#also w cushing's syndrome

[bisexualalienss]

in what world does a judge think they have authority of drugs the fda approves. hell country

[dashinghealth]

Why Weight Loss is Hard? Here are the Common Reasons You’re Not Losing Weight

Losing weight is a struggle for many people. We have all been there—trying out different diets and exercising regularly—and yet the scale just doesn’t seem to budge. It can be frustrating and demotivating, but the truth is, weight loss is hard.

There are various reasons why you may not be seeing the results you desire, and in this article, we will delve into the common reasons why weight loss is so challenging.

1. Lack of Consistency

Consistency is the key to success, and this rings true when it comes to weight loss. Many people start off strong with their diet and exercise routine, but then slowly lose motivation and fall back into old habits.

Weight loss requires sustained effort and consistency, and any slip-ups or cheat days can set you back. It’s important to stay committed and stick to your plan, even when it gets tough.

2. Underestimating Calorie Intake

Weight loss is essentially a matter of burning more calories than you consume. However, many people tend to underestimate the number of calories they are consuming.

This can be due to mindless snacking, not tracking portion sizes, or not accounting for hidden calories in sauces or dressings.

To see results, it’s important to track your calorie intake accurately and make sure you are in a calorie deficit.

Recommended: Your Weight Loss FAQs Answered: Expert Insights for Effective Results

3. Not Enough Protein Intake

Protein is an essential nutrient for weight loss. It helps to keep you feeling full, preserves muscle mass, and boosts your metabolism. However, many people don’t consume enough protein, especially when following a restrictive diet.

This can lead to muscle loss and a slower metabolism, making it harder to lose weight. Make sure to incorporate protein-rich foods such as lean meats, eggs, and legumes into your meals to support your weight loss journey.

4. Lack of Sleep

Sleep is often overlooked when it comes to weight loss, but it plays a crucial role. When we don’t get enough sleep, our bodies produce more of the hunger hormone, ghrelin, and less of the satiety hormone, leptin.

This can lead to increased cravings and overeating. Lack of sleep also affects our energy levels, making it harder to stick to our exercise routine. Aim for 7-9 hours of quality sleep each night to support your weight-loss efforts.

5. Stress and Emotional Eating

Stress and emotions can greatly impact our weight-loss journey. When we are stressed, our bodies produce cortisol, which can increase appetite and lead to cravings for unhealthy foods.

In addition, many people turn to food as a source of comfort or to cope with their emotions. This is known as emotional eating and can quickly derail weight-loss efforts. Finding healthy ways to manage stress and emotions, such as exercise or meditation, can help prevent overeating.

6. Medical Conditions and Medications

There are certain medical conditions and medications that can make weight loss more challenging. Conditions such as hypothyroidism, PCOS, and Cushing’s syndrome can affect metabolism and make it harder to lose weight.

Certain medications, such as antidepressants and steroids, can also cause weight gain. If you suspect a medical condition or medication is hindering your weight loss, consult with your doctor.

Recommended: Get Professional Medical Consultation, plus Clinically Tested and Proven Nutritional Supplements to Keep You Naturally Fit, Alive, and Healthy

In conclusion, weight loss is hard, but it’s not impossible. It requires consistency, patience, and a balanced approach.

By addressing these common reasons for not losing weight and making the necessary lifestyle changes, you can overcome the challenges and achieve your weight-loss goals. Remember to always listen to your body, be kind to yourself, and celebrate your progress along the way.

Your Weight Loss FAQs Answered: Expert Insights for Effective Results

When weight loss is a concern: When should you worry?

Will weight loss lower blood pressure?

Will weight loss lower blood sugar?

How much does blood pressure go down with weight loss?

Will weight loss lower cholesterol?

Will weight loss help knee pain?

Will weight loss cure sleep apnea?

Will weight loss help sciatica?

How Much Weight Loss Per Week is Healthy?

Why Weight Loss is Hard? Here are the Common Reasons You’re Not Losing Weight

For Weight Loss How Much Protein is Needed?

Medi Weight Loss: What are the Pros and Cons of Weight Loss Drugs?

Can weight loss reverse high blood pressure?

Is Weight Loss a Sign of Diabetes?

Is Weight Loss Surgery Worth it? Pros and Cons

No Weight Loss on Keto? Here are the Reasons You’re Not Losing Weight on Keto

Can Weight Loss Cause Hair Loss?

Can Weight Loss Cause Back Pain?

Can Weight Loss Reverse Hypothyroidism?

Can Weight Loss Reverse Heart Failure?

[mcatmemoranda]

Notes I took from HTN lecture on 10/17:

I didn't really like this lecture because he gave us old information. There are new cut-offs for HTN and there is no "pre-hypertension" anymore--now it's elevated BP, stage 1, and stage 2 HTN. And I'm pretty sure the numbers he gave are for the old guidelines. But not everyone goes by the new guidelines.

Overweight, family history, smoking, lack of exercise, age, weight = risk factors for HTN.

2 elevated BP readings in 2 or more visits is diagnostic.

UTD: ●Severe hypertension in adults (often defined as systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥120 mmHg) can be associated with a variety of acute, life-threatening complications, any one of which is considered a hypertensive emergency. Much more common, however, is the relatively or completely asymptomatic patient with a blood pressure in the "severe" range (ie, ≥180/≥120 mmHg), often a mild headache, but no signs or symptoms of acute end-organ damage. This entity of severe asymptomatic hypertension is sometimes called hypertensive urgency.

Emergency = need to reduce BP fast Malignant HTN = HTN w/ ocular changes (retinal hemorrhages, exudates) Primary HTN = no one cause for the HTN Secondary HTN = something is causing the HTN

Chronic NSAIDs—> sodium retention

Secondary HTN usually due to renal disease; also due to escape phenomenon, pheochromocytoma (episodic HTN), Cushing’s syndrome, smoking, sleep apnea, EPO, decongestants, OCPs.

More than 150 mg protein/day in urine is abnormal. More than 3 grams is nephrotic syndrome. Left Ventricular (LVH) shown on EKG, concentric LVH & LA (Left Atrium) enlargement seen on echo show end organ damage.

For elevated BP and stage 1 HTN, reduce salt intake to less than 3 grams a day, DASH diet, exercise, weight loss. Meds: thiazides, ACEIs, ARBs, CCB. Thiazides and CCBs are better for African American pts. Beta blockers are better for CHF and CAD. Diabetic pts should get ACEIs.

ACEI + ARB—> hyperkalemia, so don’t combine those 2. Every 2 to 4 weeks, titrate dose. Then when pt reaches target, titrate q 3-6 months.

Goal is 140/90 in pts less than 60, those with DM, CKD. The goal is 150/90 for pts age 80+, irrespective of comorbidities. For people age 60 to 79, the goal is 140/90 for those with comorbidities and 150/90 for those w/o comorbidities. This is what the lecturer gave us, but according to the 2017 guideline for HTN in adults:

For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mm Hg is recommended. For adults with confirmed hypertension, but without additional markers of increased CVD risk, a BP target of less than 130/80 mm Hg is recommended as reasonable.

Resistant HTN = High BP despite 3 meds (one of which is a diuretic).

[garden-of-everything]

ABIM: Endocrinology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Adrenal Disorders

Primary aldosteronism and mineralocorticoid excess:   - Sx: HYPERNATREMIA, hypokalemia, metabolic alkalosis, HTN - Dx: aldosterone:renin >20 (aldosterone >15 with low renin levels), salt challenge fails to decrease aldosterone levels --> get CT scan  - Tx: thiazide for BP control, spironolactone for hyperplasia, surgery for adenoma Adrenal insufficiency:   - Addison’s = primary: tan, orthostatic HTN, hyponatremia, hyperkalemia, hypoglycemia, prolonged QTc - Dx: morning cortisol levels --> cosyntropin stimulation test <18mcg/dL = adrenal insufficiency --> check morning ACTH levels (if decreased ACTH, MRI brain; if increased ACTH, CT adrenals) - acute Tx: dexamethasone - chronic Tx: hydrocortisone +/- fludrocortisone only if primary - x2-10 dose of steroids during stress Pheochromocytoma:   - associated with MENIIa and IIb (increased calcitonin/medullary thyroid cancer is also associated with both MENII’s; if IIa: hypercalcemia/parathyroid, if IIb: Marfan’s/neuromas) - Dx: serum or 24 hour urine metanephrines --> MRI/CT ab --> if negative: T-MIBG Tx:  surgery: - pre-op BP control with phenoxybenzamine/doxazosin/nicardipine - intra-op HTN crisis: nitroprusside or phentolamine Incidentaloma: - if <4cm, f/u CT; if >6cm, surgery - Dx with 1mg overnight dex suppression test (Cushings) + urine metanephrines (PCC) +/i if hypertensive: aldosterone:renin ratio (hyperaldosteronism if elevated)

Thyroid Disorders

Hyperthyroidism: - Grave’s: anti-TSHR Ab - associated with vitiligo - Tx: Methimazole (AE: sore throat/agranulocytosis, hepatotoxicity) > PTU (for first trimester; AE: hepatotoxicity) Hypothyroidism: - Hashimoto’s: anti-TPO antibodies - associated with primary thyroid lymphoma - Tx if TSH>10 or planning pregnancy or symptomatic *FYI: increase Synthroid dose in pregnancy and in CELIAC DISEASE Thyroiditis: 1.  subacute/DeQuervain’s: PAINFUL, Tx with NSAIDs only 2.  Peripartum: painless, autoimmune 3.  amiodarone-induced *subclinical presentation (decreased TSH, normal T4): repeat TFT in 4-6mo Thyroid nodules: - if <1cm and doesn’t look cancerous, repeat US in 3-6 months - if >1cm, FNA > Sx Euthyroid sick syndrome: transient and mild, weird TSH/T3/T4 levels during illness without prior thyroid issues; usually T3 is decreased while TSH/T4 is normal - Tx underlying illness only (no need for Synthroid) Thyroid storm:  fever, HF, psych changes/coma; Tx: PTU, propranolol/BB, steroids (vs. Myxedema coma from hypothyroidism: hypothermia/hypotension/bradycardia/bradypnea, desaturation, AMS, hyponatremia, hypoglycemia; Tx with Synthroid + hydrocortisone) *if TSH/T3/T4 are all weirdly increased or decreased, cause is likely a pituitary tumor *suspect toxic multinodular goiter when patient experiences hyperthyroid symptoms after receiving IV iodine contrast

