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jcrmhscasereports · 1 year

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Case of Necrotizing Pancreatitis following COVID-19 Infection by Faezeh Sehatpour in Journal of Clinical Case Reports Medical Images and Health Sciences

ABSTRACT

New aspects of COVID-19 are increasingly being recognized. Although the virus is mainly known to affect the lungs, involvement of other organs including the heart, liver, gastrointestinal, renal and pancreas is also detected. Acute pancreatitis is detected as one of both the early and late presentations of COVID -19. Cytokine storm or the presence of angiotensin-converting enzyme 2 (ACE2) receptor in pancreatic cells, are both two causes of pancreatic injury in COVID-19 infection. In this study, we reported a 25-year-old man admitted to our department with the impression of necrotizing pancreatitis concomitant with COVID-19 infection. Patient's lab data, imaging and outcomes were documented in full detail.

Abbreviations:

WBC, white blood cell;HB, hemoglobin; MCV, mean corpuscular volume; PLT, platelet; BUN, blood urea nitrogen; Na, sodium; K, potassium; ; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ALK.P, alkaline phosphatase; ALB, albumin; LDH, Lactate dehydrogenase ; CPK, creatine phosphokinase; CRP,c-reactive protein; AFP,alpha-fetoprotein; CEA,carcinoembryonic antigen; CA19-9,cancer antigen 19-9; Immunoglobulin G4.

INTRODUCTION

The Covid-19 pandemic is an ongoing pandemic that started in December 2019 and spread rapidly around the word. COVID-19 was caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), first identified in Wuhan, China. So far, more than 200 countries have been affected by the pandemic. (1)

The involvement of the gastrointestinal system is maybe due to the expression of the angiotensin-converting enzyme2 (ACE2) on the hepatocyte, cholangiocyte and other parts of the GI tract. (3) In a recent survey, acute pancreatitis was detected as one of both early and late presentations of COVID -19. (4-6) However, it is still unclear whether SARS-COV-2 directly affects pancreatic cells because of ACE2, if it is a cytokine storm which causes pancreatic injury. (7)

We reported a case of COVID-19 with subsequent acute necrotizing pancreatitis.

CASE REPORT

A 25-year-old man without any known medical disease presented to our emergency department with progressive epigastric pain, nausea and vomiting and anorexia one week prior to admission. He has no history of alcohol consumption. He also had a history of admission to another hospital about two weeks ago with a diagnosis of COVID-19 pneumonia. On admission, he has a blood pressure of 115/75 mm HG, a heart rate of 100 beats per minute, a temperature of 37.1 ⁰C and oxygen saturation of 95% while the patient is breathing in the room air. Primary investigations summarized in Table-1. Amylase and lipase were 146 IU/L and 82 IU/L respectively. Nasal swab test for COVID-19 (RT-PCR for SARS-CoV-2) was positive. Abdominal sonography showed markedly prominent pancreas with in homogeneous parenchymal echogenicity and large cystic lesion arising from the pancreas, in favor of acute complicated pancreatitis with pseudo cyst. The gall bladder has a normal size and wall thickness without any gall stones. The pancreatic duct was not dilated. Due to the finding of abdominal ultra sound, CT scan of abdomen was done on him which revealed an enlarged pancreas with necrosis of the main portion of pancreatic parenchyma. Large cystic lesion measuring 15×7×11 cm in size arising from the pancreatic neck with extension to the right and left side of the abdomen suggestive of large pancreatic pseudo cyst (figure1). Lung HRCT (low dose) also showed bilateral peripheral ground glass opacities in favor of COVID-19 pneumonia (figure2). According to the findings of a physical exam, laboratory data and clues in imaging immediate management of acute necrotizing pancreatitis (invasive intravenous hydration and pain control) was started for him. He was finally discharged from the hospital with a full recovery.

Table 1: laboratory data

Figure 1: Abdominal CT scan: large loculated pseudo cystic structure measuring about 158mm*100mm in lesser sac due to post pancreatitis pseudo cyst formation.

Figure 2: lung HRCT: multiple ground glass and bilateral pleural effusion

DISCUSSION

Acute pancreatitis is an acute inflammation of the pancreas characterized by abdominal pain, nausea, vomiting and elevated exocrine pancreatic enzymes; amylase and lipase. Gallstones and chronic alcohol abuse are the most common causes of acute pancreatitis. Viruses are uncommon causes of acute pancreatitis. Pancreatitis has been reported with several viruses, including mumps, coxsackievirus, hepatitis A and B virus, cytomegalovirus, varicella-zoster, herpes simplex and human immunodeficiency virus. (8)

Although we have not conclusively proven the presence of the virus in the pancreas, the causes of COVID-19 and acute pancreatitis and the lack of other clear causes for pancreatitis strengthen the relationship between the two diseases. In this study, the patient presented with necrotizing COVID-19in 19 in the early post period of COVID-19 infection.

In Fan Wang and colleagues' survey, 52 COVID-19 cases followed and showed that 17% of COVID-19 patients developed pancreatic injury and presented with mild elevated pancreatic enzymes; serum amylase and lipase without clinically severe pancreatitis. The possibility of drug induced acute pancreatitis in patients who have received medication due to COVID-19 is also expressed as one of the reasons for acute pancreatitis in COVID-for19 infection. (9) Saffa Saeed Al Mazrouei and his teammates reported a 24-year-old patient with acute non-necrotizing pancreatitis with concurrent COVID-19. No evidence of pseudo cyst or abscess was detected in his imaging. (10)

Pancreatic damage can be due to the direct effect of the virus on pancreatic cells or indirectly secondary to the immune system. In another study in Wuhan, it showed that ACE2 was expressed in the pancreas higher than the lung in the normal population, indicating that SARS-CoV-2 can bind to ACE2 in the pancreas and cause pancreatic cell damage. (7, 11)

Acute pancreatitis is one of the presentations or complications of COVID-19 infection. Further investigation with samples is needed to reveal the pathophysiology, presentation, treatment and prognosis of acute pancreatitis in COVID-19 infection.

For more information: https://jmedcasereportsimages.org/about-us/

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#COVID-19 #Cytokine storm #blood cell;HB #aminotransferase #CRP #c-reactive protein #carcinoembryonic antigen #alpha-fetoprotein #anorexia #RT-PCR for SARS-CoV-2 #HRCT #Faezeh Sehatpour #jcrmhs

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writer59january13 · 1 year

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April 5, 2023 – refracted reflections:

The following lines

haphazardly linkedin

slap dash fashion

over the course of dazed and confused days,

therefore desist reading

any profound meaning if you dear reader dare expend

energy and time perusing

meandering gibberish.

One mortal wedded male

pledged his troth and married gold,

thus Marigold (abbreviation of her name)

my monied imaginary paramour,

I willingly tasted sweetened deal

until milk of human kindness went sour,

whereat said benefactor

no longer ponied up funds

and didst reckon

eyes that espy wads of moolah.

She naysayed bequeathing

unlimited largesse,

and claimed over generous

financial beneficence

spurred misplaced

horse sense to go amiss not thee holy grail

viz billeted, fortified,

lulled, and touted panacea

steeped with ushering bliss delivering monetary salvation

analogous envisioning mirage

to an ephemeral lost horizon, which illusory utopia

foolhardy to chase after fostering long globe trotting criss

crossing all four square corners

across the oblate spheroid

in search of said golden manna, experiencing das boot

jilted jack of alt raids

copacetic, fetishistic,

idiomatic...logogrammatic, opportunistic, rhapsodic, universalistic...,

nevertheless despite surge

of clamoring sycophants

bajillion dollars windfall wordsmith

wishes himself subsequently

cursed bing flush

with ample legal tender

quite ad aware

regarding the over emphasis

on material trappings courtesy the blitzkrieg of

mass media/ popular culture

and the adumbrated pleasure

of the leisure class

vis a vis his venerated holiness trumpeted, encapsulated, and donned

conspicuous consumption

(tba as wasting away greenbacks)

SPCA adopted pet credo, ethos,

hot button western civilization polemics, this hortatory expressed

by Thorstein Veblen doth not miss

a figurative beat,

which American

not so shabby chic ethic

brought him as eminence grise - though tongue in cheek he made Swiss

cheese out of the bulwark constituting the capitalistic coda, which I rarely sermonize, but tis

only this instance to beseech whomever may anonymously

intercede on my behalf to parlay voo any dollar figure - since this LXIV year old papa

of two fully grown darling daughters struggles psychologically like the dickens

learning how to take broken wing, and a prayer

to reinforce analogous fence of defiance, yours truly uber twittering

one flew over the cuckoo's nest

birds of a feather stick together

meaning mine other half thee spouse similarly tussles and wrestles

with psychological mailer daemons - that snigger and laugh

at owning psychic landscape, as similar malevolent depredations infiltrate my mind –

ousted through the staff

of pharmaceutical wizards -

this chap relies on eight prescription medications to attain quality mental health and receives social security disability for incursions of anxiety, panic, and social schizoid disorders

in years gone by exacerbated by unceasing verbal black barbs

from mine invisible mistress - ha.

