic Fatigue:
- Chronic fatigue – over 6 months
- 60% or more medical or psychiatric
- Psychiatric illness—major depression, anxiety/panic disorder, somatization disorder
- 5% Clarified by lab studies
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Is Urinary Incontinence Dampening Your Days?Summit Health
This presentation will address the causes and types of urinary incontinence and explain how it is evaluated and can be treated. Learn about effective new approaches to help manage and resolve urinary incontinence in women of all ages!
As the rates of obesity increase, so do the medical problems caused and exacerbated by this physical state. For many, traditional methods of weight loss have proven ineffective for achieving and maintaining significant weight reduction. Bariatric surgery (ie, laparoscopic gastric banding, gastric bypass) offers these patients the opportunity to experience significant weight loss that can be maintained. The number of obese patients seeking bariatric surgery is steadily rising. But, unlike traditional diets for which risks are low and discontinuation can occur at any time, bariatric surgery has inherent risks and requires highly restrictive, long-term behavioral changes afterwards. Therefore, these patients typically are required to complete a thorough evaluation, including psychological assessment, to determine their appropriateness for surgery.
Kidney transplantation, if not contraindicated, is the most preferred renal replacement therapy for patients with end stage renal disease. Generally, live related transplantation is associated with longer term survival of the transplantated kidney as well as the patient. However, it is associated with great physical and psychological challenges for the donor. Therefore, an exhaustive physical workup as well comprehensive psychological counselling go a long way for a happy donor as well as recipient. Laparoscopic donor surgery has helped reduce surgical morbidity and improve acceptance. Moreover, to avoid medicolegal issues, exhaustive documentation is necessary.
AUB in ADOLESCENTS Dr. Jyoti Bhaskar Dr. Sharda Jain Dr. Jyoti AgarwalLifecare Centre
PREVALENCE
A population based study of 1000 adolescents:
Incidence of AUB is 40%
Out of those who have AUB
20% have bleeding disorders
Von Willebrand disease, 5%-36%;
Platelet function defects, 2%-44%;
Thrombocytopenia, 13%- 20%
Clotting factor deficiencies, 8%-9%.
Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.
Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.
Overactive bladder, DR Sharda Jain Lifecare Centre Lifecare Centre
OAB OAB is not synonymous with detrusor overactivity as the former is a symptom based diagnosis whilst the latter is an urodynamic diagnosis.
It has been estimated that 64% of patients with OAB have urodynamically proven detrusor overactivity and that 83% of patient with detrusor overactivity have symptoms suggestive of OAB.
Is Urinary Incontinence Dampening Your Days?Summit Health
This presentation will address the causes and types of urinary incontinence and explain how it is evaluated and can be treated. Learn about effective new approaches to help manage and resolve urinary incontinence in women of all ages!
As the rates of obesity increase, so do the medical problems caused and exacerbated by this physical state. For many, traditional methods of weight loss have proven ineffective for achieving and maintaining significant weight reduction. Bariatric surgery (ie, laparoscopic gastric banding, gastric bypass) offers these patients the opportunity to experience significant weight loss that can be maintained. The number of obese patients seeking bariatric surgery is steadily rising. But, unlike traditional diets for which risks are low and discontinuation can occur at any time, bariatric surgery has inherent risks and requires highly restrictive, long-term behavioral changes afterwards. Therefore, these patients typically are required to complete a thorough evaluation, including psychological assessment, to determine their appropriateness for surgery.
Kidney transplantation, if not contraindicated, is the most preferred renal replacement therapy for patients with end stage renal disease. Generally, live related transplantation is associated with longer term survival of the transplantated kidney as well as the patient. However, it is associated with great physical and psychological challenges for the donor. Therefore, an exhaustive physical workup as well comprehensive psychological counselling go a long way for a happy donor as well as recipient. Laparoscopic donor surgery has helped reduce surgical morbidity and improve acceptance. Moreover, to avoid medicolegal issues, exhaustive documentation is necessary.
