POPULARITY
4 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
2 episodes with Pharyngitis
In this episode, we review the high-yield topic Pharyngitis from the Pediatrics section at Medbullets.comFollowMedbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode of In the Clinic, Mike and Jess invite back Dr. Émélie Braschi. The team discusses Jay Mal, a 9 year old boy presenting with fatigue and fever.
From treatment of strep pharyngitis to clinical trials, ID physicians and long-time friends Buddy Creech, MD, MPH, FPIDS, Jason Newland, MD, MEd, FPIDS and Jeffrey Gerber, MD, PhD, give their hot takes.Give back to your ID community before the year ends with a donation to the IDSA Foundation. https://idsafoundation.org/
On this episode, my good friend and colleague Alex Hovey, PA-C is sitting in for Cole this episode. We review the treatment of acute rhinosinusitis and pharyngitis. We mention some treatment options for symptom relief in patients with viral sinusitis and viral pharyngitis. We spend the majority of the episode covering the treatment algorithm for bacterial sinusitis and pharyngitis. We also used this episode to review some antibiotic clinical pearls. Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! We want to give a big thanks to our sponsor, High-Powered Medicine. HPM is a book/website database of summaries for over 150 landmark clinical trials. You can get a copy of HPM, written by Dr. Alex Poppen, PharmD, at the links below: Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to give a big thanks to our main sponsor Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below: www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.
Ann Marie presents a case to Dan, Jack, and Sharmin of a young patient with tachycardia, lower extremity edema, who later develops pharyngitis. Thyrotoxicosis Schema Pharyngitis Schema Peripheral Edema Schema Download CPSolvers App here RLRCPSOLVERS
In this episode, we review the high-yield topic of Pharyngitis from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
Episode 89: Gonorrhea Basics. Written by Robert BensacenezRobert, Dr. Schlaerth, and Dr. Arreaza discuss the basics of gonorrhea, including presentation, treatment, and even a potential gonococcal vaccine.Introduction: Gonorrhea is commonly known as “the clap” or “the drip”. This ancient disease, described as “the perilous infirmity of burning” in a book called The History of Prostitution, has been treated with many remedies throughout history, including mercury, sulfur, silver, multiple plants, and even gold. Today we will discuss the clinical features, diagnosis, and current therapy of gonorrhea. By the way, did you know that gonorrhea in Spanish is used as an insult in Colombia? Well, now you know it. Definition: Gonorrhea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae (common name gonococcus), which is a gram-negative, intracellular, aerobic, diplococci. This disease leads to genitourinary tract infections such as urethritis, cervicitis, pelvic inflammatory disease (PID), and epididymitis. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Gonorrhea. Written by Robert Besancenez, MS4, Ross University School of Medicine. Moderated and edited by Hector Arreaza, MD. Discussion participation by Katherine Schlaerth, MD. Epidemiology: The disease primarily affects individuals between 15–24 years of age (half of the STI patients in the US). CDC estimates that approximately 1.6 million new gonococcal infections occurred in 2018. Incidence rates are highest among African Americans, American Indians, and Hispanic populations.Transmission is sexual (oral, genital, or anal) or perinatal (causing gonococcal conjunctivitis in neonates). Risk factors include unsafe sexual behaviors (lack of barrier protection, multiple partners, men who have sex with men (MSM), and asplenia, complement deficiencies. Individuals with low socioeconomic status are at the highest risk: poor access to medical treatment and screening, poor education, substance use, and sex work. Presentation: The incubation period is ~ 2–7 days, and sometimes patients do not develop any symptoms. Urogenital infection: Gonorrhea is commonly asymptomatic, especially in women, which increases the chance of further spreading and complications. When symptoms are present, typical symptoms include purulent vaginal or urethral discharge (purulent, yellow-green, possibly blood-tinged). Discharge is less common in female patients. Urinary symptoms include dysuria, urinary frequency, and urgency. Male: - Typical presentation is urethritis. - Penile shaft edema without other signs of inflammation.- Epididymitis: unilateral scrotal fullness sensation, scrotal swelling, redness, tenderness, relief of pain with elevation of scrotum —Prehn Sign— and positive cremasteric reflex.- Robert: Prostatitis: fever, chills, general malaise, pelvic or perineal pain, cloudy urine, prostate tenderness (examine prostate gently). Female: - Cervicitis: Friable cervix and discharge (purulent, yellow, malodorous), - PID: pelvic or lower abdominal pain, dyspareunia, fever, cervical discharge, cervical motion tenderness but also uterine or adnexal tenderness, abnormal intermenstrual bleeding. PID can be subclinical and diagnosed retroactively when tubal occlusion is discovered as part of a workup for infertility. PID can cause Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain).- Bartholinitis presents with introitus pain, edema, and discharge from the labia. - Vulvovaginitis may occur but is rare (due to the tissue preference of gonococci)Extragenital infection: Proctitis: Rectal purulent discharge, possible anorectal bleeding and pain, rectal mucosa inflammation, or rectal abscess (less common).Pharyngitis: sore throat, pharyngeal exudate, cervical lymphadenitis. Disseminated gonococcal infection (DGI): Triad of arthritis, pustular skin lesions, and tenosynovitis. As mentioned in Episode 46, on December 23, 2020, the California Department of Public Health (CDPH) sent a “Dear Colleague” letter to warn the medical community about the increased cases of DGI in California and Michigan. Increased cases may be caused by decreased STD testing and treatment because of the COVID-19 pandemic, and not necessarily because of a more virulent strain of gonorrhea. Later, treatment of gonorrhea was updated because of resistance. Epidemiology: ∼ 2% of cases. Most common in individuals younger than 40 years old, the female to male ratio is 4:1. A history of recent symptomatic genital infection is uncommon. Asymptomatic infections increase the risk of dissemination due to delayed diagnosis and treatment. Clinical features: Two distinct clinical presentations are possible. Arthritis-dermatitis syndrome:Polyarthralgias: migratory, asymmetric arthritis that may become purulent.Tenosynovitis: simultaneous inflammation of several tendons (e.g. fingers, toes, wrist, ankle).Dermatitis: vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic center. Most commonly distributed on the trunk, extremities (sometimes involving the palms and soles). Typically, < 10 lesions with a transient course (subside in 3–4 days). Additional manifestations: fever and chills (especially in the acute phase). Purulent gonococcal arthritis: Abrupt inflammation in up to 4 joints (commonly knees, ankles, and wrists). No skin manifestations, rarely tenosynovitis. Genitourinary manifestations in only 25% of affected individuals. Not to be confused with reactive arthritis. Health care providers living in California: Order Nucleic acid amplification test (NAAT) and culture specimens from urogenital, extragenital mucosal sites (e.g., pharyngeal and rectal), and from disseminated sites (e.g., skin, synovial fluid, blood, and cerebrospinal fluid) before initiating empiric antimicrobial treatment for patients with suspected DGI. Report within 24 hours of diagnosis to the California Department of Public Health. Complications of DGI: sepsis with endocarditis, meningitis, osteomyelitis, or pneumonia. Diagnosis of gonorrhea: The test of choice is Nucleic acid amplification testing (NAAT) of first-catch urine or swabs of urethra, endocervix and pharynx, and synovial fluid in disseminated infection. Other possible tests: gram stains and bacterial cultures (Thayer-Martin agar, useful for antibiotic resistance, results may take 48 hours, sensitivity is lower than NAAT.)Synovial fluid analysis: Appearance of fluid can be clear or cloudy (purulent), high Leukocyte count (up to 50,000 cells/mm3): especially segmented neutrophils, gram stain positive in < 25% of cases. Treatment: Ceftriaxone and doxycycline for uncomplicated cases, but may require different approaches in case of allergies or intolerance to these antibiotics, or in severe cases. Uncomplicated gonorrhea (affecting cervix, urethra, rectum, pharynx)First-line treatment: single-dose ceftriaxone 500 mg IM (1 G for patients >150 Kg) PLUS doxycycline 100 mg PO twice a day for 7 days If a chlamydial infection has not been excluded.During pregnancy: Ceftriaxone PLUS single-dose azithromycin 1 gram PO(doxy is contraindicated – teratogen) Complicated gonorrhea (salpingitis, adnexitis, PID/ epididymitis, orchitis)Single-dose ceftriaxone IM PLUS doxycycline PO for 10–14 days (women may require additional administration of Metronidazole PO for 14 days). DGICeftriaxone IV every 24 hours for 7 days In case Chlamydia infection has not been ruled out: PLUS doxycycline PO twice a day for 7 daysDrainage of purulent joint(s) Sequelae: Without treatment, a prolonged infection may lead to complications, such as hymenal and tubal synechiae that lead to infertility in women. Prevention:-Screening for gonorrhea (USPSTF recommendations, September 2021, Grade B): Annual NAAT screening of gonorrhea AND chlamydia for sexually active women ≤ 24 years (including pregnant persons) or > 25 years with risk factors (e.g. new or multiple sex partners, sex partner with an STI, etc.). Evaluate for other STIs if positive (e.g. chlamydia, syphilis, and HIV). There is insufficient evidence to recommend for or against screening gonorrhea in asymptomatic males (Grade I).In all patients: Evaluate and treat the patient's sexual partners from the past 60 days. Provide expedited partner therapy if the timely evaluation of sexual partners is not feasible. Single-dose cefixime PO (if chlamydia has been excluded in the patient) OR Single-dose cefixime PO PLUS doxycycline PO for 7 days. Sexual partners must be treated simultaneously to avoid reinfections. A possible gonococcal vaccine: A gonococcal vaccine is theoretically possible, let's remember that the meningococcal vaccine exists. Meningococcus is closely related to gonococcus. A study published in 2017 showed that MeNZB® (a vaccine used in New Zealand until 2011 to fight against a meningitis epidemic) provided partial protection against gonorrhea. Food for thought for you guys. Conclusion: Let's remember to screen asymptomatic women for gonorrhea, identify symptomatic patients and start treatment promptly, and prevent serious complications, and more importantly, let's promote safe sex practices to prevent this disease.Now we conclude our episode number 89 “Gonorrhea Basics”. Gonorrhea affects mainly the urogenital area, but it can spread to the pharynx, rectum, skin, and even joints. When you see septic arthritis in patients with high risk for gonorrhea, suspect disseminated gonococcal infection and start treatment promptly. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created for educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Robert Besancenez, and Katherine Schlaerth. Audio edition: Suraj Amrutia. See you next week! _____________________References:Seña, Arlene C, MD, MPH; and Myron S Cohen, MD. Treatment of uncomplicated Neisseria gonorrhoeae infections, UpToDate, updated on Jan 27, 2022. Accessed on April 5, 2022. https://www.uptodate.com/contents/treatment-of-uncomplicated-neisseria-gonorrhoeae-infections Ghanem, Khalil G, MD, PhD. Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents, UpToDate, updated on Sep 17, 2021, accessed on April 5, 2022. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-neisseria-gonorrhoeae-infection-in-adults-and-adolescents Klausner, Jeffrey D, MD, MPH. Disseminated gonococcal infection, UpToDate, updated on March 3, 2022. Accessed on April 5, 2022. https://www.uptodate.com/contents/disseminated-gonococcal-infection Petousis-Harris H, Paynter J, Morgan J, et al. Effectiveness of a group B OMV meningococcal vaccine on gonorrhea in New Zealand – a case control study. Abstract presented at: 20th International Pathogenic Neisseria Conference. Manchester, UK; 2016.
