Podcasts about qjm

Raphael Coelho e Ênio Macedo convidam Guilherme Kenzo para falar sobre abordagem de suicídio no PS em três casos.Precisa de ajuda? Ligue 188 - Centro de valorização da vida.Referências:1. Stene-Larsen, Kim, and Anne Reneflot. “Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017.” Scandinavian journal of public health vol. 47,1 (2019): 9-17. doi:10.1177/14034948177462742. Walby, Fredrik A et al. “Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis.” Psychiatric services (Washington, D.C.) vol. 69,7 (2018): 751-759. doi:10.1176/appi.ps.2017004753. Sher, L. “Preventing suicide.” QJM : monthly journal of the Association of Physicians vol. 97,10 (2004): 677-80. doi:10.1093/qjmed/hch1064. Domaradzki, Jan. “The Werther Effect, the Papageno Effect or No Effect? A Literature Review.” International journal of environmental research and public health vol. 18,5 2396. 1 Mar. 2021, doi:10.3390/ijerph180523965. https://www.planalto.gov.br/ccivil_03/leis/leis_2001/l10216.htm#:~:text=LEI%20No%2010.216%2C%20DE,modelo%20assistencial%20em%20sa%C3%BAde%20mental6. https://mpce.mp.br/wp-content/uploads/2018/04/20180061-OMS-Prevencao-do-Suicidio-Manual-para-profissionais-da-midia.pdf7. Niederkrotenthaler, Thomas et al. “Role of media reports in completed and prevented suicide: Werther v. Papageno effects.” The British journal of psychiatry : the journal of mental science vol. 197,3 (2010): 234-43. doi:10.1192/bjp.bp.109.0746338. Phillips, D P. “The influence of suggestion on suicide: substantive and theoretical implications of the Werther effect.” American sociological review vol. 39,3 (1974): 340-54.9. Jack, Belinda. “Goethe's Werther and its effects.” The lancet. Psychiatry vol. 1,1 (2014): 18-9. doi:10.1016/S2215-0366(14)70229-910. Jack, Belinda. “Goethe's Werther and its effects.” The lancet. Psychiatry vol. 1,1 (2014): 18-9. doi:10.1016/S2215-0366(14)70229-911. Guinovart, Martí et al. “Towards the Influence of Media on Suicidality: A Systematic Review of Netflix's 'Thirteen Reasons Why'.” International journal of environmental research and public health vol. 20,7 5270. 27 Mar. 2023, doi:10.3390/ijerph2007527012. Cipriani, Andrea et al. “Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis.” BMJ (Clinical research ed.) vol. 346 f3646. 27 Jun. 2013, doi:10.1136/bmj.f364613. BOTEGA, Neury Jose. Crise Suicida: Avaliação e manejo. Porto Alegre: Artmed, 2015.14. Seena Fazel, Bo Runeson. Suicide. N Engl J Med 2020;382:266-274. DOI: 10.1056/NEJMra190294415. Gustavo Turecki et al. Suicide and suicide risk. Nat Rev Dis Primers. 2019. Oct 24;5(1):74. doi: 10.1038/s41572-019-0121-0.16. https://www.setembroamarelo.com/17. Cartilha de prevenção de suicídio: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/cartilhas/2024/cartilha-prevencao-de-suicidios.pdf/view18. Baldaçara L, Rocha GA, Leite VDS, Porto DM, Grudtner RR, Diaz AP, Meleiro A, Correa H, Tung TC, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment. Braz J Psychiatry. 2021 Sep-Oct;43(5):525-537. doi: 10.1590/1516-4446-2020-0994. PMID: 33111773; PMCID: PMC8555650. - https://pubmed.ncbi.nlm.nih.gov/33111773/19. Baldaçara L, Grudtner RR, da S Leite V, Porto DM, Robis KP, Fidalgo TM, Rocha GA, Diaz AP, Meleiro A, Correa H, Tung TC, Malloy-Diniz L, Quevedo J, da Silva AG. Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention. Braz J Psychiatry. 2021 Sep-Oct;43(5):538-549. doi: 10.1590/1516-4446-2020-1108. Erratum in: Braz J Psychiatry. 2021 Sep-Oct;43(5):563. doi: 10.1590/1516-4446-2020-0025. PMID: 33331533; PMCID: PMC8555636. - https://pubmed.ncbi.nlm.nih.gov/33331533/20. https://cvv.org.br/wp-content/uploads/2023/08/manual_prevencao_suicidio_profissionais_saude.pdf21. https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/edicoes/2024/boletim-epidemiologico-volume-55-no-04.pdf

