adenosine

adenosine


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tachycardia

tachycardia



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Nutrition Myths You Still Believe ...

5 Nutrition Myths You Still Believe Even Though Science Has Proved Them Wrong

By Ginger Vieira

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fatigue

fatigue

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Chronic Fatigue Syndrome: Implications for Women and Their Health Care Providers During the Childbearing Years

Peggy Rosati Allen, CNM, WHNP, MS, LCCE

Disclosures

J Midwifery Womens Health. 2008;53(4):289-301.

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Palliative Care and Pain Management at the End of Life

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Managing fibromyalgia: An update on diagnosis and treatment

October 17, 2009 | Fibromyalgia, Pain, Arthritis

- See more at: http://www.rheumatologynetwork.com/fibromyalgia/managing-fibromyalgia-update-diagnosis-and-treatment#sthash.GaGDvsot.dpuf

Managing fibromyalgia: An update on diagnosis and treatment
October 17, 2009 | Fibromyalgia, Pain, Arthritis
- See more at: http://www.rheumatologynetwork.com/fibromyalgia/managing-fibromyalgia-update-diagnosis-and-treatment#sthash.GaGDvsot.dpuf
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Chronic Fatigue Syndrome: Diagnosis to Management

Faculty and Disclosures

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Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness

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Released:	February 10, 2015

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Diagnosis of insomnia

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Practice Guideline

A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue

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Management of Heatstroke and Heat Exhaustion

JAMES L. GLAZER, M.D., Maine Medical Center, Portland, Maine

Am Fam Physician. 2005 Jun 1;71(11):2133-2140.

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Cancer-Related Fatigue: Epidemiology, Pathogenesis, Diagnosis, and Treatment

Dtsch Arztebl Int 2012; 109(9): 161-72; DOI: 10.3238/arztebl.2012.0161

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Worker Fatigue: Managing concerns in rapid renewal highway construction projects

Author(s): Ernst A.P. Koningsveld

Organization(s): Professional Safety magazine

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weakness

weakness

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Weakness is a decrease in the strength in one or more muscles. In the strictest sense, the medical definition of weakness refers to loss of muscle strength, and this article is focused upon conditions that can result in a measurable loss of muscle function. Weakness may be generalized or may affect one muscle or muscle group exclusively. Diseases of the neuromuscular system, injuries, metabolic diseases, and toxins can all cause of measurable muscle weakness. Signs and symptoms of weakness can include trouble doing daily tasks, such as grooming or writing or problems with gait and loss of balance.

Many people use the term weakness as a synonym for
tiredness, weariness, lack of energy or fatigue, although this is not technically correct. People suffering from certain medical conditions (for example,
chronic fatigue, insomnia, cancer, heart disease, adrenal disease, or
influenza) may describe feelings of total body weakness, referring to feelings of malaise or tiredness, even though no detectable loss of muscle strength is present.

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Related
Symptoms & Signs

• Fatigue
• Muscle Cramps
• Fever

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sLides
Causes of Fatigue: Find Out Why You're So Tired
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Not Enough Sleep - Sleep Apnea - Not Enough Fuel - Anemia - Depression - Hypothyroidism -Caffeine Overload - Hidden UTI - Diabetes - Dehydration - Heart Disease - Shift Work Sleep Disorder - Food Allergies - CFS and Fibromyalgia

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Chronic Fatigue Syndrome Causes and Treatment

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Clinical Pathway: Diagnostic Algorithm For Acute Nontraumatic Bilateral Weakness

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Clinical Pathway: Diagnostic Algorithm For Acute Nontraumatic Unilateral Weakness

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FIGURE 2  Algorithm for the diagnosis of myotonias.

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Pompe Can Mimic the Presentation of Limb-Girdle Muscular Dystrophy

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Generalised muscle weakness

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The Differential Diagnosis of Weakness: 5 Cases
December 01, 2007 | Endocrine Diseases, Infection
By Namita Goyal, MD and William S. David, MD, PhD
- See more at: http://www.consultantlive.com/endocrine-diseases/differential-diagnosis-weakness-5-cases#sthash.9LNckcZl.dpuf
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ICU-Acquired Weakness

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Why Do I Always Feel Tired?” Evaluating Older Patients Reporting Fatigue

Tue, 11/12/13 - 14:19

Citation: 

Consultant. 2013;53(11):785-789

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Fever of Unknown Origin

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fever and Abdominal Pain

Authors: Christopher J Grace, M.D., FACP, Thomas L. Husted, M.D., Joseph S. Solomkin, M.D.
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Approach to the Adult Patient with Fever of Unknown Origin

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Table 1: Diagnosis of patients with diffuse abdominal pain