The PROOF Study in AxSpA: Dr. Sheila Reyes Management of Pain in Spondyloarthritis: Dr. Antoni Chan Pregnancy complications in Ankylosis Spondylitis: Dr.Olga Petryna JAKi For Refractory Still's Disease: Dr. Olga Petryna Sinusitis and Pharyngitis and RA with Dr. Richard Conway Cognitive Function and Rheumatoid Arthritis: Dr. Akhil Sood Interviews Dr. Elena Myasoedova Serum Biomarkers to Distinguish Radiographic Progression in PsA with Dr. Robert Chao
The PROOF Study in AxSpA: Dr. Sheila Reyes Management of Pain in Spondyloarthritis: Dr. Antoni Chan Pregnancy complications in Ankylosis Spondylitis: Dr.Olga Petryna JAKi For Refractory Still's Disease: Dr. Olga Petryna Sinusitis and Pharyngitis and RA with Dr. Richard Conway Cognitive Function and Rheumatoid Arthritis: Dr. Akhil Sood Interviews Dr. Elena Myasoedova Serum Biomarkers to Distinguish Radiographic Progression in PsA with Dr. Robert Chao
Unsere Teilzeit-Kinomäuse Casper und Drangsal sind mit einer neuen Folge Mit Verachtung zurück - gemeinsam und kerngesund. Nachdem Drangsal von seiner überstanden Pharyngitis, Wandererlebnissen in der Pfalz und seinem ersten Besuch in einer Wrestling-Schule erzählt hat, entsteht eine hitzige Diskussion über das Original Rezept der Jägermeister-Bomb. Außerdem klärt Casper darüber auf, was es mit seiner sagenumwobenen Scheiße-Schublade auf sich hat und spricht über den Titel seiner neuen Single „Alles war schön und nichts tat weh“. Zum Schluss erwartet euch nicht nur ein prall gefülltes Showboat, sondern auch ein handverlesenes Grill-Buffet mit bester neuer Musik.
Teach your child the puppy dog pant. Join Dr. Karen and Dr. Jack Hopkins as they talk about strep throat including its history and current treatment. Most importantly, how to talk them through the dreaded strep test!
Tayo ay pinagkatiwalaan ng Panginoon ng Buhay kaya atin itong Pagyamanin sa pananampalataya.
GAS pharyngitis is associated with a few important complications. They are usually divided in suppurative and non-suppurative - i.e. purulent and non purulent complications. The main non-suppurative complications are post-strep glomerulonephritis and acute rheumatic fever (which we did an episode on recently). A couple of the serious suppurative complications to be aware of is a peritonsillar or retropharyngeal abscess. In general, antibiotics are over-prescribed for pharyngitis. Australian guidelines these days actually only advise antibiotics in patients who are at higher risk of the “non-suppurative” complications of GAS infection. Links and resources: Follow us on Instagram @yourekiddingrightdoctors Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)
In this episode of The Nurse Practitioner Podcast, Dr. Julia Rogers, DNP, RN, CNS, FNP-BC discusses pharyngitis.
In this episode of The Nurse Practitioner Podcast, Dr. Julia Rogers, DNP, RN, CNS, FNP-BC discusses pharyngitis.
Welcome to the first episode. Here we discuss who gets strep throat and why we always want to send a culture if the rapid strep is negative.
In this month's EM Quick Hits podcast we have Salim Rezaie on clinical probability adjusted D-dimer for pulmonary embolism, Bourke Tillmann on ARDS for the ED Part 2, Brit Long & Michael Gottlieb on pharyngitis mimics, Justin Hensley on the many faces of barotrauma, Hans Rosenberg & Peter Johns on assessment of continuous vertigo and Justin Morgenstern & Jeannette Wolfe on gender-based differences in CPR... The post EM Quick Hits 23 – Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences appeared first on Emergency Medicine Cases.
This episode covers pharyngitis!
Yep we said it. We got a celebrity on the podcast. One and only Dr. Robert Centor joins us to chat all about pesky Acute Pharyngitis on the exam, why we need to worry more about suppurative complications than Rheumatic Fever, and HIV is more common than you think...
Pharyngitis?! End of the World!? Relax, chill, be still Host @Daammtayy talks about being bed -rested, California fires, & being observant in a time of chaos.
Your kid’s got a sore throat--no big deal? Think again! Listen to this episode as we wade into the depths of pediatric and adolescent pharyngitis, with the world-renowned creator of the Centor Criteria Dr. Robert Centor MD, MACP, internist and Professor-Emeritus at The University of Alabama at Birmingham School of Medicine. In this episode, we discuss/review the Centor criteria, the differential diagnosis for acute pharyngitis in the school-aged versus adolescent patient, how to treat bacterial pharyngitis, what complications to watch out for in the pediatric populations, and how we should worry more about Lemierre's syndrome than acute rheumatic fever.
Andi Marmor, MD and Sol Behar, MD review clinical features, complications, and latest treatment options of strep pharyngitis. GAS as a cause of pharyngitis is most commonly observed in children 5–15 years of age. Diagnostic studies for GAS pharyngitis are not recommended for children under 3 because acute rheumatic fever is rare in children
Episode description Dr. Zaven Sargsyan presents a Human Dx clinical unknown to student Dr. Levine, Dr. Rice and Rabih Download CPSolvers App here Case link – Human Dx App Emma Levine Emma Levine is currently a fourth-year medical student at the University of California, San Francisco, applying to Internal Medicine residency programs this fall. She… Read More »Episode 41 – Human Dx Clinical unknown with student Dr. Levine, Dr. Rice, and Rabih – Fever, pharyngitis & dyspnea
Dr. Centor discusses the diagnosis and treatment of pharyngitis in adolescents and young adults with Dr. Jeffrey Linder of Northwestern University.