Hypertension

Hyperaldosteronism:   - hypernatremia, hypokalemia, metabolic alkalosis (basically the opposite of RTA type 4) - Tx with thiazide Renal artery stenosis:  Tx with ACEi Cushing’s Disease: - round and squishy - Dx: elevated 24 hour urine cortisol, 1mg dexamethasone suppression test (positive if fails to bring cortisol <5), elevated late salivary cortisol

Lipid disorders

- start screening every 5 years in >35yoM, >45yoF; or >20 if +CAD risk - goals: LDL<160, Cholesterol <190; pretty much decrease both goals by 30 for every additional CAD risk up to 3 times - diet > exercise - offer Orlistat if BMI>30 - offer Bariatric surgery if BMI >40 OR >35 with obesity-related condition

Ovarian disorders and female reproductive health

Polycystic ovary syndrome: - amenorrhea and virilization - Dx: bleeds with progesterone challenge, has elevated LH - Tx hirsuitism with OCP --> if fails: spirnolactone; use clomiphene if wants babies Amenorrhea:   1. primary ovarian insufficiency: elevated FSH = menopause --> if normal: check karyotype to r/o Turner’s (obtain cardiac imagining and kidney US for all patients with Turner’s) *if amenorrheic because of super athleticism: screen for bulimia 2.  hypothalamic cause: functional/tumor/lymphoma; has decreased FSH and NO withdrawal bleed after progesterone challenge 3.  anatomic cause/Asherman syndrome: adhesions basically retain periods; also has no withdrawal bleeding --> Tx: surgery Ovarian cancer: - hyperandrogenism; normal DHEA levels but elevated total testosterone levels >200 in a woman = ovarian cancer until proven otherwise - Dx: TVUS --> adrenal CT

Testes and male reproductive health

Male hypogonadism:  total testosterone <200 +: - increased LH/FSH = primary testicular failure (Klinefelter’s, Mumps orchitis, XRT, autoimmune) - normal/decreased LH/FSH, elevated prolactin = secondary cause (prolactinoma --> MRI brain, opiates, steroids) --> obtain iron study to rule out hemochromatosis* *Hemochromatosis presents as tan Diabetes with elevated transaminases, and hypogonadism; has OA symptoms and is associated with CPPD/Pseudogout Male infertility: - Cystic Fibrosis is associated with azospermia, bilateral absence of vas deferens Gynecomastia: associated with anabolic steroids, marijuana, spironolactone - if elevated estradiol --> check testicular ultrasound to r/o neoplasm --> chest/adrenal CT to r/o choriocarcinoma (elevated beta hCG, lung infiltrates, hemoptysis) - if elevated LH, decreased testosterone --> check karyotype to r/o Klinefelters (associated with increased risk of breast cancer) *testosterone therapy can worsen OSA, erythrocytosis, and increases risk of clots

Diabetes mellitus

Type I: - associated with other autoimmune diseases (Celiac, vitiligo, thyroid) - DKA Type II: - Dx with two of the following on separate days: (1) fasting >126, (2) A1c >6.5%, (3) random >200, or just one of this: (4) 2 hour gtt >200 *if a health-seeming patient >35yo with h/o CAD or 2 CAD risk factors wants to do a vigorous exercise program --> do an exercise stress test first Diabetes mellitus and pregnancy:  STOP ACE/ARB/statin (teratogenic!) - obtain eye exam once/trimester - BP control with methyldopa, BB (labetalol), CCB, Hydralazine - goal: preprandial BG <90, 1 hour postprandial <120 using NPH and short-acting insulin (NOT long-acting insulin or orals) - require annual DM screening after delivery Diabetes goals: - BP <140/90: use ACEi - start statin regardless of LDL if cholesterol >135 and check yearly - cholesterol goal <135 > LDL goal <100 - annual eye exam with Q3-5 year dilated eye exam - urine albumin excretion <30; if >30, start ACEi/ARB Indications for continuous BG monitoring: (1) postprandial hyperglycemia (2) Dawn phenomenon: morning hyperglycemia (vs. Somogyi = rebound hyperglycemia) (3) overnight hypoglycemia Diabetes complications: - acute mononeuropathy: spontaneously resolves, no Tx - gastroparesis: Tx: small meals, Reglan/Erythromycin (vs. Rifaximin for Scleroderma-related bacterial overgrowth that presents similarly as bloating) - orthostatic hypotension: Tx with compression stockings +/- fludrocortisone - peripheral neuropathy: BG control --> DULOXETINE > pregabalin - HHS: plasma osm >320, BG >600-1000, normal pH/ketones; Tx with NS --> insulin --> when BG<200 and tolerating PO --> SQ insulin - DKA:  pH <7.3, bicarb <15, BG >250, elevated ketones  elevated AG vs. Diabetes insipidus: excessive thirst for cold water, can’t concentrate urine - r/o DM, hypercalcemia - Dx: water deprivation test --> if urine osm still <200 --> desmopressin challenge: (1) can concentrate after challenge = positive test --> brain MRI; Tx intranasal or PO desmo/vasopressin (2) still can’t concentrate after desmo: negative test --> kidney ultrasound; Tx sodium restriction and thiazide *if Lithium-induced: Tx Amiloride

Disorders of calcium metabolism and bone

Hypercalcemia: - hyperparathyroidism associated with MEN I and IIa (increased PTH or normal PTH with increased calcium and decreased phos), chondrocalcinosis, bone cyst --> Dx: Sestamibi scan --> Surgery *Indications for parathyroidectomy: (1) Age <50yo (2)  Ca >12 or 1 above baseline (3) GFR<60 (4) 24 hour urine Ca >400 (5) symptoms of hypercalcemia - drug-induced hypercalcemia: lithium, thiazide - sarcoidosis: increased calcitriol = active Vit D = 1, 25 Vit D - cancer / multiple myeloma: CRAB, difference in urine vs dipstick protein due to presence of undetected light chain, hypervitaminosis D - Dx: check ionized calcium first --> r/o decreased TSH --> PTH/Ca/Phos/25Vit D levels --> decreased urine calcium ( = familial hypocalciuric hypercalcemia --> Dx: CASR mutation, urine Ca;Cr ratio <0.01) Hypocalcemia:  check ionized level, because may be due to hypoalbuminemia - associated with DiGeorge - symptoms include circumoral paresthesia, Chvostek cheek tap, Trousseau BP cuff Hyperphosphatemia: - CKD (increased PTH, decreased Vit D) --> Tx: Calcitriol/1,25VitD - hypoparathyroid (decreased PTH) - pseudohypoparathyroid (increased PTH, normal Vit D) Hypophosphatemia:  - bone tenderness due to vitamin deficiency Paget’s:   - hat size changes, bone pains, fractures, femur/tibia bowing, cranial nerve compressions; heart failure - elevated alk phos --> bone scan - Tx: bisphosphonate Osteoporosis:  T-score<-2.5 (ignore age-adjusted Z-score) - get DEXA every 10 years (if normal) in woman >65 OR younger if FRAX >9.3% (they smoke, have h/o hip fx, steroid use, etc) Vitamin D deficiency and osteomalacia:   - proximal muscle weakness/falls (especially in elderly), bone pain - decreased calcium, phosphate; increased alk phos - associated with Celiac disease, liver disease, kidney disease - Dx: bone marrow biopsy (BMB) - Tx: ergocalciferol/Vit D2 Renal osteodystrophy:  ESRD pt w decreased Ca, Vit D; increased Phos, PTH; chondrocalcinosis at knees and pubic symphysis

Anterior pituitary disorders

Pituitary tumors:  MRI (order first if mass effect) - associated with MEN I, pregnancy, and check TSH! (1) Prolactinoma: prolactin >500, galactorrhea/amenorrhea/erectile dysfunction; Tx: Cabergoline (2) Acromegaly: Dx: IgF1 or oral glucose tolerance test that fails to decrease GH; Tx: surgery (3) Cushing’s: HTN, DM, proximal muscle weakness; Dx: 24 hour urine cortisol, elevated late night salivary cortisol --> elevated morning ACTH = pituitary tumor --> Tx: surgery > XRT - incidental pituitary tumors: f/u repeat MRI with prolactin levels - Rx (TCA, CCB, Reglan, opiates) and pregnancy  can cause elevated prolactin! Hypopituitarism: (1) apoplexy: sudden HA, vision change, AMS; Tx: steroids (2) Sheehans (after pregnancy): amenorrhea, no lactation (3) lymphocytic hypophysitis (occurs peripregnancy): sellar mass with anti-pituitary antibody; Tx: steroids OR if vision changes, surgery

Posterior pituitary and water metabolism

Hypernatremia:  DI: polyuria, inability to concentrate urine; Dx: water deprivation --> desmopressin: (1) concentrates urine (urine osms goes up) = MRI brain and Tx w desmo/vasopressin; (2) still doesn’t concentrate (urine osms stay low) = kidney ultrasound and Tx with salt restriction, thiazide Hyponatremia:  SIADH:  urine osm > serum osm, urine osm >500, euvolemic (vs. psychogenic polydipsia where decreased serum AND urine osm)

