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Internal Medicine - Science topic

Explore the latest questions and answers in Internal Medicine, and find Internal Medicine experts.
Questions related to Internal Medicine
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There are news on COVID-19 outbreak on ship, no matter cruise or military one.
And few aircraft carriers are also involved.
What is special about the ship arrangement that facilitated all these?
Nature 580, 18 (2020)
Limiting spread of COVID-19 from cruise ships - lessons to be learnt from Japan,
QJM: An International Journal of Medicine, , hcaa092,
COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures,
Journal of Travel Medicine, , taaa030,
Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3
Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020.
Euro Surveill. 2020;25(10):pii=2000180.
Chest CT Findings in Cases from the Cruise Ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19)
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Have a look at this useful RG link for insights.
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COVID-19 is mainly a respiratory disease that affects the lung, although other organ structures with endothelium seems to be affected too.
When should we do imaging?
What is the aim of the imaging?
How can it help with management?
Do you agree with the following consensus statement?
How will you adjust your own practice and difficulties encountered? Why?
Ref:
The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Chest. 2020 Apr 07.
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I personally believe that imaging examinations in covid should be rapid, simple and executable at the patient's bedside and therefore I believe that the most useful is LUS.
Unfortunately still today is used the chest X-ray that has been proven useless.
The purpose of LUS is to stage the pathology in order to predict its evolution, unfavorable or favorable. With LUS and blood gas analysis we can determine which patients should be discharged at home in a period when bed meals are scarce in all hospitals.
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Dear Drs,
What are the most common urine and blood tests required for diseases diagnostics and before drug dosing prescriptions?
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Many anti epileptic drugs (AED) are minimally or not bound to serum proteins, are primarily renally cleared or metabolized by non-CYP450 isoenzymes, and/or have less potential to induce/inhibit various hepatic enzyme systems.
Basically renal function test, creatinine clearance, liver function tests should be done so that we can know the dosing and possible pharmacokinetics of the drugs.
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Podocytes physiological function in the filtration barrier?
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Podocytes are highly specialized cells of the kidney glomerulus that wrap around capillaries and that neighbor cells of the Bowman’s capsule. Podocytes play an active role in preventing plasma proteins from entering the urinary ultrafiltrate by providing a barrier comprising filtration slits between foot processes, which in aggregate represent a dynamic network of cellular extensions.
Article Podocytes
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Under COVID-19, healthcare facilities requests a lot of sterilization to prevent hospital transmission of the disease. Bleach solution and many other disinfection agents may not be effective against such a large scale of usage.
Can ultraviolet light be used to inactivate the virus?
Can it be applied on whole room disinfection?
Can it be used on high turnover medical equipment sterilization? E.g. stethoscope.
Can it be used to inactivate infected donors' blood products or body fluids?
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It's 99 days since the first case of COVID-19 in Hong Kong, and we are welcoming the 5th days of 0 new cases of COVID-19 following a week of <10 cases per day.
How should we define the end of a local endemic?
How long should the latent period be defined?
When is it safe to resume social activities?
Should territory wide screening of asymptomatic people be done before declaring the end of endemic?
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The SARS-CoV-2 (Covid-19) coronavirus pandemic is a global epidemic. On a global scale, the state of the pandemic in March 2020 was announced by the World Health Organization. Therefore, this organization could declare the end of the pandemic. On the other hand, the end of the epidemic on a regional, national or local scale can be announced by national central institutions of the health care system, including the ministries of health, in agreement with the government. In order to be able to declare the end of the epidemic on a national, regional or local scale, it is necessary to have a relatively large decrease in the number of new coronavirus infections, a decrease in the number of people seriously ill with Covid-19 disease and deaths caused by this disease. The decrease in Coronavirus infections and in sick people should be sustained in a longer period, i.e. min. several months, taking into account the periods of possible occurrence of subsequent epidemic waves caused by new variants of the Coronavirus and occurring in other regions of the world. In addition, an important factor that may be taken into account in the event of declaring the end of a pandemic on a global scale or an epidemic on a regional scale will be the level of vaccination of citizens with highly effective vaccines against Coronavirus and the level of social, collective immunity of the society achieved thanks to these vaccines.
Best regards,
Dariusz Prokopowicz
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Under the pandemic of COVID-19, screening becomes important to tackle the spread. Fever is one of the screening criteria for many public places screening for access.
However, how is fever defined?
Is the 0.1 degree change makes the significance?
What is the range of standard deviation being acceptable?
What machine is accurate?
Is those hand held infrared measuring machines reliable?
Is there scenarios giving false negative tha may make a huge consequence?
Normal Body Temperature: A Systematic Review.
Open Forum Infect Dis. 2019;6(4):ofz032. Published 2019 Apr 9.
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CDC considers a person to have a fever when he or she has a measured temperature of 100.4° F (38° C) or greater, or feels warm to the touch, or gives a history of feeling feverish.
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Is there a complete tutorial for using EHR (Electronic Health Record)?
I mean extracting some data like how many people have specific symptoms?
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I don't think there would be a generic tutorial for analysing a EHR, they are all different and the software should provide help on how to search a topic. Unfortunately coding classifications systems are different across the world and within countries. See that there is considerbale variation of coding and quality. Not even HL7 is uniformly applied in the UK as a health data standard https://en.wikipedia.org/wiki/Health_Level_7 It's a difficult problem.
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Reference 
JAMA. 1990 Sep 26;264(12):1556-9.
The effect of cigarette smoking on hemoglobin levels and anemia screening.
Nordenberg D1, Yip R, Binkin NJ.
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Cigarette smoking on a regular basis raises erythrocyte count, haemoglobin concentration, and hematocrit.
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How can a patient safely taper off bisoprolol 2.5 mg who used it once daily? What schedule can he follow to taper off gradually? Any reference/paper/textbook for doing this?
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Dear Seyed Ruhollah Musavinsab. I fully agree with you. But ocassionally patients need to be individualized.Excepting renal failure, I prefer to give drugs at usual interval.
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I can't seem to find "the American Journal of Internal Medicine"'s impact factor. Does anyone know their IF and if its pubmed indexed.
In general, what are good medical research indexing for journals to have ?