Session 21 Today, we’ve got some interesting case of a 14-year-old male with some malaise and abdominal pain. Once again, we're joined by Dr. Karen Shackelford of BoardVitals. Check out the resources they have to offer. Use the promo code BOARDROUNDS to save 15% off upon purchasing a QBank. Also, they have an Ask a Clinician feature where clicking a button gives you access to a physician who will help you through specific questions or content. This feature comes with their 3-month and 6-month plan. This podcast is part of the Meded Media network where we help premeds and medical students as they journey towards becoming great physicians. [02:15] Question of the Week A 14-year-old male is evaluated for malaise and abdominal pain. He reports passing dark urine this morning. His past medical history is significant for Streptococcal pharyngitis ten days ago, for which he received Amoxicillin. Today, his vital signs are within normal limits, except for an elevated blood pressure of 145/95 mmHg. Examination reveals spatial edema with pronounced periorbital swelling. He has 1+ pedal edema bilaterally. Abdominal exam reveals mild, diffuse tenderness without rebound or guarding. Laboratory studies are unremarkable except for a serum creatinine of 2 mg/dL. What is the common finding associated with the patient's condition? (A) Hypovolemia (B) Polyuria (C) Red blood cell cast (D) Hypokalemia [03:30] Thought Process Behind the Answers The correct answer here is C. Basically, the patient has glomerulonephritis. This is characterized by red blood cell casts that are almost pathognomonic for glomerulonephritis. Poststreptococcal glomerulonephritis is not common but also not unusual. The history of streptococcal pharyngitis should lead to that conclusion. Other symptoms of glomerulonephritis include white blood cell casts, hematuria, and proteinuria. But for this question, you have to hone in on the glomerulonephritis. Other findings in the urine sediment include granular casts. Dysmorphic red blood cells are strongly associated with glomerulonephritis and proteinuria. This is clinically manifested by a slow and progressive rise in serum creatinine and fluid hypertension, peripheral or periorbital edema, and sometimes, hypercoagulability. Rhabdomyolysis may come to mind but it wasn't really an option among the choices. This could happen on the boards. There might be systemic manifestations of some underlying disease process associated with glomerulonephritis. There's a group of immunologically triggered disorders that result primarily or characterized by glomerular inflammation. It can also manifest the proliferation of glomerular tissues that damage that basement membrane, mesangium, or the capillary endothelium. [07:15] Understanding the Other Answer Choices Glomerulonephritis is associated with hypervolemia. In this case, you have the proteinuria. But with the edema, you should immediately be able to figure out that it wasn't associated with hypovolemia. The patient had pedal edema and periorbital edema. It is also important to mention that there are three primary mechanisms of glomerular inflammation. And what distinguishes a nephrotic syndrome from glomerulonephritis is the inflammation as a mechanism of damaging the glomerular apparatus. This might come in the boards that the mechanisms are either immune complex deposition as in this case. Anti-glomerular basement disease is associated with Wegener's granulomatosis, eosinophilic granulomatosis with polyangiitis, or microscopic polyangiitis. The other mechanism is the antineutrophil cytoplasmic autoantibody (ANCA) or small vessel vasculitis. It causes damage to the glomerular filtration barrier. This results in the leakage of plasma proteins and inflammatory cells into the renal tubule. Patients may even have pulmonary edema in some cases. The hypertension results from retaining salt and water. The patient has a rising creatinine and so hyperkalemia is more likely to happen. So this is an easy one to rule out. Polyuria is associated with diabetes and causes diabetic ketoacidosis. This isn't that uncommon. Further laboratory testing is needed to determine the ideology. Typically on post-streptococcal glomerulonephritis, it is self-limited. A fair amount doesn't progress to renal failure. But testing is needed to determine the ideology on other cases whether it's long-lasting or the significant decline in glomerular filtration rate. There is usually a raise in serum complement levels, anti-neutrophilic cytoplasmic autoantibodies, antiglomerular basement membrane autoantibodies, antinuclear antibodies, anti-double stranded DNA. The treatment is just supported in these cases or treatment of the underlying disorder if there is one that you can determine from these other tests. Links: Meded Media BoardVitals
A follow up to Podcast 32 - the Scratchy Throat ended up being Pharyngitis! First time ever that I've had to battle this infection which struck me down with cold sweats, achy joints and low energy. I think it was stress related with lowered my immune system then allowed the little lemmings in!
Sore throat is a common pediatric complaint. The majority of pharyngitis is viral; however, it can be useful to remember why, when and how to test for strep. On Tools You Can Use, we will cover history, PEX, testing, and treatment for strep throat.