Endocrine tumors and endocrine manifestations of tumors

Pancreatic tumors associated with MENI (hypercalcemia/hyperparathyroid, prolactinoma/pituitary tumor): - Insulinoma: Dx 72 hour fast (BG<45, insulin >5) --> CT abdomen --> still not detected?: check endoscopic ultrasound - VIPOMA: watery diarrhea - Gastrinoma/Zollinger-Ellison syndrome:  severe dyspepsia; Dx: gastrin levels --> secretin stimulation test causing increased gastrin >200 - Glucagonoma:  hyperglycemia, pustular rash, diarrhea, DVTs - Carcinoid: flushing, N/V/D/AP; Dx: 24 hour urine 5-HIAA Malignancy-associated hypercalcemia (squamous cell):  decreased PTH, normal/decreased phosphate, increased PTHrpeptide Ectopic ACTH (Cushing’s) due to tumor: associated with small cell, medullary thyroid cancer (elevated calcitonin), bronchial carcinoid (flushing, wheezing) SIADH from tumor:  associated with small cell; hyponatremia and euvolemia; urine osm >500

Hypoglycemia

- most commonly after gastrectomy/gastric bypass - insulin use: decreased C-peptide - sulfonylurea: increased C-peptide --> check for medication in urine - insulinoma:  seen in MEN I with hypercalcemia/hyperparathyroid, prolactinoma/pituitary adenoma; Dx with 72 hour fast: if BG <45 and insulin >5 --> CT abdomen - exercise-induced delayed hypoglycemia: Tx: complex carbs

Polyglandular disorders

MENI (���3P’s”):   (1) Pituitary: prolactinoma, acromegaly, Cushings (2) Pancreas:  insulinoma hypoglycemia, VIPoma diarrhea, gastrinoma GERD, carcinoid flushing, glucagonoma hyperglycemia (3) Parathyroid: hypercalcemia MENIIa: (1) Parathyroid: hypercalcemia (2) PCC: hypertension (3) Medullary thyroid cancer: elevated calcitonin MENIIb: (1) Marfan’s/neuromas (2) PCC: hypertension (3) Medullary thyroid cancer: elevated calcitonin

[didanawisgi]

CAUSES OF ACUTE PANCREATITIS: "GET SMASH'D" Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics) · A-P-G-A-R: A - appearance (color) P - pulse (heart rate) G - grimmace (reflex, irritability) A - activity (muscle tone) R - respiratory effort · Multiple Endocrine Neoplasia: Each of the MENs is a disease of three or two letters plus a feature. MEN I is a disease of 3 P's (pituitary, parathyroid, and pancreas) plus adrenal cortex MEN II is a disease of 2 C's(carcinoma of thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIB(aka MEN III) · Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate · Acute pneumonia caused by Miscellaneous microbes--Mononuclear infiltrate · Takayasu's diz = pulseless diz, therefore when you have Takayasu's, I can't Tak'a yu pulse. · CAGE--alcohol use screening Have you ever felt it necessary to CUT DOWN on your drinking? Has anyone ever told you they were ANNOYED by your drinking? Have you ever felt GUILTY about your drinking? Have you ever felt the need to have a drink in the morning for an EYE OPENER? · P-Q-R-S-T--eliciting and HPI and exploring symptoms P--palliative or provocative factors for the pain Q--quality of pain(burning, stabbing, aching, etc.) R--region of body affected S--severity of pain(usually 1-10 scale) T--timing of pain(eg.-after meals, in the morning, etc.) · A-S-C-L-A-S-T--eliciting and HPI and exploring symptoms A--aggravatiing and alleviating factors S--severity C--character, quality L--location A--associated sx S--setting T--timing note: ASCLAST means let the patient talk first, then ask him/her specific questions · Argyll-Robertson Pupil--syphilitic pupil: Accommodation reflex present, Pupillary reflex absent due to damage at pretectal area. Also called the "prostitute's pupil" (accommodates but does not react). · The five W's--post-operative fever Wind--pneumonia, atelectasis Wound--wound infections Water--urinary tract infection Walking--walking can help reduce deep vein thromboses and pulmonary embolus Wonderdrugs--especially anesthesia · Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER T--trauma O--obesity M--malignancy S--surgery C--cardiac disease H--hospitalization R--rest (bed-bound) E--estrogen, pregnancy, post-partum P--past hx F--fracture E--elderly R--road trip · ARTERIAL OCCLUSION: pain pallor pulselessness paresthesias · HYPERSENSITIVITY REACTIONS: "Anna Cycled Immediately Downhill--Gell & Goombs" or "ACID." Type I Anaphylaxis Type II Cytotoxic-mediated Type III Immune-complex Type IV Delayed hypersensitivity · WBC Count: "Never Let Mom Eat Beans" and "60, 30, 6, 3, 1" Neutrophils 60% Lymphocytes 30% Monocytes 6% Eosinophils 3% Basophils 1:

Alcohol abuse screening questions CAGE:

