Robbinstychsen7453

Lumbar Back Pain and Impaired Vision - an Alarming Differential Diagnosis Abstract. Aortic dissection is much less common than other causes of back pain, yet associated with a high mortality. Despite major advances in noninvasive imaging, the correct diagnosis is made in less than half of the cases. End-organ malperfusion can lead to a broad spectrum of symptoms making diagnosis difficult. This clinical case illustrates the importance of a careful history and thorough clinical examination, as well as noninvasive imaging without delay in order to improve the prognosis and chances of survival.CME-Laboratory 63 Diagnostics of Iron Metabolism Abstract. Iron deficiency is common and affects the course of many chronic diseases. The diagnosis of absolute and manifest iron deficiency anemia can be easily made by measuring hemoglobin and serum ferritin levels. In inflammatory diseases, the diagnosis can be facilitated by additional laboratory parameters such as soluble transferrin receptor. In several chronic diseases like cardiac or renal failure, different and higher thresholds for serum ferritin apply depending on the disease and stage, sometimes with additional consideration of transferrin saturation. Transferrin saturation is also important for the diagnosis of hemochromatosis. In patients with transferrin saturation >45 %, diagnosis usually requires evidence of homozygosity for the C282Y mutation in the HFE gene.CME ECG 68/Answers Gender Specificities in Heart Rhythm Disorders Abstract. Sex differences in heart rhythm disorders have been described, especially due to differences of hormone status in women and men. In general, women do have a higher baseline heart rate than men and shorter refractory periods of most structures in the conduction system, except the ventricles. This is particularly apparent in paroxysmal supraventricular tachycardias. The incidence of a dual AV nodal physiology is the same in both sexes. However, an AV-nodal reentry tachycardia is much more frequent in women than in men. The embryonal disposition for an accessory pathway, as well as the resultant AV reentry tachycardia is more common in men than in women. Focal atrial tachycardias do not reveal a clear dominance between the sexes. Knowledge about sex-related differences in heart rhythm disorders are relevant for its diagnostics. Therefore, important aspects will be discussed in this article.Evidence-Based Indication for Proton Pump Inhibitors - a Group Practice Perspective Abstract. Little is known about the extent of non-evidence-based proton pump inhibitor (PPI) prescriptions in the general practice setting in Switzerland. A recommendation for long-term therapy was included in the "Top 5 list" of "smarter medicine" for the outpatient internal medicine in 2014. The observational study recorded the proportion of patients without evidence-based indication for PPI in a practice with six general practitioners retrospectively over three months. Of 2225 patients analysed, 11.1 % (n = 248) took a PPI. find more The percentage of patients without a clear evidence-based indication was 46.8 %. Almost every second patient did not have a clear evidence-based indication for PPI. The results could be an incentive for general practitioners to reconsider the indication when prescribing PPI, also in the sense of "smarter medicine".CME/Answers Harmful Alcohol Consumption in the Elderly Abstract. Harmful alcohol consumption is an increasing clinical problem in many patients. Often excessive alcohol consumption is not addressed in clinical practice and there is still a high level of stigmatization around this topic. The early recognition and early therapeutic intervention are crucial for success. The general practitioner plays a key role in the (early) diagnosis, initiation and follow-up of alcohol-related problems. In this article the ideal procedures for the recognition of high-risk consumption are summarized. In daily practice, an ideal tool is the 'brief intervention' approach. The major steps and procedures for brief intervention for alcohol misuse are summarized and discussed.CME Patients and Their Work at the General Practitioner's Abstract. Complaints related to occupational burden are more often presented to the General Practitioner than generally expected. Despite the fact that most of these work-related complaints do not qualify for recognition as occupational disease the family doctor is in the position to set the course for adequate therapeutic treatment and prevention. In order to consult his patients efficiently he must have a proper concept of the Health and Safety regulation at the workplace and he must know which social insurance plays which role in the concert.COVID-19 and Headaches Abstract. Headaches are a common symptom of COVID-19 infections. Patients generally describe them as bilateral, predominantly frontal, squeezing and of moderate or severe intensity. Searching for "Red Flags" often allows distinction from primary headaches - usually fever, cough, and elevated inflammatory markers accompany COVID-19-associated headaches. Prospective studies did not confirm caveats against the use of ibuprofen as symptomatic treatment. While carrying facial masks often caused headaches, probably by compressing sensory nerves, many patients' migraine frequencies dropped during lockdown. Treatment of patients with primary headaches was complicated by quarantine and many centres offered online consultations.Significance The systematic investigation of oxidative modification of proteins by reactive oxygen species started in 1980. Later, it was shown that reactive nitrogen species could also modify proteins. Some protein oxidative modifications promote loss of protein function, cleavage or aggregation, and some result in proteo-toxicity and cellular homeostasis disruption. Recent Advances Previously, protein oxidation was associated exclusively to damage. However, not all oxidative modifications are necessarily associated with damage, as with Met and Cys protein residue oxidation. In these cases, redox state changes can alter protein structure, catalytic function, and signaling processes in response to metabolic and/or environmental alterations. This review aims to integrate the present knowledge on redox modifications of proteins with their fate and role in redox signaling and human pathological conditions. Critical Issues It is hypothesized that protein oxidation participates in the development and progression of many pathological conditions.