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Unintentional Weight Loss Causes

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101. CrackCAST E129 – Bacteria

for the primary location of infection. Cutaneous diphtheria can occur as a primary skin infection or as a secondary infection of a preexisting wound. Circulating exotoxin causes the systemic symptoms of diphtheria, most profoundly affecting the nervous system, heart, and kidneys. Progression of symptoms/signs: Generic URTI symptoms Low grade fever and sore throat are the most frequent presenting complaints. Weakness, dysphagia, headache, voice changes, and loss of appetite ⅓ develop cervical lymphadenopathy (...) , an important , is deficient Asplenia chronic alcohol abuse, active and passive smoking, Corticosteroid use recent respiratory illness. Clinical presentation- All of the major pathophysiologic events of meningococcal sepsis are caused by the host’s inflammatory response to the organism causing functional and histologic damage to the microvasculature, resulting in increased vascular permeability, pathologic vasoconstriction and vasodilation, loss of thromboresistance, DIC, and profound myocardial dysfunction

2017 CandiEM

102. Food Deserts and Food Swamps: A Primer

-processed food consumed, the poorer the diet quality and the higher risk of developing nutrition-related chronic conditions .8,9 Our long-term diet patterns are a determinant of health outcomes such as the development of nutrition-related chronic conditions, e.g., excess weight gain, cardiovascular disease, type 2 diabetes and some types of cancer. 10 Some symptoms of poor mental health such as depression and anxiety have also been linked to suboptimal diet patterns. 11-13 FOOD DESERTS AND FOOD SWAMPS (...) and cancer in Canada were $19.8 billion in 2015. 16 Inadequate vegetable and fruit consumption alone costs 3.3 billion per year through a mix of direct healthcare costs and losses in productivity. 16 What Factors Influence Food Choices? Income is a primary determinant of diet quality. In 2012, almost 13% of Canadian households experienced food insecurity, 19 defined as “inadequate or insecure access to food because of financial constraints.” 20 Not having enough money makes it difficult

2017 National Collaborating Centre for Environmental Health

103. Spotlight: Subacute Endocarditis: The Great Masquerader

with hypertension, hypothyroidism and no known history of valvular heart disease presented to his primary care doctor with one month of generalized weakness and unintentional weight loss. The patient felt unwell, with neck and shoulder pain. He reported fever to 102 degrees Fahrenheit and cough at home. The patient had a dental procedure one month prior to admission. His blood work revealed white blood cells of 13.6mg/dL, hemoglobin of 13mg/dL, iron 27 ug/dl, TIBC 306 ug/dL with ferritin >800 ug/L and ESR 101mm (...) the risk of embolization with improvement in symptoms. The cause of his endocarditis was thought to be secondary to the dental procedure months before diagnosis; teeth #14 and #19 were found to have extensive carious lesions requiring extraction prior to surgery. Discussion : Why does Streptococcus viridans have a predilection toward heart valves in bacteremia? In population studies, viridans group Streptococcus is among the most common cause of endocarditis. Both host and bacterial factors contribute

2017 Clinical Correlations

105. CRACKCast E125 – Electrolyte Disorders

. Ion exchange resin 1. Emergently in cardiac arrest, urgently in renal failure; may delay if renal function is normal 2. In patients with rhabdomyolysis or tumor lysis syndrome with intact urine output, not effective acutely [4] What are the five most common causes of hypokalemia? Most common cause in the outpatient world = thiazide diuretics. The five most common causes of hypokalemia are: renal losses, increased nonrenal losses (sweating, diarrhea, vomiting, laxatives) decreased potassium intake (...) , with simultaneous oral and IV replacement. [7] What are the three main types of hypernatremia? Give 3 examples of each. By far, the most common cause is a patient with an altered thirst mechanism (elderly, disabled patient) without access to free water. Hypernatremia can be divided into three physiologic pairings: hypernatremia with dehydration and low total body sodium, hypernatremia with low total body water and normal total body sodium, hypernatremia with increased total body sodium [1] Double loss