AUB in ADOLESCENTS Dr. Jyoti Bhaskar Dr. Sharda Jain Dr. Jyoti AgarwalLifecare Centre
PREVALENCE
A population based study of 1000 adolescents:
Incidence of AUB is 40%
Out of those who have AUB
20% have bleeding disorders
Von Willebrand disease, 5%-36%;
Platelet function defects, 2%-44%;
Thrombocytopenia, 13%- 20%
Clotting factor deficiencies, 8%-9%.
Urinary incontinence is loss of bladder control. Symptoms can range from mild leaking to uncontrollable wetting. It can happen to anyone, but it becomes more common with age.
Most bladder control problems happen when muscles are too weak or too active. If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is stress incontinence. If bladder muscles become too active, you may feel a strong urge to go to the bathroom when you have little urine in your bladder. This is urge incontinence or overactive bladder. There are other causes of incontinence, such as prostate problems and nerve damage.
SHARE Ovarian Cancer RoundTable: Coping with Side Effects bkling
During SHARE's roundtable discussion for women with ovarian cancer, oncology nurse Heather Augustyniak provided tips that can help patients manage the side effects of treatment.
Basic introduction to Health screening in Malaysia.
Health screening refers to the process of testing or examining people who do not have symptoms of a particular disease or condition to identify if they are at risk of developing it. This type of screening can help detect diseases or conditions at an early stage, before symptoms develop, allowing for earlier treatment and a better chance of a positive outcome. Health screening can also identify risk factors that individuals may have for developing certain diseases, which can help guide preventive measures and lifestyle modifications to reduce the risk of developing the disease.
Health screening can take many different forms, depending on the disease or condition being screened for and the population being targeted.
Some common types of health screenings include:
Cancer screenings: Screening tests for cancer can help detect tumors or other abnormalities in the body before symptoms develop. Examples of cancer screenings include mammograms for breast cancer, colonoscopies for colon cancer, and Pap tests for cervical cancer.
Cardiovascular disease screenings: These screenings help identify risk factors for heart disease and stroke, such as high blood pressure, high cholesterol, and diabetes. Tests might include blood pressure checks, cholesterol tests, and glucose tests.
Infectious disease screenings: Testing for infectious diseases like HIV, hepatitis, and sexually transmitted infections can help identify people who are infected and in need of treatment, as well as prevent the spread of these diseases to others.
Genetic screenings: Some health screenings are designed to identify genetic mutations that increase the risk of certain conditions, such as breast cancer or cystic fibrosis.
The benefits of health screening can be significant, as detecting diseases or risk factors early can lead to better outcomes and quality of life for individuals. However, health screening also has some potential downsides, including the possibility of false-positive or false-negative results, anxiety or distress related to the screening process, and overdiagnosis and overtreatment of conditions that may never have caused harm. To maximize the benefits of health screening while minimizing the potential risks, it is important to carefully consider which screening tests are appropriate for each individual based on their age, sex, medical history, and other risk factors. Health screening should also be part of a broader approach to preventive care that includes healthy lifestyle choices, regular check-ups with a healthcare provider, and appropriate immunizations.
In conclusion, health screening is an important tool for identifying diseases and risk factors early, but it is important to approach it with caution and careful consideration of individual needs and risk factors. With proper use, health screening can be an effective tool for promoting health and preventing disease.