Happy October Everyone! With the dangers of pharyngitis covered last month, Brian and I have left the scariest sore throat of them all to now. It’s a disease that strikes without warning, leaves a wake of decimated organs behind it . . . but is pretty easily defeated by penicillin. The fearsome, the horrific . . . Strep Throat! Ok, it’s not that exciting, but it is common. SUPER common. And everyone will ask you about it for the rest of your career. So are you gonna test? Are you gonna treat? Are you gonna take the time to talk to patients about what will actually make them feel better? That and more on this month’s episode of AZEMCast. The AZEMCast Team Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast https://itunes.apple.com/us/podcast/arizona-emcast/id685439303?mt=2https://azemcast.podbean.com/feed/
Happy September Everyone! This month we are going back to simpler times and simpler complaints. Something I guarantee you will be seen on every single shift for the rest of your life. The dreaded . . . SORE THROAT!!! And as boring as that topic may seem, it’s common and it’s fraught with pitfalls, perils and unsatisfied customers. For this month, to ease you into it, we start with the dangerous etiologies as we coast into the mundane in October. All hot potato voices and stridor are impersonated . . . badly, The AZEMCast Team Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast https://itunes.apple.com/us/podcast/arizona-emcast/id685439303?mt=2https://azemcast.podbean.com/feed/
This week we review some recent publications on steroids in pharyngitis and the VAN assessment in stroke. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_150_0_Final_Cut.m4a Download Leave a Comment Tags: Pharyngitis, Steroids, VAN Assessment Show Notes Read More The SGEM: SGEM #203: Let Me Clear My Sore Throat with a Corticosteroid Core EM: Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis REBEL EM: Does it Take a VAN to Identify Emergency Large Vessel Occlusion (EVLO) in Ischemic Stroke? REBEL EM: Stroke Workflow in 2018
This week we review some recent publications on steroids in pharyngitis and the VAN assessment in stroke. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_150_0_Final_Cut.m4a Download Leave a Comment Tags: Pharyngitis, Steroids, VAN Assessment Show Notes Read More The SGEM: SGEM #203: Let Me Clear My Sore Throat with a Corticosteroid Core EM: Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis REBEL EM: Does it Take a VAN to Identify Emergency Large Vessel Occlusion (EVLO) in Ischemic Stroke? REBEL EM: Stroke Workflow in 2018
Podcast summary of articles from the May 2018 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine. Topics include D-dimer evaluation for Pulmonary Embolism, Propofol for pediatric headaches, Diabetic Ketoacidosis treatment in adults, a case report on a toxidrome in pregnancy and board review on pharyngitis mimics. Guest speaker is Dr. Prashanth Swamy from the Metrohealth Emergency Medicine Residency.
In the edition of the Ercast journal club thrombectomy in pts with delayed stroke presentation shows promise beware behavioral changes after procedural sedation kids with isolated linear skull fractures have a good short term prognosis procalcitonin may help decrease abx use in respiratory infections steroids in mild sore throat help... a little Registration for ConCert (the big board recertification exam we take once a decade) has opened. If this is your year to take the exam, there's only one place to go for board review. The DAWN Trial Nogueira, Raul G., et al. "Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct." New England Journal of Medicine 378.1 (2017). PMID:29129157 What happens when thrombectomy is done when last normal was over 6 hours ago? 206 patients with occlusion of the intracranial internal carotid artery, middle cerebral artery, or both these were patients excluded from TPA because of time from onset or they had persistent occlusion despite TPA Pts had to get either perfusion CT or diffusion weighted MRI to see if there was salvageable brain (there had to be) 107 got thrombectomy and 99 didn't. 90 day functional independence: 49% thombectomy vs 13 % controls No significant difference in symptomatic intracranial hemorrhage or 90 day mortality Trial stopped early because of superiority of thrombectomy Majority of patients were wake up strokes, a group we've had pretty much nothing to offer previously Industry sponsored, many conflicts of interest Rob's take-This trial uses salvageable brain as a determinant of treatment which makes sense as these are the patents who may actually benefit from reperfusion. This purports to speak for the patient 6-24 hours, but from what I can tell, treatment was heavily skewed toward those with time from last normal 16 hours and under, so it doesn't really tell us much about 24 hours. I will be consulting stroke centers with this patient cohort. Adam's take- Impressive. I like that this is tissue based, not time based. Skull Fractures in Kids Bressan, Silvia, et al. "A Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children." Annals of emergency medicine (2017). PMID: 29174834 Are pediatric patients with isolated skull fractures at increased risk for short term adverse events? Pool of 21 studies, over 6,000 kids with isolated skull fractures. One required emergency neurosurgery, none died. All kids had CT scan or MRI to exclude intracranial injury 6 out of 570 had bleeding on a second scan and zero had surgery. The incidence of delayed hemorrhage is super low and even those with bleeding didn't need an intervention. Unless there is a change, you don't need to rescan. Author take home: "Children with isolated skull fractures were at extremely low risk for emergency neurosurgery or death, but were frequently hospitalized. Clinically stable children with an isolated skull fracture may be considered for outpatient management in the absence of other clinical concerns." Rob's take-An otherwise well appearing child with isolated skull fracture has an excellent short term neurosurgical prognosis and probably don't need hospitalization based on the skull fracture alone Adam's take-Open and shut case. One kid out of over 6,000 is pretty good odds and that one patient got meningeal repair. Procalcitonin is dead. Long live procalcitonin Schuetz, Philipp, et al. "Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis." The Lancet Infectious Diseases 18.1 (2018): 95-107. PMID: 29037960 Over 6,000 patients with respiratory infections Decision to give antibiotics based on procalcitioin level Primary endpoints: Mortality, treatment failure Secondary endpoints: Antibiotic use No significant difference in death, treatment failure, ICU length of stay Antitiocis initiated 86% controls, 70% procalcitonin guided and shorter duration of abx using procalcitonin as the guide Fewer Abx side effects with procalcitonin guided therapy Adam's take-This is not a lifesaving study, this is a safety study. The point is, can you safely withhold antibiotics from people? This study says you can, based on procalc level in a patient with respiratory infection. The scenario I envision is someone with CHF, COPD, fever, and coughing. If the procalc is low, I don't have to add a horrendous quinolone to your 25 other meds, you can take tessalon perles and do better. I'm going to keep one more abx prescription out of the pool and it's not going to harm the patient. This is a noniferiory trial to me. Prescribing fewer antibiotics is a worthwhile goal to me. We know that using procalcitonin for that purpose works and this study says it is safe. Steroids for sore throat Little, Paul, et al. "Effect of oral Dexamethasone without immediate antibiotics vs placebo on acute sore throats in adults: a randomized clinical trial." JAMA 317.15 (2017): 1535-1543. PMID: 28418482 RCT of 576 adults with sore throat not requiring immediate abx. Treated with either steroid or placebo Most afebrile and did not have pus on tonsils Results: Symptoms better at 48 hours (but not 24) with dexamethasone Rob's take- Set the expecation that it will take 48 hours to start feeling better if giving steroids. That being said, I don't think that steroids are worth it in most mild sore throat patients. NSAIDS, tea, and time Adam's take- A cofounder for me was that 14% of the dexamethasone and 19% of no dex group had strep, a confounder I don't like. Steroids probably work a little, they're probably safe, but they're not amazing The Brain Does Not Love Ketamine as Much as You Do Pearce, Jean I., et al. "Behavioral Changes in Children After Emergency Department Procedural Sedation." Academic Emergency Medicine (2017). PMID: 28992364 82 kids received ketamine for procedures in the ED Most had forearm fracutres Most had analgesia before procedure 22% with negative behaviors changes after discharge. Anxiety, aggression, withdrawal, sleep anxiety, separation anxiety Higher odd of this happening in kids anxious before procedure, nonwhite Rob's take- ketamine is an excellent drug, but can have lasting effects. Also, it's not totally benign, one patient had over 30 seconds of apnea. Still one of our best options, but discuss with parents the post discharge behavioral changes that might occur Adam's take- I don't think this is a study about ketamine at all. This says nothing about ketamine, this talks about procedural sedation. There is a long history of research about general anesthesia that shows a similar pattern- post op kids have behoaboiral disturbance a week after and the kids who come into the OR have worse outcomes, and if you treat the anxiety before the procedure, they have better outcomes.This could have been propofol nitrous, whatever. The kids who start out anxious pre-procduere have a much higher incidence of behavioral disturbance post procedure.In my opinion, this study shows that anxious kids are more likely to be disrupted by this experience than non-anxious kids. I am going to give a lot more versed. Maybe this is the versed indication that works with ketamine.