Contributor: Jorge Chalit-Hernandez, OMS3 Educational Pearls: Serotonin syndrome occurs most commonly due to the combination of monoamine oxidase inhibition with concomitant serotonergic medications like SSRIs Examples of unexpected monoamine oxidase inhibitors Linezolid - a last-line antibiotic reserved for patients with true anaphylaxis to penicillins and cephalosporins Methylene blue - not mentioned in the podcast due to its uncommon usage for methemoglobinemia Other medications that can interact with SSRIs to cause serotonin syndrome Dextromethorphan - primarily an anti-tussive at sigma opioid receptors that also has serotonin reuptake inhibition Clinical presentation of serotonin syndrome Altered mental status Autonomic dysregulation leading to hypertension (most common), hypotension, and tachycardia Hyperthermia Neuromuscular hyperactivity - tremors, myoclonus, and hyperreflexia Hunter Criteria (high sensitivity and specificity for serotonin syndrome): Spontaneous clonus Inducible clonus + agitation or diaphoresis Ocular clonus + agitation or diaphoresis Tremor + hyperreflexia Hypertonia, temperature > 38º C, and ocular or inducible clonus Management of serotonin syndrome Primarily supportive - benzodiazepines can help treat hypertension, agitation, and hyperthermia. Patients often require repeated and higher dosing of benzodiazepines Avoid antipyretics to treat hyperthermia since the elevated temperature is due to sustained muscle contraction and not central temperature dysregulation In refractory patients, cyproheptadine (a 5HT2 antagonist) may be used as a second-line treatment Patients with temperatures > 41.1º C or 106º F require medically induced paralysis and intubation to control their temperature References Boyer EW, Shannon M. The serotonin syndrome [published correction appears in N Engl J Med. 2007 Jun 7;356(23):2437] [published correction appears in N Engl J Med. 2009 Oct 22;361(17):1714]. N Engl J Med. 2005;352(11):1112-1120. doi:10.1056/NEJMra041867 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96(9):635-642. doi:10.1093/qjmed/hcg109 Ramsay RR, Dunford C, Gillman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction. Br J Pharmacol. 2007;152(6):946-951. doi:10.1038/sj.bjp.0707430 Schwartz AR, Pizon AF, Brooks DE. Dextromethorphan-induced serotonin syndrome. Clin Toxicol (Phila). 2008;46(8):771-773. doi:10.1080/15563650701668625 Thomas CR, Rosenberg M, Blythe V, Meyer WJ 3rd. Serotonin syndrome and linezolid. J Am Acad Child Adolesc Psychiatry. 2004;43(7):790. doi:10.1097/01.chi.0000128830.13997.aa Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/

Vi har vært på konferanse og intervjuet professor Jan Kristian Damås om gentamicin – et effektivt og i skandinavisk sammenheng hyppig brukt antibiotikum - men internasjonalt også mye debattert legemiddel.Referanser: Ritchie ND, Irvine SC, Helps A, Robb F, Jones BL, Seaton RA. Restrictive antibiotic stewardship associated with reduced hospital mortality in gram-negative infection. Qjm. 2017;110(3):155-61.McDermott JH, Mahaveer A, James RA, Booth N, Turner M, Harvey KE, et al. Rapid Point-of-Care Genotyping to Avoid Aminoglycoside-Induced Ototoxicity in Neonatal Intensive Care. JAMA Pediatrics. 2022;176(5):486-92.Grønmo M, Møller-Stray J, Akselsen PE, Lindemann PC, Fostervold A, Vestby Knudsen C, Knudsen PK, Lindbæk M, Tonby K, Sundsfjord A. Gentamicin bør fortsatt inngå i empirisk sepsisregime hos voksne. Tidsskr Nor Legeforen. 2024.Vidal L, Gafter-Gvili A, Borok S, Fraser A, Leibovici L, Paul M. Efficacy and safety of aminoglycoside monotherapy: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2007 Aug;60(2):247-57. Hosted on Acast. See acast.com/privacy for more information.

En el episodio de hoy, os traigo un tema muy presente en neurorrehabilitación y en las consultas de neurología en relación con la esclerosis múltiple y es nada menos que la fatiga. La fatiga, ese síntoma tan temido desde siempre, tanto por pacientes como por profesionales de la salud, que es uno de los más reportados, con cifras de prevalencia entre 52 y el 90% de los pacientes (Nagaraj et al., 2013). Indagamos en la fisiopatología de la fatiga para entender mejor este fenómeno, también diferentes formas de ver la fatiga con sus distintas nomenclaturas o términos, vamos a ver cómo se suele evaluar en el entorno clínico y en investigación y finalmente daremos algunas pinceladas de tratamiento neuromodulador. Referencias del episodio: 1. Adibi, I., Sanayei, M., Tabibian, F., Ramezani, N., Pourmohammadi, A., & Azimzadeh, K. (2022). Multiple sclerosis-related fatigue lacks a unified definition: A narrative review. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 27, 24. https://doi.org/10.4103/jrms.jrms_1401_20 (https://pubmed.ncbi.nlm.nih.gov/35419061/). 2. Ayache, S. S., & Chalah, M. A. (2017). Fatigue in multiple sclerosis - Insights into evaluation and management. Neurophysiologie clinique = Clinical neurophysiology, 47(2), 139–171. https://doi.org/10.1016/j.neucli.2017.02.004 (https://pubmed.ncbi.nlm.nih.gov/28416274/). 3. Ayache, S. S., Serratrice, N., Abi Lahoud, G. N., & Chalah, M. A. (2022). Fatigue in Multiple Sclerosis: A Review of the Exploratory and Therapeutic Potential of Non-Invasive Brain Stimulation. Frontiers in neurology, 13, 813965. https://doi.org/10.3389/fneur.2022.813965 (https://pubmed.ncbi.nlm.nih.gov/35572947/). 4. Bhattarai, J. J., Patel, K. S., Dunn, K. M., Brown, A., Opelt, B., & Hughes, A. J. (2023). Sleep disturbance and fatigue in multiple sclerosis: A systematic review and meta-analysis. Multiple sclerosis journal - experimental, translational and clinical, 9(3), 20552173231194352. https://doi.org/10.1177/20552173231194352 (https://pubmed.ncbi.nlm.nih.gov/37641617/). 5. Braley, T. J., & Chervin, R. D. (2010). Fatigue in multiple sclerosis: mechanisms, evaluation, and treatment. Sleep, 33(8), 1061–1067. https://doi.org/10.1093/sleep/33.8.1061 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910465/). 6. Capone, F., Motolese, F., Falato, E., Rossi, M., & Di Lazzaro, V. (2020). The Potential Role of Neurophysiology in the Management of Multiple Sclerosis-Related Fatigue. Frontiers in neurology, 11, 251. https://doi.org/10.3389/fneur.2020.00251 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212459/). 7. Chalah, M. A., Riachi, N., Ahdab, R., Créange, A., Lefaucheur, J. P., & Ayache, S. S. (2015). Fatigue in Multiple Sclerosis: Neural Correlates and the Role of Non-Invasive Brain Stimulation. Frontiers in cellular neuroscience, 9, 460. https://doi.org/10.3389/fncel.2015.00460 (https://pubmed.ncbi.nlm.nih.gov/26648845/). 8. Chalah, M. A., Kauv, P., Créange, A., Hodel, J., Lefaucheur, J. P., & Ayache, S. S. (2019). Neurophysiological, radiological and neuropsychological evaluation of fatigue in multiple sclerosis. Multiple sclerosis and related disorders, 28, 145–152. https://doi.org/10.1016/j.msard.2018.12.029 (https://pubmed.ncbi.nlm.nih.gov/30594815/). 9. Dittner, A. J., Wessely, S. C., & Brown, R. G. (2004). The assessment of fatigue: a practical guide for clinicians and researchers. Journal of psychosomatic research, 56(2), 157–170. https://doi.org/10.1016/S0022-3999(03)00371-4 (https://pubmed.ncbi.nlm.nih.gov/15016573/). 10. Dobryakova, E., Genova, H. M., DeLuca, J., & Wylie, G. R. (2015). The dopamine imbalance hypothesis of fatigue in multiple sclerosis and other neurological disorders. Frontiers in neurology, 6, 52. https://doi.org/10.3389/fneur.2015.00052 (https://pubmed.ncbi.nlm.nih.gov/25814977/). 11. Freal, J. E., Kraft, G. H., & Coryell, J. K. (1984). Symptomatic fatigue in multiple sclerosis. Archives of physical medicine and rehabilitation, 65(3), 135–138 (https://pubmed.ncbi.nlm.nih.gov/6703889/). 12. Gaede, G., Tiede, M., Lorenz, I., Brandt, A. U., Pfueller, C., Dörr, J., Bellmann-Strobl, J., Piper, S. K., Roth, Y., Zangen, A., Schippling, S., & Paul, F. (2017). Safety and preliminary efficacy of deep transcranial magnetic stimulation in MS-related fatigue. Neurology(R) neuroimmunology & neuroinflammation, 5(1), e423. https://doi.org/10.1212/NXI.0000000000000423 (https://pubmed.ncbi.nlm.nih.gov/29259998/). 13. Garis, G., Haupts, M., Duning, T., & Hildebrandt, H. (2023). Heart rate variability and fatigue in MS: two parallel pathways representing disseminated inflammatory processes?. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 44(1), 83–98. https://doi.org/10.1007/s10072-022-06385-1 (https://pubmed.ncbi.nlm.nih.gov/36125573/). 14. Hanken, K., Eling, P., & Hildebrandt, H. (2014). The representation of inflammatory signals in the brain - a model for subjective fatigue in multiple sclerosis. Frontiers in neurology, 5, 264. https://doi.org/10.3389/fneur.2014.00264 (https://pubmed.ncbi.nlm.nih.gov/25566171/). 15. Iriarte, J., Subirá, M. L., & Castro, P. (2000). Modalities of fatigue in multiple sclerosis: correlation with clinical and biological factors. Multiple sclerosis (Houndmills, Basingstoke, England), 6(2), 124–130. https://doi.org/10.1177/135245850000600212 (https://pubmed.ncbi.nlm.nih.gov/10773859/). 