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Unintentional Weight Loss Causes

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161. Primary Care Corner with Geoffrey Modest MD: SPRINT Trial: Elderly Subgroup Study of Lower Blood Pressure Goal

or LVEF <35%, clinical dementia, prevalent stroke , unintentional weight loss of >10%, an SBP of <110 mmHg after standing for 1 minute , or residing in a nursing home Not surprisingly, the NNT was much lower in this trial than the overall SPRINT trial, given the higher event rate of this older group And, reassuringly re: orthostatic hypotension, this subgroup analysis is pretty convincing that there was no increase, but they did exclude anyone with a standing SBP <110 But, a few caveats here (...) patients had SBP difference of 10.8 mm Hg, less fit 11.3 and fit 13.5 mmHg) Primary composite outcome (nonfatal MI, acute coronary syndrome, nonfatal stroke, nonfatal acute decompensated heart failure, death from cardiovascular cause): 102 events in intensive group (2.59%/yr) vs 148 (3.85%/yr) on standard therapy, a 34% reduction [HR 0.66 (0.51-0.85)]. Number-needed-to-treat for 3.14 years was 27 Secondary outcome (all-cause mortality): 73 deathsin intensive group vs 107 on standard therapy, a 33

2016 Evidence-Based Medicine blog

162. First Line Therapy of Advanced Stage Follicular Lymphoma in Patients Not Eligible for Standard Immunochemotherapy

, drenching night sweats, or unintentional weight loss of >10% of normal body weight over a period of 6 months or less) Hematopoietic insufficiency (at least one of the following: granulocytopenia <1500 cells/μl, Hb < 10 g/dl, thrombocytopenia <100.000 cells/μl) Compressive syndrome Pleural/peritoneal effusion Symptomatic nodal or extranodal manifestations At least one bi-dimensionally measurable lesion (> 1.5 cm in its largest dimension by CT scan or MRI) Adequate hematologic function (unless (...) is superior to single agent OBINUTUZUMAB in medically non-fit, 'compromised' patients in terms of anti-lymphoma activity (primary objective), side effects, and quality of life. For the assessment of the anti-lymphoma activity the "event free survival (EFS)" will be applied as primary endpoint. EFS is defined as the time from the day of randomization to the date of first documented disease progression, death by any cause, or institution of a new anti-lymphoma treatment. Condition or disease Intervention

2017 Clinical Trials

163. Gerontology Research Programme: The Singapore Longitudinal Ageing Studies (SLAS I & II)

and Cognitive Frailty) [ Time Frame: 20 years - once every 3-4 years ] Physical frailty was assessed by scores (1 = present, 0 = absent) for five components (shrinking, weakness, slowness, exhaustion, and low Physical Activity (PA)) proposed by Fried et al (3), with the following operational modifications: (i) Shrinking was defined by unintentional weight loss of 4 kg or more in the past 6 months, or BMI less than 18.5 kg/m2, or calf circumference of 31 cm or less. (ii) Weakness was assessed by knee (...) /learning, visuospatial ability, language, attention, and executive functioning. All domains are calculated by weighted averages of age and education adjusted scores. Tests: (i) Digit Span forward and backwards tasks (9); (ii) Rey's Auditory Verbal Learning Test (10); (iii) Story Memory Test (11); (iv) Brief Visuospatial Memory Test - Revised (12); (v) Boston Naming Test (13); (vi) Clock Reading Test; (viii) Colour Trials 1 and 2 (14); (ix) Block Design task (9). Frailty (Measuring the physical

2017 Clinical Trials

164. Tailoring Mobile Health Technology to Reduce Obesity and Improve Cardiovascular Health in Resource-Limited Neighborhood Environments

-directed exercise (walks around the block, climbing stairs) is acceptable for inclusion, with subjects encouraged to continue such activity throughout the program. Eligible participants must be able to provide informed consent independently and also speak and read English at the 8th grade level. EXCLUSION CRITERIA: Medical condition, including recent unintentional weight loss, that might prohibit safe participation in the intervention Diagnosis of diabetes mellitus by self-report Fasting blood glucose (...) hormonal changes during pregnancy that affect study variables and potential pregnancy-related restrictions on exercise. Currently participating in a structured exercise or weight-loss program (e.g., Weight Watchers, NutriSystem, or fitness training) Have undergone weight loss (bariatric) surgery Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided

2017 Clinical Trials

165. Moderate Alcohol and Cardiovascular Health Trial

of any organ transplant Unintentional weight loss >10% in last 6 months Currently participating in another clinical trial (intervention trial) with CVD outcomes. Note: Participant must wait until the completion of his/her activities or the completion of the other trial before being screened for MACH15. Local restrictions for entry by participants can be more conservative if mandated. Not willing or able to provide a name and contact information for at least one additional contact person other than (...) : ethanol, beer, wine, spirits No Intervention: Abstention Abstention from alcohol Outcome Measures Go to Primary Outcome Measures : Cardiovascular Disease or Death [ Time Frame: Every 3 months for up to 90 months or close out, or until date of death ] Time from baseline to a composite endpoint comprised of the first occurrence of a non-fatal myocardial infarction, non-fatal ischemic stroke, hospitalization for angina, coronary/carotid revascularization, or all-cause mortality. Secondary Outcome

2017 Clinical Trials

166. Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report (PubMed)

to become inflamed. We report the case of a 25-year-old female presenting with unintentional weight loss and fatigue. Since her initial labs were concerning for possible infection with hepatobiliary abnormalities, a contrast-enhanced CT was obtained. This study revealed a large periampullary diverticulum with mucosal enhancement and fat stranding consistent with diverticulitis. (...) Lemmel Syndrome Secondary to Duodenal Diverticulitis: A Case Report Lemmel syndrome occurs when a duodenal diverticulum causes obstructive jaundice due to a mechanical obstruction of the common bile duct. Additional pathophysiologic processes may also contribute to the development of Lemmel syndrome. These include duodenal diverticula causing dysfunction of the sphincter of Oddi as well as compression of the common bile duct by duodenal diverticula. It is uncommon for duodenal diverticulum

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2017 Cureus

167. A Rare Case of Fusobacterium Necrophorum Liver Abscesses (PubMed)

A Rare Case of Fusobacterium Necrophorum Liver Abscesses Liver abscesses are an uncommon disease that can present with vague symptoms. Fusobacterium necrophorum causing liver abscesses is a rare condition and only a few cases have been reported. An 88-year-old female presented to her primary care physician with one week of fevers, night sweats, chills, fatigue and vague right upper quadrant abdominal pain. She denied nausea, vomiting, constipation, diarrhea and unintentional weight loss

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2017 Clinics and practice

168. Dilated Thoracic Esophagus Presenting with Painful Progressive Persistent Dysphagia and Leukocytosis of Unknown Origin (PubMed)

and a dilated thoracic esophagus with painful, progressive, and persistent dysphagia and leukocytosis of unknown origin. A 77-year-old man with a past medical history of hypertension and colonic cancer status post right hemicolectomy (surveillance negative) presented to the emergency department with painful, progressive, persistent, and worsening dysphagia for the past three weeks. It was associated with an unintentional weight loss of ten pounds in one month and nausea with non-bilious and non-bloody (...) Dilated Thoracic Esophagus Presenting with Painful Progressive Persistent Dysphagia and Leukocytosis of Unknown Origin Esophageal cancer is the eighth-most common cause of cancer-related mortality worldwide. The most common presenting symptom in advanced distal esophageal cancer is the sensation of sticking food, but it may sometimes present with bleeding and related complications, or asymptomatic leukocytosis. We present the case of a 77-year-old afebrile man with chronic alcoholism

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2017 Cureus

169. Cytomegalovirus-mononucleosis-induced thyroiditis in an immunocompetent patient (PubMed)

weight loss over the same time course Physical examination revealed mild tachycardia, an intention tremor and a normal-sized, nontender thyroid gland without palpable nodules. The remainder of the physical examination was unremarkable and without stigmata of Graves' disease. Her initial blood tests revealed overt thyrotoxicosis, elevated liver enzymes, an elevated C-reactive protein, a negative monospot and a positive CMV IgM antibody. Thyroid sonography revealed areas of hypoechogenicity (...) Cytomegalovirus-mononucleosis-induced thyroiditis in an immunocompetent patient Enteroviruses, including coxsackieviruses and Echovirus, are well known pathogens responsible for the development of thyroiditis. We describe the case of a 49-year-old woman with no personal or family history of thyroid disease who presented to the emergency room with a two-week history of daily fevers up to 39°C, a sore throat, occasional palpitations and diaphoresis, decreased appetite and an unintentional 10 kg

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2017 Endocrinology, diabetes & metabolism case reports

170. Coping with Common GI Symptoms in the Community: A Global Perspective on Heartburn, Constipation, Bloating, and Abdominal Pain/Discomfort