1. Ever felt it necessary to Cut down on drinking? 2. Has anyone ever said they felt Annoyed by your drinking? 3. Ever felt Guilty about drinking? 4 Ever felt a need to have a morning drink as an Eye opener? Abdominal swelling causes 5 F's: Fat Feces Fluid Flatus Fetus Full-sized tumors Patient examination organization SOAP: Subjective: what the patient says. Objective: what the examiner observes. Assessment: what the examiner thinks is going on. Plan: what they intend to do about it. Vomiting: non-GIT differential ABCDEFGHI: Acute renal failure Brain [increased ICP] Cardiac [inferior MI] DKA Ears [labyrinthitis] Foreign substances [Tylenol, theo, etc.] Glaucoma Hyperemesis gravidarum Infection [pyelonephritis, meningitis] History: quick EMS medical history checklist SAMPLE: Signs/ Symptoms Allergies Medications Pertinent history Last oral intake Events preceding this incident Pain history checklist OPQRSTU: Onset of pain (time, duration) Palliative factors for pain Quality of pain (throbbing, stabbing, dull, etc.) Region of body affected Severity of pain (usually scale of 1-10) Timing of pain (after exercise, in evening, etc.) U: How does it affect 'U' in your daily life? · May wish to expand to OPPQRRSTTUVW, with the extra letters representing: Provocative factors Radiation (how does pain spread) Treatments tried Deja Vu: Has this happened before? Worry: What do you think or fear that it is? Differential diagnosis checklist "A VITAMIN C" A and C stand for Acquired and Congenital · VITAMIN stands for: Vascular Inflammatory (Infectious and non-Infectious) Trauma/ Toxins Autoimmune Metabolic Idiopathic Neoplastic · Example usage: List causes of decreased vision: Central retinal artery occlusion, Retinitis pigmentosa, Perforation to gobe, Chronic Gentamycin use, Ruematoid arthritis, Diabetes, Idiopathic, Any eye tumor, Myopia. Sign vs. symptoms Ign: something I can detect even if patient is unconscious. sYMptom is something only hYM knows about. Eyes: abbreviations for the eyes You look OUt with Both eyes. Take the Right dose so you won't OD [overdose]. The only one that is Left is OS. · Both eyes=OU, Right eye=OD, Left eye=OS. Medical history: disease checklist MJ THREADS: Myocardial infarction Jaundice Tuberculosis Hypertension Rheumatic fever/ Rheumatoid arthritis Epilepsy Asthma Diabetes Strokes Pain history checklist "On Days Feeling Low Character, Run A Seven Pace Race": Onset Duration Frequency Location Character Radiation Severity Precipitating factors Relieving factors Pain history checklist ASK LAST: Aggravating/ Alleviating Severity Karacter Location Associated symptoms Setting Timing Pain history checklist SOCRATES: Site Onset Character Radiation Alleviating factors/ Associated symptoms Timing (duration, frequency) Exacerbating factors Severity · Alternatively, Signs and Symptoms with the 'S'. Symptom attributes "FAST LQQ'S": Factors that make it better/worse Associated manifestations Setting Timing Location Quality Quantity Severity Heart valve auscultation sites "All Patients Take Meds": · Reading from top left: Aortic Pulmonary Tricuspid Mitral · See diagram. · Alternatively: All Prostitutes Take Money. · Alternatively: APe To Man. Four point physical assessment of a disease "I'm A People Person": Inspection Auscultation Percussion Palpation Physical exam for 'lumps and bumps' "6 Students and 3 Teachers go for CAMPFIRE": Site, Size, Shape, Surface, Skin, Scar Tenderness, Temperature, Transillumination Consistency Attachment Mobility Pulsation Fluctuation Irreducibility Regional lymph nodes Edge Surgical sieve VANISHED: Vascular Accident & trauma Neoplastic Inflammatory Septic Haematologic/ Hereditary Endocrinological Degenerative Differential diagnosis checklist "I VINDICATE": Iatrogenic Vascular Infectious Neoplastic Degenerative/ Drugs Inflammatory/ Idiopathic Congenital Allergic/ Autoimmune Traumatic Endocrinal & metabolic Symptom sieve "TIN CAN BED DIP POG": Trauma Infection Neoplasm Cardiac Autoimmune Neurological Blood/ Bone Endocrine Disintegration/ Degeneration Drugs Iatrogenic/ Idiopathic Psychological Paediatric Obstetric Gynaecological Pain history checklist LOST WAR: Location Onset Severity Time Worsening factors Alleviating factors Radiation Short statue causes RETARD HEIGHT: Rickets Endocrine (cretinism, hypopituitarism, Cushing's) Turner syndrome Achondroplasia Respiratory (suppurative lung disease) Down syndrome Hereditary Environmental (postirradiation, postinfectious) IUGR GI (malabsorption) Heart (congenital heart disease) Tilted backbone (scoliosis) Ascultation: crackles (rales )"PEBbles": Pneumonia Edema of lung Bronchitis Pain history checklist CHLORIDE: Character (stabbing, throbbing, etc.) Location Onset Radiation Intensity Duration Events (associated with, or palliative and provocative factors) Differential diagnosis CIMETIDINE: Congenital Infection/ Inflammatory Metabolic Endocrine Trauma Iatrogenic Degenerative Idiopathic Neoplastic Everything else Sign vs. symptom Remember Ace of Base's song that goes like this: "I Saw the Sign, and it opened up my eyes". The physician sees the signs. Systems review: systems checklist I PUNCH EAR: Integumental Pulmonary Urogenital Nervous Cardiovascular Hematolymphoid Endocrine Alimentary Reproductive Pain history checklist MR. C T FARADS: Main site Radiation Character Timing Frequency Associated factors Relieving factors Aggravating factors Duration Severity Abdomen assessment To assess abdomen, palpate all 4 quadrants for DR. GERM: Distension: liver problems, bowel obstruction Rigidity (board like): bleeding Guarding: muscular tension when touched Eviseration/ Ecchymosis Rebound tenderness: infection Masses Pain history checklist CLITORIS: Character Location Intensity Timing Onset Radiating Irritating and relieving factors Symptoms associated Past medical history (PMH) VAMP THIS: Vices (tobacco, alcohol, other drugs, sexual risks) Allergies Medications Preexisting medical conditions Trauma Hospitalizations Immunizations Surgeries Patient profile (PP) LADDERS: Living situation/ Lifestyle Anxiety Depression Daily activities (describe a typical day) Environmental risks/ Exposure Relationships Support system/ Stress Family history (FH) BALD CHASM: Blood pressure (high) Arthritis Lung disease Diabetes Cancer Heart disease Alcoholism Stroke Mental health disorders (depression, etc.) Differential diagnosis checklist DIRECTION: Drugs Infection Rheumatologic Endocrine Cardiovascular Trauma Inflammatory Other Neoplasm Pathologic classification NIT DIT FIT: Neoplastic Infectious Traumatic Degenerative/ Drugs Immune Toxic Vascular Inflammatory Totally obscure Pyrexia of Unknown Origin: history taking SIT ON FRAD: Sexual history Immunisation status Travel history Occupational history Nutrition (consumption of dairy products, etc.) Family history Recreational habits Animal contacts (including ticks and other vectors) Drug history Health related behavior (HRB) topics: history taking "Healthy SEEDS": Substances (alcohol, tobacco, IV drugs?) Environment (hazards at home or work? feel safe?) Exercise (what do you do? how often do you do it?) Diet (any special diet?) Sex (active with m/f/both? >1 partner? safe sex? STD history? difficulty with arousal or orgasm? history of abuse?) · I find this order works well: patients most expect to be asked about alcohol and they least want to talk about their STD history, but taking a solid HRB history first reassures them that it's all part of good medical care. Breast history checklist LMNOP: Lump Mammary changes Nipple changes Other symptoms Patient risk factors Pain history checklist COLDER BARS: Character Onset Location Duration Exacerbating factors Radiation Before (ever happened before) Associated symptoms Relieving factors Severity Pain history checklist SO CRAP: Site Onset Character Radiates to Associated symptoms/ Alleviating and exacerbating factors Periodicity History, HCFA components for E+M coding Q LSD MCAT: Quality Location Severity Duration Modifying factors Context Associated signs and symptoms Timing Surgical sieve for diagnostic categories INVESTIGATIONS: Iatrogenic Neoplastic Vascular Endocrine Structural/ Mechanical Traumatic Inflammatory Genetic/ Congenital Autoimmune Toxic Infective Old age/ Degenerative Nutritional Spontaneous/ Idiopathic Mental state examination: stages in order "Assessed Mental State To Be Positively Clinically Unremarkable": Appearance and behaviour [observe state, clothing...] Mood [recent spirit] Speech [rate, form, content] Thinking [thoughts, perceptions] Behavioural abnormalities Perception abnormalities Cognition [time, place, age...] Understanding of condition [ideas, expectations, concerns] Branham sign: definition BRAnham sign: BRAdycardia after compression or excision of a large AV fistula. Glasgow coma scale: components and numbers · Scale types is 3 V's: Visual response Verbal response Vibratory (motor) response · Scale scores are 4,5,6: Scale of 4: see so much more Scale of 5: talking jive Scale of 6: feels the pricks (if testing motor by pain withdrawl) Meckel’s diverticulum- rule of 2’s 2 inches long, 2 feet from the ileocecal valve, 2% of the population commonlly presents in the first 2 years of life may contain 2 types of epithelial tissue Pheochromocytoma-rule of 10s: 10% malignant 10% Bilateral 10% extraadrenal 10% calcified 10% children 10% familial * discussed 10 times more often than actually seen Aphasia "BROKen aphasia" (Broca’s aphasia-broken speech) "Wordys aphasia" (Wernicke’s aphasia- wordy, but making no sense) GET SMASH'D--Causes of Acute pancreatitis Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune(PAN), Scorpion bites, Hyperlipidemia, Drugs(azathioprine, diuretics) (Multiple endocrine neoplasia) Each of the MENs is a disease of three or two letters plus a feature. "MEN I" is a disease of the 3 Ps (pituitary, parathyroid and pancreas) plus adrenal cortex. "MEN II " is a disease of the two Cs (carcinoma of the thyroid and catacholamines [pheochromocytoma]) plus parathyroid for MEN IIa or mucocutaneous neuromas for MEN IIb (aka MEN III). Acute pneumonia caused by Pyogenic bacteria--PMN infiltrate Acute pneumonia caused by Miscellaneous microbes --Mononuclear infiltrate Takayasu's diz = pulseless diz, therefore when you have Takayasu's, I can't Tak'a yu pulse. Argyll-Robertson Pupil--syphilitic pupil (AKA "Prostitute's pupil" - Accommodates, but doesn't react ) Accommodation reflex present, Pupillary reflex absent CAGE--alcohol use screening 1. Have you ever felt it necessary to CUT DOWN on your drinking? 2. Has anyone ever told you they were ANNOYED by your drinking? 3. Have you ever felt GUILTY about your drinking? 4. Have you ever felt the need to have a drink in the morning for an EYE OPENER? P-Q-R-S-T--eliciting and HPI and exploring symptoms P--palliative or provocative factors for the pain Q--quality of pain(burning, stabbing, aching, etc.) R--region of body affected S--severity of pain(usually 1-10 scale) T--timing of pain(eg.-after meals, in the morning, etc.) The five W's--post-operative fever Wind--pneumonia, atelectasis Water--urinary tract infection Wound--wound infections Wonderdrugs--especially anesthesia Walking--walking can help reduce deep vein thromboses and pulmonary embolus ACID or "Anna Cycled Immediately Downhill" classification of hypersensitivity reactions Type I - Anaphylaxis Type II - Cytotoxic-mediated Type III - Immune-complex Type IV - Delayed hypersensitivity WBC Count: "Never Let Momma Eat Beans(60, 30, 6, 3, 1) Neutrophils 60% Lymphocytes 30% Monocytes 6% Eosinophils 3% Basophils 1% A-P-G-A-R: A - appearance (color) P - pulse (heart rate) G - grimmace (reflex, irritability) A - activity (muscle tone) R - respiratory effort Predisposing Conditions for Pulmonary Embolism: TOM SCHREPFER T--trauma O--obesity M--malignancy S--surgery C--cardiac disease H--hospitalization R--rest (bed-bound) E--estrogen, pregnancy, post-partum P--past hx F--fracture E--elderly R--road trip The 4 P's of arterial Occlusion: pain pallor pulselessness paresthesias The 4 T's of Anterior Mediastinal Mass:Thyroid tumor,Thymoma,Teratoma, Terrible Lymphoma

[drjeandoddspethealthresource]

Vestibular Dysfunctions in Dogs and Cats

Head tilt? Walking in circles? Your companion dog or cat is likely trying to regain his sense of balance or his spatial orientation is off. The cause is more than likely a vestibular dysfunction. Most often it is an inner ear infection, but several other diseases and conditions can cause vestibular problems.

Classification

The two broad categorizations of vestibular dysfunctions are peripheral (inner ear) and central (brain stem/central nervous system) because of their locations. Peripheral vestibular disorders are the most common.

Signs & Diagnosis

The most common signs for both peripheral and central vestibular disorders are:

Head tilt

Vestibular ataxia – loss of coordination

Tight circling, falling, or rolling

Nystagmus – uncontrolled eye movements

Nausea

Strabismus – eyes do not align; and squinting often occurs

Three additional signs – proprioception (sense of where the body is, in relation to itself), mentation (mental activity), and certain cranial nerve deficits – are indicators of possible central vestibular dysfunction.

The first step is a complete neurological examination that puts a companion pet through a series of physical tests. However, it is not perfect. For instance, Troxel et al. conducted a comparative study to help veterinarians distinguish between the two types and analyzed the dysfunctions individually. Of the 20 dogs with central vestibular dysfunction, 95% of the dogs had abnormal postural reactions, 45% of the dogs had mentation change, and 60% of dogs had cranial nerve deficits other than central nerve VIII. These results are good, but ultimately definitive diagnosis of both vestibular dysfunctions is best done with an MRI (magnetic resonance imaging). Spinal fluid taps are also a part of the standard protocol for central vestibular dysfunction.    

But, as I always say, “What is causing this bodily system to not function properly?” We know of several other causes of vestibular dysfunction. So, we need to rule them in or out with blood and other tests.

Peripheral Vestibular Causes

Inner ear infections – Most of the time, these ear infections occur because a bacterial or fungal (often yeast) infection has spread from the outer ear to the inner, so a course of antibiotics or other antimicrobials will need to be given. Personally, I do not support the prolonged or continuous use of antibiotics, so I would want to dig deeper to search for any underlying causes or predispositions. Recurring ear infections are quite often caused by a food sensitivity/intolerance, environmental inhalant (atopy) or contact sensitivity/allergy. So, we need to test for these two conditions to lessen or stop the dependence on antimicrobials.

Congenital vestibular disease is reported in German Shepherds, Doberman Pinschers, English Cockers, and Siamese and Burmese cats. Since it is present early in life, many companion pets adapt to it.

Tumors (cancer)

Hypothyroidism – The thyroid affects so many different pathways in the body that testing for it should be annual. Thyroid medication, if warranted, should lessen or stop the vestibular symptoms.