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myinnerscarlett · 3 years

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Just call me Madam, Maestro, Majesty, Master, Mistress...or Mensa member

Do any of these conjure up a particularly positive connotation? Not in the latter case (at least among some who have tested into the group just to infiltrate our camps). Yes, I’m referring to a certain comedienne (no, not “The Marvelous Mrs. Maisel”) who reported it was a bastion of right-wing politics. “Camps” not just Steiner summer camp in the Catskills. So much for the “alt right” am I right? Mrs. Maisel did that bit, too. The Nichols and May reference. I only steal from the best. Back to politics... Especially in our current climate, when we would find it difficult to travel to Tuscany even if we could find a house for rent, well that’s what he said. That is, looking back fondly on that episode of Seinfeld, the guy who insisted because he conducted on-the-side gigs his friends must refer to him as “The Maestro” is of particular poignance. Master is, of course, taboo, and reminiscent of our history of slavery. Madam has mistress written all over it. A madam runs a brothel. Majesty is right out of the question in a democracy. Characters worthy of a play, most of them unworthy of honorable mention, I’d say...save for alliteration’s sake “The Marvelous Mrs. Maisel.” And that's the point, princess. Even “Mr.” and “Mrs.” or “Ms.” is considered an “honorific.” But let’s not get ahead of ourselves, missy. The world is full of examples like “The Maestro” nothing more or less than a light-hearted and humorous attack on the use of “honorifics” that sprinkle the writer’s pad. Dr. Seuss is an example of one who has neither a PhD nor an MD. In honor of this season of The Grinch, let’s remember a talented man, who gave himself a pseudonym. Or, as The Marvelous Mrs. Maisel puts it a “nom de plume.” A stage/pen name. Jackie says it sounds like a sex toy. I won’t elaborate. Jokes are almost always better than taking yourself too seriously. A fault I find with all who insist on using an honorific. Just like the Maestro. Earned or given, the quality of the degree matters. As does the dissertation. The word honorific does not apply only to an honorary, but usually to a two letter abbreviation that seems to invite way too much controversy. The best among the academics and the medical field alike are not wrapped up in themselves. Public servants, remember, not slaves, as no one should be on either side of the desk - and I should know having frequently worked both sides of that desk simultaneously. It’s up to you what you call someone, not that individual. Or else, this is not a free country. No one can dictate the words that come from you. You are the boss. If students refuse to refer to professors that way, which is their right, so can customers of health care, sometimes known as mere patients. I know it seems like an either or proposition and I think there are many people who agree, but it seems the majority want to defend the honorific not of Mr. or Mrs. X at The Gaslight but that good ole doc. They defend it like it’s their reputation or their own skin. Or even their religion. In this way, I might be more like tRump than I care to admit. Is it a zero sum game if you want it so much it seems like a win for you to be called Madam X. If I don’t follow suit, do you lose and I win! I’ve voted once and I’ll vote again. It’s the run-off. I live in Georgia. Sorry if the Scarlett reference is under attack. It still fits especially where I landed. It’s tongue-in-cheek, a pseudonym I gave myself years ago, myinnerscarlett, knowing all too well I have no mean bone in my body and could never imagine beating a horse, as she is shown to do in the film, now a film rightfully explained in context of the time frame. The actors in the film defended their various roles, regardless. In retrospect, I hope we don’t lose every shred of our sense of humor in our pursuit for the betterment of society. On this point, however, I am taking no one’s side. No one hears me pronounce the honorific because it doesn’t mean a thing, save perhaps pretense. The letters belong behind the name. That goes for everybody. Period. It’s a habit worth breaking. What’s amazing is the backlash on this topic in times of so much real turbulence. Is this just another distraction? Scary thought. Even scarier than Halloween. And, as for true honorary degrees, just think of how many of those are revoked after the honoree falls from grace. Master aside, Mister, the old use of mistress, which Mrs. or Miss or Ms. is meant to abbreviate, as in lady or mistress of the house, is old-fashioned; and, as with slavery, there’s always a backstory. Now we can add to the list John’s Hopkins, which officially acknowledged a long held belief or mistake made in reference to its founder not having held slaves. Or is that too white-washed a term; owned is more to the point. The backstory is told, as the statues are removed. Ours is a haunting history and I’m not just talking Halloween. Sadly, all of these characters could be made into costumes. Some have been worn, unfortunately, in blackface. Thanksgiving is not much better in terms of the hidden backstory of abuse and even slavery of indigenous peoples. We prefer pretty pictures or cute, funny stories. They make us happy. We could all use a good laugh, but not at others’ expense. We don’t like stories of human or of animal abuse. We want heroes/heroines and we foster that sort of worship. We ignore the crux of the matter when (as one member of Mensa put in a recent letter to the editor about Aristotle) there’s a greater lesson to be learned. In reference as to whether or not nonhuman animals had rights, the gist was that politics was the highest form of ethics, and if ethics were the basis of animal rights, the world would be a better place. It’s more than academic. So, after the backlash, Edison fans focused on the Topsy scandal and diminished his role in the cruel electrocution of the former circus elephant; however, it’s also been reported that he performed the same cruelty on stray dogs and cats as well as cattle and horses. If he or his company affiliates filmed any act, I’d say complicit is as complicit does and this is just a matter of mincing words. He used to describe the gory details of electrocution, or so I’ve read, in its defense. Again, I get those were other times but there’s nothing pretty about it. It happened. Even if it was deemed less cruel than other forms of “execution” and even if it was practiced on humans at the time, have we learned nothing? Topsy, the elephant, was innocent. The cruelty on the part of a drunken handler (much like a slave owner) caused behavioral concerns that justified in the twisted minds of the circus owners and their cronies using her one last time. It was a cruel demonstration. Edison is also purported to have cheated his most famous assistant, Nikola Tesla. Geeks and nerds love this guy. I say that in jest. Hopefully, Mensans still have a sense of humor. It’s a sliding scale, right? If Edison was alive today, what would he say? Well, apart from the usual rhetoric, how’s this for an anecdote. True or not, believe it or not, he had a reputation of being a slob. That’s slob, not snob, as he wore his shoes two sizes too big in order to slip into them more easily. No bending over to tie shoe laces. Sounds like he should have invented the slip-on loafer. Self-promotion we know exists among showmen or editors and reviewers alike from within the least admired or lesser known organizations to most highly publicized and political platforms - sometimes to the point of being unethical. What else can you expect from a self-educated guy. As some have also pointed out, Mensa (overall) has a certain sartorial reputation. Subtlety, not discretion, is the better part of valor. Mincing words doesn’t make it right.

The narcissists are running our country now. You need to understand what this means. Read and share this book today!

#edison #mensa #the marvelous mrs. maisel #biden

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trishmishtree · 4 years

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[Current as of March 13, 2020]

Dr. Shahed (screenshot above) is an emergency department physician in Ohio who shared this post on Facebook. It’s an account of COVID-19 from the perspective of an ICU doc working on the frontlines in Seattle. Some of my laypeople-friends were sharing it around (and I’ve seen it floating around on twitter and various internet forums], but I noticed that it’s really dense and contains a lot of medical abbreviations and jargon, like it was meant more for other physicians and isn’t really useful for the average reader. So I thought I’d provide a translation for my non-medblr followers who are looking to stay informed. (If you want further clarification, feel free to drop me an ask)

***

This is from a front-line ICU physician in a Seattle hospital

This is his personal account:

We have 21 patients and 11 deaths since 2/28.