This episode features Dr. Brent Egan discussing the target blood pressure in older adults, and Dr. Mark Aronson discussing the use of dexamethasone for acute pharyngitis pain in adults. Dr. Nancy Sokol hosts.
It's a special episode of The Rounds Table this week with guest hosts Dr. Fraser Pollard and Dr. Ashley Minuk. Fraser and Ashley are family physicians in Trenton, Ontario. Sore throat is a very common presentation in family practice. Many patients who seek care expect a prescription to offer some kind of relief. For adults, ...The post Sore Throats & Sore Legs! Dexamethasone for Adult Pharyngitis and the Benefits of an Active Commute appeared first on Healthy Debate.
It's a special episode of The Rounds Table this week with guest hosts Dr. Fraser Pollard and Dr. Ashley Minuk. Fraser and Ashley are family physicians in Trenton, Ontario. Sore throat is a very common presentation in family practice. Many patients who seek care expect a prescription to offer some kind of relief. For adults, ... The post Sore Throats & Sore Legs! Dexamethasone for Adult Pharyngitis and the Benefits of an Active Commute appeared first on Healthy Debate.
When patients present with symptoms of a sore throat, an option for managing the pain that is sometimes used is corticosteroids. A randomized trial of a 1-time dose of 10 mg in patients with moderate to severe pharyngitis who were deemed to not need antibiotics found higher rates of symptom resolution at 48 hours. Learning Objectives: Understand potential benefits of corticosteroids for treatment of pain of acute pharyngitis Understand limitations of evidence for benefit Understand other options for symptom relief
Summary: Dr. Robert Centor’s Knowledge Food, Part 2! On this episode of The Curbsiders, we continue our discussion with the legendary Dr. Centor, focusing on pharyngitis and the highly entertaining origin of the Centor Criteria. Not only do we learn how to dominate pharyngitis, but we also uncover one of Dr. Watto’s knowledge deficits - Lemierre’s Syndrome. (He owes us a two minute talk on Lemierre’s Syndrome in case you’re wondering. I know I am.) Clinical Pearls: Admit your own limitations! Many overestimate their skills as a clinical educator. Preadolescents get streptococcal pharyngitis (...or it’s nothing). Adolescents are much more complicated with streptococcus, EBV, CMV, acute HIV, fusobacterium, and multiple other causes. Important: Separate the causes of pharyngitis in preadolescents and adolescents. General rule: Sore throats should not cause rigors; if present then admit patient, obtain blood cultures, and start antibiotics. Do NOT miss a peritonsillar abscess or Lemierre’s Syndrome in acute pharyngitis. Pharyngitis improves within three to five days. Failure to improve should prompt a more thorough investigation. Lemierre’s Syndrome (1 in 70,000 untreated pharyngitis patients) is septic thrombophlebitis of the internal jugular vein. The treatment is IV antibiotics and NOT anticoagulation. Dr. Centor and the IDSA recommends Amoxicillin once daily and, if penicillin allergic, Clindamycin. The most recent IDSA update recommends a 10-day course of Amoxicillin (50mg/kg up to 1000mg once daily). Dr. Centor’s “Take-Home” Points: Adolescents tend to have more complicated pharyngitis Pharyngitis and rigors? Admit, obtain cultures, and start antibiotics. Sore throats don’t get worse and, if they do, you need to rethink the case Disclosures: Dr. Centor reports no relevant financial disclosures for this topic. Learning objectives: By the end of this podcast listeners will be able to: Identify the limitations of the Centor Criteria in regards to (a) preadolescents and (b) adolescents, taking special precautions in the adolescent population Understand which acute pharyngitis patients require a more thorough investigation Be able to identify Amoxicillin as the treatment of choice for acute bacterial pharyngitis with Clindamycin as the second-line antibiotics choice. Links from the show: Check our Dr. Centor’s wonderful blog, at http://www.medrants.com or on twitter https://twitter.com/medrants Centor’s Criteria (MDCalc) -- http://www.mdcalc.com/modified-centor-score-for-strep-pharyngitis/ IDSA Guidelines on Diagnosis and Management of Group A Streptococcus Pharyngitis - http://cid.oxfordjournals.org/content/early/2012/09/06/cid.cis629.full.pdf+html Original article using the Centor score for pharyngitis https://www.ncbi.nlm.nih.gov/pubmed/6763125?dopt=abstract Dr. Centor’s article on fusobacterium Centor RM, et al. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Ann Intern Med. 2015 Feb 17;162(4):241-7. doi: 10.7326/M14-1305.