Overly enthusiastic ear cleaning that can cause irritation and inflammation and might even rupture the eardrum.

Idiopathic – Also known as “old dog vestibular disease” and often thought incorrectly to be caused by a stroke. The signs often disappear within a few days with supportive care.

Idiopathic cat – Most cases arise in the northeast portion of the United States during the summer months. The signs often disappear within a few days with supportive care.

Inflammatory polyps – Commonly seen in cats and can be removed.

Trauma

Ototoxicity – Caused by medications; treatment is to discontinue the use of the drug. Some medications may also cause permanent hearing loss.

Central Vestibular Causes

As previously mentioned, central vestibular dysfunction is rarely seen compared to the peripheral dysfunction.

Thiamine deficiency – Generally seen in cats fed all-fish diets.

Cysts

Hypothyroidism

Cushing's Disease

Tumors

Infectious disease

Granulomatous Meningoencephalomyelitis; Necrotizing Leukoencephalitis; Necrotizing Meningoencephalitis – Prognosis is poor.

Syringomyelia – most common in the Cavalier King Charles Spaniel; also in the Pug, French bulldog and Chihuahua

Embolism  

Metronidazole toxicosis – Metronidazole (Flagyl) is an antibiotic used to treat bacterial infections including those of the vagina, bowel, skin, joints, and respiratory tract. Seizures may also be present.

Stroke is a common cause of central vestibular dysfunction, and may occur secondary to blood vessel infarction or hemorrhage into the brain.

Trauma – Vestibular signs may be due to primary damage, or secondary to raised intracranial pressure, brain herniation or hemorrhage.

Treatment

The best treatment protocol is to figure out the primary or underlying condition, if possible, such as a food sensitivity, hypothyroidism or use of medications.

Secondly, these patients will need varying degrees of supportive care, but that really depends on location and severity.

Motion sickness medications can alleviate nausea and vomiting.

Homeopathic or Chinese medicinal herbs can be given.

Physical or rehabilitation therapy can improve stability.

W. Jean Dodds, DVM Hemopet / NutriScan 11561 Salinaz Avenue Garden Grove, CA 92843

References

LeCouteur, Richard A. "Vestibular Disorders of Dogs and Cats (Proceedings)." Veterinary Calendar. DVM360, 01 Apr. 2009. Web. 29 Jan. 2017. http://veterinarycalendar.dvm360.com/vestibular-disorders-dogs-and-cats-proceedings?id=&sk=&date=&%0A%09%09%09&pageID=5.

Mariani, Christopher L., DVM. "Full Tilt! Diagnosing and Managing Vestibular Dysfunction in Dogs and Cats (Proceedings)." Veterinary Calendar. DVM360, 01 May 2011. Web. 29 Jan. 2017. http://veterinarycalendar.dvm360.com/full-tilt-diagnosing-and-managing-vestibular-dysfunction-dogs-and-cats-proceedings?id=&sk=&date=&pageID=2.

Rylander, Helena, DVM. "Vestibular Syndrome: What's Causing the Head Tilt and Other Neurologic Signs?" Veterinary Medicine. DVM360, 1 July 2012. Web. 29 Jan. 2017. http://veterinarymedicine.dvm360.com/vestibular-syndrome-whats-causing-head-tilt-and-other-neurologic-signs?id=&pageID=1&sk=&date=.

Troxel, MT, KJ Drobatz, and CH Vite. "Signs of Neurologic Dysfunction in Dogs with Central versus Peripheral Vestibular Disease." Journal of the American Veterinary Medical Association 227.4 (2005): 570-74. U.S. National Library of Medicine. Web. 29 Jan. 2017. http://www.ncbi.nlm.nih.gov/pubmed/16117064.

[thesittingduck]

Diprosone cream reviews Uses, Dosage, Side Effects, Precautions,Warnings

Drug Online

Diprosone cream reviews >> Generic drug of the Therapeutic class: Dermatology active ingredients: Betamethasone

Diprosone cream reviews

Important to know about diprosone cream ?

This drug is a local corticosteroid of strong activity.

It is recommended in certain skin diseases such as contact dermatitis, atopic dermatitis, psoriasis, but your doctor may prescribe it in other cases.

What is Diprosone cream used for and indications ?

Preferred indications where local corticosteroid therapy is held for the best treatment:

contact eczema,

atopic dermatitis,

lichenification.

Indications where local corticosteroid therapy is one of the usual treatments:

stasis dermatitis,

psoriasis (excluding extensive plaques),

lichen,

non-parasitic prurigo,

dyshidrose,

genital sclero-atrophic lichen,

ring granuloma,

discoid lupus erythematosus,

seborrheic dermatitis with the exception of the face,

symptomatic treatment of pruritus of fungus mycosis.

Indications of circumstance for a short duration:

insect bites and parasitic prurigo after etiological treatment.

Diprosone is presented in 3 forms:

the cream form is more particularly intended for acute, oozing lesions;

the ointment form is more particularly intended for dry or scaly lesions;

the lotion form is more particularly intended for the lesions of the folds and the hair areas.

Note: each dermatosis must be treated with a corticosteroid of the most appropriate level knowing that depending on the results, we may be led to substitute a product of a stronger or less strong activity on all or part of the lesions.

diprosone cream dosage

Treatment should be limited to 1 to 2 applications per day.

An increase in the number of daily applications could aggravate the adverse effects without improving the therapeutic effects.

The treatment of large areas requires monitoring of the number of tubes used.

It is advisable to apply the product in spaced keys, then to spread it while massaging slightly until it is entirely absorbed.

Some dermatoses (psoriasis, atopic dermatitis …) make it desirable to stop gradually. It can be obtained by reducing the frequency of applications and / or by the use of a less strong or less dosed corticosteroid.

Contraindications

Betamethasone hypersensitivity

Cetostearyl alcohol hypersensitivity

Chlorocresol hypersensitivity

Primary bacterial skin infection

Primary viral skin infection

Primary fungal skin infection

Primary parasitic skin infection

Hypersensitivity to the active substance or to any of the excipients listed in the Composition section.

Primary bacterial, viral, fungal or parasitic infections.

Ulcerated lesions.

Acne.

Rosacea.

Application to the eyelids (risk of glaucoma).

How it works Diprosone?

Pharmacotherapeutic class:

Topical corticosteroids are classified into 4 levels of activity according to cutaneous vasoconstriction tests: very strong activity, strong, moderate, weak.

The Diprosone 0.05 percent cream is of strong activity.

Active on certain inflammatory processes (for example: hypersensitivity of contact) and the itchy effect related to them. Vasoconstrictor. Inhibits cell multiplication.

what’s Diprosone dosage side effects precautions?

Prolonged use of corticosteroids with strong activity may cause skin atrophy, telangiectasia (to be particularly feared on the face), stretch marks (at the root of the limbs in particular, and occurring more readily in adolescents), a secondary ecchymotic purpura to atrophy, skin fragility.

In the face, corticosteroids can create perioral dermatitis or aggravate rosacea .

Healed wounds, pressure ulcers and leg ulcers may be delayed healing

Potential for systemic effects .

Acneiform or pustular eruptions, hypertrichosis, depigmentations have been reported.

Secondary infections, especially under occlusive dressing or in folds and allergic contact dermatoses have also been reported when using local corticosteroids.

Diprosone Interactions

Based on local use of this product: At the recommended doses, betamethasone for topical use is not likely to cause clinically significant drug interactions.

Warnings and Precautions

Special warnings

The prolonged use on the face of corticosteroids with strong activity exposes to the occurrence of cortico-induced and paradoxically cortico-sensitive dermatitis, with rebound after each stop. Progressive weaning, which is particularly difficult, is necessary.

Due to the passage of corticosteroids into the general circulation, treatment over large areas or under occlusion may result in the systemic effects of systemic corticosteroids, particularly in infants and young children. They consist of a cushingoid syndrome and a slowing of growth. These effects disappear upon discontinuation of treatment, but abrupt discontinuation may be followed by acute adrenal insufficiency.

This medicine contains cetostearyl alcohol and may cause local skin reactions (eg contact eczema).

This medicine contains chlorocresol and may cause allergic reactions.

Precautions for use

In infants, it is best to avoid strong corticosteroids. Particularly, we must be wary of spontaneous occlusion phenomena that may occur in folds or under layers.

In case of bacterial or mycotic infection of a cortico-sensitive dermatosis, precede the use of the corticosteroid of a specific treatment.

If local intolerance appears, treatment should be interrupted and the cause should be sought.

Drive and use machines

Not applicable.

PREGNANCY / BREAST FEEDING / FERTILITY

diprosone during pregnancy

No teratogenicity studies were performed with local corticosteroids.

Nevertheless, studies concerning the use of corticosteroids per os did not show a malformation risk higher than that observed in the general population.

Breastfeeding

During a treatment per os, breastfeeding should be avoided because corticosteroids are excreted in breast milk. 

Locally, the transdermal route, and therefore the risk of excretion of corticosteroid in milk, will be a function of the treated surface, the degree of epidermal deterioration and the duration of treatment.

What should I do if I miss a dose?

Do not apply a double dose to make up for the dose you forgot to apply.

What happens if I overdose from Diprosone ?

Always use DIPROSONE 0.05 PERCENT, cream, as your doctor has told you. If you have accidentally applied more DIPROSONE 0.05 PERCENT, cream, than prescribed by your doctor, do not worry but avoid duplicating it.

Excessive or prolonged use of local corticosteroids may lead to manifestations of hypercorticism, including Cushing’s disease.

Treatment: Appropriate symptomatic treatment is indicated.

What is  Forms and Composition ?

FORMS and PRESENTATIONS

0.05% cream:   30 g tube. Ointment 0.05%:   30 g tube. 0.05% lotion:   30 g bottle.