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You are right this journal (http://www.sciencepublishinggroup.com/journal/index?journalid=252) is not indexed in the SCIE of Clarivate so it has no impact factor (use this link to check https://mjl.clarivate.com/home ) and is not indexed in Scopus (https://www.scopus.com/sources.uri?zone=TopNavBar&origin=searchbasic ). Besides the big warning sign as mentioned by Mohammed O. Al-Amr , there are more red flags:
-Their indexing page mentioned a lot of the notorious misleading metrics like DRJI, Universal Impact Factor and Eurasian Scientific Journal Index (see also https://beallslist.net/misleading-metrics/ )
-They charge 970 USD for a basically non-indexed journal this is way too high
-Contact info still mentions US address while it is already well-known, they are from Pakistan (https://en.wikipedia.org/wiki/Science_Publishing_Group ). Why hide this you might wonder…
So, avoid.
Best regards.
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Presenting it in a graph would make it easier for readers to capture the pattern, but no new info is added other that what's mentioned in the table.
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Avoid one graph and one table using the same data. This is a recipe for rejection by the journals!
It is not always possible to present all data as a graph particularly when there are many different variables of interest in the article, in such cases, a table is required. However, if the variables are few (e.g. number of medications used by the patients in the study), then it is preferable to use graph.
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As per recent diagnostic criteria for the diagnosis of NTM, there is a chance of overdiagnosis of NTM, thereby enhancing the potential toxicities of the drugs. There is also a chance of undertreatment. How do you defend this column? What do you think?
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Hi, good day! Nontuberculous mycobacteria are a diverse group of mycobacterial species that causes different clinical infections in children and adults. According to Ingen (2013), 25 species have been strongly associated with NTM out of the 140 known NTM species in the literature/studies. Isolation of M. kansasii and M. malmoense from pulmonary specimens usually indicates disease, whereas Mycobacterium gordonae , M. simiae, or M. chelonae are said to be contaminants rather than causative agents of true disease. Mycobacterium avium complex (MAC), M. xenopi, and M. abscessus form an intermediate category between these two extremes (Ingen,2013). NTM species differ in their clinical relevance therefore, the need for correct species identification is very important. As per your question, to prevent the chance of overdiagnosis and undertreatment of NTM, it is crucial to identify the particular causative agent that caused the condition/illness as well as its clinical relevance. to make a firm diagnosis, a culture of the clinical specimens, and a histological examination of tissue biopsy specimens are needed. Diagnosing NTM disease is complex therefore a good communication between clinicians, radiologists, and microbiologists may help in optimizing the culture conditions in line with the particularities of the patients.
if you want to know more about the diagnosis of NMT, this article might help you:
Ingen, J. (2013). Diagnosis of Nontuberculous Mycobacterial Infections. Diagnosis of Nontuberculous Mycobacterial Infections. DOI:10.1055/s-0033-1333569
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Greetings,
Recently I have been assigned several tasks of making presentations for webinar by a superior. The presentations are mainly about treatments in oncology such as immunotherapy and targeted therapy.
In the process of making the presentation, a few graphs such as kaplan-meier survival are needed to be included in the PowerPoint presentation. However, I then suddenly remembered that several speakers in symposiums had this sort of beautiful graph (Picture 1.). When I check the PowerPoint file, it is as if they design or make the graph in the PowerPoint directly, resulting in a well-suited graph for viewing.
On the other hand, the best that I could do was downloading the figure or slides directly from the journal and even then, it was still horrendous occasionally and unsuitable for presentation in my opinion (Picture 2.)
I want to ask whether there is an easy way to make beautiful graph like in picture 1 without allocating significant time. I also want to know how they do it. Do they use professional designers in the firstplace or is there an automatic software to make this?
Many thanks for the help
Kevin
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Kevin Winston, if you know MS office, then it is so easy, make/draw chart/ graphs etc in MS Excel, and copy/paste to MS Power point as mentioned by Dr. Dariusz Prokopowicz.
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Many studies and analyes we do require statistics to back up. However, many times the results run out to be statistically significant, yet when interpret it in the clinical context, it is too small to be significant.
This is rather frustrating. Any solution for solving this?
Is those very small interval unit scale more easily affected?
Can we change our analytics method to cope with the results?
Beyond statistical significance: clinical interpretation of rehabilitation research literature.
Int J Sports Phys Ther. 2014;9(5):726–736.
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Good question
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For example immunology and allergy and infectious diseases.
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Yes. You can added five or all. OK. man.
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Hello, I am appraising a survey study of nurses.  The researchers, who are nurses, have cited that study participants were selected from their own department in a general internal medicine unit.  Is this considered a potential selection bias because of the personal association between the researcher and study participants.
Many Thanks for any feedback.
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I have the same question. I am planning to do a qualitative inquiry using a phenomenological approach. The planned dissertation is about how first year qualified nurses are constructing their professional identity within governmental hospitals. As I am also a 12 year experienced nurse working in one of the local hospital, I was considering to eliminate the cohort which are allocated in my hospital setting. I wish to have an opinion. Should I include them or exclude them?
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COVID-19 has pull people apart from each other. Social distancing is the main way to prevent spreading of infection. Tele-medicine, once used for rural area remote healthcare model, is the emerging new way of practice under COVID-19.
Different specialties have different practicing needs, what difficulties do you encounter on applying tele-medicine under COVID-19 in your specialty? Will tele-medicine totally uproot the usual face-to-face room consultation of medical practitioners? And becoming the new service model?
What is your view?
Some references:
Virtually Perfect? Telemedicine for Covid-19
NEJM
DOI: 10.1056/NEJMp2003539
Covid-19 and Health Care’s Digital Revolution
NEJM
DOI: 10.1056/NEJMp2005835
Telemedicine in the Era of COVID-19
The Journal of Allergy and Clinical Immunology: In Practice
DOI: 10.1016/j.jaip.2020.03.008
Keep Calm and Log On: Telemedicine for COVID-19 Pandemic Response.
DOI: 10.12788/jhm.3419
‘Healing at a distance’—telemedicine and COVID-19
Public Money & Management
DOI: 10.1080/09540962.2020.1748855
The Role of Telehealth in Reducing the Mental Health Burden from COVID-19
Telemedicine and e-Health
DOI: 10.1089/tmj.2020.0068
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Hello, in Portugal, during Covid there was a huge increase of tele consultation. Still some barriers were found:
- older people have more difficulties in using digital tools.
- 3G and 4G coverage is still low in some rural areas.