2017 CandiEM

106. Management of Bleeding in Patients on Oral Anticoagulants

of AF and with low-molecular-weight heparin in the treatment and prevention of venous thromboembolism (5,6).The favorableoutcomes with DOACs and the emergence of reversal agents (7) may also further increase the proportionate use of DOACs and in?uence the management of bleeding that complicates anticoagulant use (8). This document wasinformed by the scienti?cevidence presented and expert opinions considered during the Anticoagulation Consortium Roundtable, and by subse- quent review and deliberation (...) hemodynamic instability, require close moni- toring, ideally in the acute or critical care setting. Addi- tional considerations are time of ingestion of last dose of anticoagulant and whether there was an intentional or unintentional overdose. Clinicians should be mindful of comorbiditiesandconcomitanttreatmentsthatcouldalso contribute to bleeding or alter its management (e.g., antiplatelet therapy, thrombocytopenia, uremia, or liver disease) and manage them as appropriate. 5.2. De?ning Bleed Severity

2017 American College of Cardiology

107. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

14) • When considered separately from other CVDs, stroke ranks No. 5 among all causes of death, behind dis- eases of the heart, cancer, chronic lower respiratory disease, and unintentional injuries/accidents. • Globally, in 2013 there were 6.5 million stroke deaths, making stroke the second-leading cause of death behind ischemic heart disease. • Approximately 795 000 strokes occur in the United States each year. On average, every 40 seconds, someone in the United States has a stroke (...) , and other government agencies, brings together in a single document the most up- to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure 1 ), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals

2017 American Heart Association

108. Management of Dyslipidaemia

& Head, Department of Cardiology, Hospital Pulau Pinang Prof Dr Tilakavati Karupaiah Professor & Head of Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia Dr Wardati Mazlan Kepli, Phd Clinical Pharmacist Pharmacy Department Hospital Serdang Edition of Clinical Practice Guidelines 5 th5 RATIONALE AND PROCESS OF GUIDELINE DEVELOPMENT Rationale: In Malaysia, cardiovascular disease (CVD) is the leading cause of death in both men and women 1 . CVD includes coronary heart (...) C: Comparison: ? Therapeutic lifestyle intervention vs placebo ? Pharmacological therapy vs lifestyle intervention O: Outcome: ? Reduction in Cardiovascular Disease- Events, vascular mortality ? Reduction in All cause mortality 7Edition of Clinical Practice Guidelines 5 th Type of Question- Involves: ? Therapy – Lipid lowering ? Harm – Increase in Cardiovascular Event Rate, Adverse effects due to Lipid lowering and/or Pharmacotherapy ? Prognosis – Cardiovascular Risk Reduction ? Prevention

2017 Ministry of Health, Malaysia

109. Considerations on glycaemic control in older and/or frail individuals with diabetes and advanced kidney disease

].Oldageanddiabetesare the two most important causes of decline in renal function [4]. Inolderindividualswithchronickidneydisease(CKD)anddia- betes,theriskoffrailtyisconsiderable[5].Frailtycanherebybe definedasaclinicalsyndromeinwhichthreeormoreofthefol- lowing criteria are present: unintentional weight loss (10 lbs in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed and low physical activity [6]. A major characteristic of the frailty diathesis is an increased sus- ceptibility (...) was different in this regard, with a mean age of 66 years [10]. Observational stud- ies suggested that, in patients with diabetes and more than 75 years old, an HbA 1c below 6.9% can be protective when comparedwiththegeneralpopulation[11].However,ifCKD is one of the comorbidities, then all-cause mortality can increaseinthediabetesgroupfrom37%upto333%,depend- entontheestimatedglomerularfiltrationrate(eGFR)[11]. However, in patients over 75 years old with CKD (eGFR 7% for peo- ple with limited life expectancy

2017 European Renal Best Practice

110. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease

ability to tolerate physiological stresses, including reduced or delayed ability to recover from a stressor. Frailty is also associated with increased incidence of CVD through interrelating inflammatory pathways. Although many different measures of frailty exist, physical frailty is conceptually distinctive from the frailty index , , and relates more directly to functional attributes. , Physical frailty is usually defined as a phenotype that includes 5 domains (unintentional weight loss, exhaustion (...) and strength also decline, with proportionately greater impact as age, disease, and sedentariness synergistically escalate. , Age-associated loss of skeletal muscle mass, called sarcopenia, involves both loss of muscle fibers and reduced fiber size. Whereas muscle mass constitutes 30% of body weight in younger adults, it decreases to ≈15% of body weight by 75 years of age. The loss of strength that accompanies the loss of muscle mass and function in older adults typically leads to the need for greater