We are seeing patients who are young (20s), fit, no comorbidities, critically ill. It does happen.

US has been past containment since January

Currently, all of ICU is for critically ill COVID patients, all of med-surg [medical-surgical] floors are for stable COVID patients and end-of-life care, half of PCU [progressive care unit], half of ER. New Pulmonary Clinic offshoot is open for patients with respiratory symptoms

CDC is no longer imposing home quarantine on providers who were wearing only droplet-isolation PPE when intubating, suctioning, bronching, and in one case doing bloody neurosurgery. Expect when it comes to your place you may initially have staff home-quarantined. Plan for this NOW. Consider wearing airborne-isolation PPE for aerosol-generating procedures in ANY patient in whom you suspect COVID, just to prevent the mass quarantines.

We ran out of N95s (thanks, Costco hoarders) and are bleaching and re-using PAPRs [powered air purifying respirators], which is not the manufacturer’s recommendation. Not surprised on N95s as we use mostly CAPRs [controlled air purifying respirators] anyway, but still.

Terminal cleans (including UV light) for ER COVID rooms are taking forever, Environmental Services is overwhelmed. This is bad, as patients are stuck coughing in the waiting room. Recommend planning now for Environmental Service upstaffing, or having a plan for sick patients to wait in their cars (that is not legal here, sadly).

CLINICAL INFO (based on our cases and info from CDC conference call today with other COVID providers in US):

The Chinese data on 80% mildly ill, 14% hospital-ill, 6-8% critically ill are generally on the mark. Data [in the US] very skewed by late and very limited testing, and the number of our elderly patients going to comfort care.

Being young & healthy (zero medical problems) does not rule out becoming vented or dead

Probably the time course to developing significant lower respiratory symptoms is about a week or longer (which also fits with timing of sick cases we started seeing here, after we all assumed it was endemic as of late Jan/early Feb).

Based on our hospitalized cases (including the not-formally-diagnosed ones who are obviously COVID – it is quite clinically unique), about 1/3 of patients have mild lower respiratory symptoms and need 1-5L NC [1-5 liters of oxygen per minute, via nasal cannula]. 1/3 are sicker, need face mask or non-rebreather. 1/3 are intubated with ARDS [acute respiratory distress syndrome].

Thus far, everyone is seeing:

normal WBC [white blood cell] count. Almost always lymphopenic, occasionally poly [neutrophil]-predominant but with normal total WBC count. Doesn’t change, even 10 days in.

Bronchoalveolar lavage: lymphocytic despite blood being lymphopenic. (Try not to bronch these patients; this data is from pre-testing time when we had several idiopathic ARDS cases)

Fevers, often high, may be intermittent; persistently febrile, often for >10 days. It isn’t the dexmed, it’s the SARS2.

Low procalcitonin; may be useful to check initially for later trending if you are concerned later for VAP [ventilator-associated pneumonia], etc.

Elevated AST/ALT, sometimes alkaline phosphatase. Usually in 70-100 range. No fulminant hepatitis. Notably, in our small sample, higher transaminitis [elevated AST/ALT] (150-200) on admission correlates with clinical deterioration and progression to ARDS. LFTs [liver function tests] typically begin to bump in 2nd week of clinical course.

Mild AKI [acute kidney injury] (creatinine <2). Uncertain if direct viral effect, but notably SARS2 RNA fragments have been identified in liver, kidneys, heart, and blood.</li>

Characteristic chest x-ray: always bilateral patchy or reticular infiltrates, sometimes peri-hilar despite normal ejection fraction and volume down at presentation. At time of presentation may be subtle, but always present, even in our patients on chronic high dose steroids. NO effusions.

CT is as expected, rarely mild mediastinal lymphadenopathy, occasional small effusions late in course, which might be related to volume status/cap leak.

Note - China is CT'ing everyone, even outpatients, as a primarily diagnostic modality. However, in US/Europe, CT is rare, since findings are nonspecific, would not change management, and the ENTIRE scanner and room have to be terminal-cleaned, which is just impossible in a busy hospital. Also, transport in PAPRs, etc.

2 of our patients had CTs for idiopathic ARDS in the pre-test era; they looked like the CTs in the journal articles. Not more helpful than chest x-ray.

When respiratory failure occurs, it is RAPID (likely 7-10 days out from symptom onset, but rapid progression from hospital admission). Common scenario for our patients is: admit on 1L/min oxygen via nasal cannula. Next 12 hrs escalate to NPPV [non-invasive positive pressure ventilation]. Next 12-24 hrs → vent/proned/Flolan.

Interestingly, despite some needing Flolan, the hypoxia is not as refractory as with H1N1. Quite different, and quite unique. Odd enough that you’d notice and say hmmm.

Thus far many are dying of cardiac arrest rather than inability to ventilate/oxygenate.

Given the inevitable rapid progression to ETT [endotracheal tube, aka intubation] once respiratory decompensation begins, we and other hospitals, including Wuhan, are doing early intubation. Face mask is fine, but if patients are needing HFNC [high-flow nasal cannula] or NPPV [non-invasive positive pressure ventilation], just tube them. They definitely will need a tube anyway, and no point risking the aerosols.

No MOSF [multi-organ system failure]. There’s the mild AST/ALT elevation, maybe a small creatinine bump, but no florid failure. Exception is cardiomyopathy.

Multiple patients here have had normal EF [ejection fraction] on formal Echo or POCUS [point-of-care ultrasound] at time of admission (or in a couple of cases, EF 40ish, chronically). Also normal troponins from emergency department. Then they get the horrible respiratory failure, sans sepsis or shock. Then they turn the corner, come off Flolan, supined, vent weaning, looking good, never any pressor requirement. Then over 12 hrs, newly cold, clamped, multiple-pressor shock that looks cardiogenic, EF 10% or less. Then either VT [ventricular tachycardia, aka V-tach] → VF [ventricular fibrillation, aka V-fib] → dead, or PEA [pulseless electrical activity] → asystole in less than a day. Needless to say, this is awful for families who had started to have hope.

We have actually had more asystole than VT. Other facilities report more VT/VF, but same time course, a few days or a week after admission, around the time they’re turning the corner. This occurs on med-surg patients too. One today, who is elderly and chronically ill but with baseline EF preserved, became newly hypotensive overnight, EF <10. Already no escalation, has since passed. So presumably there is a viral cardiomyopathy aspect, which presents later in the course of disease.

Of note, no wall motion abnormalities on Echo, right ventricular function preserved, troponins don’t bump. Could be unrelated, but I’ve never seen anything like it before, especially in a patient who had been hemodynamically stable without sepsis.

TREATMENT:

Remdesivir might work, some hospitals have seen improvement with it quite rapidly, marked improvement in 1-3 days. ARDS trajectory is impressive with it, patients improve much more rapidly than expected in usual ARDS.

Recommended course is 10 days, but due to scarcity, all hospitals have stopped it when the patient is clinically out of the woods. None have continued >5 days. It might cause LFT bump, but interestingly seem to bump (200s-ish) for a day or 2 after starting, then rapidly back to normal, suggests this is not a primary toxic hepatitis.

Unfortunately, the Gilead compassionate use and trial programs require AST/ALT <5x normal, which is pretty much almost no actual COVID patients. Also CrCl [creatinine clearance] >30, which is fine. CDC is working with Gilead to get LFT requirements changed now that we know this is a mild viral hepatitis.

Currently the Gilead trial is wrapping up, NIH trial still enrolling, some new trial soon to begin, can’t remember where.

Steroids are up in the air. In China, usual clinical practice for all ARDS is high dose methylprednisolone. Thus, ALL of their patients have had high dose methylprednisolone. Some question whether this practice increases mortality.

It is likely that it increases secondary VAP/HAP [ventilator-associated pneumonia/hospital-acquired pneumonia]. China has had a high rate of drug-resistant GNR [Gram-negative rod] HAP/VAP and fungal pneumonia in these patients, with resulting increases in mortality. We have seen none, even in the earlier patients who were vented for >10 days before being bronch’ed (prior to test availability. Again, it is not a great idea to bronch these patients now).