- Lack of good tele consultation tools available to be used, some physicians then still want to do the face to face consultation.
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As a public health measures to control the spread of the pandemic coronavirus, social distancing and home quarantine are implemented in some countries.
As a matter of fact, patients are absence from clinic under COVID-19, and clinic-based diabetic control monitoring becomes challenging.
Do you expect a change in diabetic control for these patients when staying home?
They have less exercise, and may eat more snacks at home.
Or in contrast, they are too bored, and have time to develop new exercise without pressure from work? Besides, they are banned from social around, and may eat drink less alcohol and eat less feast.
What do you think?
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COVID-19 will increase vascular complications
Coronavirus associated with respiratory distress and ph changes Both Quarantine &Thinking increase stress hormones so more oxidations Limited Exercise will increase blood glucose level
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COVID-19 is spreading around the world, and faeces were popular and agreed for the presence of viral RNA with different studies reported. Its presence mean that the gastrointestinal (GI) tract is one of the hosting organ for such coronavirus.
How are other parts of the GI tract system affected by this virus?
Reference:
Clinical features of covid-19-related liver damage.
Clin Gastroenterol Hepatol. 2020 Apr 10.
Pancreatic injury patterns in patients with COVID-19 pneumonia.
Gastroenterology. 2020 Apr 01.
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COVID-19 is affecting all kinds of human activities, research is not exempted. Many ongoing research studies are not paused because of COVID-19, patient recruitment cannot be continued, follow up visits are not stict to schedule, intervention procedures may be delayed, blood test monitor are postponed.
I would expect a higher loss to follow up rate during this period, which would affect the reliability of research. Even after COVID-19, will the recruited subjects have some difference than those recruited before?
What do you think?
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I am in a contiuous activities during this mandatory vacation but at home office..
Wish you all healthy life.
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Working in the research field, you will be weighted by your h-index.
However, publications might not be cited by others despite your hard work.
Do you think we should publish only citable research or publish as many as we could to contribute the academic field?
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Sunny Chi Lik Au I agree with Dean Whitehead (Citation isn't just a 'numbers game )
regards
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50 years old man who visited Internal medicine clinic doing well without any complain or any other disease. He said to the doctor that he is screening his blood sugar at home (finger prick device)He had family history of DM2 so he was anxious about his situation. All the readings during the day are normal except that at early morning which was around 107 mg/dl in average for the last 30 days. Knowing that he sleep at 11pm and glucocheck done at 9 am.
*Should I consider this reading Abnormal and treat him as a pre-diabetic person ?
*Note: This Q is only to improve my knowledge about DM
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Yes. He is a prediabetic individual. Why.....?
According to the Michigan Diabetes Center's recordings which were considerably accepted as references by the American Diabetes Association, it classified population using Fasting Plasma Glucose (FPG) into:
euglycemic 72-102 mg/dL
prediabetic 103-125 mg/dL
diabetic ≥ 126 mg/dL
therefore, the second group must be warry via periodic check, good glycemic food control, and body exercises
from my experience point of view, many prediabetic subjects consult my clinic, continuing to have their normal life on my instructions
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I co-authored an article in 2011 on a new effective Migraine treatment (Winter Edition of the Canadian Journal of General Internal Medicine), authored by Kenyon and Phillips yet Research Gate prints that I cannot upload unless I am an author. I am! My name was second but I equally authored and performed the research.
B L Phillips
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I will suggest to try to add them back if it fails then contact researchgate.
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Hello
Request a colleague to do a research paper (Psychology)
Thanks
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Great initiative. I will be happy to provide statistical analysis power and research methods...
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Helicobacter pylori inhabit the gastrointestinal tract, one person’s poison may be another’s cure. Helicobacter pylori, the bacterium that causes gastric ulcers and stomach cancer in some people, may actually protect against cancer of the esophagus. So, What about your experience in the paradoxical effect of Helicobacter pylori infection? and why their resistance to treatment was increased?
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I have no experience in this field, but i think the following article will be helpful
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Do you consider this be thrombocytopenia?
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Thrombocytopenias with the presence of normal functioning thrombocytes may provide some survival advantages for human being since myocardial infarction and stroke are the most common causes of death in developed countries at the moment, and the roles of thrombocytes in such events are significant. Thus initiation of low dose aspirin is strongly advised above the age of 50 years.
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1.What is the function of Appendix(Cecal Appendix) in the body?
2.What will happen for a person after Appendectomy?(with Appendicitis)
3.What will happen if the normal Appendix remove?(without Appendicitis)
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In addition to the earlier answers, recent studies suggest very early appendectomy may be associated with autoimmune disease development, including inflammatory bowel disease (IBD), rheumatoid arthritis and lupus. This is probably due to an exaggerated immune response, one that has not been adequately primed for appropriate reaction due to the absent appendix - a seat of lymphoid tissue. The 'hygiene hypothesis' applied to IBD may also be applied to this phenomenon. Further, this indicates a possible role of the appendix in "post-natal" immune tolerance, akin to the role of the thymus in-utero.
The other theory put-forth recently is the protective benefit of appendectomy in preventing neurodegenerative disease. The immune response initiated by the lymphoid tissue in the appendix each time they are stimulated result in free radicals, reactive oxygen species and other metabolic byproducts that have been implicated in the pathogenesis of neurodegenerative diseases including Parkinson's. The model of hepatic encephalopathy is a good comparison.
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Age-related immune system dysfunction and inflammatory cell signals are prevalent in the geriatric population. Which is more responsible for rhinitis and post-nasal drip, and what other factors may be involved?
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Dear Ana
Rhinitis is defined as inflammation of the nasal mucosa and is characterized by symptoms of congestion, rhinorrhea, itching of the nose, postnasal drip, and sneezing. It can be divided broadly into two major categories: allergic and nonallergic. Allergic rhinitis is an IgE-mediated inflammation of the nasal passageways triggered by various allergens such as dust, pollens, or molds. Nonallergic rhinitis is characterized by non-IgE-mediated symptoms typical of rhinitis, such as congestion and clear rhinorrhea, with less prominence of sneezing and ocular/nasal pruritis. I suggest that article; for reading ( Allergy Asthma Clin Immunol. 2010; 6(1): 10. ).