There are a lot of misconceptions out there when it comes to PCOS. People often make assumptions and it can be hard to work out fact from fiction. Here are some important points that every Doctor should be aware of.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. ACCME Information
Our Errors in Diagnosing Fatigue
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3. Disclosure Information
Our Errors in Diagnosing Fatigue
The panelists on today’s webinar have the following financial relationships to disclose:
• Dr. Harris McIlwain has the following relationships to disclose:
– Speakers’ Bureau: Takada, Warner Chilcott
• Dr. Michael Morse has the following relationships to disclose:
– Grant/Research Support: BMS, Novartis, Precision Biologics
– Speakers’ Bureau: Genentech, Novartis, Onyx, Bayer, Amgen, Prometheus
– Advisory Committee: Genentech, Amgen, Sanofi
• Dr. Martin A. Samuels has no relevant financial relationships to disclose
• None of the Best Doctors staff who assisted in preparing the content of this webinar
have relevant financial relationships to disclose
• No reference will be made to off label use and/or investigational use of
pharmaceuticals/devices in this webinar
4. Harris McIlwain, MD
Internal Medicine, Rheumatology, Geriatric Medicine
McIlwain Medical Group
Michael Morse
Department of Medicine, Medical Oncology Division
Specializing in Gastrointestinal Oncology
Duke University School of Medicine
Martin Samuels, MD, MSc, FAAN, MACP, FRCP
Chairman, Department of Neurology, Brigham and Women’s Hospital
Professor of Neurology, Harvard Medical School
Moderator and Panel
5. Tonight 3 things you need to know
• Best Doctors provides medical consultations/second opinions
through a unique and collaborative analytical process
• If you are an elected Best Doctor you are invited to consult on
cases (and earn an honorarium)
• Free pilot program – physicians may initiate collaborations on
their complex cases
6. Harris McIlwain, MD
Internal Medicine, Rheumatology, Geriatric Medicine
McIlwain Medical Group
Michael Morse
Department of Medicine, Medical Oncology Division
Specializing in Gastrointestinal Oncology
Duke University School of Medicine
Martin Samuels, MD, MSc, FAAN, MACP, FRCP
Chairman, Department of Neurology, Brigham and Women’s Hospital
Professor of Neurology, Harvard Medical School
Moderator and Panel
7. Dr. Martin Samuels
Fatigue
• 79 y/o woman with 5 months of progressive fatigue.
• Difficulty climbing stairs and rising from chair 5
months ago.
• Difficulty combing her hair and began using walker 1
month ago.
• Problem progressed to point where walking was very
difficult; admitted to the hospital
8. History
• hypertension, hyperlipidemia, stroke in 1995 without residual
symptoms, stable angina and diastolic dysfunction, osteoarthritis
s/p R shoulder and hip arthroplasty.
• During current illness noted bilateral leg swelling, worsened chronic
hip pain, 20lb weight gain, and easy bruising; newly diagnosed with
diabetes shortly after admission to hospital.
• No fevers, night sweats, shortness of breath, chest
pain, rash, alopecia, constipation/diarrhea, cold/heat
intolerance, numbness, incontinence, dysphagia, diplopia, or
dysarthria.
• Medications:
furosemide, KCl, lisinopril, atenolol, imdur, norvasc, celexa, insulin.
• SH: No smoking, drugs, or alcohol.
• FH: Father died of MI at age 53.
9. Physical Exam
• Vital signs: normal
• General: obese, facial edema, 2+ pitting edema in distal arms and
legs, multiple ecchymoses on arms
• MS: poor attention and delayed recall.
• CN: no bulbar weakness.
• Motor: normal tone; decreased deltoid bulk bilaterally. Moderate
proximal weakness upper and lower extremities; full distal power.
No fasciculations. Decreased direct muscle excitability
• Reflexes: slightly diminished and slow in upper extremities, normal
at knees, absent at ankles, no Babinski signs
• Sensation: decreased pinprick in feet.
• Coordination: normal in upper extremities.
• Gait: needs assistance to stand and can only take a few steps.
14. More History
On re-examination, found that patient had
started waxing her upper lip several months
ago for the first time. She had a plethoric
and swollen face. Her IV sites refused to
heal.
15. More Testing
• 8AM cortisol = 71 (nl 8-25)
• dexamethasone suppression test (1mg dex at
11PM) subsequent 8am cortisol 71
• 24 hr urine free cortisol 1459 (nl range 4-50)
16. More Test Results…
• ACTH 120 (nl 5-27)
• MRI Brain: slightly delayed enhancement in
two small areas of pituitary gland
17. Cushing Disease Take-aways
Basophilic adenoma of the pituitary
Treatment is transphenoidal hypophysectomy
Can imitate hypothyroidism
Diabetes and poor wound healing
are clues to the correct diagnosis
18. Dr. Michael Morse
Fatigue due to iron deficiency anemia
due to an undiagnosed colon cancer
• 46 yo woman complained of 6 mo of “tiredness” by the end of
her workday;
• mild dyspnea climbing stairs she attributed to obesity
• Reported history of restless legs
• Exam was unremarkable; Chewing ice chips.
