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More research is needed to acquire a comprehensive protocol for the management of AF in the obese population that can be applied by primary healthcare providers to combat this evolving matter.Objectives To determine the neurological manifestations in AIDS patients with a recent diagnosis. Materials and methods A descriptive, retrospective study was carried out on 82 patients, admitted to the University Hospital in Curitiba for a period of 30 months, with positive serology for HIV, using the enzyme-linked immunosorbent assay (ELISA) method for diagnosis and confirmation. Results Of the 82 patients studied, 28 (34.1%) presented neurological manifestations; 16 were male (57.14%) and 12 female (42.85%). The age ranged from 22 to 79 years, with a median age of 35 years. Neurological manifestations were headache (19.29%), motor deficit (19.29%), cranial nerve disorders (14.03%), epileptic seizures (10.52%), dementia (8.77%), coma (5.26%), ataxia (5.26%), mental confusion (5.26%), and tremor (3.5%). Cerebrovascular and neuroinfectious diseases (including neurotoxoplasmosis, bacterial and cryptococcal meningitis, and cerebral tuberculosis) were the most frequent diagnosis with 10 cases each (33.33%). Of the 28 patients, 10 (35.7%) died and 18 (64.28%) were discharged. Conclusion Based on the results found, it appears that one-third of AIDS patients with up to one year of diagnosis (34.14%) have some type of neurological manifestation, highlighting the importance of performing specific anamnesis and neurological examination in these patients.Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic procedure in the management of biliary and pancreatic disorders. Despite advances in ERCP facilities and techniques, pancreatitis remains the most common and feared complication of this procedure. The technical challenges of ERCP could be further compounded by variations in the configuration of the pancreatic ductal system. As a result, the knowledge of these variations and their potential role in the development of post-ERCP pancreatitis (PEP) is essential to any successful risk reduction strategy. This review provides an overview of the anatomy and embryological basis of pancreatic duct variations, as well as explore the different types and prevalence of these variations. Also, we discuss the mechanisms of PEP and provide evidence supporting a link between the variations and PEP using published data.In obstructive sleep apnea (OSA), there are brief episodes of partial or total upper airway obstruction during sleep, which leads to apnea or hypopneas. Much attention is required to understand OSA's effects on the human body, owing to how common but under-diagnosed this disorder remains. Though the role of OSA in cardiovascular (CV) disease is commonly discussed, it remains unclear how it induces changes in the human body. The intermittent and recurrent hypoxia occurring at the cellular level in this condition is critical for the dramatic changes observed. Vascular endothelial cell (VEC) injury and other mechanisms seen in OSA lead to changes in the CV system. GW441756 clinical trial can take a toll on a person's overall functioning, especially with so much importance in today's time on preventing and treating cardiac-related deaths. A total of 31 published articles were included from the PubMed database for our literature review. #link# Most of the studies showed a strong association of OSA with hypertension, especially resistant hypertension. Findings were consistent with OSA's independent role in causing CV diseases, included heart failure, coronary artery disease (cardiac ischemia), arrhythmias, and ischemic stroke. Continuous Positive Airway Pressure (CPAP) is one of the reliable and beneficial treatments for OSA patients. OSA is a treatable and modifiable risk factor for cardiac events and related deaths. The primary purpose of our review article was to address any existing gaps between OSA and its effect on the human body with particular emphasis on cardiovascular changes.Varenicline is one of two non-nicotine replacement therapy medications approved by the FDA for smoking cessation. It has also demonstrated some success in trials for the treatment of alcohol use disorder. In this case report, we present a case of a 38-year-old male with a history of alcohol and tobacco use disorders and no other psychiatric history, including no history of suicidal ideation or suicide attempts, who was admitted to an inpatient psychiatric facility after a suicide attempt while acutely intoxicated with alcohol one week after starting varenicline treatment for smoking cessation. Reports from the media, and literature from the FDA and manufacturers of CHANTIX® have mentioned a potential interaction between varenicline and alcohol that can subsequently cause "unusual and aggressive behaviors" that are "often accompanied by amnesia to the events"; however, we were unable to find any case reports related to a potential interaction between the two causing a suicide attempt in a PubMed search. Therefore, to our knowledge, this represents the first case report of its kind.Introduction Use of computers for doctor-patient communication is increasing. Considering effective doctor-patient communication is important for good health outcomes. This study helps to determine the level of acceptance of telemedicine in general public and factors associated with it. Methods This survey with cross-sectional analysis comprised a brief survey with 15 questions. The survey was distributed in public places to determine the opinions of the general public. Results Randomly selected 125 participants completed the questionnaire. Synchronous telemedicine was favored by young people (82% in the 18-34 age group vs 37.5% of participants aged >55 