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Collecting ideas of research regarding the above mentioned field to formulate a phd proposal
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You may wish to check on FAO paper on livestock strategy in the region at http://www.fao.org/3/a-mp852e.pdf
Sudan's report for year 2017 on OIE World Animal Health Information System shows that there a number of animal diseases and zoonoses: see the link https://www.oie.int/wahis_2/public/wahid.php/Reviewreport/semestrial/review?year=2017&semester=0&wild=0&country=SDN&this_country_code=SDN&detailed=1
Check as well some of our studies on Sudan:
I hope this helps you decide which disease and what aspects you can contribute to Sudan's livestock sector through your PhD research.
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For example , instead of heart beating so fast = Palpitations
Faint, pass out = Pre-syncope
What is this process called (Translation of what the patient describes into medical terminology) so I can study it more efficiently and search more info.about it?
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Nomenclature.
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When you prescribe a medication, what is your go-to-site/book/reference to check for adverse reactions? And what type of adverse reactions do you check? Is it type A adverse reactions only that you check?
And in other words: what are the most important adverse reactions that you must check?
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Several:
1. Package insert
2. Physician Desk Reference
3. Online resources of FDA
4. Review published peer-reviewed journal articles
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This is an area I have been involved in for several years with contacts in China, including the Cooper China Center, where I have visited and lectured. Two good friends and esteemed colleagues are doing a lot with the Chinese, and we have a contingent visiting our lab/cardaic rehab program in June. My contacts include: Drs James Skinner, Weimo Zhu, and Wilson Zhu. If I can be of help to your group, or become formally involved, I'd welcome the opportunity.
Barry Franklin, PhD, FAHA, MAACVPR, FACSM
Director, Preventive Cardiology/Cardiac Rehabilitation
Beaumont Health
Professor, Internal Medicine, OUWB School of medicine
248 655-5766
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Even I have no previous contacts wuth Cooper China, Cardiac Rehab is an area that my Center and I personally have been involved since several decades ago with broad experience in the education in this field of a lot of foreigners. It will be our pleasure to have the opportunity to get involved in this project.
Thanks for your question.
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Excuse my naive experience in this area.
Lets assume we have a patient with 2nd degree hemorrhoids, and we want to apply topical product to reduce the swelling of hemorrhoids, do we apply the product on the hemorrhoids after it prolapse or we wait till it return to its position spontaneously then we apply using an applicator? I mean the proper timing for the application of the product.
Second scenario, we have a patient with third degree hemorrhoids, will we apply the product on the prolapsed hemorrhoids or we reduce it manually then we apply the product afterwards using the applicator?
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According to my experience,there is no difference but the patient may be more comfortable when it is reduced
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When we sent a project to our ethical committee, they usually ask: 'how can a family physician relevant to this topic?' I would like to know 'what are the limitations of a family physician to study?'. Surgery? Internal medicine? Psychiatry? Genetics? ...
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In my opinion, strict limitation is impossible, even meaningless. Maybe rotation departments of family medicine speciality education may give an idea, but on the other hand; the patient spectrum and personal interests in family medicine make such requests meaningless. I believe that the variety of articles in the leading journals of family medicine can be used when defending the discipline.
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Hi. Do we need to ask permission from the related publishers if we want to use tables and figures from journal article or a citation is enough ?
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Since the copyright of an article has to be transferred to the publisher by the author(s) before publication, permission to use a table or a figure has to be requested from the publisher. It must be cited in the legend of the table or figure with reference and "with permission of ...". There is an exception only with public sources, whereby the source must be specified however also exactly.
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How to differentiate granulomatosis with polyangiitis from microscopic polyangiitis?
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The clinical picture and ANCA pattern may help....
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If so, is there any evidence for that?
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One has to make certain one has baseline liver enzymes prior to any exposure to aspirin then another set of enzymes post-exposure to aspirin.
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I am working on a forensic case with a psychiatrist regarding a man we evaluated in a psychiatric evaluation who developed complex partial seizures due to clandestine lab exposure, specifically lithium and methamphetamine labs, throughout his career working as a police officer. We reviewed his current list of medications, and he is taking 50 mg of sertraline (Zoloft) once per day.
The research that I found shows that higher doses of sertraline increases the risk of seizure, including partial complex, and that sertraline and methylphenidate (a CNS stimulant) can precipitate seizures. Though, I'm trying to eliminate variables here... 50 mg qd of sertraline is an ordinary prescription. Were the lithium and/or meth vapors interacting with his sertraline, or is there another reason why he was experiencing seizures?
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Marie Humbert-Claude Béatrice Marianne Ewalds-Kvist Thank you for the answers and literature! Will ask more questions with more later when needed.
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I need a good doctor to be a mentor for my graduation research.
My topic is about vitamin D, so I want orthopedic, family medicine or internal medicine physician.
How can I find?
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What is your research about Zahra?
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What is the Best resource/Website to learn the pathology of any disease?
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You should consider to have a look at :
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Dear colleagues,
Do you have an idea about the source of light through which we see dreams ? and what is the source of light through which we can see the colors we see in dreams?
I wish you all the best
Huda
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Blind people have no visual imagery in their dreams, if born blind. Dreams do process past memories; in a dream, different temporal memory layers can be mixed over into 'one film'. We do not dream with our eyes, it is a brain function in sleep as the brain is a non-stop organ (you could put a light bulb on it).The existence of pre-cognitive dreams, which is portrayed in prophetic literature, e.g. Joseph in Egypt, cannot be ruled out. A healthy sleep cycle (chronobiology) and dreamimg are closely connected, in medical terms, to 'free' the memory from non-necessary psycho-logical ballast of life experiences.
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This question has arisen from contributor Pete Batcheller, who added a response to my question "Is Botox an effective treatment for Episodic Migraines?".  Mr Batcheller is a very dedicated believer that high dose Vit D3 is effective in preventing Cluster Headaches (CH). 
High dose Vit D3 has been researched for its anti-inflammatory functions and it is possible it may help reduce the incidence and severity of CH when used in doses of 10,000 IU a day. Bearing in mind the morbidity of CH and the low price of VitD3 supplements, it suggests it is worth trying provided the potential harmful effects of Hypervitaminosis D are avoided.