• Labs: normal TSH, Hgb 11.8 MCV 78
• Initially thought to have fatigue from her obesity and anemia
from menses
• 6 months later diagnosed with colon cancer of the cecum
when she became more anemia and GI work-up performed.
19. Take away points:
• Colon cancer symptoms: crampy abdominal pain, change in
stool habits, blood in stool are not always present with early
tumors or cecal tumors.
• Iron deficiency anemia can be a presenting sign of colon
cancer
• Signs of iron deficiency include fatigue, pica (especially
pagophasia = the pathologic consumption of ice), and
secondary restless leg syndrome
20. Worsening Fatigue in a patient with chronic
hepatitis C/cirrhosis due to an undiagnosed (due
to lack of screening) hepatocellular carcinoma
• 67 yo man with hypertension, diabetes mellitus, CAD, and
cirrhosis with a prior diagnosis of Hepatitis C when he was
noted to have elevated LFTs on a physical exam
• Had tried interferon but was noncompliant
• Presented with worsening fatigue, increased abdominal
distension, peripheral edema
• Labs: anemia, elevated transaminases and bilirubin
• Initially observed
• Diagnosed with HCC on CT scan after presenting 3 months
later with worsening abdominal pain.
21. Take away points
• Fatigue is present in 50-100% of hepatitis C infected
individuals
• AASLD recommends screening for HCC in: Cirrhosis (any
etiology) or HBV+: older, family history, cirrhosis; Surveillance
for HCC should be performed with ultrasonography (level II);
Screening should occur every 6-12 months
22. Fatigue due to hypercalcemia in a patient with a
gastric cancer with bone metastases and
humoral hypercalcemia of malignancy.
• 68 yo woman originally from China; in generally good health
but was brought to clinic by her son for
lethargy, tiredness, and back pain after working in her garden
all day.
• Labs: TSH normal; Hgb 11.0; normal LFTs
• No initial diagnosis made
• Diagnosed with hypercalcemia and eventually to gastric
cancer when she returned with confusion.
23. Take away points:
• Symptoms of hypercalcemia:
– polyuria, polydipsia, anorexia, nausea, constipation, includ
e weakness, confusion, coma
• Causes of hypercalcemia:
– primary hyperparathyroidism and malignancy (bone
metastases, humeral hypercalcemia of
malignancy, myeloma) are the most common;
– others: thyrotoxicosis, hypervitaminosis D, Milk alkali
syndrome, adrenal
insufficiency, thiazides, immobilization, sarcoidosis
24. Dr. Harris McIlwain
Fatigue and Pain
• 42 year old female
• 1 year history of fatigue, exhaustion, difficult
to keep up with children as a teacher
• Extreme fatigue, difficulty
concentration, decreased short term memory
25. • Pain and stiffness in feet, then legs and whole
body over past year
• Muscle weakness arms and legs, muscle
fatigue with use
• Pain in shoulders, hips, neck, back
26.
27. • No inflammation in joints on exam
• Tender trigger points present
• Multiple negative lab studies, consultants
28. • Negative nerve conduction
studies, electromyography
• No improvement with
corticosteroids, antidepressants, IVIG
29. Fatigue History
• Felt as generalized weakness (hard to get
started)
• Felt as easy fatigability (difficulty with
endurance)
• Felt as mental fatigue (lower concentration
and short term memory)
30. • Chronic fatigue – over 6 months
• 60% or more medical or psychiatric
• Psychiatric illness—major depression,
anxiety/panic disorder, somatization
disorder
• 5% Clarified by lab studies
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