31/129. Physical symptoms under forced-phase advance treatment in a patient with delayed sleep phase syndrome: a case report.The physical symptoms that are observed with forced waking in patients with delayed sleep phase syndrome (DSPS) often prevent the successful treatment of patients. Better understanding of these symptoms will assist in providing appropriate treatment in such patients. Herein, a 19-year-old female patient with DSPS is described, in whom headache, fatigue, and dizziness were observed under forced-phase advance treatment. Statistical analysis showed that her headache was dependent on the therapeutic week, and her fatigue was dependent on the period of the day. There was no association between dizziness and either factor. Experience with this patient indicates that the fatigue observed with forced waking is related to the circadian system. This relationship should be explored for other physical symptoms as well.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
32/129. Symptomatic hyperthyroidism in a patient taking the dietary supplement tiratricol.An 87-year-old woman was referred for evaluation of nervousness, tremor, insomnia, and fatigue of 2 months' duration. Initial laboratory evaluation revealed a suppressed thyrotropin level and an elevated triiodothyronine level. A review of her medications revealed that she had started taking several dietary supplements at the recommendation of her chiropractor before the onset of symptoms. One of these was tiratricol (3,5,3'-triiodothyroacetic acid or Triac), a substance sold as a dietary supplement despite classification as a drug by the food and Drug Administration. Tiratricol has weak thyromimetic effects, can inhibit pituitary thyrotropin secretion, and in higher doses can significantly stimulate metabolism. Such was the case with this patient who presented with signs, symptoms, and biochemical evidence of hyperthyroidism that promptly resolved after discontinuation of tiratricol therapy. To our knowledge, this is the first reported case of documented thyrotoxicosis secondary to tiratricol use. Because tiratricol is still available for sale on several internet sites, this case emphasizes the importance of inquiring about the use of dietary supplements in all patients. The availability of such products on the internet increases the already complex task of monitoring patients' use of dietary supplements.- - - - - - - - - - ranking = 0.28571428571429keywords = ms (Clic here for more details about this article) |
33/129. A critical analysis of the value of symptom models for managing chronic fatigue in patients with end stage renal disease.Preparing hemodialysis nurses to assume facilitator positions during health assessment and intervention planning requires that the traditional helping of hemodialysis clients, which refers to helping clients identify symptoms so that nurses or doctors can decide on actions, be augmented with the application of symptom models. In this article, a discussion is provided of how two symptom models, the Symptom Interpretation Model (SIM) and the Symptom Self-Care Response Model (SSCRM), prepare hemodialysis nurses to use an empowerment education approach to influence positive client outcomes. An analysis of the clinical usefulness of both models applied to a case study involving a chronically-fatigued hemodialysis client provides examples of strengths and weaknesses of the process by which clients assess and decide what to do about their symptoms. The paper clearly demonstrates that the application of symptom models enhances nursing knowledge and positively influences nursing practice.- - - - - - - - - - ranking = 0.28571428571429keywords = ms (Clic here for more details about this article) |
34/129. multiple sclerosis and oral care.multiple sclerosis is a complex neurological condition affecting sensory and motor nerve transmission. Its progression and symptoms are unpredictable and vary from person to person as well as over time. Common early symptoms include visual disturbances, facial pain or trigeminal neuralgia and paraesthesia or numbness of feet, legs, hands and arms. These, plus symptoms of spasticity, spasms, tremor, fatigue, depression and progressive disability, impact on the individual's ability to maintain oral health, cope with dental treatment and access dental services. Also, many of the medications used in the symptomatic management of the condition have the potential to cause dry mouth and associated oral disease. There is no cure for multiple sclerosis, and treatment focuses on prevention of disability and maintenance of quality of life. Increasingly a multi-disciplinary team approach is used where the individual, if appropriate his/her carer, and the specialist nurse are key figures. The dental team plays an essential role in ensuring that oral health impacts positively on general health.- - - - - - - - - - ranking = 158.15924492861keywords = multiple sclerosis, sclerosis, ms (Clic here for more details about this article) |