2017 American Heart Association

111. Management of Opioid Therapy (OT) for Chronic Pain

prescriptions were still written in 2012.[11] The increase in opioid prescribing is matched by a parallel increase in morbidity, mortality, opioid-related overdose death rates, and substance use disorders (SUD) treatment admissions from 1999 to 2008.[12,13] In 2009, drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents.[14] In 2014, 1.9 million Americans were affected by an OUD related to non-medical use of prescription pain relievers,[15 (...) associated with changes in the central nervous system (CNS) known as central sensitization.[38] Whereas acute and subacute pain are thought to involve primarily nociceptive processing areas in the CNS, chronic pain is thought to be associated with alterations in brain centers involved with emotions, reward, and executive function as well as central sensitization of nociceptive pathways across several CNS areas.[39-41] There are many causes of chronic pain. Pain arising from persistent peripheral

2017 VA/DoD Clinical Practice Guidelines

112. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review

and Definitions Appendix G. Strength of Evidence Table Appendix H. Head-to-Head Studies for Predictive Utility Appendix I. Indirect Studies for Predictive Utility Appendix J. Studies of Reliability and Ease of Use Appendix K. Quality Assessment of Studies of Predictive Utility Appendix L. Quality Assessments of Studies of Reliability and Ease of Use xi Executive Summary Background Unintentional injuries are the leading cause of death among people in the United States ages 1 to 44, and the third leading cause (...) among people ages 45 to 64. 1 Among all age groups, motor vehicle crashes are the first or second leading cause of unintentional injury death. 2 In 2011, there were approximately 40,000,000 emergency department (ED) visits for injuries; of these approximately 2.5 million were due to trauma complications and unspecified injuries. 3 Approximately 18 percent of patients seen in the ED for an injury were transported by emergency medical services (EMS) personnel. 4 Traumatic brain injury (TBI

2017 Effective Health Care Program (AHRQ)

113. Consolidated guideline on sexual and reproductive health and rights of women living with HIV

assessing conditions that may be caused or complicated by intimate partner violence, in order to improve diagnosis/identification and subsequent care. Strong recommendation, indirect evidence Strong recommendation, indirect evidence 1. Reference for this and all the existing recommendations in the next section on integration of services: Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, second edition

2017 World Health Organisation Guidelines

114. Psychosis and schizophrenia in adults: prevention and management

benefits and possible side effects of each drug, including: metabolic (including weight gain and diabetes) extrapyramidal (including akathisia, dyskinesia and dystonia) cardiovascular (including prolonging the QT interval) hormonal (including increasing plasma prolactin) other (including unpleasant subjective experiences). [2009; amended 2014] [2009; amended 2014] Psychosis and schizophrenia in adults: prevention and management (CG178) © NICE 2019. All rights reserved. Subject to Notice of rights (...) ethnic and cultural backgrounds using explanatory models of illness for people from diverse ethnic and cultural Psychosis and schizophrenia in adults: prevention and management (CG178) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 55backgrounds explaining the causes of psychosis or schizophrenia and treatment options addressing cultural and ethnic differences in treatment expectations and adherence addressing

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

115. Sialanar (glycopyrronium) - for treating severe drooling of saliva in children and adolescents (aged 3 years and above) with conditions affecting the nervous system, such as cerebral palsy, epilepsy and neurodegenerative diseases

IPC in-process control IR Infrared i.v. intravenous(ly) kg kilogram(s) ?z terminal elimination rate constant L litre(s) LD 50 lethal dose 50% LDPE low density polyethylene LLOQ Lower Limit of Quantification LoA Letter of Access LOD loss on drying LoD limit of detection LoQ limit of quantitation M muscarinic (receptor) MA Marketing Authorisation MAA Marketing Authorisation Application MAH Marketing Authorisation Holder mBMRS Modified Behavioural and Medical Rating Scale mg milligram(s) MHRA (...) ) No 1901/2006. The eligibility to the centralised procedure was agreed upon by the EMA/CHMP on 24 October 2013. The applicant applied for the following indication: Treatment of sialorrhoea (chronic pathological drooling) in children aged 2 to M3 > M2/M4 > M5. GP is 2-4 times more selective for the M3 and M1 subtypes than M2, making it one of the most potent M3 blockers available (Bird et al. 2011). The applied dose is based on the weight of the child, starting with approximately 0.02 mg/kg per dose

