Fecal microbiota transplantation, as a microbiota-target therapy, is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases. New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota. This review shows that it is an exciting time in the burgeoning science of FMT application in C. Difficile infection and previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.
about 5 years ago
This study was conducted to better define the pathophysiology, risk factors, and therapeutic approach to exercise-associated hyponatremia. Medical records from all participants in the 1998 Suzuki Rock ‘N’ Roll Marathon® who presented to 14 Emergency Departments (EDs) were retrospectively reviewed to identify risk factors for the development of hyponatremia. Hyponatremic patients were compared to other runners with regard to race time and to other marathon participants seen in the ED with regard to gender, clinical signs of dehydration, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An original treatment algorithm incorporating the early use of hypertonic saline (HTS) was evaluated prospectively in our own ED for participants in the 1999 marathon to evaluate improvements in sodium correction rate and incidence of complications. A total of 26 patients from the 1998 and 1999 marathons were hyponatremic [serum sodium (SNa) ≤135 mEq/L] including 15 with severe hyponatremia (SNa ≤ 125 mEq/L). Three developed seizures and required intubation and admission to an intensive care unit. Hyponatremic patients were more likely to be female, use NSAIDS, and have slower finishing times. Hyponatremic runners reported drinking “as much as possible” during and after the race and were less likely to have clinical signs of dehydration. An inverse relationship between initial SNa and time of presentation was observed, with late presentation predicting lower SNa values. The use of HTS in selected 1999 patients resulted in faster SNa correction times and fewer complications than observed for 1998 patients. It is concluded that the development of exercise-associated hyponatremia is associated with excessive fluid consumption during and after extreme athletic events. Additional risk factors include female gender, slower race times, and NSAID use. The use of HTS in selected patients seems to be safe and efficacious.
almost 6 years ago
Now fully revised and updated with the latest guidelines, this new edition of the Oxford Handbook of Paediatrics is a compact guide to all aspects of acute and chronic paediatrics. The handbook's team of specialist contributors and editors have successfully condensed many years of clinical experience into a pocket-sized compendium of clinical problems and treatment options. Taking a child-centred approach to the subject, the authors have provided comprehensive coverage of areas such as neonatology, surgery, genetics and congenital malformations, and child protection in a user-friendly and succinct style. Sections are also devoted to covering the treatment of children in the community, and the psychological effects of illness on both the child and their family. All chapters have been updated for this new edition, with completely overhauled chapters on neurology and respiratory medicine, the latest management guidelines on inherited metabolic disease, further information on medical and research ethics, and enhanced usage of diagnostic and treatment algorithms. With practical advice and space for personalized notes, this handbook will be invaluable to all those involved in the care of the younger patient.
almost 5 years ago
This narrated case report illustrates this newly discovered porphyria and also provides some background medical education to the porphyrias as a whole.
about 8 years ago
Internal medicine on Instagram: “Systemic AL amyloidosis - macroglossia An enlarged tongue is present in this patient with systemic amyloidosis.”
“Systemic AL amyloidosis - macroglossia An enlarged tongue is present in this patient with systemic amyloidosis.”
about 6 years ago
Metabolic acidosis is defined as an arterial blood pH <7.35 with plasma bicarbonate <22 mmol/L. Learn about Metabolic acidosis on Metabolic acidosis page
over 5 years ago
Metabolic Alkalosis Treatment & Management: Approach Considerations, Chloride-Responsive Alkalosis, Chloride-Resistant Metabolic Alkalosis
Metabolic alkalosis is a primary increase in serum bicarbonate (HCO3 -) concentration. This occurs as a consequence of a loss of H+ from the body or a gain in HCO3 -.
over 5 years ago
Hyperkalaemia is defined as plasma potassium in excess of 5.5 mmol/L. [ 31969 : Renal Association Treatment of Acute Hyperkalaemia in Adults (2012) ] The...
over 5 years ago
Fecal microbiota transplantation (FMT), as a microbiota-target therapy, is arguably very effective for curing Clostridium difficile infection and has good outcomes in other intestinal diseases. New insights have raised an interest in FMT for the management of extra-intestinal disorders associated with gut microbiota. This review shows that it is an exciting time in the burgeoning science of FMT application in C. Difficile infection and previously unexpected areas, including metabolic diseases, neuropsychiatric disorders, autoimmune diseases, allergic disorders, and tumors.
about 5 years ago
The reference given when answering the question about the increase in permeability of sodium ions during hypocalcemia is satisfactory but "does hypocalcemia not reduce the release of neurotransmitters at a chemical synapse" Will it not affect the speed and efficiency of conduction of impulse. Therefore how will it cause tetany?" Reference Increased Permeability of the Sodium Channels When There Is a Deficit of Calcium Ions. The concentration of calcium ions in the extracellular fluid also has a profound effect on the voltage level at which the sodium channels become activated. When there is a deficit of calcium ions, the sodium channels become activated (opened) by very little increase of the membrane potential from its normal, very negative level. Therefore, the nerve fiber becomes highly excitable, sometimes discharging repetitively without provocation rather than remaining in the resting state. In fact, the calcium ion concentration needs to fall only 50 per cent below normal before spontaneous discharge occurs in some peripheral nerves, often causing muscle “tetany.”This is sometimes lethal because of tetanic contraction of the respiratory muscles. The probable way in which calcium ions affect the sodium channels is as follows:These ions appear to bind to the exterior surfaces of the sodium channel protein molecule. The positive charges of these calcium ions in turn alter the electrical state of the channel protein itself, in this way altering the voltage level required to open the sodium gate. From: Guyton, Arthur C. Textbook of medical physiology / Arthur C. Guyton, John E. Hall.—11th ed.
over 7 years ago
I was discussing with a renal consultant the reasons for avoiding thiazides in patients with sarcoidosis with renal involvement. I think it is well established that they can cause hypercalcaemia but after (not very much) searching on the internet and in textbooks I can't seem to find out why? Does anybody know?
over 6 years ago