COMPOSITION

  p tube or flask Betamethasone (DCI) 15 mg (as micronized betamethasone dipropionate: 19.2 mg / tube)

Excipients:

Cream: petrolatum, cetostearyl alcohol, liquid paraffin, polyoxyethylene glycol 1000 monocetyl ether, sodium dihydrogen phosphate monohydrate, chlorocresol, concentrated phosphoric acid, purified water. Excipients with known effect: cetostearyl alcohol, chlorocresol.

Ointment: liquid paraffin, white petrolatum.

Lotion: isopropyl alcohol, carbomer (carbopol 974 P), sodium hydroxide, purified water.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Diprosone cream reviews Uses, Dosage, Side Effects, Precautions,Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/3dElnB7 via Edrug Online from faculty of medicine https://bit.ly/2CHojQC via Faculty of Medicine

[colinfitzpatrick]

Diprosone cream reviews Uses, Dosage, Side Effects, Precautions,Warnings

Drug Online

Diprosone cream reviews >> Generic drug of the Therapeutic class: Dermatology active ingredients: Betamethasone

Diprosone cream reviews

Important to know about diprosone cream ?

This drug is a local corticosteroid of strong activity.

It is recommended in certain skin diseases such as contact dermatitis, atopic dermatitis, psoriasis, but your doctor may prescribe it in other cases.

What is Diprosone cream used for and indications ?

Preferred indications where local corticosteroid therapy is held for the best treatment:

contact eczema,

atopic dermatitis,

lichenification.

Indications where local corticosteroid therapy is one of the usual treatments:

stasis dermatitis,

psoriasis (excluding extensive plaques),

lichen,

non-parasitic prurigo,

dyshidrose,

genital sclero-atrophic lichen,

ring granuloma,

discoid lupus erythematosus,

seborrheic dermatitis with the exception of the face,

symptomatic treatment of pruritus of fungus mycosis.

Indications of circumstance for a short duration:

insect bites and parasitic prurigo after etiological treatment.

Diprosone is presented in 3 forms:

the cream form is more particularly intended for acute, oozing lesions;

the ointment form is more particularly intended for dry or scaly lesions;

the lotion form is more particularly intended for the lesions of the folds and the hair areas.

Note: each dermatosis must be treated with a corticosteroid of the most appropriate level knowing that depending on the results, we may be led to substitute a product of a stronger or less strong activity on all or part of the lesions.

diprosone cream dosage

Treatment should be limited to 1 to 2 applications per day.

An increase in the number of daily applications could aggravate the adverse effects without improving the therapeutic effects.

The treatment of large areas requires monitoring of the number of tubes used.

It is advisable to apply the product in spaced keys, then to spread it while massaging slightly until it is entirely absorbed.

Some dermatoses (psoriasis, atopic dermatitis …) make it desirable to stop gradually. It can be obtained by reducing the frequency of applications and / or by the use of a less strong or less dosed corticosteroid.

Contraindications

Betamethasone hypersensitivity

Cetostearyl alcohol hypersensitivity

Chlorocresol hypersensitivity

Primary bacterial skin infection

Primary viral skin infection

Primary fungal skin infection

Primary parasitic skin infection

Hypersensitivity to the active substance or to any of the excipients listed in the Composition section.

Primary bacterial, viral, fungal or parasitic infections.

Ulcerated lesions.

Acne.

Rosacea.

Application to the eyelids (risk of glaucoma).

How it works Diprosone?

Pharmacotherapeutic class:

Topical corticosteroids are classified into 4 levels of activity according to cutaneous vasoconstriction tests: very strong activity, strong, moderate, weak.

The Diprosone 0.05 percent cream is of strong activity.

Active on certain inflammatory processes (for example: hypersensitivity of contact) and the itchy effect related to them. Vasoconstrictor. Inhibits cell multiplication.

what’s Diprosone dosage side effects precautions?

Prolonged use of corticosteroids with strong activity may cause skin atrophy, telangiectasia (to be particularly feared on the face), stretch marks (at the root of the limbs in particular, and occurring more readily in adolescents), a secondary ecchymotic purpura to atrophy, skin fragility.

In the face, corticosteroids can create perioral dermatitis or aggravate rosacea .

Healed wounds, pressure ulcers and leg ulcers may be delayed healing

Potential for systemic effects .

Acneiform or pustular eruptions, hypertrichosis, depigmentations have been reported.

Secondary infections, especially under occlusive dressing or in folds and allergic contact dermatoses have also been reported when using local corticosteroids.

Diprosone Interactions

Based on local use of this product: At the recommended doses, betamethasone for topical use is not likely to cause clinically significant drug interactions.

Warnings and Precautions

Special warnings

The prolonged use on the face of corticosteroids with strong activity exposes to the occurrence of cortico-induced and paradoxically cortico-sensitive dermatitis, with rebound after each stop. Progressive weaning, which is particularly difficult, is necessary.

Due to the passage of corticosteroids into the general circulation, treatment over large areas or under occlusion may result in the systemic effects of systemic corticosteroids, particularly in infants and young children. They consist of a cushingoid syndrome and a slowing of growth. These effects disappear upon discontinuation of treatment, but abrupt discontinuation may be followed by acute adrenal insufficiency.

This medicine contains cetostearyl alcohol and may cause local skin reactions (eg contact eczema).

This medicine contains chlorocresol and may cause allergic reactions.

Precautions for use

In infants, it is best to avoid strong corticosteroids. Particularly, we must be wary of spontaneous occlusion phenomena that may occur in folds or under layers.

In case of bacterial or mycotic infection of a cortico-sensitive dermatosis, precede the use of the corticosteroid of a specific treatment.

If local intolerance appears, treatment should be interrupted and the cause should be sought.

Drive and use machines

Not applicable.

PREGNANCY / BREAST FEEDING / FERTILITY

diprosone during pregnancy

No teratogenicity studies were performed with local corticosteroids.

Nevertheless, studies concerning the use of corticosteroids per os did not show a malformation risk higher than that observed in the general population.

Breastfeeding

During a treatment per os, breastfeeding should be avoided because corticosteroids are excreted in breast milk. 

Locally, the transdermal route, and therefore the risk of excretion of corticosteroid in milk, will be a function of the treated surface, the degree of epidermal deterioration and the duration of treatment.

What should I do if I miss a dose?

Do not apply a double dose to make up for the dose you forgot to apply.

What happens if I overdose from Diprosone ?

Always use DIPROSONE 0.05 PERCENT, cream, as your doctor has told you. If you have accidentally applied more DIPROSONE 0.05 PERCENT, cream, than prescribed by your doctor, do not worry but avoid duplicating it.

Excessive or prolonged use of local corticosteroids may lead to manifestations of hypercorticism, including Cushing’s disease.

Treatment: Appropriate symptomatic treatment is indicated.

What is  Forms and Composition ?

FORMS and PRESENTATIONS

0.05% cream:   30 g tube. Ointment 0.05%:   30 g tube. 0.05% lotion:   30 g bottle.

COMPOSITION

  p tube or flask Betamethasone (DCI) 15 mg (as micronized betamethasone dipropionate: 19.2 mg / tube)

Excipients:

Cream: petrolatum, cetostearyl alcohol, liquid paraffin, polyoxyethylene glycol 1000 monocetyl ether, sodium dihydrogen phosphate monohydrate, chlorocresol, concentrated phosphoric acid, purified water. Excipients with known effect: cetostearyl alcohol, chlorocresol.

Ointment: liquid paraffin, white petrolatum.

Lotion: isopropyl alcohol, carbomer (carbopol 974 P), sodium hydroxide, purified water.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post Diprosone cream reviews Uses, Dosage, Side Effects, Precautions,Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/3dElnB7 via Edrug Online

[maleenhancementmd]

erectile dysfunction site:mayoclinic.org

Contents

Flashes; decreased body

Erectile dysfunction clinic memphis

Tn. erectile dysfunction

Total health perspective.alternatively

Penile prostheses are considered the gold standard treatment for medically refractory erectile dysfunction, and overall these devices have high.

Erectile dysfunction – the inability to get or maintain an erection firm enough for sex – is common in men who have diabetes, especially those with type 2.

 · Erectile dysfunction is a common problem for men who have diabetes – but it’s not inevitable. Consider prevention strategies, treatment options and more. Erectile dysfunction – the inability to get or maintain an erection firm enough for sex – is common in men who have diabetes, especially those with type 2 diabetes.

Erectile dysfunction; Bone thinning, which can lead to broken bones; Hot flashes; decreased body hair, smaller genitalia and growth of breast.

daily erectile dysfunction medication erectile dysfunction symptom checker Effects of a low-energy diet on sexual function and lower urinary tract symptoms in obese men. Int J obes. 2010;34:1396-403. kaka D, Domagaa Z, Dworak J, Womperski K, Rusiecki L, Marciniak W, et al.For thousands of years, humans have recognized that the sun plays a role in the emergence and transmission of viruses.

 · Prescription medications used to treat erectile dysfunction – sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and others – work by increasing blood flow to the penis when you become sexually aroused. Some "herbal viagra" supplements are advertised as a cheaper alternative, available without a prescription..

serotonin erectile dysfunction erectile dysfunction memphis tn The Alpha Centers an erectile dysfunction clinic memphis, tn. erectile dysfunction Clinic. As a specialist clinic, our staff of esteemed TENNESSEE licensed medical providers approach your sexual health from a total health perspective.alternatively, Dapoxetine, a medication that delays ejaculation by suppressing the serotonin transporter and elevating serotonin’s action at the post synaptic cleft can be used. If a man suffers both from premature ejaculation and erectile dysfunction, a combination medication based on Tadalafil (Cialis) and Dapoxetine can be used.

. in conditions such as erectile dysfunction or premature ejaculation.. of infertility, such as a sperm duct defect or chromosomal disorder.

Signs and symptoms men with Cushing syndrome may experience. Decreased libido; Decreased fertility; Erectile dysfunction.

 · If you’re taking an oral erectile dysfunction medication and have sudden loss of hearing or vision, seek prompt medical attention. An erection that doesn’t go away on its own. Called priapism, this rare condition can be painful and requires medical treatment to avoid damage to your penis. If you have an erection that lasts more than four hours.