He quotes a paper "Burton et al. titled A Phase I/II Safety Trial of High Dose Oral Vitamin D3 with Calcium Supplementation in Patients with Multiple Sclerosis" where doses up to 40,000IU a day were given over 48 weeks and the serum 25(OH)D (along with Serum + Urinary Calcium and other markers were measured)
While it is very clear to me that this is not a sufficiently long period to be certain that the long term dangers of heart attacks and kidney damage due to increased serum 25(OH) are not worsened, the interesting observation from Burton's work was that though there was a significant delayed rise in Serum 25(OH)D to a maximum of 410nmol this fell again to approx 200nmol during the period when 10,000IU was taken, and by extrapolation would probably fall further if the time the 10,000IU was take had been extended
It is now generally accepted that 5,000 IU given long term is safe
So, bearing in mind the intense morbidity of CH and CH may be associated with low serum levels of 30nmol or less of 25(OH)D:-
1. Does anybody have experience of high dose (10,000IU/day) VitD3 for CH
2. What serum level of 25(OH)D would be safe to run at for extended periods? Is 200nmol safe? What papers are there to back up safe levels when adminise
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Of course absence of evidence is not evidence of absence (of an effect), and placebo effect is often a default medical position when there is no evidence there might be one!
Indeed the idea that doses of >2000U a day may produce toxicity is mentioned on the basis that it is an oil soluble vitamin that could be stored, but without evidence of this.
I have no answers whether high dose Vit D3 can help CH but I have spoken extensively to endocrinologists on the matter
1. a)10000U a day is very unlikely to produce toxic levels in itself. The danger is related to the potential rise in Serum Ca levels and if this remains normal then there should be no problem with renal stones etc.
b) Vit D deficiency may rarely mask a parathyroid tumour, which can be the cause of increased Serum Ca levels when D3 levels are corrected.
I do not know whether high dose D3 (10000U/d) can produce increased Serum Ca in someone who had previously normal D3 levels, but it seems sensible to monitor it
2. The use of high dose Vit D3 should not be confused with treatment of D3 deficiency. One is using supra-physiological levels of D3 to (possibly) treat CH. The possible mode of action is unclear but may be related to an anti-inflammatory function, but this theory is certainly speculative!
Severe CH is sometimes called Suicide Headache and is debilitating. Perhaps high dose D3 may not be without risks, but with the suffering due to CH and the potential risks of other treatments, perhaps it should be explored further. It is after all a very cheap treatment...
It would be really good to hear more thoughts....
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As BMJ and Cochrane discouraged uncontrolled before-after studies, what are the chances of publishing such studies (not related to hematology or oncology) in clinical journals?
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Dear Jakub,
of course it is easier to publish a randomized-controlled study. But there are some other quality characteristics:
- large sample size
- good and complete description of the methods
- good performed statistical analyses
- interesting questions / endpoints and clear study results
- very new results of an interesting new and current topic
I think, you can manage to publish the study!
Best regards
Tanja
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Is that a true organ?
What do you think?
Your body is lined with a network of fluid-filled cavities that—until now—were unknown to science. The team that made that discovery thinks the cavities qualify as a new human organ, which they’ve dubbed the “interstitium,” Live Science reports. The new organ was spotted when researchers looked at live human tissue with a new imaging technique. Previous methods have mostly looked at tissue that’s dead and drained of fluid, so the cavities weren’t visible, the team reports in Scientific Reports.
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Dear Abdallah
The so called "intersticium" is a lymphatic dependent space with very little or no fluid inside it. It was known to anatomists for more than 200 years.
Discovery sometimes is not about discovering something new, but making a big fuzz about old things. Then it seems as a "new discovery".
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hi 
what are the different pressure waveforms inside internal carotide artery?
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After answering this question two years ago I did the calculus for the exponential decay curve which occurs after the systolic peak and before the diastolic trough. If the pressure is plotted as log pressure against time you get a straight line (approximately). The slope of this line can be derived. It is proportional to compliance (C) multiplied by resistance (R) of the blood vessels (RC).
I wrote an app for my iPhone in BASIC which was fun to play with in the ICU. Unfortunately I could not find a way to separate the two components R and C and in disease states hardening of the arteries increases resistance and decreases compliance. This means the two factors tend to cancel each other out, making the calculation of RC less sensitive. But the program can help us understand sepsis cases where resistance drops over time.
Some people use the pulse pressure, which is systolic pressure minus diastolic pressure, but this does not take into account the pulse rate. The slower the heart rate the longer the time between the systolic peak and the diastolic trough. This gives more time for the blood pressure to drop off as blood flows away from the heart. Consequently the diastolic pressure drops as heart rate decreases. But if we calculate RC it takes into account all three factors: Systolic Pressure (PS), Diastolic Pressure (DP) and heart rate (HR).
Perhaps I should write an article about this, but who would publish it?
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I would like to belong to this project. Which is the first step?
Sincerely.
Diana Rodríguez Hurtado M.D FACP
Full Professor Faculty of Medicine Universidad Peruana Cayetano Heredia.
Internal Medicine - Geriatrics
Master in Clinical Epidemiology.
Mobile: 51 999395806
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The intent is a mutually beneficial exchange of information and knowledge - so sharing will bring benefits. While the focus is on SAGE and SAGE-related data, we actively encourage comparisons to other data sets and interactions/exchanges on that to better understand the drivers of differences in health created by unique policy and cultural issues.
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I was approached by this journal for reviewer/editorial board membership, but not sure if they are legit.
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Hi I'm new in Researchgate and I know your question has already been answered.
But this article published in March 2017 in Nature is about this topic and is very useful to learn more about and gives some warning signs to detect predatory journals.
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Complications related to viral hepatitis, alcohol-related and non-alcoholic liver disease, are the main reason for seeking gastroenterologists and hepatologists advice. In addition, hepatocellular carcinoma often arise on the ground of hepatitis, representing the fifth most common cancer in men and the ninth in women. In 2015, the World Health Organization estimated that 325 million people were living with chronic hepatitis infections (hepatitis B or C) worldwide and that globally, 1.34 million people died of viral in 2015.
In front of this global health problem, gastroenterologists, hepatologists and hepato-biliary-pancreatic (HBP) surgeons, are daily involved in the clinical routine in taking difficult clinical decisions. As Sir William Osler quoted: “medicine is a science of uncertainty and an art of probability” and no doctor returns home from a busy day at the hospital without the nagging feeling that some of his/her diagnoses may turn out to be wrong, or some treatments may not lead to the expected cure. Probability is a recurring theme in medical practice and the ability of dealing with risk and uncertainty can be elicited through a special kind of intelligence. In 2012, The UK psychologist Dylan Evans defined it as “risk-intelligence” that is "a special kind of intelligence for thinking about risk and uncertainty", at the core of which is the ability to estimate probabilities accurately.  