2016 European Medicines Agency - EPARs

116. Guidance on the clinical management of deliberate self-harm (DSH) and on the organisation and delivery of services

%). Important adverse outcomes associated with hospital-treated DSH include repetition of non- fatal DSH, suicide, all-cause mortality, mental health morbidity (e.g. anxiety, depression, substance use), impaired quality of life and impairment of functioning in physical, psychological and social domains. Rates of suicide and repetition of DSH are considered to be the key clinical outcomes for hospital-treated DSH (Carroll et al., 2014). At the time of the previous RANZCP DSH CPG (Boyce et al., 2003; RANZCP (...) in which the individual deliberately causes self-injury or ingests a substance in excess of any prescribed or generally recognised therapeutic dosage’ (Kreitman, 1979). Following the World Health Organization (WHO) multicentre study of parasuicide (De Leo et al., 2006), unifying terminologies were proposed, but these have not been universally adopted. The National Institute for Health and Care Excellence (NICE) 1 guidelines (National Collaborating Centre for Mental Health, 2004) do not use the term DSH

2016 Royal Australian and New Zealand College of Psychiatrists

117. Constipation in older adults: Stepwise approach to keep things moving

for alarm features ( ) that require additional investigations to rule out structural diseases (eg, colon cancer). , Mrs N.M. does not have any alarm features. Box 2. Alarm features of constipation Most important questions to ask your patient: Have you had any fever, had unintentional weight loss, had blood in or on your stool, felt any masses (abdominal or rectal), had night symptoms, or had any other unexplained symptoms? Are you vomiting? Do you have a lot of abdominal pain? Are you still passing gas (...) to reduce constipation. (In this article, PEG 3350 is without electrolytes, unless otherwise stated.) Three months ago she fell in her bungalow and fractured a rib. She is now living in a seniors’ apartment building and gets help from her daughter who lives nearby. Today, upon questioning, Mrs N.M. describes her bowel movements as infrequent (2 to 3 times per week), with hard lumpy stools and some straining. She denies having any nausea, vomiting, blood in the stool, rectal bleeding, fever, weight loss

2016 RxFiles

118. Alcohol: Adult Unhealthy Drinking

Advantages Disadvantages ? Useful for decreasing heavy drinking in patients with a goal of reducing drinking. ? Not FDA-approved for this indication. ? Tapering up to effective dose, which is required to minimize side effects, takes 6–10 weeks. ? Potential side effects include dizziness, ataxia, somnolence, memory difficulties, depression, anxiousness, confusion, nystagmus, weight loss, and nausea. ? Many patients cannot tolerate. ? Avoid in patients with history of renal calculi. Disulfiram Advantages (...) alcohol consumption accounts for 10% of deaths among working-age adults in the United States (Stahre 2014). Recommended drinking limits differ for men and women. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. Alcohol is water soluble, so women typically achieve higher blood-alcohol concentration (BAC) because they have less body water. Although some evidence from observational studies indicates that light

2016 Kaiser Permanente Clinical Guidelines

119. Influencing the trajectories of ageing

; and psychosocial factors such as social vulnerability. 21 A recent innovation has been the development of an electronic frailty index that can be calculated from routine data in primary care. In contrast, the phenotype approach identifies physical frailty in individuals with three out of five criteria: unintentional weight loss; exhaustion; low physical activity; reduced grip strength; and slow gait speed. 22 The first three items are self-reported whilst grip strength and gait speed are usually measured (...) and pharmacological – to slow the trajectory of ageing and maintain health in later life. A report by the Academy highlighted the urgent need to understand the connections between underlying processes of ageing and the causes of age-related disease, and identified a range of strategic priorities for ageing research in the UK. 1 One of the report’s five recommendations was to develop interventions in ageing and age-related diseases. In addition, the Academy’s recent report ‘Improving the health of the public

2016 Academy of Medical Sciences

120. Treatment of HIV-1-positive adults with antiretroviral therapy (interim update)

with an expert source (e.g. www.hiv-druginteractions.org). ? We suggest that if abacavir is to be used with ribavirin, the ribavirin should be weight-based dose- adjusted (2C) 8.3 HIV-related cancers 8.3.1 When to start ART 8.3.1.1 AIDS-defining malignancies BHIVA guidelines for the treatment of HIV-1-positive adults with ART 2015 (2016 interim update) August 2016 20 ? We recommend that all patients with AIDS-defining malignancies should start ART promptly (1B). 8.3.1.1.1 Kaposi sarcoma (KS) ? We recommend (...) their consultation style appropriately. They should also consider how to make information accessible and understandable to PLWH (e.g. with pictures, symbols, large print and different languages) [1], including addressing linguistic and cultural issues. Youth is consistently associated with lower adherence to ART, loss to follow-up and other negative healthcare behaviours [27] and some studies have found an independent association between poorer adherence and attendance and female gender [28], so information

2017 British HIV Association

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