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9 skin conditions that could signal a more serious problem, Defence Online

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Your outer layer could expose health and fitness situations taking place internally.

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Joe Raedel/Getty

Several interior well being circumstances can result in signs and symptoms in the skin.

INSIDER spoke with a dermatologist about some pores and skin indications of inner health issues.

Circumstances like lupus, inflammatory bowel sickness, diabetic issues, and over- or underactive thyroid can influence the skin in unique techniques.

The skin is your body’s premier organ, so it’s not as well stunning that quite a few interior health problems can cause alterations to the pores and skin, far too.

“In a way, you can believe of your skin as a window into the inside body,” Dr. Kathleen Suozzi, assistant professor of dermatology at Yale University of Drugs, advised INSIDER. “The wide the greater part of different medical situations can manifest with difficulties, reactions, or conclusions on the skin.”

Compiling a checklist of each and every pores and skin symptom of every single inside ailment would be difficult – Suozzi characterised this as a “huge” matter to which “whole textbooks” are dedicated – but there are some exclusive skin improvements that may possibly be early indicators of really serious systemic wellbeing disorders.

Browse on to study about some illustrations.

1. Itching

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Persistent itching may be a signal of Hodgkin lymphoma, Suozzi explained.

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9nong/Shutterstock

“Sometimes if a individual has intractable itch, we’ll examine …to make sure they don’t have Hodgkin lymphoma,” Suozzi said. “Rarely, that can be a presenting indication.”

Hodgkin lymphoma is a variety of cancer that impacts white blood cells named lymphocytes, and the most common symptom of the illness is an enlarged lymph node in the neck, the armpit or the groin, in accordance to the American Cancer Society.

It’s also critical to keep in mind that there are several, lots of other well being situations that aren’t most cancers that can also bring about itchy skin.

2. Thicker, darker skin on some components of the entire body

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Some people with diabetes may well have darker or thicker pores and skin in their skin folds.

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Jaral Lertjamekorn/Shutterstock

Suozzi stated that a condition called acanthosis nigricans (AN), in which the skin thickens and darkens in sure spots, can be a signal that a person has diabetic issues.

“It’s an region of hyperpigmentation, or darkening of the pores and skin, that takes place in the pores and skin folds,” she explained. “Classically [it happens] in the back again of the neck, or in the creases of the arms. Primarily in children, which is a indication that you may want to verify them for diabetes.”

The affliction can also occur in fully healthful people today or occur simply because of sure prescription drugs or other ailments, according to the American Academy of Dermatology (AAD).

3. Heat, sweaty pores and skin or chilly, dry pores and skin

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Heat, moist skin could be one indicator of an overactive thyroid.

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cliplab.professional/Shutterstock

An overactive or underactive thyroid can result in alterations in how your skin feels, Suozzi discussed.

The thyroid is a butterfly-shaped gland in the neck. It releases hormones that do the job to control fat burning capacity, coronary heart fee, system temperature, and far more. But in some folks, the thyroid can be overactive, generating a lot more thyroid hormones than the body demands (a.k.a. hyperthyroidism), or underactive, building far too small ( a.k.a. hypothyroidism). Both equally disorders guide to a wide array of attainable signs throughout the whole system, including the pores and skin.

Examine a lot more: 17 things you need to know about your thyroid – because it controls a good deal extra in your physique than you’d think

“In standard, with overactive thyroid, your pores and skin is warm and moist thanks to amplified sweating, vs . underactive thyroid, [when the skin] can be cold, pale, rough, and dry,” Suozzi reported.

4. Hair loss or thinning

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Thyroid illness could also have an impact on hair.

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srisakorn wonglakorn/Shutterstock

“Patients with thyroid illness can also get hair variations,” Suozzi mentioned. “So if a individual existing with hair loss, we will occasionally, dependent on the high-quality of the hair loss, examine their thyroid operate.”

She stated that men and women with an overactive thyroid can experience hair thinning, although people today with an underactive thyroid can drop hair in a quite certain location: The outer third of their eyebrows.

5. Darkening skin

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Folks with Addison condition may perhaps experience darkening of their skin that will make them seem tan, according to Suozzi.

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James Heilman, MD/Wikimedia Commons/Attribution–Share Alike

In Addison’s condition, the adrenal glands – which sit just on prime of the kidneys – don’t create adequate of the hormones cortisol and aldosterone.

The most widespread symptom of Addison’s disorder is fatigue, in accordance to the Countrywide Organization for Rare Conditions (NORD), but it can also lead to skin variations.

Suozzi described that hormonal adjustments in Addison’s disease individuals can make the pores and skin additional pigmented,

“These people search tan,” she claimed.

NORD provides that this darker, or hyperpigmented, skin can also occur in patches, often in the vicinity of scars or pores and skin creases like knuckles. In actuality, these pores and skin modifications can materialize yrs just before other symptoms of Addison’s ailment develop, in accordance to NORD.

6. Sensitivity to solar

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Sunshine sensitivity is one pores and skin symptom that can point out lupus.

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Trybex/Shutterstock

Solar sensitivity is 1 of quite a few distinctive pores and skin signals that could show lupus, a issue in which the body’s immune procedure assaults its very own organs and tissue.

In truth, Suozzi mentioned, specified pores and skin signs and symptoms are element of the standards physicians use to diagnose lupus.

“One factor would be photosensitivity – reacting much more than normal to sunshine exposure,” she explained. (About 50% of men and women with lupus practical experience this sensitivity, according to the Johns Hopkins Lupus Centre.)

She additional that selected rashes can also denote the condition. The to start with is a malar rash (also referred to as a “butterfly rash,” so named mainly because it spreads throughout both equally cheeks in a butterfly shape. The second is termed a discoid lupus rash, she mentioned.

Finally, mouth ulcers can also be a pores and skin indication of lupus – the mucous membrane within your mouth is regarded part of your pores and skin, Suozzi stated.

7. A hump amongst the shoulders

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Individuals with Cushing’s syndrome can have a lump concerning their shoulders.

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Rawpixel.com/Shutterstock

In Cushing’s syndrome, the adrenal glands generate an extra of the anxiety hormone cortisol. A person of the condition’s lots of indicators is a fatty hump located concerning the shoulders.

“We connect with it the buffalo hump,” Suozzi claimed. “It’s a roundness on the upper back under the neck.”

“[Cushing’s syndrome] individuals can also get stretch marks named striae that sometimes just erupt,” she added. “That can be a presenting indication of the disease.”

8. A type of tender bump under the pores and skin

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An illustration of erythema nodosum, which could be a indicator of inflammatory bowel illness.

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James Heilman, MD/Wikimedia Commons/Attribution–Share Alike

Suozzi reported that inflammatory bowel disorder (IBD), an umbrella expression that features Crohn’s ailment and ulcerative colitis, can manifest with precise pores and skin signs and symptoms.

“One is called pyoderma gangrenosum – it’s these eroded lesions that display up on the legs and they never heal,” she mentioned. “And if younger clients get that, we often glance to make guaranteed they do not have Crohn’s ailment or ulcerative colitis.” (You can see a photograph of pyoderma gangrenosum at the Mayo Clinic website, but be warned that it’s graphic.)

A further feasible pores and skin sign of IBD is erythema nodosum, she additional. This is when tender, purple bumps type under the skin, normally on the shins but from time to time in other places on the physique.

“It can present up in people for a assortment of reasons, but it does make us go glimpse [for IBD],” Suozzi stated.

9. A kind of rash on the backs of the palms

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Gottron’s papules, pictured listed here, could be a signal of a fewer widespread autoimmune condition.

resource

Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider/Wikimedia Commons/Attribution–Share Alike

Dermatomyositis is a condition that can result in the two muscle weak spot and distinctive skin concerns.

“[It’s a] less popular autoimmune dysfunction, but it has quite attribute pores and skin results,” Suozzi claimed.

A person is a rash termed Gottron’s papules that seems on the back of the hands, Suozzi stated.

A different is called the shawl indication. It is a pink rash that addresses the shoulders, arms, and upper again in a sample that resembles a scarf.

The post 9 skin conditions that could signal a more serious problem, Defence Online appeared first on Defence Online.

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Preventing and treating symptoms of nasal allergies (allergic rhinitis), for example due to hayfever, pet allergies or dust mite allergies. The spray relieves symptoms such as sneezing, itchy and runny nose, itchy and watery eyes, blocked nose and sinus discomfort. Avamys nasal spray may be prescribed for adults and children aged six years and over. How does Avamys nasal spray work? Avamys nasal spray contains the active ingredient fluticasone furoate, which is a type of medicine known as a corticosteroid (or steroid). Corticosteroids are hormones produced naturally by the adrenal glands that have many important functions, including control of allergic and inflammatory responses. Fluticasone is a synthetic corticosteroid that's used by nasal spray to reduce allergic reactions and inflammation in the nasal passages. It works by stopping the cells in the nasal passages from releasing chemicals that normally trigger an allergic reaction. 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Desloratadine (Neoclarityn) What you should know if you've been prescribed this antihistamine to treat your allergies, including dose and possible side effects Patch testing Patch testing for skin allergies Antihistamines Ilaxten (bilastine) We explain everything you should know if you've been prescribed this antihistamine to treat your allergies, including dosage and possible... House dust mite allergy Asthma – what to tell your doctor during a consultation Boy holds two medicine tablets Alimemazine Everything you should know about taking this antihistamine, including recommended dose and possible side effects Giving a child medicine Children and medicine Allergy causes, symptoms, and treatments Mizollen (mizolastine) We explain everything you should know if you've been prescribed this antihistamine to treat your allergies, including recommended dose and... It happened to me... I developed allergies when I was an adult woman with hay fever sneezing How can I get rid of my hay fever? 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Live well. CONDITIONSBEAUTYMEDICINESPROCEDURESLIVE WELLASK THE EXPERTHEALTHY EATINGPARENTINGHEALTH SERVICESRECIPESSUPPORT GROUPSFORUMS Hearst Magazines UK ABOUT NETDOCTOR COMMERCIAL OPPORTUNITIES DISCLAIMER PRIVACY POLICY COOKIE POLICY CONTACT US COMPLAINTS SITE MAP The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions. NetDoctor is a publication of Hearst Magazines UK which is the trading name of The National Magazine Company Ltd, 72 Broadwick Street, London, W1F 9EP. Registered in England 112955. All rights reserved. NetDoctor, part of the Hearst UK wellbeing network. Copyright © 2017. NetDoctor.co.uk is a trademark.