Consequently, doctors are routinely asked to make predictions, and their predictions would lead to a consistent payoff when regarding a patient’s life. At the basis of “wise” medical decisions, physician’s experience surely plays a vital role. However, doctors can assume that their competency in a given area can be significantly higher than it really is. Such illusory superiority, is described as the Dunning – Kruger effect, a meta-cognitive bias leading to a discrepancy between the way people actually perform and the way they perceive their own performance level. The concept of “risk-intelligence” relies on the confidence that each subject has with their own knowledge, thus returning accurate probability estimates, and a “wise” doctor should be aware that he/she do not known, thus, returning high risk-intelligence.
To date, little is known about risk-intelligence and the Dunning – Kruger effect between doctors, and, especially, among hepatologists, a specialty strongly involved in important clinical decisions. With this aim we conducted a survey to test how risk-intelligence affects medical decision making in this particular clinical setting and whether the Dunning – Kruger bias can effectively affect these physicians.
If you are a gastroenterologist, hepatologist or HBP surgeon please help us in investigate this issue by completing the following survey:
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Thank!
(I hope you will find the correct answers in the appendix section of the manuscript we are writing!)
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S-1 seems to be seriously useful against a variety of tumors, & my remote research at Yale, on 5-azaorotic acid (pyrimidine antimetabolite, which he calls "Oxo") was cited in Shirakawa's original paper (misspelling my name  "Grant" in the text, but correctly as "Granat" in the reference).
We had given it IV; he incorporated it as PO, leading to significant diminution of the side-effects of 5-FU.
I think we need that oral drug here in the US, for gastric & pancreatic cancer; & probably for colon, although it's fairly equivalent to Xeloda.
I did not continue in research or oncology, but became a practicing Family Physician, still in Private Practice, but very interested in what has become of my humble research years ago. And I have patients who I believe could benefit from the advantages of S-1.
I would especially like to hear from any of the Japanese original researchers.
Pepi Granat, MD 
Pepi Granat, MD
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Did you mean "non-inferior" above re: S-1 & capecitabine? (your first statement).
PG
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D-ribose has demonstrated significant enhancing abilities in replenishing deficient cellular energy levels following myocardial ischemia, does the metabolic pathway differ from that of D-glucose? It seems to be more ready for catabolism for the ischemic tissue in the congestive heart failure!!
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Dr. Bader,
It depends what you mean by "replenishing deficient cellular energy levels".
One of the characteristics of ischemia in any tissue (but especially heart) is a net loss of 5'-nucleotides.  To replenish these nucleotides (either by de novo synthesis or by salvage synthesis), the cell needs phosphoribosyl pyrophosphate (PRPP) as one of the staring materials.  Ribose is phosphorylated to ribose-1-phosphate, which is then metabolized to PRPP via PRPP synthetase.  Most tissues (aside from liver) have low levels of PRPP synthetase, so the process is slow; however, addition of ribose will enhance nucleoside salvage synthesis in heart two-fold or even more.
Glucose, on the other hand, uses glycolysis and the Krebs cycle to increase ATP levels (and, by proxy, levels of other 5'-nucleotides) via chemiosmosis and the mitochondrial F1-ATPase.  This increase is dependent on the parent molecules for these nucleotides (ADP, CDP, GDP, UDP, TTP) being present.  Glucose will not enhance the levels of these parent molecules, only see to the addition of the final phosphate (an increase in energy charge, but not total cellular levels).
So, ribose and glucose are really doing different things from a cellular point of view.
Cheers,
T. Geisbuhler
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Refractory angina  ,chelating agent, benefits 
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Based on TACT trial...ACC recommended chelation therapy as class 2b indication for therapy of stable ischaemic heart disease.. In 2014.Further studies are needed in this aspect. 
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The effects of Daith ear piercings on migraines was first noticed by chance.
After Dr Thomas Cohn a respected pain physician in the USA noted on his blog in March 2015 that people were reporting improvements in their migraines, increasing numbers of migraine sufferers are having Daith Piercings.
Is anybody studying this effect?
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 I read your discussion with great interest as it touches the underlying mechanisms of the potential effect that Daith piercing may have on migraines. My background is from biomaterials and I confess immediately that I'm a complete novice in migraine and it's treatment. However, I realised that since the interest in using the piercing as a potential treatment or placebo treatment is high among the patients and apparently some doctors now, there is an opportunity to offer my knowhow for use. Daith piercings have a relatively high complication rate due to the difficult area, type of tissue, piercing models used and lack of standardisation of the actual procedure. No one seems to even know in which exact spot should the piercing be placed to be effective.
Our technology has been developed to alleviate the problems soft tissues have around titanium implants. Basically our material is able to achieve a strong bonding between the cell's and tissues and the implant surface. It is already in use in dental implants and there it's function is to speed up the healing and closure of the gingival tissue wound around the implant, thus reducing the risk of bacteria being able to enter the wound. Other effects observed are that no fibrous encapsulation forms around the implant, inflammatory response is reduced and general healing is improved.
I'm interested in starting a project on the daith piercing, because I read from Dr. Blatchley's internet survey results that exactly these type of complications are common also around the piercings. The goals of the project should be such that the potential treatment would be as safe and effective as the current knowhow already allows. Now, I understand that such project would be foolish to run without the expertise of people like yourselves, because without the understanding of the underlying mechanisms, it would have a high potential going wrong. I wish to therefore ask you all what you think of the potential of Daith piercing as a treatment option. In my mind from an implantology point of view it's a fairly straight forward project. But what are your thoughts on the neurological evidence? what are the main objectives and biggest failure pits?
best regards
Ilkka
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The project is intriguing demonstrating that targeted external irradiation of rabbits or dogs with energetic carbon ions can reduce fatal ventricular arrhythmia via upregulation of gap junction protein connexin 43 and that such antiarrhythmogenic potential persists at least one year after single irradiation.