	Risk Factors	Presentation	Evaluation
Primary Peritonitis	·        Ascites due to cirrhosis, severe hypoalbuminemia from nephrotic syndrome, CHF, malignancy ·        CAPD catheter ·        VP shunts	·        Diffuse abdominal pain, fever, nausea, vomiting1 ·        Leukocytosis3 ·        Other signs and symptoms of hepatic failure5	·        Blood cultures4 ·        AAS ·        Abdominal CT scan ·        Paracentesis2 ·        Liver enzymes7 ·        Amylase, lipase
Secondary Peritonitis	·        Appendicitis ·        Cholecystitis ·        Diverticulitis ·        Peptic ulcer disease ·        Abdominal injury ·        GI neoplasm ·        Bowel obstruction ·        Mesenteric ischemia ·        Surgical anastomotic leak ·        GU infections6	·        Acute onset of diffuse abdominal pain, fever, nausea, vomiting ·        Abdomen rigid, hypoactive or absent bowel sounds, guarding and rebound tenderness ·        Leukocytosis3	·        Blood cultures4 ·        AAS ·        Abdominal CT scan ·        Liver enzymes7 ·        Amylase, lipase ·        Exploratory laparotomy
Lower Lobe Pneumonia	·        Aspiration ·        Smoking ·        COPD	·        Upper abdominal pain ·        Cough, hypoxia may be present ·        Localized rales on chest examination	·        Blood cultures ·        Chest x-ray

CT, computerized tomography; CHF, congestive heart failure; COPD, chronic obstructive lung disease; GI, gastrointestinal; GU, genitourinary; CAPD, continuous peritoneal dialysis catheter; VP, ventriculoperitoneal; AAS, acute abdominal series
¹ Patients with cirrhosis and primary peritonitis may occasionally present without fever or abdominal pain. Consideration should be given to perform paracentesis inpatients with ascites.
² Ascitic fluid should be sent for white blood cell count and differential, protein, Gram stain and culture, lactate level and pH. Fluid may also be inserted into a blood culture bottle for culture. The yield of ascitic fluid Gram stain and culture is poor. A negative test result does not exclude spontaneous bacterial peritonitis (SBP). A fluid white blood cell count > 250 cells/mm3 is diagnostic of SBP.
³ Patients with overwhelming infections may have leukopenia and marked bandemia
⁴ Two sets should be obtained prior to the start of antibiotics. The yield of blood cultures in secondary peritonitis approaches 75%, while it is substantially poorer in patients with SBP.
⁵ Encephalopathy, variceal bleeding
⁶ septic abortion, salpingitis, post partum endometritis
⁷ Liver enzymes; aspartate amino transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin



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Table 2: Diagnosis of patients with localized abdominal pain

	Risk Factors	Presentation	Evaluation
Hepatitis	·        Alcohol ingestion ·        IDU ·        Ingestion of contaminated food	·        RUQ pain ·        Fever, nausea, vomiting ·        Jaundice	·        Liver enzymes7 ·        Serologic tests for viral hepatitis3 ·        Serologic tests for less common causes as indicated4
Hepatic abscess	·        Appendicitis ·        Diverticulitis ·        Cholecystitis ·        Bacteremia	·        RUQ and epigastric pain ·        Fever, nausea, vomiting ·        Leukocytosis	·        Blood cultures ·        Liver enzymes7 ·        RUQ ultrasound ·        CT scan
Cholecystitis1	·        Gallstones ·        Trauma, burns	·        Postprandial RUQ and epigastric pain ·        Fever, nausea, vomiting ·        (+) Murphy’s sign2 ·        Leukocytosis	·        Blood cultures ·        RUQ ultrasound5 ·        Liver enzymes7 ·        Amylase, lipase
Cholangitis	·        Obstruction of the biliary tree from gallstones, malignancy, surgery	·        RUQ pain6 ·        Fever, nausea, vomiting ·        Jaundice ·        Leukocytosis	·        Blood cultures ·        RUQ ultrasound ·        Liver enzymes7 ·        Amylase, lipase
Appendicitis	·        Generally none ·        Foreign bodies ·        Tumor ·        Strictures ·        Parasitic infection8	·        Periumbilical pain migrating to RLQ ·        Fever, nausea, vomiting ·        Leukocytosis	·        CT scan
Diverticulitis	·        Diverticulosis	·        LLQ pain9 ·        Fever, nausea, vomiting ·        Leukocytosis	·        Blood cultures ·        CT scan
Splenic abscess	·        Bacteremia ·        Endocarditis ·        Sickle cell disease ·        IVDA	·        LUQ pain referred to left shoulder ·        Fever, nausea, vomiting ·        Leukocytosis	·        CT scan ·        CXR11
Colitis10	·        Contaminated food and water ·        Antibiotics ·        Recent hospitalization	·        Diarrhea, hematochezia ·        RLQ, LLQ pain ·        Fever ·        Leukocytosis	·        Stool culture10 ·        Fecal leukocytes ·        Clostridium difficiletoxin assay
Pelvic Inflammatory Disease	·        Young age and  sexual active12 ·        New sexual partner ·        Bacterial vaginosis ·        IUD	·        RLQ, LLQ pain ·        Fever ·        Leukocytosis	·        Bimanual pelvic examination ·        Pelvic ultrasound ·        CT scan
Endometritis	·        Pregnancy13	·        Suprapubic pain ·        Fever ·        Leukocytosis	·        Bimanual pelvic examination
Pancreatic abscess	·        Pancreatitis	·        Periumbilical and back pain ·        Fever ·        Leukocytosis	·        Blood cultures ·        Liver enzymes7 ·        Amylase, lipase ·        CT scan
Renal abscess	·        Kidney stones ·        Ureteral obstruction ·        DM ·        Bacteremia	·        Flank and back pain ·        Fever ·        Leukocytosis	·        Blood cultures ·        Urine culture ·        Renal ultrasound ·        CT scan
Pyelonephritis	·        Kidney stones ·        Ureteral obstruction ·        DM	·        Flank and back pain ·        Fever, nausea, vomiting ·        Leukocytosis	·        Blood cultures ·        Urine culture ·        Renal ultrasound