• Dysphonia, recurrent cough • GI bleeding • Evidence of iron-deficiency anemia • Progressive unintentional weight loss • Lymphadenopathy • Epigastric mass WGO Global Guidelines Common GI symptoms (long version) 14 © World Gastroenterology Organisation, 2013 • New-onset heartburn at age > 50–55 years • Family history of esophageal adenocarcinoma [46] 3.6 Heartburn—management cascade • Occasional/intermittent heartburn usually has no long-lasting effects. • Pain and discomfort caused by heartburn (...) , and prominent weight loss; diarrhea may be present. • Gynecological pathology—pain associated with, and worsened by, menses; it should be remembered that IBS is often worse with menstruation. Gynecologic causes of chronic/recurrent abdominal pain/discomfort are: endometriosis, dysfunctional uterine bleeding, pelvic inflammatory disease, and ovarian cancer (may mimic IBS or dyspepsia and be difficult to detect). Ruptured ovarian cyst and ectopic pregnancy present with acute abdominal pain. A pelvic

2013 World Gastroenterology Organisation

171. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology and The Obesity Society

Professor of Medicine and Director, Metabolic Support, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York, 8 Director, Bone Densitometry Unit and Osteoporosis Center, Texas Institute for Reproductive Medicine and Endocrinology, 9 Medical Director, Weight Loss and Diabetes Center, Endocrinology, Northeast Medical Group, Greenwich Hospital/Yale New Haven Health, and Clinical Associate Professor of Medicine, Drexel University College (...) adipose tissue dysfunction (adiposopathy) (Grade A, BEL 1). Adult feeding behavior is solidly rooted from childhood, so it is important to counsel adult patients to include their families, especially their children, in healthy eat- ing behavior changes (Grade B, BEL 2). Nutrition counseling should be culturally, linguistically, and educationally provided to meet individual patient needs (Grade D, BEL 4). • R9. The weight-loss goal for overweight or obese patients is 5 to 10% of current body weight

2013 American Association of Clinical Endocrinologists

172. Localized Nodal Indolent Lymphoma

, or unintentional weight loss of >10% in the 6 months before presentation, occur in about 20% of patients. 1 University of Florida Proton Therapy Institute, Jacksonville, Florida. 2 Panel Chair, University of Rochester Medical Center, Rochester, New York. 3 Panel Vice-chair, Princess Margaret Hospital, Toronto, Ontario, Canada. 4 Stanford Cancer Center, Stanford, California, American Society of Clinical Oncology. 5 MD Anderson Cancer Center, Houston, Texas. 6 Emory University, Atlanta, Georgia, American Society (...) ) to doses of 35 Gy to 50 Gy at 1.5 Gy to 2.5 Gy per fraction. With a median follow-up of 7.7 years, the median OS time was 13.8 years with a 10- year freedom from recurrence rate of 44% and an OS rate of 64%. In the experience of Princess Margaret Hospital (Toronto, Ontario) [24] treating 190 patients with stage I or II follicular lymphoma, definitive treatment with RT (with variations in radiation field designs and doses) led to a 12-year relapse-free survival rate of 53%, a cause- specific survival

2013 American College of Radiology

173. Elder Abuse and Women's Health

of appropriate actions, which causes harm, risk of harm, or distress to an individual 60 years or older and occurs: a) within a relationship where there is an expectation of trust; or b) when the targeted act is directed towards an elder person by virtue of age or disabilities. Elder abuse can be intentional or unintentional, can take various forms, and includes but is not limited to physical, psychological, emotional, or sexual abuse, neglect, abandonment, and financial exploitation” ( ) (see ). The U.S (...) : Social withdrawal Depression or anxiety Insomnia Anorexia Vague reports of health problems Examination: Passivity Poor engagement Flat affect Weight loss Physical abuse Use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include, but is not limited to, such acts of violence as striking (with or without an object), beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical

2013 American College of Obstetricians and Gynecologists

174. Alcohol impacts health: A rapid Review of the Evidence

in their background report: weight gain, cognitive decline with age, coronary heart disease (CHD), bone health, and 16 unintentional injury. The Committee limited the reviews to studies with greater methodological rigour and only conducted systematic reviews of observational prospective studies and randomized control trials. There were two exceptions: (1) alcohol intake and unintentional injury because cross- sectional or case control studies are of equal or better validity; and (2) alcohol intake related to CHD (...) relationships. These relationships can be linear (e.g., as more alcohol is consumed, risk increases for breast cancer); J-shaped (i.e., low levels of alcohol consumption are protective for heart disease and then risk increases at higher doses); or accelerating (i.e., risk for liver cirrhosis increases rapidly as consumption increases). However, irregular, heavy drinking patterns are also likely to result in harms such as suicide, violent behaviours, and heart disease. 3. Heart disease and all-cause