Summary: Dr. Robert Centor’s Knowledge Food, Part 1. This Halloween, the “Curse of Knowledge” is REAL! So you think you can teach? This master clinician educator, known for “Centor’s Criteria,” schools us the most common errors made by medical educators and how to improve learner retention. While we only scratch the surface, Season 1’s arguably penultimate episode should NOT be missed. After all, how else are you going to learn about Pretty Pimpin’? Stay tuned for Part Duex when we briefly review Pharyngitis and Dr. Watto finally learns about Lemierre’s Syndrome! As always, you’re welcome. Clinical Pearls: Don’t fall victim to the “Curse of Knowledge!” Remember that your students/residents do not know what you know! Effective rounding should include a healthy mixture of both table-top and bedside rounds. Feedback should be specific, timely (even immediate!), and focused on improvement. Allow the learner to self-evaluate before providing specific feedback and invite all members of the team to provide collaborative feedback. Always remember that feedback should be positive as well as constructive. There are multiple courses available to further your own skills as a medical educator The physician-educator should embody the “servant leader” and prioritize medical education (the “service” you are providing). Consider blogging to improve your own writing! Dr. Centor’s “Take-Home” Points: The “Curse of Knowledge” is real -- never assume the basics are known. The attending physician should embody service before self. Dr. Centor’s playlist -- Matt Duncan, Lawrence, Saint Paul and the Broken Bones, Houndmouth, Kurt Vile Disclosures: Dr. Centor reports no relevant financial disclosures for this topic. Learning objectives: By the end of this podcast listeners will be able to: Understand the basics concepts that underscore effective feedback (specific, timely, and collaborative) Identify the tenants that underscore effective rounding Re-evaluate your own teaching style and consider training seminars to improve your skills as a medical educator Links from the show: Dr. Centor’s Blog -- http://www.medrants.com/ Dr. Bradley Sharpe’s profile -- http://profiles.ucsf.edu/bradley.sharpe Stanford Faculty Development Course -- http://sfdc.stanford.edu/ UCSF Workshop - “Developing Skills in the Art of Effective Feedback” -- http://meded.ucsf.edu/radme/developing-skills-art-effective-feedback Ten Tips for Receiving Feedback -- http://med-ed-online.net/index.php/meo/article/view/25141 Who should take statins? -- https://www.washingtonpost.com/news/to-your-health/wp/2016/10/04/who-should-take-statins-a-vicious-debate-over-cholesterol-drugs-side-effects/?postshare=1551475707596812&tid=ss_tw Kurt Vile - “Pretty Pimpin” -- https://www.youtube.com/watch?v=659pppwniXA 7 Habits of Highly Effective People by Stephen Covey Made to Stick: Why Some Ideas Survive and Others Die by Chip and Dan Heath
This episode covers Chapter 23 of Rosen's Emergency Medicine. Episode overview: List 8 Emergent Diagnoses for the chief complaint of sore throat List the most common viral, bacterial, and non-infectious causes of sore throat List at least 8 Describe the modified Centor Criteria and their use Wisecracks: Describe the pros and cons of antibiotics for suspected or confirmed acute GAS pharyngitis (see Rosen’s page 202) Other than Group B Strep, name 6 agents causing exudative pharyngitis
This episode covers Chapter 23 of Rosen's Emergency Medicine. Episode overview: List 8 Emergent Diagnoses for the chief complaint of sore throat List the most common viral, bacterial, and non-infectious causes of sore throat List at least 8 Describe the modified Centor Criteria and their use Wisecracks: Describe the pros and cons of antibiotics for suspected or confirmed acute GAS pharyngitis (see Rosen’s page 202) Other than Group B Strep, name 6 agents causing exudative pharyngitis
This may be a bit hard to swallow, but not every disease process in the Emergency Department is exciting. Streptococcal pharyngitis is an incredibly common condition, especially in the Pediatric Emergency Department and I wanted to take this opportunity to answer some common questions. Who knows, perhaps after listening to this edition of PEM Currents you […]
Dr. Leeor Sommer who runs ENT hands-on workshops and Dr. Maria Ivankovic, lecturer extraordinaire on ENT emergencies discuss ENT Emergencies Pearls, Pitfalls, Tips & Tricks: Dr. Ivankovic's stepwise approach to managing epistaxis including the best local anesthetics, the use of ice to decrease nasal flow, who requires antibiotics, the management of hypertension in epistaxis, tranexamic acid for nose bleeds and managing posterior bleeds, tips for nasal and ear foreign body removal including the use of tissue adhesive, how to pick up and work up the dreaded Malignant Otitis Externa including key diagnostic pearls the best tests, sudden sensorineural hearing loss ('The Bells' Palsy of the Ear') including how to save a patient from losing their hearing, Epiglottitis including diagnostic clues and imaging findings, Pharyngitis work-up and treatment: Do we need to work-up and treat with antibiotics at all? & The Toronto Throat Score, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management including the use of C1 Esterase inhibitors. The post Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks appeared first on Emergency Medicine Cases.