IDU, injection drug use; RUQ, right upper quadrant; RLQ, right lower quadrant; LLQ, Left lower quadrant; LUQ, left upper quadrant; CT, computerized tomography; DM, diabetes mellitus; CXR, chest x-ray; IUD, Intrauterine contraceptive devices
¹ 95% due to gallstones. Acalculous cholecystitis can be seen after trauma, surgery, burns and in those with HIV infection, immune suppression and DM
² Murphy’s sign: inspiratory arrest during palpation of the RUQ. Named after John B. Murphy (1857- 1918), a Chicago, Illinois surgeon.
³ Hepatitis A virus IgG and IgM antibody, Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (HBsAb), Hepatitis B core antibody (HBcAb), Hepatitis C virus antibody.
⁴ IgM, IgG antibody for cytomegalovirus (CMV), monospot for Epstein Barr Virus (EBV) infection, antibody for human immunodeficiency virus (HIV) infection
⁵ Thickened gallbladder wall, pericholecystic fluid, (+) sonographic Murphy’s Sign
⁶ The classic Charcot’s triad of RUQ pain, fever and jaundice is seen in less than 20% of patients.
⁷ Liver enzymes: aspartate amino transferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin
⁸ Enterobius vermicularis, Ascaris lumbricoides, Strongyloides stercoralis
⁹ Pain may be RLQ or suprapubic depending on the position of the colon and location of the inflamed diverticula.
¹⁰ Including food borne bacterial colitis from Campylobacter, Salmonella, Shigella, Escherichia. Coli 015H7 and antibiotic related Clostridium difficile.
¹¹ May reveal left lower lobe atelectasis, effusion, elevated left hemidiaphragm
¹²  Pelvic inflammatory Diseases (PID) are often due to sexually transmitted pathogens such as Neisseria gonorrhoeae or Chlamydia trachomatis.
¹³ Seen more often with cesarian section, ruptured membranes for > 6 hours, multiple cervical examinations and chorioamnionitis.
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Table 3: Microbiology of diffuse peritonitis

Clinical Diagnosis	Community acquired	Hospital acquired
Primary Peritonitis1	·        E. coli, Klebsiella pneumoniae,Proteus spp, Enterobacter spp OR ·        S. pneumoniae OR ·        Streptococci, enterococci	·        Resistant  E. coli, Klebsiella spp, Proteus spp, Enterobacter spp OR ·        P. aeruginosa
Secondary Peritonitis2	·        E. coli, Klebsiella spp, Proteus spp, Enterobacter spp AND ·        Enterococci AND ·        Anaerobes including Bacteroides,Clostridium, Prevotella	·        Resistant  E. coli, Klebsiella spp, Proteus spp, Enterobacter spp, P. aeruginosa, Serratia, Acinetobacter AND ·        Enterococci including VRE AND ·        Anaerobes including Bacteroides, Clostridium, Prevotella AND ·        Candida spp.

¹Primary peritonitis is most often monomicrobial. One third of patients have negative cultures from paracentesis. Anaerobic bacteria are uncommon and isolation should raise the concern of secondary peritonitis.
² Secondary peritonitis is polymicrobic involving aerobic gram negative rods (GNR), enterococci and anaerobes.
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9 Ways Some People Will Take Advantage of You

 

Is someone in your life slowly driving you up a wall? This may be why.
Post published by Diane Dreher Ph.D. on Mar 06, 2015 in Your Personal Renaissance
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In Sheep's Clothing: Understanding and Dealing with Manipulative People

by George K. Simon Jr.
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nice

An Illustrated Celebration of the Many Things Home Can Mean

By: Maria Popova

A sweet reminder that despite our different walks of life, we have in common a shared longing to belong.

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The Night Life of Trees:

Exquisite Handmade Illustrations Based on Indian Mythology

by Maria Popova

 

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Four Charles Bukowski Poems Animated

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Bluebird animation based on Charles Bukowski's poem

A Beautiful Animated Adaptation of Bukowski’s Poem “Bluebird”

by Maria Popova    |   go    |

books and chiLdhood

Edward Gorey’s Never-Before-Seen Letters and Illustrated Envelopes

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what about meALs …

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nice

A Funny Thing Happened on the Way to School:

 

A Charming Catalog of Excuses and an Allegory for How Human Imagination Works

by Maria Popova

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