35/129. Tau exon 10 16 mutation FTDP-17 presenting clinically as sporadic young onset PSP.The authors describe a case of clinically diagnosed young onset progressive supranuclear palsy (PSP) with symptom onset at 40 years of age and no family history of neurodegenerative disease. There was no history of falls during the first year of symptoms. Genetic analysis identified this patient as having a tau exon 10 16 mutation (MAPT, IVS10, C-U, 16). Neuropathologic examination confirmed the genetic diagnosis of frontotemporal dementia. An age at onset younger than 50 years combined with the absence of early falls may indicate the possibility of a tau mutation in clinically diagnosed PSP.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
36/129. dyspnea on exertion, fatigue, and pallor in a 50-year-old active duty soldier.OBJECTIVE: To discuss a comprehensive diagnostic approach to an active duty patient presenting with dyspnea on exertion, fatigue, and pallor. A 50-year-old active duty E-6 white male in Al Udeid, qatar, presented with progressive dyspnea on exertion, fatigue, and new pallor. This case illustrates the course of events from Al Udeid to the Walter Reed Army Medical Center, where the final diagnosis was made. Along the way, questions with discussions explore the various diagnostic and management aspects of his case and highlight military relevant issues that include efficient diagnostic algorithms in the field and transfusion of scarce blood products.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
37/129. creatine phosphate kinase elevations signaling muscle damage following exposures to anticholinesterases: 2 sentinel patients.In this study, the authors describe 2 patients who experienced confirmed exposures to anticholinesterases that commenced in the 1970s. Subsequently, elevations in creatine phosphate kinase (CPK) were initially detected more than a decade following the first acute exposure. Beginning in the early 1980s, the patients suffered from progressive generalized muscle weakness, chronic fatigue, myopathy, neuropathy, and severe neurobehavioral impairments. Previous occupational exposures included pyridostigmine, as well as isopropyl methylphosphonofluoridate (percutaneous lethal dose [LD50] < 28 mg/kg body weight), and 1 patient had exposure to agricultural organophosphates. The authors hypothesize that the workers' CPK elevations, first detected more than a decade following acute exposures to anticholinesterases, were sentinel events for impending muscle damage and necrosis. Many gulf war veterans with gulf war disease who reported exposures to anticholinesterases 1 decade earlier currently suffer from vague neuromuscular and cognitive impairments. Therefore, medical programs for gulf war veterans with gulf war syndrome should include surveillance for elevated CPK, abnormalities of neuromuscular conduction, and genetic susceptibility, and they should promote therapeutic trials for palliation.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
38/129. Laparoscopic approach to the management of intraabdominal unicentric Castleman's disease.Castleman's disease, or angiofollicular lymphoid hyperplasia, is a rare lymphoproliferative disorder of unknown etiology. We present the case of an 18-year-old woman who was admitted with symptoms of fatigue, weakness, early satiety, and weight gain. A subhepatic mass anterior to the pancreas was discovered on ultrasound. After being treated via the laparoscopic approach with complete surgical resection she recovered well. This case thus represents a new application for laparoscopy and expands the indications for its use.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
39/129. Diagnostic and management strategies for anaemia in adults.BACKGROUND: Anaemia is often an incidental finding or is discovered when patients present with nonspecific symptoms such as tiredness. OBJECTIVE: This article presents strategies to identify the cause of anaemia and uses four case studies to illustrate these principles. DISCUSSION: Few diagnostic tests can completely rule in or rule out causes of anaemia. This makes the investigation of anaemia complex. An understanding of the limitations of tests in aiding diagnosis is required.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
40/129. From trench fever to endocarditis.The case of a 44 year old woman with infective endocarditis due to bartonella quintana, an organism long recognised to cause a condition known as trench fever, is reported. This case illustrates the lengthy differential diagnosis of "culture negative" endocarditis. In addition the presence of serological cross reactivity of Bartonella spp and chlamydia spp demonstrates the potential for misdiagnosis in these circumstances.- - - - - - - - - - ranking = 0.14285714285714keywords = ms (Clic here for more details about this article) |
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