years; p55 vs. 51.3% in the age group 35-53 years vs. 71% in age group 18-34 years). Receiving video education for specific health concerns was favored by those who used a computer frequently (94.6% who used a computer more than two hours a month vs 77% who used a computer less than two hours a month; p =0.02). Conclusion Telemedicine is generally favored, but physicians should be mindful about older people as they may not feel comfortable. Step by step guidance should be provided especially to senior citizens for telemedicine and portal use.Pancreatic pathology is one of the causes of abdominal ascites. The estimated prevalence of pancreatic ascites is 3.5% in patients with chronic pancreatitis and it is mostly caused by pancreatic duct dehiscence in the setting of chronic pancreatitis. Other etiologies include pancreatic pseudocysts, trauma, severe acute pancreatitis and rupture to the pancreas. Management of this condition includes conservative management like holding feeds, total parenteral nutrition, administering somatostatin analogues or sometimes invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP) and surgery. ERCP is an unusual cause of pancreatic ascites and only one other case report has linked an association between ERCP and the development of pancreatic ascites. Our case report contributes to this literature and aims to shed light on this under-reported cause of pancreatic ascites.Background It is common for patients to enter Barrett's oesophagus (BO) surveillance based on endoscopic appearances before the diagnosis is histologically confirmed. We set out to review this practice by establishing the accuracy of endoscopic diagnoses of BO. Methods All gastroscopy reports in which a diagnosis of BO was recorded were reviewed over one year. link2 These were compared to the histopathological reports to assess diagnostic accuracy. Results BO was diagnosed in 84 procedures. This diagnosis was incorrect according to histology in 42.9% (n=36) of cases. Diagnostic accuracy was higher with gastroenterologists (38.8% incorrect, n=21) compared to surgeons (50% incorrect, n=15). Diagnostic accuracy was higher with consultants (34.9% incorrect, n=22) compared to registrars (66.7% incorrect, n=14). The dose of sedation used had no impact on accuracy. Unnecessary surveillance was booked in 36.1% (n=13) of cases. Conclusion It is insufficient to rely on endoscopic appearances alone to diagnose BO, irrespective of speciality or experience. The diagnosis should only be made after reviewing the histopathology report. This can eliminate unnecessary repeat endoscopy procedures, sparing patients from unjustifiable risk and helping to cut down on long waiting lists in endoscopy departments. The implementation of the Prague classification and Seattle protocol can improve diagnostic accuracy.Myasthenia gravis is an auto-immune disease that results in muscle weakness caused by antibodies released against acetylcholine receptors at the presynaptic membrane. Treatment options include acetylcholinesterase medications that cause a wide range of side-effects by increasing the concentration of acetylcholine at the synaptic cleft. One peculiar side effect seen is the precipitation of myocardial infarction caused by an excess of acetylcholine especially among elderly females. We present an interesting case of an 88-year-old female with a history of lung cancer newly diagnosed with paraneoplastic myasthenia gravis, started on treatment with prednisone 40 mg daily, and pyridostigmine 60 mg every six hours. She initially showed remarkable improvement in symptoms within a few hours, however, one day later, the patient developed sudden onset of chest pain radiating towards her left arm. A 12-lead electrocardiogram (EKG) showed diffuse ST-elevation in anterior leads and cardiac enzymes were found to be elevated. Pyridostigmine was stopped and the patient was started on heparin. The patient underwent cardiac catheterization which showed 50% stenosis in the right coronary artery (RCA) and 70% in the left anterior descending artery (LAD). The patient was monitored in the cardiac care unit (CCU) for 24 hours and later on discharged home on oral prednisone. It is a common practice to start treatment with anti-cholinesterase medications in newly diagnosed patients of myasthenia gravis, however, these medications can precipitate myocardial ischemia by coronary vasogenic spasm or by their arrhythmogenic effect. It is important to be aware of these outcomes while starting patients on these medications.Background Podcasts and their use in medical education, particularly emergency medicine (EM), are growing and becoming more popular. Many podcasts focus on EM, but the number of podcasts on each EM subspecialty remains unknown. Therefore, the goal of this study was to ascertain the number of podcasts available by EM subspecialty and collect the basic characteristics of each podcast. Methods We conducted a Google-based, investigational study of EM podcasts by subspecialty from July 2019 to January 2020. Search terms included "podcasts in ____", where the EM subspecialties of Toxicology, Ultrasound, Wilderness Medicine, Emergency Medicine Services, Medical Education, and Simulation were inserted to identify podcasts. Results Emergency Medical Services (EMS) and Medical Education subspecialties have the most active podcasts. Toxicology and EMS have the most inactive podcasts, while Medical Education and Simulation were the only subspecialties found to not have any identified inactive podcasts. link3 Conclusions The use of podcasts in EM has been increasing overall, but physicians in specific subspecialties, such as EMS and Medical Education, have access to a larger number of podcasts specific to their subspecialty than others.
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