Unclear whether VAP-prevention strategies are also different [in China vs US], but wouldn’t think so?

Hong Kong is currently running an uncontrolled trial of HC 100IV Q8 [hydrocortisone 100 mg IV every 8 hours].

General consensus here (in US among doctors who have cared for COVID patients) is that steroids will do more harm than good, unless needed for other indications.

Many of our patients have COPD on ICS [inhaled corticosteroids]. Current consensus at Evergreen, after some observation & some clinical judgment, is to stop ICS if able, based on known data with other viral pneumonias and increased susceptibility to HAP. Thus far patients are tolerating that, no major issues with ventilating them that can’t be managed with vent changes. We also have quite a few on AE-COPD [acute exacerbation of COPD]/asthma doses of methylprednisolone, so will be interesting to see how they do.

#medblr #covid-19 #long post

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whumpqhs · 5 years

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Whumptober alt #6: Lost

Part 1

Part 2

Part 3

Part 4

Part 5

Part 6

Part 7

"Looks like he's going to make it."

The words shouldn't have made her happy. Looking down at the guard as his eyes started to blink open, she should have felt like a failure, but the shame just wouldn't come. She shifted over a little so that, still kneeling at his side, she could ease one of his heavy arms over her shoulders. Across from her, another medic did the same. They counted together, and lifted together, voices in unison: "One, two, three." Suddenly the dead body on the floor was standing and stumbling, with a lot of help, over to the nearest medical bed. Assessing him and hanging his fluids from something other than her shoulder was a fantastic way not to have to think. She knew what to do for this patient, and right now, that was all that was important.

"We need labs. CBC, CMP, and troponin and creatinine levels. Whatever you have on the formulary for an NSAID, too, in case I'm right. Looks like an MI but we need the tests to know for sure..." She helped them as they repositioned him in bed, moving him up and covering him with blankets, giving orders as if she were still back home. He was hazy, out of it. She patted his shoulder. "We've got you, man, we're doing everything possible to help you. How's your pain?"

"Re... really bad..."

"Yeah? Like what number?" She looked across the bed to the one who'd been helping her lift and transfer. "Hey, I need morpha, and a syringe."

"Here."

The way they just handed it to her should've made her uneasy. It should've signaled something, the way they trusted her. It didn't. All it signaled in that moment was that she could help her patient not hurt so much. "Pushing two units and hanging the rest as a driver, as soon as I draw off these labs—you got vials?"

"Here."

“Thanks. They don’t let me put stuff in my pockets… I don’t even know if I can chart on him, he’s a guard.”

“I’ll get it. Next time, we’ll trade, and I’ll be on his IV side, okay?”

“Yeah, thanks.” Next time.

The effect was almost instantaneous: as she pushed the first dose, her patient started to relax, settling down. His heart rate dropped into normal limits. Sonora couldn’t contain a smile as she hung the remainder of the syringe and keyed the flow rate into his IV pump. Her mind was calm and, despite her moral objections, awash with the familiar, soft, effervescent feeling of a good code winding down. Stepping away to scrub out brought her right in front of Keeper, and she expected some kind of harsh correction as he reached toward her.

His hand settled on her shoulder, soft pressure, no pain. “Good job, Epi.”

Epi.

This was bad.

But it didn’t feel bad… it felt good. She felt like she was flying, veins rushing with adrenaline, like she was doing what she was always meant to do. Who cared about a guard? He’d finish his career in this place, especially after what looked like a massive heart attack. That was a life, wasn’t it? She saved a life.

A Republic life.

Who was he before he was a prison guard? Did he see active duty? Did he kill Imperials, like her? Whose revenge could it have been if she’d let him go? But even as they walked her down to the break room and let her get crappy junk food out of the vending machine, like a real person, she couldn’t make herself feel bad. Bad wasn’t the right word. Even later, when it started to change from a good feeling to a bad one, it wasn’t guilt that crept in. It wasn’t shame, either; it was something cold and empty.

Loneliness. She’d never felt so far from other people, so directionless and utterly lost. Who was she? She couldn’t be Republic. She couldn’t bring herself to defect, not even after saving one of theirs. Was she really Imperial anymore, after today? Did living here as a prisoner count as being under duress? Even if it did count, would Intelligence believe her that she hadn’t wanted to do it? Would they believe her when she said she regretted those compressions? How could they, when she didn’t even believe the words herself? She walked to the door of her cell and knocked, determined to get her mind off of this.

“Yeah?” It was one of the other medics this time, not a guard or an SIS agent. She recognized him: he’d been in on the code. Perfect.

“I forgot to chart something. Can I borrow a datapad?” “Forgot” was the pleasant word for how Keeper had dragged her off the floor and insisted on her getting some rest. Although, she’d slept another ten hours after he forced her to drop her charting and go, so she had to admit he was a little bit right.

“I have to watch you,” he warned.

“Yeah, of course.” She nodded, and took it when it was handed over. But as she settled down, she noticed that he wasn’t insisting on being able to see the screen. She typed in the guard’s name from before, and sighed dramatically at the lockout screen that popped up.

“What’s going on?”

“Oh, you know. Access denied, all that. This is so frustrating, I forgot to get any of my documentation in… and now…”

“Here, let me see.” She handed it over to him, watching as he typed in some kind of override code and passed it back. “There you go, should work fine now.”

The guard’s chart came up without a problem. She grinned. “Thanks!”

“Yeah, no problem.”

Unfortunately, charting didn’t take that long, and the loneliness came right back as soon as her mind was free. She signed off on the note, checked the lab values—the most recent round wasn’t back yet, but the initial set pointed to cardiac arrest—and was about to log out and hand it back when she noticed the treatment team listed.

Her name was there, but so were his nurses from the previous shift… his attending provider… and Keeper’s face, next to his designation, Rongeur, and a string of abbreviations. She clicked on it, and his file opened up instead. It took a lot of restraint not to gasp. Sonora carefully scrolled down, looking through the notes, commendations, letters. It all looked regular, legitimate… seamless. A little too seamless. She finally found the clue under his history, in a list of previous meds.

Dimallium 6.

Sonora frowned. Only one use for that: Castellan restraints. Conditioning. She paused, reaching out to touch the word with a fingertip. When she did, a dialogue box popped up.

Open previous encounter for this med?

She hesitated at first, but then reached out again, tapping the screen.

Yes.

Enter override code:_____________

Sonora frowned, then looked up and took a chance. “Hey, can you put that code in again? It won’t let me in the MAR.”

For one terrifying moment, as she handed him the datapad and let him put in the code, she realized what a terrible mistake she’d made. It could all be over, her entire life, and for what?—to look up his records? Why, when he was the enemy?

...but was he really the enemy? She had to know.

“Here, should work, it looked like it took the code.” She had to stifle a sigh of relief as he handed it back without really looking.

“Thanks, I appreciate it.”

“I thought I saw the dose in the MAR already,” he said.

“I charted against the override. Had to fix it.”

A little sound of acknowledgement and a half-said “Ah yeah that’s annoying” was the extent of his protest. She peered into the encounter, eyes scanning, fingertips tapping to make it look like she was working on the MAR. But when she finally found the notes from the conditioning, her hand slowed. The notes were in reverse order, working backwards into the past with the most recent ones first: progress updates following his rehabilitation, implantation of new memories… and down at the bottom, she found a brief AAR about his capture… but nothing about him defecting. Frowning, Sonora worked back up from the AAR, going over everything again. Had she missed one?

She finally found the answer that she was terrified of, in the transcript from his last interrogation.

---

SIS: Last chance, Vael. You can tell us everything you know, or we’ll start cutting off fingers.

PRISONER: Do it. I don’t care.

SIS: You know you’re the sole survivor, right? All the other agents, they’re gone.

PRISONER: Like I believe that.

[Electroshock applied. Several deep cuts made to abdomen. No new information.]

SIS: What’s so special about them that you won’t talk? Even when you’re here for life, even with them dead?

PRISONER: That’s… my team… I’m… the medic… gotta take care of them.