16. Jaeger, S., Paul, F., Scheel, M., Brandt, A., Heine, J., Pach, D., Witt, C. M., Bellmann-Strobl, J., & Finke, C. (2019). Multiple sclerosis-related fatigue: Altered resting-state functional connectivity of the ventral striatum and dorsolateral prefrontal cortex. Multiple sclerosis (Houndmills, Basingstoke, England), 25(4), 554–564. https://doi.org/10.1177/1352458518758911 (https://pubmed.ncbi.nlm.nih.gov/29464981/). 17. Langeskov-Christensen, M., Heine, M., Kwakkel, G., & Dalgas, U. (2015). Aerobic capacity in persons with multiple sclerosis: a systematic review and meta-analysis. Sports medicine (Auckland, N.Z.), 45(6), 905–923. https://doi.org/10.1007/s40279-015-0307-x (https://pubmed.ncbi.nlm.nih.gov/25739555/). 18. Linnhoff, S., Fiene, M., Heinze, H. J., & Zaehle, T. (2019). Cognitive Fatigue in Multiple Sclerosis: An Objective Approach to Diagnosis and Treatment by Transcranial Electrical Stimulation. Brain sciences, 9(5), 100. https://doi.org/10.3390/brainsci9050100 (https://pubmed.ncbi.nlm.nih.gov/31052593/). 19. Liu, M., Fan, S., Xu, Y., & Cui, L. (2019). Non-invasive brain stimulation for fatigue in multiple sclerosis patients: A systematic review and meta-analysis. Multiple sclerosis and related disorders, 36, 101375. https://doi.org/10.1016/j.msard.2019.08.017 (https://pubmed.ncbi.nlm.nih.gov/31491597/). 20. Loy, B. D., Taylor, R. L., Fling, B. W., & Horak, F. B. (2017). Relationship between perceived fatigue and performance fatigability in people with multiple sclerosis: A systematic review and meta-analysis. Journal of psychosomatic research, 100, 1–7. https://doi.org/10.1016/j.jpsychores.2017.06.017 (https://pubmed.ncbi.nlm.nih.gov/28789787/). 21. Mills, R. J., & Young, C. A. (2008). A medical definition of fatigue in multiple sclerosis. QJM : monthly journal of the Association of Physicians, 101(1), 49–60. https://doi.org/10.1093/qjmed/hcm122 (https://pubmed.ncbi.nlm.nih.gov/18194977/). 22. Nagaraj, K., Taly, A. B., Gupta, A., Prasad, C., & Christopher, R. (2013). Prevalence of fatigue in patients with multiple sclerosis and its effect on the quality of life. Journal of neurosciences in rural practice, 4(3), 278–282. https://doi.org/10.4103/0976-3147.118774 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821412/). 23. Patejdl, R., Penner, I. K., Noack, T. K., & Zettl, U. K. (2016). Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration. Autoimmunity reviews, 15(3), 210–220. https://doi.org/10.1016/j.autrev.2015.11.005 (https://pubmed.ncbi.nlm.nih.gov/26589194/). 24. Patejdl, R., & Zettl, U. K. (2022). The pathophysiology of motor fatigue and fatigability in multiple sclerosis. Frontiers in neurology, 13, 891415. https://doi.org/10.3389/fneur.2022.891415 (https://pubmed.ncbi.nlm.nih.gov/35968278/). 25. Torres-Costoso, A., Martínez-Vizcaíno, V., Reina-Gutiérrez, S., Álvarez-Bueno, C., Guzmán-Pavón, M. J., Pozuelo-Carrascosa, D. P., Fernández-Rodríguez, R., Sanchez-López, M., & Cavero-Redondo, I. (2022). Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise. Archives of physical medicine and rehabilitation, 103(5), 970–987.e18. https://doi.org/10.1016/j.apmr.2021.08.008 (https://pubmed.ncbi.nlm.nih.gov/34509464/). 26. Yang, T. T., Wang, L., Deng, X. Y., & Yu, G. (2017). Pharmacological treatments for fatigue in patients with multiple sclerosis: A systematic review and meta-analysis. Journal of the neurological sciences, 380, 256–261. https://doi.org/10.1016/j.jns.2017.07.042 (https://pubmed.ncbi.nlm.nih.gov/28870581/). 27. Zimek, D., Miklusova, M., & Mares, J. (2023). Overview of the Current Pathophysiology of Fatigue in Multiple Sclerosis, Its Diagnosis and Treatment Options - Review Article. Neuropsychiatric disease and treatment, 19, 2485–2497. https://doi.org/10.2147/NDT.S429862 (https://pubmed.ncbi.nlm.nih.gov/38029042/). 28. Zhou, X., Li, K., Chen, S., Zhou, W., Li, J., Huang, Q., Xu, T., Gao, Z., Wang, D., Zhao, S., & Dong, H. (2022). Clinical application of transcranial magnetic stimulation in multiple sclerosis. Frontiers in immunology, 13, 902658. https://doi.org/10.3389/fimmu.2022.902658 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9483183/).