Dr. Leeor Sommer who runs ENT hands-on workshops and Dr. Maria Ivankovic, lecturer extraordinaire on ENT emergencies discuss ENT Emergencies Pearls, Pitfalls, Tips & Tricks: Dr. Ivankovic's stepwise approach to managing epistaxis including the best local anesthetics, the use of ice to decrease nasal flow, who requires antibiotics, the management of hypertension in epistaxis, tranexamic acid for nose bleeds and managing posterior bleeds, tips for nasal and ear foreign body removal including the use of tissue adhesive, how to pick up and work up the dreaded Malignant Otitis Externa including key diagnostic pearls the best tests, sudden sensorineural hearing loss ('The Bells' Palsy of the Ear') including how to save a patient from losing their hearing, Epiglottitis including diagnostic clues and imaging findings, Pharyngitis work-up and treatment: Do we need to work-up and treat with antibiotics at all? & The Toronto Throat Score, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management including the use of C1 Esterase inhibitors. The post Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks appeared first on Emergency Medicine Cases.
Dr. Leeor Sommer,who runs annual ENT workshops in Toronto give us his Best Case Ever involving an Extubation in the ED gone bad. In the related Episode 38 - ENT Emergencies - Pearls & Pitfalls, Tips & Tricks, Dr. Leeor Sommer and Dr. Maria Ivankovic, lecturer extrodinaire on ENT emergencies discuss: Dr. Ivankovic's stepwise approach to managing epistaxis, Tips for nasal and ear foreign body removal, How to pick up and work up the dreaded Malignant Otitis Externa, Sudden sensorineural hearing loss ('The Bells' Palsy of the Ear'), Epiglottitis work-up and management, Pharyngitis work-up and treatment - Does anyone with phayrngitis need antibiotics?, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management. The post Best Case Ever 19: Extubation in the ED appeared first on Emergency Medicine Cases.
The Infectious Diseases Society of America's Guideline Update presents concise summaries of important IDSA guidelines. This podcast discusses the IDSA Clinical Practice Guideline for Diagnosis and Management of Group A Streptococcal Pharyngitis. For details of the guidelines presented, please go to www.idsociety.org .Presented by: Neil S. Skolnik, M.D., Professor of Family and Community Medicine, Temple University School of Medicine, Associate Director, Family Medicine Residency Program, Abington Memorial Hospital. Standord T. Shulman, MDChief, Division of Infectious Diseases Ann & Robert H. Lurie Childrens's Hospital of ChicagoVirginia H. Rogers Professor of Pediatric Infectious DiseasesNowthwestern University Feinberg School of Medicine
Pharyngitis in adolescents and young adults; interview with Robert M. Centor, MD, of the University of Alabama at Birmingham; plus a summary of all the articles in the issue.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 10/19
Fragestellung: Das PFAPA-Syndrom ist ein erworbenes periodisches Fiebersyndrom (PFS). Das Akronym PFAPA ist zusammengesetzt aus den Leitsymptomen des Krankheitsbildes: Periodisches Fieber, Aphthöse Stomatitis, Pharyngitis und Adenitis. Da es sich aufgrund der unspezifischen Symptomatik und unbekannter Pathogenese um eine Ausschlussdiagnose handelt, stellen sich folgende Fragen: Finden sich bei Patienten mit der klinischen Diagnose PFAPA Mutationen in Genen für bekannte hereditäre PFS und gibt es Überschneidungen mit deren Krankheitsbildern? Methodik: Von Patienten mit der Verdachtsdiagnose PFAPA wurden die demographischen, klinischen und therapiebezogenen Daten sowie die Laborbefunde retrospektiv aus den Akten und einem Patientenfragebogen erhoben. Die molekulargenetische Untersuchung der Gene TNFRSF1A (TNF-Rezeptor-assoziiertes periodisches Syndrom TRAPS; Exons 2-7), MEFV (Familiäres Mittelmeerfieber FMF; Exons 2 und 10), MVK (Mevalonatkinasedefizienz, Hyper-IgD-Syndrom HIDS; Exons 6, 9 und 11) und CIAS1 (Cryopyrin-assoziierte periodische Syndrome CAPS; Exon 3) wurde mittels PCR und Sequenzierung genomischer DNA durchgeführt. Ergebnisse: Untersucht wurden 71 Kinder (51 Jungen (71,8 %), 20 Mädchen (28,2 %)) im Alter von drei bis 17 Jahren (Mittelwert 8,6 Jahre) mit Krankheitsbeginn vor dem fünften Lebensjahr. Bei 55 (77,5 %) der 71 Patienten konnte durch die genetische Untersuchung ein hereditäres PFS ausgeschlossen und so die klinische Verdachtsdiagnose PFAPA-Syndrom bekräftigt werden. Neben den o.g. Kardinalsymptomen traten Schüttelfrost, Kopfschmerzen, Hauterscheinungen, gastrointestinale und muskuloskelettale Symptome auf. Die Entzündungsparameter waren im Fieberschub signifikant erhöht. 16 Patienten (22,5 %) erwiesen sich als Träger von Mutationen, die mit hereditären PFS assoziiert sind. Bei sieben Kindern (9,9 %) wurden Mutationen im TNFRSF1A-Gen gefunden, bei je fünf Kindern (je 7,0 %) Mutationen in den MEFV- und MVK-Genen und bei einem Jungen (1,4 %) eine CIAS1-Mutation. Unter diesen Alterationsträgern waren ein Mädchen mit sowohl einer TNFRSF1A- als auch einer MVK-Mutation und ein Junge mit einer MEFV- und einer TNFRSF1A-Mutation. Zudem wurde eine bisher in der Literatur nicht beschriebene TNFRSF1A-Mutation gefunden. Schlussfolgerung: Der Anteil Mutations-positiver Patienten von 22,5 % rechtfertigt bei Kindern mit klinischem Verdacht auf ein PFAPA-Syndrom die molekulargenetische Untersuchung als einen unverzichtbaren Bestandteil der Diagnostik. Denn nur die adäquate und frühzeitige Therapie eines sonst möglicherweise nicht erkannten und behandelbaren hereditären PFS erhöht die Lebensqualität und bewahrt den Patienten vor diesbezüglich assoziierten Spätschäden wie einer Amyloidose.
Harrisons Online Update
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