2013 Peel Health Library

175. Australian guidelines for the treatment of acute stress disorder and posttraumatic stress disorder

Professor Malcolm Hopwood (President Elect) Australian Association of Social Workers Ms Elizabeth Sommerville (Mental Health Professional Officer) Australian Child and Adolescent Trauma, Loss and Grief Network Ms Michelle Roberts (Psychologist) Australian College of Mental Health Nurses Professor Brenda Happell (Fellow) Australian Guidance and Counselling Association Ms Roslyn Isles (President) Australian Guidance and Counselling Association Ms Lesley Fraser (Secretary) Australian Psychological Society (...) practice. Amongst the key GPPs: • For people presenting to primary care services with repeated non-specific physical health problems, it is recommended that the primary care practitioner consider screening for psychological causes, including asking whether the person has experienced a traumatic event and describing some examples of such events. • A thorough assessment is required, covering relevant history (including trauma history), PTSD and related diagnoses, general psychiatric status (noting extent

2013 Clinical Practice Guidelines Portal

176. Treatment of HIV-1 positive adults with antiretroviral therapy

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

2014 British HIV Association

177. Investigation and management of Chronic Lymphocytic Leukaemia

finding on a routine full blood count. Clinical evaluation should elicit a family history of lymphoid malignancy, define the clinical stage (Table ) and determine whether B symptoms (fever, weight loss, night sweats), profound lethargy and cytopenias are CLL‐related, due to marrow infiltration, immune destruction or hypersplenism, or have an alternative cause. Table 2. Staging systems in CLL BINET Stage Features A <3 Lymphoid areas a The five lymphoid areas comprise: uni or bilateral cervical (...) with an increase of more than 50% over a 2‐month period or lymphocyte doubling time (LDT) of <6 months. In patients with initial blood lymphocyte counts <30 × 10 9 /l, LDT should not be used as a single parameter to define a treatment indication. Autoimmune anaemia and/or thrombocytopenia that is poorly responsive to corticosteroids or other standard therapy. Constitutional symptoms, defined as any one or more of the following disease‐related symptoms or signs Unintentional weight loss of 10% or more within

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2012 British Committee for Standards in Haematology

178. Osteoporosis in Men

. The reviewed document was approved by The Endocrine Society Council before submission for peer review. Conclusions: Osteoporosis in men causes significant morbidity and mortality. We recommend testing higher risk men [aged ≥70 and men aged 50–69 who have risk factors ( e.g . low body weight, prior fracture as an adult, smoking, etc .)] using central dual-energy x-ray absorptiometry. Laboratory testing should be done to detect contributing causes. Adequate calcium and vitamin D and weight-bearing exercise (...) and physical examination may provide important information. Osteomalacia, usually due to severe vitamin D deficiency, is common in men with hip fractures. Other causes of bone loss, such as hyperparathyroidism, kidney and liver disease, hypogonadism, and hypercalciuria, are sufficiently common in high-risk men to warrant evaluation ( ). A 24-h urine calcium measurement is useful to identify idiopathic hypercalciuria or calcium malabsorption. Hypercalciuria can be managed with thiazide diuretics

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2012 The Endocrine Society

179. Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain

of the patient and family be ob- tained (50,52,53,55,58,177-180). 1.1 Comprehensive Assessment 1.1.1 Pain Condition A thorough history and physical examination must be documented to determine the type, cause, and nature of the pain, including questions about past investigations and interventions for pain. This history also should include medication trials and the pain intensity and the functional impairment that arises from it (i.e., impact of pain on ac- tivities of daily living, work, and other aspects (...) of medication taken, when it was taken or identify the source of the drug. ? Some patients state that the expected drug is not found in the urine because they are high metab- olizers. They may state that they are on diuretics and are drinking fluids to lose weight or on diet pills, and since they have so much fat, it cannot be detected. Most of the explanations are untrue, however, as only a small percentage of persons are considered ultra rapid metabolizers and may me- tabolize specific drugs more rapidly

2012 American Society of Interventional Pain Physicians

180. Peptest for diagnosing gastro-oesophageal reflux

, and a report is sent to the patient and doctor. Current NHS options Current NHS options NICE guidance on dyspepsia makes recommendations on the diagnosis, management and treatment of GORD. The aims are to control symptoms, heal oesophagitis and prevent recurrent oesophagitis or other complications. The guideline recommends referral for endoscopy if there are any red-flag symptoms, which include: gastrointestinal bleeding persistent vomiting progressive unintentional weight loss aged 55 years or older (...) have an increased risk of becoming cancerous in time. Conversion of Barrett's oesophagus to oesophageal adenocarcinoma has a lifetime risk of 5% in men and 3% in women (Jankowski 2010). GORD is normally diagnosed empirically with a trial of proton pump inhibitors or by endoscopy, manometry or pH testing when more serious disease is suspected. It may present with atypical symptoms, including chronic cough, hoarseness, loss of voice, laryngeal pain or ear, and nose and throat symptoms caused

2015 National Institute for Health and Clinical Excellence - Advice

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