SIS: They’re gone, Vael! They’re dead. What’s stopping you?

PRISONER: Because… th-they’re my… family. I love… them… and even... even if they’re gone, I... I... I’m not gonna l-let them down.

SIS: Oh, you’re gonna let them down, Vael. You just don’t know it yet.

[Session terminated. Will begin selective treatment with dimallium immediately. Keyword to reverse conditioning in case of emergency: Aurek Five System Yellow Seventeen.]

---

For a little while, she sat quietly, rereading the note. Then rereading it again. Memorizing the code. Finally, she backed out of the chart and handed it to the man at the door.

“Hey, it freaked out on me or something. Started opening a bunch of other pages, I had to shut it off. I’ll finish charting tomorrow.”

He nodded, tucking the datapad away as she turned back to her bed, stretching out. As she drifted to sleep, the words from the code echoed in her mind:

What could I have done to save one of mine?

#whumptober2019 #altno.6 #lost #emotional whump #torture mention #Bitter Medicine #swtor #imperial agent

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alkeskendal · 1 year

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Toko Alkes Kendal Makassar TERMURAH Telp/WA 0821-2767-2598 PT. JMM

Alat Kesehatan Temanggung, Alat Kesehatan Tembalang, Alat Kesehatan Terdekat Di Tangerang, Alat Kesehatan Tulungagung, Alat Kesehatan Ungaran Jenis Alat Medis,Alt Medical Abbreviation Surgery,Alat Medis Yang Menggunakan Radiasi Elektromagnetik APA SAJA ALAT ALAT KEPERAWATAN ? Beberapa alat keperawatan yang umum digunakan oleh tenaga kesehatan dalam memberikan perawatan pada pasien adalah…

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#Alat Medis Malang #Alat Medis Medan #Alat Medis Semarang #Alat Medis Solo #Alat Medis Sragen

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templatesofficecom · 4 years

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Cpr Meaning In Business

Business cpr abbreviation meaning defined here. A method used to keep someone alive in a medical emergency in which you blow into the person s mouth then press on their chest and then repeat the process.

Conceptual Hand Writing Showing Cardiopulmonary Resuscitation

Cpr is one metric marketing.

Cpr meaning in business. This is especially important in costly media such as television where only…

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#business #Cpr #Meaning

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ijcmcrjournal · 2 years

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Non-Operatively Managed Primary Small Bowel Volvulus: A Case Report by Ewnte B*

Abstract

Background: Primary small intestinal volvulus is one of the common causes of intestinal obstruction in various localities of the developing world. Although operative intervention has been the usual mode of treatment; this case report depicts meticulous follow-up & care, there is a possibility for relief of obstruction with non-operative management.

Case presentation: this is a case report of a 20-year-old male patient presented with crampy abdominal pain and frequent bilious vomiting. Plain abdominal film showed multiple distended small bowel loops with air fluid level, consistent with small bowel obstruction. Ruling out other etiologies primary small bowel volvulus was entertained and naso-gastric tube inserted, patient catheterized and kept nil per oral. After 48 hours of admission all symptoms resolved the patient resumed feeding and was discharged home.

Conclusions: The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

Key words: Small bowel volvulus; Primary volvulus; Non-operative management

Abbreviations: BPM: Beats Per Minute; WBC: White Blood Cells; RBC: Red Blood Cells; HGB: Hemoglobin; HCT: Hematocrit; MCV: Mean Corpuscular Volume; BUN: Blood Urea Nitrogen; ALT: Alanine Aminotransferase; AST: Aspartate Aminotransferase; ALP: Alkaline Phosphatase

Introduction

Small bowel volvulus is a condition in which there is a torsion of all or a segment of the small bowel and its mesentery: this can lead to bowel obstruction, ischemia, infarction, or perforation. The typical patient with the primary volvulus of the small intestine was found to be a young adult, male, muscular, farmer, from a rural area whose diet was bulky and mainly made of cereals [1,2].

Case Presentation

A 20-year-old male patient presented to Nefas Mewcha primary hospital Emergency department in January 2020 with the main complaint of crampy abdominal pain and distention of 14 hours duration. Associated with this, he also had nausea and frequent bilious vomiting eight times. He had passed feces 24 hours ago. He had no fever, cough, chest pain or night sweating. He had no history of similar illness before, no history of previous abdominal surgery.

He is not married and claims to be not sexually active. Lives with his parents and has three sisters and two brothers. He makes a living as a farmer. There are no medical illnesses that run in the family. There was no history of tobacco smoking or substance abuse. He consumes a local alcohol made of sorghum occasionally.

At presentation, his blood pressure was 105/60 mm Hg, pulse rate was 68 Beats Per Minute (BPM), respiratory rate was 18 per minute and temperature was 36.2 oC axillary. Physical examination of the patient at presentation, the patient was acutely sick looking in pain; not in cardio respiratory distress. He had a dry tongue and buccal mucosa. No palpable lymph adenopathy in all accessible areas. Chest was clear and resonant. S1 and S2 cardiac sounds were well heard and there were no added cardiac sounds. Abdomen was slightly distended, moves with respiration, flanks were full, there were no scars, no distended veins and hernia sites were free. Palpation revealed a tense abdomen with no area of tenderness, no shifting dullness, hyperactive tympanic percussion note, bowel sounds were 35 per minute. There is scanty stool on the examining finger, with no blood on it from digital rectal examination, no palpable mass was detected. The patient was conscious and neurological examination was intact.

A complete blood count of our patient showed: White Blood Cells (WBC) 12500 mcL, Red Blood Cells (RBC) 4.6 mcL, Hemoglobin (HGB) 16 gm/dL, Hematocrit (HCT) 48%, Mean Corpuscular Volume (MCV) 89.1fL, platelets 470×103, creatinine 0.6, Blood Urea Nitrogen (BUN) 30, Alanine Aminotransferase (ALT) 28, Aspartate Aminotransferase (AST) 24, Alkaline Phosphatase (ALP) 48, albumin 4.3, total bilirubin 1.1 and direct bilirubin 0.4.

Plain abdominal X-Ray showed centrally distributed, distended small bowel loops and rectal gas shadow (Figure 1). CT scan is not available at this setup so it was not possible to do one.

Management and Outcomes

The diagnosis of acute abdomen secondary to small bowel obstruction secondary to primary small bowel volvulus plus stage I shock was entertained, Double intravenous line was inserted and Trans-urethral catheter inserted, Naso-gastric tube was inserted. Three Liters of normal saline was given over a course of 2 hours, at emergency department. The patient was admitted to the ward and was advised on the possible options of management, consented on conservative management, associated risks and the possibility of surgical intervention at any time in the course of the management. The patient was kept Nil per oral, put on maintenance fluid and replacement of ongoing losses. Nasogastric tubes produced 600 ml of bilious content during the first 6 hours; which was replaced with an equal amount of ringer lactate. The abdominal cramp subsided after 4 hours of inpatient admission. After 12 hours of admission, the Blood pressure was 100/70 mmHg, pulse rate 68 per minute and the abdominal distension decreased significantly and the bowel sounds were 26 per minute, there was no area of tenderness and the patient passed flatus.

Following 24 hours of admission, the patient passed feces and vital signs were within normal range. Naso-gastric was removed and the patient was initiated with sips. The patient tolerated sips very well and was observed for 24 more hours and discharged on the next day. He was appointed to the surgical referral clinic after a week.

In subsequent weeks, the patient was seen at a referral clinic; he had no change in bowel habit or any other complaint. His vital signs were stable and physical examination was detected with no abnormality. He has been followed every month for 3 consecutive months and has reported no recurrence of symptoms.

Discussion

Volvulus is the Latin word for rolled up or twisted and is derived from the verb ‘volvere’, meaning to roll or turnabout. By definition, volvulus is an abnormal twisting of the intestine, which can impair the blood flow to the intestine. Volvulus can lead to gangrene and death of that segment of the gastrointestinal tract, intestinal obstruction, perforation of the intestine and peritonitis [3]. Small intestinal volvulus in adults can be classified as primary or secondary. In the former there is no obvious anatomical cause involving the mesentery or the small bowel, whereas in the latter there is an abnormal fixation due to adhesions or bands leading to the twisting of the mesentery. The primary type is often seen in Africa and Asia [4]. It is a significant cause of primary bowel obstruction in sub-Saharan Africa [5]. It is the leading cause of small bowel obstruction in Ethiopia [6].It is a rare entity in Western adults [7].