Heart has long been considered as one of radioresistant tissues. For instance, TD5/5 for the heart (tolerance dose at normal tissue complication provability of 5% within 5 years after fractionated exposures) was considered to be 40-60 Gy depending on the volume irradiated within the heart, for which effect considered was perimyocarditis ( https://www.ncbi.nlm.nih.gov/pubmed/2032882 ).
However, the International Commission on Radiological Protection (ICRP) now classifies circulatory disease (cardio- and cerebrovascular disease) as tissue reactions (formerly called deterministic effects or non-stochastic effects) and has recently recommended the first ever threshold to the heart and brain. The threshold dose recommended was 0.5 Gy independent of dose rate, which was recommended as dose causing 1% circulatory disease mortality at >10 years after exposure.
The dose used in the project is 15 Gy, which is significantly higher than 0.5 Gy (but of course with the caveat that the threshold for humans can not directly be compared with that for rabbits or dogs). In addition, the relative biological effectiveness (RBE) value of carbon ions for circulatory effects, which I do not think is available, may be high. 
Therefore, in the short term the recovery from fatal ventricular arrhythmia will surely outweigh the risk of "second" life threatening circulatory effects, but in the long term the impact of such late onset circulatory effects may need to be considered.
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Thank you
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When to measure INR _as a follow up monitoring_ following warfarin administration in a patient with VTE? 
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INR should be measured after 3 days of starting warfarin therapy. After that, measurement is variable between institutions. It an be done every week first and if INR is in the therapeutic range continue every 2 weeks and then every 4 weeks. 
There is a guide: Evidence-Based Management of Anticoagulant Therapy
CHEST 2012; 141(2)(Suppl):e152S–e184S
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Status quo and perspectives
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Yes, milk from animals fed industrial food
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Its a very common condition we are encountering. Its difficult to keep patients for long in hospital to control HTN only,
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45days
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Annals of Internal Medicine published today a very interesting paper introducing the "E-value" as a way of assessing robustness of Relative Risk, Odds Ratios, Hazard Ratios etc which may change how we interpret and present these statistics.  I'd like to hear the opinion of statisticians?
If anyone want to play with the E-value I've attached a calculator
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The article is not open for reading so it's hard to comment.
Usually "e value" is "expected value"  so there seems to be risk of semantic confusion  
And... No one accused me of being a statistician. But all these kinds of tools are dangerous in the hands of the unwary.  There are ALWAYS built in assumptions such as the underlying distributions are Gaussian or some other silliness.
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Acute pulmonary embolism has varied presentations ranging from asymptomatic, incidentally discovered emboli to massive embolism, causing immediate death. Tumor embolism is a rare but unique complication of malignancies. This uncommon catastrophe of a malignant tumor in a young patient, culminating as a pulmonary embolism, is being reported for the first time
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Hi to everyone. I treated with iv iron only (1.5 g of FCM) a 13 years old girl presented with extreme anaemia at Paediatric ER. Starting Hb was 3.3 g/dL and the girl experienced only a mild asthenia and mild tachycardia. After 28 day Hb arose to 11.9 g/dL and general conditions quickly improved. 
I would like to write a Case report.
Does anyone know other similar cases in literature? The patient isn't a Jeovah Witness.
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Dear José Antonio,
I remember...NATA Congress, Lisbon 2008! 9 years ago.
I know...publish or perish..
In these years I actually did a lot of studies but I didn't publish them. Thank you  for your exhortation! I'm just writing an article on plasma appropriateness (presented at NATA Congress in Florence)
Dear Jorge Luis,
as you pointed out, the dissolved oxygen in the blood is very important in these cases and is often used in JW with life-threatening anaemia.
Dear Antonio,
I agree with you. It's exciting for me sharing knowledges.
If you are interested, you can find me (and my group voted in Patient Blood management ) on Twitter (@PbmOvestMi), Facebook (@PbmOvestMi) and LinkedIn ( www.linkedin.com/in/ivo-beverina-78385377 )
Best regards to everybody!
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I want to calculate the appropriate dose of ferrous sulfate for anemic patient depending on MCV, HB level and his diet ?
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Thank you . My comment was not addressed to you, but your response is amazing, I had same question as was asked but some answers were not specific but were helpful
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In the web from Health university of Utah, it said that the right atrium contracts slightly before the left atrium.
Any references discuss about it?
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This is a very well known fact, described every where and very easy to confirm in human beings and other mammals. The sinoatrial node (SAN) is the normal pacemaker (origin of cardiac rhythm) and is located in the upper right aspect of the right atrium. The wave-front of depolarization that causes atrial myocardial contraction starts in the right atrial myocardium that is close to the SAN. Independently of intra- atrial specialized conduction fascicles  in human atria, right atrium (RA) starts and complete contraction before Left atrium (LA). 
A very interesting reference in the field is the book: "the conduction system of the heart" edited by Wellens, Lie and Janse.
Best regards,
RA.
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Can in future combined CT FFR and CT coronary angiography replace invasive coronary angiography for diagnosis of CAD ?
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FFR-CT is a novel technology that enables determination of the functional significance of lesions noninvasively, using sophisticated computer algorithms based on computational fluid dynamics applied to coronary CTA . There is evidence from several randomized studies, comparing FFR-CT with invasive FFR (representing the gold standard), that FFR-CT can be helpful in evaluation of hemodynamic significance of stenosis, especially in patients with intermediate severity stenosis.
-B.K. Koo The present and future of fractional flow reserve
Circulation Journal, 78 (2014), pp. 1048–1054
-Noninvasive Fractional Flow Reserve Derived From Coronary CT Angiography Clinical Data and Scientific Principles
James K. Min, Charles A. Taylor, Stephan Achenbach, Bon Kwon Koo, Jonathon Leipsic, Bjarne L. Nørgaard, Nico J. Pijls, Bernard De Bruyne JACC: CARDIOVASCULAR IMAGING, VOL. 8, NO. 10, 2015
Noninvasive Fractional Flow Reserve From CT OCTOBER 2015:1209 – 2 2
-Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: Technology and clinical update
Matthew Budoff, Rine Nakansihi, Vascular Health and Risk Management 2016;12:269—278
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A patient took 4500 mg acetaminophen in 3 days span along with the following drugs prescribed by a homeopath practitioner- Arsenic, Calcium Sulphide and Bryum album (dipped in alcohol). He developed Fulminant Hepatic Failure SGPT rocketed from 1158 U/L to 3796 U/L overnight. No virus detected. Can acetaminophen do such damage at so low dose?