Coraz powszechniejszym problemem stają się niedobory pokarmowe, szczególnie te subkliniczne. Ich powszechność wynika z nieprawidłowego stylu życia, ale także zwiększającej się liczby osób cierpiących na choroby przewlekłe. Jednymi z najczęściej spotykanych są niedobory żelaza i witaminy B12. Dlaczego tak się dzieje? Kto jest w grupie ryzyka? Jakie objawy mogą pojawiać się przy niedoborze żelaza, a jakie w przypadku witaminy B12?  Jakie badania wykonać badania wykryć ich niedobór? Na te i inne pytania odpowiemy w dzisiejszym odcinku. Zachęcam Was do regularnych badań. A gdybyście chcieli skorzystać z domowego pobrania badań laboratoryjnych z krwi to z kodem DRKARABIN20 otrzymacie 20% zniżki na na badania laboratoryjne z pobraniem w domu #uCiebie z #uPacjenta. Kod działa przy zamówieniu powyżej 250 zł na wszystkie badania i pakiety. Możecie skorzystać z gotowych pakietów badań laboratoryjnych w kierunku niedoborów pokarmowych: Pakiet badań niedobór witamin i składników mineralnych (podstawowy) z konsultacją wyników: https://upacjenta.pl/pakiet/badania-na-niedobor-witamin-podstawowe Pakiet badań niedobór witamin i składników mineralnych (rozszerzony) z konsultacją wyników: https://upacjenta.pl/pakiet/badania-na-niedobor-witamin-rozszerzony-konsultacja Natomiast tylko do 12.05.24 r. kod DRKARABIN30 daje aż 30% zniżki na mój autorski pakiet badań profilaktycznych “długoWITALNI”: https://upacjenta.pl/landing-page/pakiet-dlugowitalni Ten materiał nie stanowi zamiennika wizyty lekarskiej. Nie jest też poradą zdrowotną, ani nie służy do diagnozowania ani leczenia chorób. Materiał ma charakter wyłącznie edukacyjny. Autorka nie ponosi odpowiedzialności za sposób wykorzystania przedstawionych informacji. Lista publikacji o których wspominamy w podcaście: Allen R.P. i wsp.Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (RLSSG) consensus criteria-history, rationale, description, and significance. Sleep Med. (2014) 15:860–73. Connor J.R. i wsp. Neuropathological examination suggests impaired brain iron acquisition in restless legs syndrome. Neurology. (2003) 61:304–9 Allen R.P. i Earley C.J. The role of iron in restless legs syndrome. Mov disord. (2007) 18(22 Suppl):S440–8 Choroby wewnętrzne, pod redakcją Szczeklik A., Medycyna Praktyczna Kraków 2021 Andrès E . i wsp. The pathophysiology of elevated vitamin B12 in clinical practice. QJM. 2013 Jun;106(6):505-15. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization Castellanos-Sinco H.B. i wsp. Megaloblastic anaemia: Folic acid and vitamin B12 metabolism. Revista Médica Del Hospital General De México 2015,  78, 3, 135-14. Allen L.H. i wsp. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J Nutr. 2018 Dec 1;148(suppl_4):1995S-2027S. 0:00 Intro 0:37 - Wstęp 01:33 - Dlaczego niedobory są coraz powszechniejsze? 04:43 - Grupy ryzyka niedoborów pokarmowych 07:38 - Co wspólnego mają żelazo i witamina B12? 10:02 - Jakie mogą być następstwa niedoborów pokarmowych? 12:07 - Rola żelaza w organizmie 14:06 - Objawy niedoboru żelaza 16:33 - Grupy ryzyka niedoboru żelaza 19:39 - Jak zbadać niedobór żelaza? 27:44 - Jak rozpoznać niedobór żelaza? 30:21 - Niedobór witaminy B12 - objawy 34:28 - Grupy ryzyka niedoboru witaminy B12 37:21 - Jak zbadać niedobór witaminy B12?

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: July 18, 2017 In our first episode with neurology content, we will discuss my research interest in neurologic deterioration after stroke. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. The case discussed in this episode is fictional and does not contain any patient health-identifying information. REFERENCES Balami JS, Chen RL, Grunwald IQ, Buchan AM. Neurological complications of acute ischaemic stroke. Lancet Neurol 2011;10(4):357-71. PMID 21247806 Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM 2006;99(9):625-33. PMID 16905751 Siegler JE, Boehme AK, Albright KC, et al. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. J Stroke Cerebrovasc Dis 2013;22(8):e549-56. PMID 23867039 Thanvi B, Treadwell S, Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgrad Med J 2008;84(994):412-7. PMID 18832401  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: October 5, 2017 Dr. David Coughlin returns for this week's Teaching Through Clinical Cases to discuss the management of a delirious patient with a hyperkinetic movement disorder. Produced by James E Siegler. Music by Hyson, Josh Woodward, Komiku, and Peter Rudenko. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. Am Fam Physician 2010;81(9):1139-42. PMID 20433130 Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005;352(11):1112-20. PMID 15784664 Dosi R, Ambaliya A, Joshi H, Patell R. Serotonin syndrome versus neuroleptic malignant syndrome: a challenging clinical quandary. BMJ Case Rep 2014;2014:bcr2014204154. PMID 24957740 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM 2003;96(9):635-42. PMID 12925718 Lappin RI, Auchincloss EL. Treatment of the serotonin syndrome with cyproheptadine. N Engl J Med 1994;331(15):1021-2. PMID 8084345 Mills KC. Serotonin syndrome. Am Fam Physician 1995;52(5):1475-82. PMID 7572570 Pedavally S, Fugate JE, Rabinstein AA. Serotonin syndrome in the intensive care unit: clinical presentations and precipitating medications. Neurocrit Care 2014;21(1):108-13. PMID 24052457 Radomski JW, Dursun SM, Reveley MA, Kutcher SP. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses 2000;55(3):218-24. PMID 10985912  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Chapter 7ReferencesSands JM, Blount MA and Klein JD. Regulation of Renal Urea Transport by Vasopressin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116377/In this invited piece, Sands and colleagues explain that although urea is permeable across membranes, this is slow, thus urea transporters in the kidney, under control of vasopressin, are needed to facilitate transport and create the medullary gradient. Text book using 20% of extracellular compartment being in the intravascular compartment. https://courses.lumenlearning.com/ap2/chapter/body-fluids-and-fluid-compartments-no-content/ another one: https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Book%3A_Anatomy_and_Physiology_(Boundless)/25%3A_Body_Fluids_and_Acid-Base_Balance/25.2%3A_Body_Fluids/25.2B%3A_Fluid_Compartments The chapter I wrote where I went through the math in figure 7-3. It was a major revelation to me: https://docs.google.com/document/d/17BM1xihvlztuQlU8GVNhEDoPLzr6GounHYZAtVUkLvw/edit?usp=sharing Association Between ICU-Acquired Hypernatremia and In-Hospital Mortality https://journals.lww.com/ccejournal/fulltext/2020/12000/association_between_icu_acquired_hypernatremia_and.26.aspx Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients https://pubmed.ncbi.nlm.nih.gov/30948456/ Edelman IS, Leibman J, O'Meara MP and Birkenfeld LW. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. JCI 1958. This classic paper calculates the total body exchangeable sodium and potassium and establishes the relationship between these. Understanding this painstacking work helps understand the effect of supplementing potassium in the setting of hyponatremia. https://dm5migu4zj3pb.cloudfront.net/manuscripts/103000/103712/cache/103712.1-20201218131357-covered-e0fd13ba177f913fd3156f593ead4cfd.pdfEdelman is the Root of Almost All Good in Nephrology https://www.renalfellow.org/2014/11/20/edelman-is-root-of-almost-all-good-in/ Jens Titze and his team published a pair of articles that shocked those interested in salt and water in JCI in 2017. High Salt intake reprioritizes osmolyte and energy metabolism for body fluid conservation https://www.jci.org/articles/view/88532Increased salt consumption induces body water conservation and decreases fluid intake https://www.jci.org/articles/view/88530in this exciting exploration of the basic assumptions that we hold true regarding salt and water (and staring Russian cosmonauts and an incredible controlled simulation of salt and water intake), Titze shows that high sodium intake does not simply drive water consumption (as we usually teach) but instead leads to a complex hormonal and metabolic response (even with diurnal variation!) and results in body water conservation and decreased water consumption. And accompanying editorial from Mark Zeidel: salt and water, not so simple. https://www.jci.org/articles/view/94004In addition, Titze and others have done interesting work on sodium deposition in tissues where it may also be a source for systemic inflammation.https://pubmed.ncbi.nlm.nih.gov/28154199/Jens Titze talking about salt, water, thirsting a TEDx talk. https://www.youtube.com/watch?v=jQQPBmnIuCY A discussion/debate of the overfill vs. underfill theory of edema in the nephrotic syndrome (hint- overfill theory triumphs) would be incomplete without a reference to congenital analbuminemia. This reference from Frontiers in Genetics explores the diagnosis, phenotype and molecular genetics and reveal that patients tend to have only mild edema but severe hyperlipidemia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478806/The finding that proteinuria can directly lead to sodium retention based on a study when puromycin aminoglycoside induced proteinuria of one kidney lead to sodium retention by that kidney which was localized to the distal nephron. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC436841/?page=9Plasmin may be the culprit at the level of the epithelial sodium channel based on Tom Kleyman's work: https://jasn.asnjournals.org/content/20/2/233Amiloride may help! (stay tuned for amiloride in a future episode) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016639/An old favorite of JC's from the Kidney International feature which debates the cause of edema in the nephrotic syndrome.https://www.sciencedirect.com/science/article/pii/S0085253815583075Under protest, we hobbled through a discussion of the Gibbs Donnan affect even encouraged by one of Amy's fellows based on this article from QJM: https://academic.oup.com/qjmed/article/101/10/827/1520972 suggesting that our understanding of the role of hyponatremia in fractures might be all wrong- it could be related to hypoalbuminemia.

Welcome to Episode 15 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 15 of “The 2 View” – Guidelines for the evaluation and diagnosis of chest pain, non-traumatic shoulder pain in the ER, thoughts on recertification, and mushrooms & psychedelics. 2021 AHA/ACC/etc. Guideline for the Evaluation and Diagnosis of Chest Pain Chest Pain Choice. care that fits. Published May 19, 2021. Accessed March 29, 2022. https://carethatfits.org/chest-pain-choice/ Grauer K. ECG Blog #292 — Why Did the Patient Die? Blogspot.com. Published March 21, 2022. Accessed March 29, 2022. https://ecg-interpretation.blogspot.com/2022/03/ecg-blog-292-why-did-patient-die.html Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published October 28, 2021. Accessed March 29, 2022. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029 Non-Traumatic Shoulder Pain in the ER Appropriate Use Criteria Program. CMS.gov. Last Modified December 1, 2021. Accessed March 29, 2022. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program Center For Medicare & Medicaid Implement New Rules for Shoulder Pain Diagnosis. Sonosite.com. Published January 22, 2020. Accessed March 29, 2022. https://www.sonosite.com/blog/center-medicare-medicaid-implement-new-rules-shoulder-pain-diagnosis Elaassar MMN, Emadeldin A, Zidan DZ, Sakr HM, Abdelazim H. Chronic non-traumatic shoulder pain: evaluation with ultrasonography and conventional mr imaging. QJM. Oxford Academic. Published May 19, 2020. Accessed March 29, 2022. https://academic.oup.com/qjmed/article/113/Supplement_1/hcaa068.013/5829209?login=true Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. National Library of Medicine: National Center for Biotechnology Information. Published November 12, 2005. Accessed March 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283277/ Parker, et al. Musculoskeletal imaging: Medicare use, costs, and potential for cost substitution. Journal of American College of Radiology. 2008: 182:188. PANRE-LA Option for PA Recertification - What Do We Think about Recertification? Admin M. Home. Aaenp-natl.org. AAENP. Accessed March 29, 2022. https://www.aaenp-natl.org/ American Association of Nurse Practitioners. AANP. American Association of Nurse Practitioners. Published September 4, 2019. Accessed March 29, 2022. https://www.aanp.org/ American Nurses Credentialing Center. ANA. Accessed March 29, 2022. https://www.nursingworld.org/ancc/ Homepage. PNCB. Accessed March 29, 2022. https://www.pncb.org/ Maintain Certification. NCCPA. Published September 15, 2020. Accessed March 29, 2022. https://www.nccpa.net/maintain-certification/#panre-la-faqs NCCPA Announces Permanent Alternative to PANRE, PANRE-LA. NCCPA. Published December 1, 2021. Accessed March 29, 2022. https://www.nccpa.net/news/panre-la/ Mushrooms and Psychedelics Approach to Altered Mental Status. Default. CDEM. Accessed March 29, 2022. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-approach-to/approach-to-altered-mental-status Garcia J, Costa VM, Carvalho A, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. NIH. Published September 12, 2015. Accessed March 29, 2022. https://pubmed.ncbi.nlm.nih.gov/26375431/ Lowe H, Toyang N, Steele B, et al. The Therapeutic Potential of Psilocybin. Molecules. NIH. Published May 2021. Accessed March 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156539/ Something Sweet COVID-19 Therapeutics Locator. Arcgis.com. ASPR. Accessed March 29, 2022. https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ Prevention of SARS-CoV-2 Infection. NIH: COVID-19 Treatment Guidelines. Last Updated March 24, 2022. Accessed March 29, 2022. https://www.covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

An immersive reading of excerpts from ‘The Botanic Garden Part II: The Loves of Plants' by Erasmus Darwin with reflection on dropsy, digitalis, heart failure and medical myths. Excerpts 415 Bolster'd with down, amid a thousand wants,        Pale Dropsy rears his bloated form, and pants;        "Quench me, ye cool pellucid rills!" he cries,        Wets his parch'd tongue, and rolls his hollow eyes.        So bends tormented TANTALUS to drink,420 While from his lips the refluent waters shrink;        Again the rising stream his bosom laves,        And Thirst consumes him 'mid circumfluent waves.        —Divine HYGEIA, from the bending sky        Descending, listens to his piercing cry;425 Assumes bright DIGITALIS' dress and air,        Her ruby cheek, white neck, and raven hair;        Four youths protect her from the circling throng,        And like the Nymph the Goddess steps along.—        —O'er Him She waves her serpent-wreathed wand,430 Cheers with her voice, and raises with her hand,        Warms with rekindling bloom his visage wan,        And charms the shapeless monster into man.Reference https://www.gutenberg.org/ebooks/10671 (Lines 415-432) Accessed 1.15.22Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail. 2014;2(1):24-31.Falk RH. "Bendopnea" or "kamptopnea?": Some thoughts on terminology and mechanisms. JACC Heart Fail. 2014 Aug;2(4):425.Littler WA. Withering, Darwin and digitalis. QJM. 2019 Dec 1;112(12):887-890.Littler WA. William Withering digitalis and the pulse. QJM. 2019 Aug 1;112(8):565-566Smulyan H. The Beat Goes On: The Story of Five Ageless Cardiac Drugs. Am J Med Sci. 2018 Nov;356(5):441-450.Krikler DM. Withering and the foxglove: the making of a myth. Br Heart J. 1985;54(3):256-257. doi:10.1136/hrt.54.3.256Wilcox RA , Whitham EM. The symbol of modern medicine: why one snake is more than two. Ann Intern Med. 2003;138:673–677.Rogers, Kara. "Guinea Worm Disease". Encyclopedia Britannica, 3 Jul. 2018, https://www.britannica.com/science/guinea-worm-disease. Accessed 21 February 2022.

Braquehais, MD, Vargas-Cáceres, S., Gómez-Durán, E., Nieva, G., Valero, S., Casas, M., y Bruguera, E. (2020). El impacto de la pandemia de COVID-19 en la salud mental de los profesionales de la salud. QJM: revista mensual de la Asociación de Médicos , hcaa207. Publicación anticipada en línea. https://doi.org/10.1093/qjmed/hcaa207 --- Send in a voice message: https://anchor.fm/las-poderosas-celulas-nk/message

Dans ce 42ème épisode du Pharmascope, Nicolas, Sébastien et leur invitée continuent leur discussion sur le syndrome sérotoninergique. Cette fois, ils abordent les controverses entourant certaines substances possiblement en cause et la prise en charge de cette fameuse toxicité. Les objectifs pour cet épisode sont : Identifier des classes médicamenteuses ayant un lien causal controversé avec la toxicité sérotoninergiqueComprendre la prise en charge du syndrome sérotoninergique Ressources pertinentes en lien avec l’épisode Étude évaluant les critères diagnostiques de HunterDunkley EJ et coll. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635-42. Articles de revue sur le syndrome sérotoninergiqueFoong et coll. The scoop on serotonin syndrome. Can Pharm J. 2018; 151(4): 233-9. Jurek L et coll. Le syndrome sérotoninergique: une revue actualisée de la littérature. Rev Med Interne. 2019;40:98-104. Foong AL et coll. Démystifier le syndrome (ou la toxicité) sérotoninergique. Can Fam Physician. 2018;64:e422-30.