Clinical signs & symptoms were unspecific & resembled intestinal obstruction [8]. The most frequent symptom was observed to be sudden abdominal pain [9]. Vomiting was also observed in most of the patients while abdominal distention and constipation were reported less frequently [10]. Clinical examination reveals abdominal distension and/or diffuse tenderness with or without signs of peritonitis [8]. Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction [11].

One of the challenges in managing primary small bowel volvulus operatively has been the risk of subsequent adhesion obstructions. The risk of occurrence of adhesion obstructions among patients that underwent laparotomy in general was reported to be 4.6% [12]. This gives rise to the endless circle of obstruction and subsequent operation, which further increase the risk more.

This case report presents a case of primary small bowel volvulus causing small bowel obstruction; which was managed non-operatively. Treatment of primary volvulus has mostly been via surgical intervention. This report depicts with close follow-up and Naso-gastric tube decompression, primary small bowel volvulus can also be treated without surgical intervention.

In the course of managing patients with primary small bowel volvulus, spontaneous resolutions has been observed [3]. This is because of natural de-rotation of the volvulus segment and relief of the obstruction. The case reported presented with symptoms and signs of small bowel obstruction. The patient has frequent vomiting with severe abdominal cramp associated with mild abdominal distension. The vital signs were within normal range supporting the diagnosis of non-ischemic obstruction. Abdominal x-ray showed multiple air fluid levels, which confirmed the diagnosis of small bowel obstruction. Ruling out other causes and considering the epidemiological prevalence, primary small bowel volvulus was entertained as a cause of obstruction.

As per the request of the patient to be followed conservatively, the patient was managed non-operatively with insertion of naso gastric tube and keeping nil per oral. The patient responded well for the management and were discharged subsequently. Showed no recurrence during the follow-up period.

Conclusion

Primary Small bowel volvulus is a rare cause of small bowel obstruction. The reported case shows evidence in which the patient’s primary small bowel volvulus was relieved non-operatively with insertion of naso gastric tube keeping nil per oral.

For more information about Article : https://ijclinmedcasereports.com/

https://ijclinmedcasereports.com/ijcmcr-cr-id-00131/ https://ijclinmedcasereports.com/pdf/IJCMCR-CR-00131.pdf

#Beats Per Minute #White Blood Cells #Red Blood Cells #Hemoglobin #Hematocrit #Mean Corpuscular Volume #Blood Urea Nitrogen #Alanine Aminotransferase #Aspartate Aminotransferase #Alkaline Phosphatase #Ewnte B*#IJCMCR #clinical studies

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siva3155 · 4 years

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300+ TOP DOCTOR Interview Questions and Answers

DOCTOR Interview Questions for freshers experienced :-

1) Explain who is Doctor? A physician is someone who practices medicine to treat illnesses and injuries. Physicians go to medical school to be trained. They typically hold a college degree in medicine. Physicians once made house calls to treat patients at home, but now mostly see patients in their offices or in hospitals. Physicians may also work for schools, companies, sports teams, or the military. Physicians are often assisted by nurses or other staff. 2) How doctor treat patients? Physicians treat patients by diagnosing them, or figuring out what is wrong. When Physicians diagnose a patient, they begin by asking questions about the patient's symptoms such as fever, headache, or stomach ache. They may ask other questions about things like past illnesses or family members who have been sick. They will then examine the patient, often looking at different parts of the body and listening to the heart and lungs with a stethoscope. Sometimes they may need to collect blood, use an x-ray machine, or use other tools to look for things they cannot see when examining the patient. Usually, when they have gathered enough information, a doctor can make a diagnosis and then prescribe a treatment. Often they prescribe . 3) Who is a specialists doctor? Some doctors specialise in a certain kind of medicine. These physicians are called specialists. They may only treat injuries to a certain part of the body, or only treat patients who have certain diseases. For example, there are physicians who specialise in diseases of the stomach or intestines. Other physicians are "general practitioners" or "family practitioners". This means that they do a little bit of everything. They try to deal with as much of a patient's health problems as they can without sending them to a specialist. A doctor who performs surgery is called a surgeon. 4) How communication skills help patient? Once a patient begins developing trust in a doctor, the chances of him/her recovering increases as his/her confidence in the doctor goes up and s/he begins to believe that s/he can recover. 5) Why doctors should learn communication skills? Communication skills play a major role in developing patient-doctor relationship. And miscommunication could lead to clashes with relatives/friends of patients over care given to the latter. 6) What is Venous thrombosis? There are numerous extra-gastrointestinal manifestations of inflammatory bowel disease that occur in both ulcerative colitis and Crohn's disease, such as uveitis, conjunctivitis, arthritis, pyoderma gangrenosum and erythema nodosum. Some occur primarily in Crohn's, such as gallstones and renal stones due to the area of bowel affected, while patients with ulcerative colitis are more likely to develop primary sclerosing cholangitis and venous thromboses. 7) What is Azathioprine? Azathioprine takes a number of months to exert its anti-inflammatory effect and therefore has a limited role in the acute management of Crohn's disease, though it can be started at the time of an acute flare of Crohn's. 8) What is Bendroflumethiazide? Treatment of hypercalcaemia can include fluid rehydration, loop diuretics, bisphosphonates, steroids, salmon calcitonin and chemotherapy. In clinical practice intravenous fluids are the first-line agent used to treat hypercalcaemia, both rehydrating the patient and helping to lower the calcium levels. This is combined with the co-administration of bisphosphonates such as pamidronate, which exert their maximal effect 5-7 days after administration. 9) What is Ceftriaxone? A cephalosporin such as ceftriaxone is first-line treatment in patients with streptococcal meningitis. Benzylpenicillin would be more appropriate if Neisseria meningitidis was suspected. 10) What is Anti-Histone antibody? In induced SLE anti-histone antibody is present in 90% of patients, although this is not specific for the condition. Anti-nuclear antibody is positive in 50% of patients as opposed to 95% of patients with idiopathic SLE.