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complex interaction between paracetamol and alcohol intak
the acute administration of ethanol inhibits the potentially toxic oxidative metabolism of paracetamol and protects against liver damage. This protection decreased when the concentration of ethanol decreased.the critical period is that the time between ethanol and paracetamol intak
while chronic alcoholism, microsomal enzyme induced with increased toxic metabolic activation of paracetamol and enhanced hepatotoxicity.  elevation of SGOT/SGPT ratio may be 5 times greater than normal
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A 21 year old had a strep throat infection 2 months ago. She took two courses of Amoxicillin and clavulanate potassium 875 mg / 125 mg. 2 weeks ago she went to an ENT specialist complaining that her voice has not returned to normal yet. She had a laryngoscopy that revealed the presence of esophageal candidal infection that has ascended to the larynx. She was prescribed Clarithromycin 500mg 1 pill/day for 7 days, Pantover 40mg 1pill/day for 20 days, Fexofenadine hydrochloride 120mg 1pill/day for 10 days.
She had a stool analysis done on the same day same day because she also complained of mucous in her stool. It revealed the presence of yeast. No ova, or cysts were seen. Pus Cells were 0-1/HPF. Erythrocytes were 1-2/HPF. No occult blood was seen. 
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Streptococcal infection is susceptible to natural penicillins. Oropharingeal candidiasis could be a complication of antibiotics therapy, if there is no any other reason( Hiv, inhailed corticosterroids, immune suppressive agents). Anyway there is no need for macrolides  (they are not active against Candida infection and they can cause diarrhea) gastric acid suppression by PPi  can make conditions for candida growth. What's the aim of antihistamines prescription? For candidiasis antifungal drug should be used: fluconasole or nystatin  ( if regisrered) . Second one acts locally on mucosa membrane because it's not absorbed from git. 
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Some answers come in a recent webinar where my close colleagues from VRCM* cover this question based on their own experience and that from other groups in the field. This recorded talk is available on-demand at: www.stagowebinars.com
*) F. Dignat-George & R. Lacroix from Vascular Research Center of Marseille (F), see corresponding ResearchGate pages 
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And for those who are not aware of ISEV initiatives::
Spread the Word! 
Let your colleagues know about the Annual ISEV2017 Meeting in Toronto! Reach out to those who are and those who might be interested in exosomes, ectosomes and other extracellular vesicles. ISEV2017 is the only global and comprehensive meeting covering the entire field of extracellular vesicle studies.  With each new member, attendee and presenter the ideas become richer, data more exciting, field more mature and the Society stronger. 
Share on your networks!
 
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mycoses, 2017
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Here you have
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Or evidence about envenomation of poisonous snakes in general
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HBOT FOR HEALING OF TISSUE COMPROMISED BY LOW BLOOD FLOWS , IS 
TIME PROVEN & mY EXPERIENCE WITH THIS HAS BEEN VERY GOOD. 
Where there has been compartment syndrome also I feel this therapy will be useful.
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A late event In Constrictive ventricular hypertrophy is a sudden dilatation, which clinicians understand to be a critical sign of impending final heart failure. Linzbach, the famous german Cardiopathologist, introduced into literature the term " Gefügedilatation" hence suggesting that the myocardial alignmrent is rearranged such that the heart dilates. Unfortunately, even his pupil famousWaldemar Hort could explain after Linzbach died, how his teacher had conceived  the reallignment might happen.
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Dear Dr. Paul Peter Lunkenheimer. It was interesting to learn about the original hypotheses of your compatriot as well as the morphofunctional model that is remarkably presented in your article "Models of Ventricular Structure and Function Reviewed for Clinical Cardiologists". Thanks
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A long standing hypertensive patient with heart failure of reduced ejection fraction. He is in functional class II and recently presented with bradycardia increasing fatigue.
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2:1 HB
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if anybody having this pdf, please share.
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Hi, another book with the same title is available in pdf form (by another author):
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Is there any guideline or published papers regarding the use of maintenance IV fluids in patients with fluid overload (eg. CKD or HF) who are already using diuretics to relive symptoms of pulmonary congestion?? 
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If they have any pulmonary issues secondary to hypervolemia, fluids are not indicated. However, if you are talking about a stable CHF patient with chronic diuretic use who needs maintenance therapy for whatever reason, 5% dextrose in a solution of 0.9% saline is acceptable at modest rates amounting to the fluid restriction they have been following as outpatient (~1.5L per day).
You may want to go through this article.
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As many as 20% of patients with community-acquired pneumonia (CAP) worsen despite guideline-adherent antimicrobial therapy; in fact, some cases are caused by viruses (NEJM JW Gen Med Sep 1 2015 and N Engl J Med 2015; 373:415). Systemic corticosteroids might reduce the cytokine and inflammatory responses that can lead to some CAP treatment failures. In two recent randomized controlled trials, researchers found outcome improvements with steroid therapy (NEJM JW Infect Dis Mar 2015 and Lancet 2015; 385:1511; NEJM JW Infect Dis Apr 2015 and JAMA 2015; 313:677); however, these trials were not powered to detect mortality differences.
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I think because of heterogenity of causative agents and different pathophysiology in different types of pneumonia, there could not be any net suggestion to give steroids even in severe pneumonia. We need to know more about concerete panthophysiology of given patient - e.g. some biomarkers - to have information about how does the immune system work in concrete patient. Without this data I do not give steroids because for me infection=no steroids unless I find some contribution of some autoimmunity or autodestructive process.
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Hi. I have a very quick question.
Do you know if the ki for apixaban and riveroxaban against fXI are somewhere published?
I know that they aren't fXI inhibitors but, it was just for curiosity.
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Really thanks Adam. It is exactly the info that I need.
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42 year male, case of Hepatitis C (genotype 3) with very high viral load, was treated with Sofosbuvir 400 mg OD with Ribavirin 800 mg, tolerated well with rapid viral response rate. After 12 wks of therapy, he has started c/o severe weakness, and his baseline blood parameters showed Hb of 5.6 gm/dl amd TC of 5000/cmm with normal DLC. Other parameters are normal. Now, whether to stop Ribavirin or simply reduce the dose? Is there any role of Erythropoitein? If yes, at what dose?
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Kindly look at the attached link.
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