Dr. David Coughlin returns for this week's Teaching Through Clinical Cases to discuss the management of a delirious patient with a hyperkinetic movement disorder. Produced by James E. Siegler. Music by Hyson, Josh Woodward, Komiku and Peter Rudenko. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision making. REFERENCES Mills KC. Serotonin syndrome. American family physician. 1995;52:1475-1482 Radomski J, Dursun S, Reveley M, Kutcher S. An exploratory approach to the serotonin syndrome: An update of clinical phenomenology and revised diagnostic criteria. Medical hypotheses. 2000;55:218-224 Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The hunter serotonin toxicity criteria: Simple and accurate diagnostic decision rules for serotonin toxicity. QJM : monthly journal of the Association of Physicians. 2003;96:635-642 Boyer EW, Shannon M. The serotonin syndrome. The New England journal of medicine. 2005;352:1112-1120 Dosi R, Ambaliya A, Joshi H, Patell R. Serotonin syndrome versus neuroleptic malignant syndrome: A challenging clinical quandary. BMJ case reports. 2014;2014:bcr2014204154 Lappin RI, Auchincloss EL. Treatment of the serotonin syndrome with cyproheptadine. The New England journal of medicine. 1994;331:1021-1022 Pedavally S, Fugate JE, Rabinstein AA. Serotonin syndrome in the intensive care unit: Clinical presentations and precipitating medications. Neurocritical care. 2014;21:108-113 Ables AZ, Nagubilli R. Prevention, recognition, and management of serotonin syndrome. American family physician. 2010;81:1139-1142

Kyla och värme har förmåga att starkt påverka på en mängd olika processer i kroppen Exempelvis påverkas blodflöde, inflammation, aktivering av nervsystemet, avslappning i muskler och frisättning av ett flertal hormoner. Vad finns det för fördelar och nackdelar med kallvattenbad och liknande terapiformer för immunförsvar och hälsa? Och vad är viktigt att tänka på om man har en autoimmun sjukdom? I det här avsnittet berättar Karl Hultén både om sina egna erfarenheter av att använda kallbad för symptomlindring och avslappning, samt går in på vad som konkret händer i kroppen och vad som är viktigt att tänka på om man vill prova denna terapiform. Läs mer här: http://www.paleoteket.se/avsnitt-19-koldterapi-immunforsvar-och-halsa/ Referenser: Huttunen, Pirkko, Leena Kokko, and Virpi Ylijukuri. "Winter swimming improves general well-being." International Journal of Circumpolar Health 63.2 (2004) Siems, W. G., et al. "Improved antioxidative protection in winter swimmers." Qjm 92.4 (1999): Goedsche, K., et al. "Repeated cold water stimulations (hydrotherapy according to Kneipp) in patients with COPD." Forschende Komplementarmedizin (2006) 14.3 (2007) Mooventhan, A., and L. Nivethitha. "Scientific evidence-based effects of hydrotherapy on various systems of the body." North American journal of medical sciences 6.5 (2014) ****************** * Vill stötta podcasten med en gåva? Podcasten är gratis att lyssna på, men inte gratis att göra. Om du vill stötta vårt arbete med podcasten kan du ge en (liten eller stor) gåva genom att SWISHa till nummer: 1231496728 eller betala till BG 785-9267. Som meddelande skriv "gåva". Lägg också till "din epost + TACK" om du vill att vi tackar dig i podcasten, vilket vi såklart gärna gör. ******************* * Vill du ge en recension av podcasten på Itunes? Då skulle vi bli väldigt glada och fler kan då hitta till podcasten. Du går in via på datorn eller telefonen och söker på “Paleoteket” under fliken ”Affär”, sedan klicka på loggan och välja ”Betyg och recensioner”. Även om du prenumererar på podcasten behöver du söka upp den på nytt för att lämna en recension. ******************* Vill du ha mer information från oss? * Prenumerera på podcasten via Itunes, Soundcloud eller i din Podcast-app. Sök på "Paleoteket". * Prenumerera på vårt nyhetsbrev på www.paleoteket.se * Följ oss på Facebook: www.facebook.com/paleoteket.se * Följ oss på Instagram: www.instagram.com/paleoteket.se

In our first episode with neurology content, we will discuss my research interest in neurologic deterioration after stroke. Enjoy! BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision making in routine clinical practice. The case discussed in this episode is fictional and does not contain any patient health identifying information. REFERENCES 1. Siegler JE, Boehme AK, Albright KC, George AJ, Monlezun DJ, Beasley TM and Martin-Schild S. A proposal for the classification of etiologies of neurologic deterioration after acute ischemic stroke. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2013;22:e549-56. 2. Thanvi B, Treadwell S and Robinson T. Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management. Postgraduate medical journal. 2008;84:412-7. 3. Balami JS, Chen RL, Grunwald IQ and Buchan AM. Neurological complications of acute ischaemic stroke. The Lancet Neurology. 2011;10:357-71. 4. Kwan J and Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM : monthly journal of the Association of Physicians. 2006;99:625-33.