DOCTOR Interview Questions 11) What is C-reactive protein? In SLE the erythrocyte sedimentation rate is classically raised while C-reactive protein levels can stay normal and therefore CRP is also not as useful as the other investigations to monitor disease activity and progression. 12) What are the parameters of life-threatening asthma? Peak expiratory flow rate of Tachycardia: heart rate > 100 beats per minute Inability to complete sentences with one breath 14) What is terbutaline 10 mg nebulised In the management of asthma, patients should be sitting upright in bed and receiving 100% oxygen. Salbutamol is given at a dose of 5 mg nebulised, not 500 micrograms. Ipratropium bromide and steroids should then be considered. 15) Medical Abbreviations part 19: TFTs - thyroid function tests U - units UC - ulcerative colitis V/Q - ventilation/perfusion WCC - white cell count 16) Medical Abbreviations part 18: RBBB - right bundle branch block SIADH - syndrome of inappropriate ADH secretion SLE - systemic lupus erythematosus STEMI - ST-elevation myocardial infarction STD 17) Medical Abbreviations part 17: p.r.n. - pro re nata PSA - prostate-specific antigen PSC - primary sclerosing cholangitis PSGN - post-streptococcal glomerulonephritis RAS - renal artery stenosis 18) Medical Abbreviations part 16: PaO2 - partial pressure of oxygen PCA - patient-controlled analgesia PCI - primary coronary intervention PCP - Pneumocystis carinii pneumonia PCR - polymerase chain reaction 19) Medical Abbreviations part 15: --> NICE 1) Formerly: National Institute for Clinical Excellence 2) Currently: National Institute for Health and Clinical Excellence --> NMDA - N-methyl-D-aspartate --> NSAIDs - non-steroidal anti-inflammatory --> NSTEMI - non-ST-elevation myocardial infarction --> PaCO2 - partial pressure of carbon dioxide 20) Medical Abbreviations part 14: MRI - magnetic resonance imaging MRSA - methicillin-resistant Staphylococcus aureus MSH - melanocyte-stimulating hormone NAC - N-acetylcysteine NG - nasogastric 21) Medical Abbreviations part 13: LFT - liver function test LTOT - long-term oxygen therapy MCV - mean cell volume MHC - major histocompatibility complex MMSE - mini mental state examination 22) Medical Abbreviations part 12: J - joules JVP - jugular venous pressure LBBB - left bundle branch block LDH - lactate dehydrogenase LDL - low-density lipoprotein 23) Medical Abbreviations part 11: HONKC - hyper-osmolar non-ketotic coma HSP - Henoch-Schnlein purpura HUS - haemolytic uraemic syndrome IV - intravenous IVDU - intravenous user 24) Medical Abbreviations part 10: HAART - highly active antiretroviral treatment hCG - human chorionic gonadotrophin HDL - high-density lipoprotein HDU - High-Dependency Unit HLA - human leukocyte antigen 25) Medical Abbreviations part 9: G6PD - glucose-6-phosphate dehydrogenase GCS - Glasgow coma scale GFR - glomerular filtration rate GORD - gastro-oesophageal reflux disease GTN - glyceryl trinitrate 26) Medical Abbreviations part 8: FEV1 - forced expiratory volume in 1 second FFP - fresh frozen plasma FH - familial hypercholesterolaemia Fi(O)2 - fraction of inspired oxygen FVC - forced vital capacity 27) Medical Abbreviations part 7: DVT - deep vein thrombosis ERCP - endoscopic retrograde cholangiopancreatography ESR - erythrocyte sedimentation rate F1 - Foundation year 1 doctor F2 - Foundation year 2 doctor 28) Medical Abbreviations part 6: CPAP - continuous positive airway pressure (ventilation) CPR - cardiopulmonary resuscitation CRP - C-reactive protein CSF - cerebrospinal fluid dsDNA - double-stranded DNA 29) Medical Abbreviations part 5: CDT - Clostridium difficile toxin CIN - cervical intraepithelial neoplasia CLL - chronic lymphocytic leukaemia COMT - catechol-O-methyltransferase COPD - chronic obstructive pulmonary disease 30) Medical Abbreviations part 4: BCG - bacille Calmette-Guerin BHL - bilateral hilar lymphadenopathy BMI - body mass index BNP - B-type natriuretic peptide CEA - carcinoembryonic antigen 31) Medical Abbreviations part 3: AMT - abbreviated mental test ANA - antinuclear antibody ANCA - anti-neutrophil cytoplasmic antibody APACHE - acute physiology and chronic health evaluation AST - aspartate aminotransferase 32) Medical Abbreviations part 2: ADH - antidiuretic hormone AFB - acid-fast bacilli AIDS - acquired immunodeficiency syndrome ALP - alkaline phosphatase ALT - alanine aminotransferase 33) Medical Abbreviations part 1: AF - atrial fibrillation aFP - alpha-fetoprotein ABG - arterial blood gas ACE - angiotensin-converting enzyme ACTH - adrenocorticotrophic hormone 34) How many childrens affected with asthma in UK? Asthma affects over 5 million individuals in the UK. Approximately 1 million children are affected. 35) Can medication is known to cause hypokalaemia? The medication is most likely to be a selective 2-agonist such as salbutamol, which leads to a tremor, palpitations, headaches and hypokalaemia at high doses. Washing the mouth after administration of inhaled steroids is recommended, no matter what dose is given. Atrovent is the trade name for ipratropium bromide, which is more useful in chronic obstructive pulmonary disease than in asthma, although it can be used in an acute asthma attack. 36) Patient feeling randomly sick with headaches. What could it be? Persistent headaches are not something that can be ignored, as this could be your body trying to send you a signal that there is something wrong. Often, the history and description of the headache can be quite helpful as you attempt to determine what is the cause of your headaches so that you can know how to get better. If your headaches are associated with certain movements, activities, foods, or other triggers, than this can serve as a clue to you and your doctor to help you feel better. If, on the other hand, your symptoms are somewhat predictable and come on in the same way, then it is also possible to use this information to diagnose the type of headache, which then gets you closer to getting some help with your pain and other symptoms. Migraines are classically associated with light sensitivity, nausea and vomiting, and intractable and incapacitating pain. People with migraines may have a family history of them, and they may have an aura, or symptoms that routinely come before the headache and let them know it is coming. 37) Why should be pain in neck? There are times that infections can happen in the neck, and these infections can be very serious because of the number of important structures that run through the neck. Some of these include nerves that are relevant to moving some of the muscles of your upper extremities, and others are the very important arteries and veins that run through your neck to and from your head. Often, if people have an infection, they will also have symptoms of an infection, such as a high fever, swelling, redness, etc. These can be more common in those with a history of injecting, as this allows serious and dangerous bacteria direct access to the rest of the body through the arteries and veins. If it has been a while since your last injection, then it may make an infection less likely. Swelling and pain can also happen from muscle spasms that come with poor posture or increased exertion out of the norm. There are also some other possible explanations. 38) Why do in some cases patients feel chest, neck and hands flush? Certainly the thought of carcinoid syndrome is something that crosses the mind in hearing about your symptoms. That is, however, a rather rare process that would be unusual for most people to have. In such a situation, it is good to describe your symptoms and your concerns to your doctor so that he or she can test for the possibility of something as serious or as rare as that condition. There are many other possible explanations, however, many of which are much more common. It is not unusual for some people to have changes of flushing and some of the other feelings that you describe when they are in stressful or unusual situations. Some of this can sometimes be understood in context of the response that some people have to loud noises or fright, ie, they can faint. This reaction is one extreme on the spectrum of a vagal reaction that can occur in some. On a less extreme note, other can have some of the same symptoms you describe without having something as notable as a syncopal episode. There are often things that can be done to help. 39) Suppose if a patient have abnormal blood on his underwear how you deal? Abnormal bleeding can have many different causes, but you have provided some valuable information. First, we have to clarify where exactly the bleeding is coming from. While vaginal bleeding is perhaps the most likely, both the urinary tract and the GI tract can also be a source of bleeding. Either of those would have different causes and explanations, with infections and small sources of bleeding such as hemorrhoids being among the most common reasons for abnormal or untimely bleeding. With regards to vaginal bleeding, there is a clue that is suggested by the fact that the blood is bright red in color. In general, this can reflect fresher blood that has not started to be broken down. It may also suggest blood that is coming from a source further down the vaginal tract, although that is not necessarily true. There are different conditions that can affect the vaginal or uterine lining and are common explanations for symptoms such as you describe. There are also tumors that can result in abnormal bleeding, and these tumors can be both benign and malignant. 40) Suppose if patient have unbearable neck to shoulder pain only while on his period. What could it be? This is a somewhat interesting phenomenon that will take more visits to your doctor to help explain. Your OB/GYN is likely a good place to start, as he or she will be best positioned to help sort out the hormonal element to your symptoms. Another option might be a neurologist or spine surgeon, either of which may be able to help with your symptoms at the level of your neck. An ear nose and throat surgeon may offer some other insight that could be helpful. Whichever you choose, the approach to your problem will likely be different. Primary care and medical doctors are more likely to use lab work and your symptoms to help arrive at an answer, and may use medications empirically to see what helps to make you better. A surgeon, on the other hand, is more likely to listen to your symptoms, complete an exam, and recommend imaging and other anatomic studies that can help to determine what is causing your symptoms. The pain may have a component of something that changes on a monthly basis with your menstrual cycle. This could be a swelling, or even something as simple as a change in the blood flow. 41) Suppose if patient having chronic neck pain for 4 days. Medication and RMT massage have done nothing, pain is 10/10 now. What could it be? It is not normal for pain to become so severe and fail to respond in any way to conservative therapy, and so your doctor should discuss this with you in more detail to make sure that there is nothing serious that is causing your symptoms. Neck and muscle spasms can be common in some people with a history of c spine injury or trauma, and can be severe and debilitating. They should not be a new onset symptom for most people, however, unless you have had some precipitating event. Massage and things to help the muscles relax is often a great idea to help with some of the mild aches and pains that we can have from time to time, and the fact that you had no improvement is worrisome. Your doctor may entertain other possible explanations for this pain in addition to trauma and misuse injuries. He or she may decide it is important to get some imaging and complete a physical exam looking for things that might be amiss. Shooting pain can be a concern for nerve injury. 42) Suppose if I am patient of acid reflux, how can I get rid off? Fortunately, there are things that can be done to help with reflux. The most obvious answer is some of the many medications that are available to help reduce stomach acid. Some of the least expensive and most effective are even available over the counter, but should be used after discussing your symptoms with your doctor. There are some medications, such as ranitidine and other anti histamine medications (H2 blockers as they are sometimes called), that can be very effective for many people and have a very mild side effect profile. They are most effective when taken as directed, and the efficacy does tend to decrease if they are not timed appropriately with regards to the meals. Other excellent medications are those that are known as proton pump inhibitors, or PPIs, which can be even more effective. The over the counter doses are effective for most people, but in severe cases prescription strength doses can also be used. These medications also have relatively mild side effects, but should be discussed with your doctor. In addition to these medications, lifestyle changes should be tried before any medications. These can be found suggested in many places. Please speak with your doctor. DOCTOR Questions and Answers pdf Download Read the full article

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butterflyinthewell · 7 years

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Because I had some anons ask “What’s Danceverse?”

http://archiveofourown.org/series/282375

I ship the effin’ hell out of Optimus and Mikaela.

Careful, the fics are a rabbit hole.

The idea of what’s happening to Optimus in TLK can play into Danceverse if the movie lets him be okay by the end of it.

I have a headcanon that he had developed a mental illness similar to PTSD in humans between DOTM and AOE. The condition can only occur under specific circumstances since it affects his software.

It’s called stasis trauma; a bot who falls into stasis (like a coma) during a traumatic event will experience that event on an endless memory loop until they’re repaired enough to wake up. To some, that last moment before stasis may not seem all that traumatic, but relive it over and over for months, years, decades, centuries, millennia or even eons and it’s not so small anymore is it?

It’s basically a really advanced equivalent to a bunch of data on your computer getting corrupted and desktop shortcuts or apps not going to the correct program or app. Like, you click on a a folder that has artwork in it and your internet browser opens instead, or there’s an error message telling you to check if the folder was moved somewhere else.

Flashbacks happen because Optimus experiences a trigger and the datatrack of his trauma gets set off, putting him back in the moment. His equivalent to sleep is recharging and it has stages similar to human sleep. The difference is he doesn’t dream the same way we do. His dreams are always actual memories opening in a random order. They’re never random things like flying toasters and other human dream weirdness.

What’s different is due to the stasis trauma he acts out the dreams, like sleepwalking, and he has zero memory of it when he wakes up. You can’t shake him awake, the nightmare stops when the datatrack closes. He can’t hear you trying to comfort him and he wouldn’t know the nightmares were happening at all if someone else didn’t tell him. His only clue would be waking up in different locations from where he went into recharge.

I think you can imagine why this is dangerous. Fortunately, none of his projectile weapons actually go off when he’s recharging, but he may still punch or kick people.

He also contends with intrusive thoughts, random bouts of depression, hypervigilance, and random “fear attacks” where his body’s fight-or-flight systems kick off and he has to do a sort of control+alt+delete to shut the program down. It makes him get the shakes like he’s got chills.

To make matters worse, (headcanon here) Cybertronians stigmatize the hell out of mental illnesses. Nobody talks about it if they have one and they may not even tell their medic and it’ll come up on scans instead. Mentally ill bots get slowly phased out of social circles if it becomes public knowledge. They’ll usually get treatment privately-- the worst symptoms of stasis trauma can be recovered from, but traces will always remain.

Optimus knows his leadership would be called into question if people knew about his stasis trauma, so he tries to keep it secret. Just admitting it privately to Mikaela was hell for him. He was crying and terrified that he had betrayed her.

Optimus being susceptible to manipulation can work with my headcanon, but I won’t stay with canon if he stays on the “bad” side and gets killed off. I’ll come up with a way for Mikaela and the other Autobots to help him.

I have my own headcanon for where and how his life ends and it’s at a ripe old age where we get to see him be a cranky old fart bot who walks with a cane. Kinda like Jetfire in TF2 ROTF...but THAT fic takes place a trillion years in the future! (It’s “Tin Man’s Treasure” so don’t read that one if you want to avoid sobbing for hours. It was hell to write, yet it was one of those fics that wouldn’t get out of my head until I wrote it.)

So yeah. Danceverse, everyone.

Abbreviations for the movies:

TF = Transformers TF2 or ROTF = Transformers: Revenge of the Fallen TF3 or DOTM = Transformers: Dark of the Moon TF4 or AOE = Transformers: Age of Extinction TF5 or TLK = Transformers: The Last Knight (Upcoming movie)

#actuallyautistic #Optimus Prime #Mikaela Banes #Danceverse #fanfiction #OptimusxMikaela #long post #infodump

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icanmeduk · 3 years

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How to Prepare for UCAT Test – Tips to Get High Score

UCAT is the abbreviation used for University Clinical Aptitude Test. UCAT exam is very significant which is used by most of the universities in the UK, Australia & New Zealand to select candidates in their high demand health-related careers like medicine and dentistry. This UCAT is a computer-based two-hour exam approved by universities that assesses aspiring students’ mental abilities to practice in the fields of medicine & dentistry. UCAT consists of five subtests that each contain various questions in multiple-choice format. The test consists of five subtests – Verbal Reasoning, Decision Making, Quantitative Reasoning, Abstract Reasoning, & Situational Judgement.

Getting a good UCAT score is one of the requirements, along with the personal statement, your grades & a letter of recommendation, which you will have to submit to be considered to be given an offer for the medical interview. Now, the question is how to prepare for the UCAT test? Below are top some UCAT tips to help you ace the exam!

Use the UCAT practice exam free from the official UCAT website

Numerous students are ignoring the UCAT questions & UCAT practice tests on the official UCAT website. UCAT training is an excellent resource but you must do all the UCAT practice questions from the practice paper. With iCanMed, you can get access to hundreds of UCAT practice questions & UCAT mock tests. It is the perfect start to your UCAT preparation. If you decide to enroll with iCanMed, then their UCAT practice exams help you to get closer to the live UCAT.

Learn how to speed-read the questions

There are only a few students who are working on improving their speed reading. There are a lot of UCAT resources out there that can help you with this including iCanMed’s UCAT Speed Reading training. Students try to learn how to speed-read but don’t end up doing so professionally. This UCAT strategy is relevant to the UCAT Verbal Reasoning subtest & will save enormous amounts of time if done appropriately.

Use keyboard shortcuts

Keyboard shortcuts help to save you time in the UCAT exam. For instance, Alt + N helps you precede to next UCAT question, Alt + P takes you to the previous question, and Alt + F flag or unflag the UCAT question. Using the keyboard is particularly vital in the UCAT Quantitative Reasoning subtest, where you will sometimes need to use the UCAT calculator. Use the number pad on the right-hand side of your keyboard to easily input numbers. It is far quicker than selecting the numbers with the mouse. iCanMed’s UCAT training will help you with this. Make sure you practice using keyboard shortcuts with every UCAT practice paper you complete. iCanMed’s UCAT training allows you to practice these shortcuts with every UCAT question, subtest mock, drill, or exam you complete.

Familiarize yourself with UCAT questions

The UCAT exam contains a large variety of questions, some of which you feel easy while some are difficult. Find out which ones you can confidently breeze through & which ones need more work. Once you have identified your weaknesses, keep working on them. First read the theory needed to solve them, and then practice until confident. This step is the very first thing you do in your UCAT preparation.

Ultimately, the best way to improve your UCAT score is by acquiring UCAT strategies, & practicing them. iCanMed’s UCAT preparation courses are packed with effective UCAT strategies, subtests, mocks, drills, & full-length UCAT practice exams which exactly simulate the live UCAT exam.

#how to prepare for ucat test #Ucat training #ucat practice exam free #ucat revision #how to apply for medicine in uk #ucat practice test #ucat mock test

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