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New Post has been published on Biology Dictionary

New Post has been published on https://biologydictionary.net/hyperplasia/

Hyperplasia

Hyperplasia Definition

Hyperplasia or “hypergenesis” refers to an increase in the number of cells within a given tissue as a result of cellular proliferation. Since hyperplasia refers to an increased number of cells, the cell appears normal in size, but can lead to an enlargement of an organ or tissue. Such proliferation occurs in response to a particular stimulus and remains under mechanisms of regulation by the cell. In some cases, hyperplasia can be a pathological response to abnormal levels of growth factors or hormones, resulting in a number of disorders. Moreover, since the cells are rapidly dividing, it increases the risk of cancer, due to unregulated cellular proliferation in the absence of physiological stimuli.

Causes of Hyperplasia

There are numerous causes of hyperplasia, including the demand for increased tissue to compensate for a loss of cells (e.g., the skin or wound healing), chronic inflammation, hormones, growth factors, and diseased tissue within the body. Some forms of hyperplasia are required on an ongoing basis, such as the replacement of skin cells as they are sloughed off from the epidermal layer. In addition, hyperplasia is also required in the breasts of pregnant women for the growth of the milk glands in order to breastfeed the newborn. The process of hyperplasia is also used (and abused) in various sports for the purpose of increasing the number of skeletal muscle cells to improve athletic performance.

Types of Hyperplasia

There are many manifestations and disorders of hyperplasia, depending on the affected tissues or organs. Some of the most common types of hyperplasia are listed below:

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia is an enlargement of the prostate due to hyperplasia of the epithelial and stromal cells comprising the prostate (shown below). Such hyperplasia causes the formation of discrete nodules on the prostate which can eventually obstruct the bladder, causing complications such as bladder stones, kidney disease, and urinary tract infections. It is thought that testosterone and its metabolites play a key role in the induction of hyperplasia of the prostate. One reason for increased levels of testosterone in this tissue is hypothesized to be the result of the insufficient drainage of the spermatic venous system, which increases the hydrostatic pressure and testosterone in the prostate, thereby inducing hyperplasia.

Cushing’s Disease

Cushing’s disease results from hyperplasia of the adrenal cortex in response to the enhanced secretion of adrenocorticotropic hormone from the anterior pituitary. Such enhanced secretion is often caused by the overproduction of hypothalamus corticotrophin releasing hormone or a pituitary adenoma.

Sebaceous Hyperplasia

Sebaceous hyperplasia involves hyperplasia of the sebaceous glands located in the skin. This condition is commonly observed in newborn infants and older adults and is characterized by the increased secretion of sebum (the oily substance secreted by the sebaceous glands) and formation of yellow-colored papules on the face. This condition is typically self-resolving, but laser treatments are also available.

Hemihyperplasia

Hemihyperplasia occurs when the growth of one side of the body is greater than that of the other. This condition can result in the generation of limbs that are longer on one side than the other, with differing levels of severity. Since this condition can be debilitating, there are several treatment options ranging from bone lengthening, bone resection, and the insertion of a growth plate in order to correct the condition. An example of an individual with this condition is presented below:

Intimal Hyperplasia

Intimal hyperplasia refers to hyperplasia of the tunica intima (endothelial lining) of blood vessels in response to injury. Since this process is a normal physiological response, it often causes graft failure following any form of vascular reconstructive or bypass surgery.

Compensatory Liver Hyperplasia

Compensatory liver hyperplasia involves hyperplasia of the liver hepatocytes in response to damage or injury. This gives the liver its unique regenerative ability and allows for substantial liver resections (e.g., for the purpose of liver transplantation).

Endometrial Hyperplasia

Endometrial hyperplasia refers to hyperplasia of the uterine inner lining in response to elevated levels of estrogen. Estrogen can be overproduced in conditions, such as obesity, various cancers, polycystic ovary syndrome, and other exogenous sources of estrogen (e.g., hormone therapy). This condition is associated with an increased risk of cancer.

Quiz

1. Which of the follow terms correctly describes “hyperplasia”? (Multichoice) A. The enlargement of skeletal muscle cells. B. The proliferation of skeletal muscle cells. C. The proliferation of ductal cells in the breasts during pregnancy. D. The enlargement of ductal cells in the breasts during pregnancy.

Answer to Question #1

B and C are correct. The “hyperplasia” refers to the proliferation of the cells in a particular tissue or organ, whereas “hypertrophy” refers to the enlargement of cells in a particular tissue or organ. The terms are often confused.

2. Which of the following is NOT a characteristic of hyperplasia: (Multichoice) A. Regulated cellular proliferation in response to environmental stimuli. B. Tissue regeneration. C. Tissue repair in response to injury. D. Cellular proliferation in the absence of environmental stimuli.

Answer to Question #2

A, B, and C are correct. Hyperplasia is a normal physiological response of cells to various environmental stimuli (e.g., injury, hormones, growth factors, etc.). Thus, unregulated cellular proliferation is a characteristic of cancerous cells, termed neoplasia.

References

Charalampakis V, Tahrani AA, Helmy A, Gupta JK, and Singhal R. (2016). Polycystic ovary syndrome and endometrial hyperplasia: an overview of the role of bariatric surgery in female fertility. Eur J Obstet Gynecol Reprod Biol. 207:220-226.

Chaudhary MA, Guo LW, Shi X, Chen G, Gong S, Liu B, and Kent KC. (2016). Periadventitial drug delivery for the prevention of intimal hyperplasia following open surgery. J Control Release. 233:174-80.

Craiglow BG, Ko CJ, and Antaya RJ. (2014). Two cases of hemihyperplasia-multiple lipomatosis syndrome and review of asymmetric hemihyperplasia syndromes. Pediatr Dermatol. 31(4):507-10.

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(via https://www.youtube.com/watch?v=A5U1GjPqmP0)

How To Teach Your Dog To Stop Eating Poop! 2017 Blogger ► http://teachmehow33.blogspot.com/ S U B S C R I B E: http://bit.ly/2prB0U6 If your adult dog starts to dine on dung, you should consult with your vet to rule out such health problems as: • parasites • diets deficient in nutrients and calories • malabsorption syndromes • diabetes, Cushing's, thyroid disease, and other conditions that might cause an increase in appetite • drugs, such as steroids In many cases, dogs start to eat their own poop because of some kind of environmental stress or behavioral triggers, including: • Isolation: Studies have shown that dogs who are kept alone in kennels or basements are more likely to eat poop than those dogs who live close to their people. • Restrictive confinement: Spending too much time confined in a small spaces can cause the problem. It's not unusual to see coprophagia in dogs rescued from crowded shelters. • Anxiety: often a result of a person using punishment or harsh methods during housetraining. According to this theory, dogs may eliminate and then eat their own poop to get rid of the evidence, but then they are punished more. It becomes a vicious cycle. • Attention-seeking: Dogs eat their own poop to get a reaction from their humans, which they inevitably will. So if you see your dog doing this, don't overreact. • Inappropriate association with real food: Dogs who are fed in close proximity to their feces may make a connection between the odors of food and those of poop and will be unable to tell the difference. • Scenting it on their mothers: Lindsay writes that in some cases, puppies will get confused by sniffing fecal odors on their mother's breath after she has cleaned them. Also, sometimes mothers may regurgitate food that is mixed with puppy fecal matter. He calls this an "appetitive inoculation," which may set a puppy up to develop this bad habit. • Living with a sick or elderly dog: Sometimes a healthy dog will consume stools from a weaker canine member of the household, especially in cases of fecal incontinence. Scientists hypothesize that this may be related to the instinct to protect the pack from predators. How to Stop Your Dog From Eating Poop Veterinarians and dog owners have seen improvements with a handful of strategies, including: • Vitamin supplementation: There's been a long-standing theory that dogs eat feces because they are missing something in their diets. Vitamin-B deficiency, in particular, has been a prime suspect, and studies have backed this up. In 1981, scientists showed fecal microbial activity synthesized thiamine, a B-vitamin. Other research found other missing nutrients. • Enzyme supplementation: The modern canine diet is higher in carbohydrates and lower in meat-based proteins and fats than the canine ancestral diet. Some people have had success with a meat tenderizer that contains papain, an enzyme. • Taste-aversion products: The theory is that certain tastes and smells are as disgusting to dogs as the idea of stool eating is to us and that spraying certain substances on poop will make it less appealing. Many of these products contain monosodium glutamate, chamomile, pepper-plant derivatives, yucca, garlic, and parsley. Perhaps the best way to stop the problem is through training and environmental management methods, including: • Keep the dog's living area clean, including the yard, so there will be no poops for him to pick up. • Cat owners should keep that litter box clean or out of the dog's reach. • Supervise your dog on walks, and pick up after him immediately. • Training. Work hard on the commands "leave it" and "come." One simple exercise, suggested by Debra Horwitz, DVM, Diplomate ACVB and Gary Landsberg, DVM, Diplomate ACVB, is to teach your dog to come to you for a food treat as soon as he has eliminated. That way, the dog will develop a habit of running to you for a tasty tidbit, instead of reaching for the revolting recyclable on the the ground. Sources: http://www.akc.org/content/health/art... Applied Dog Behavior and Training, by Steven R. Lindsay; "Coprophagia in Dogs—Behavior," VCA Animal Hospitals fact sheet; "Coprophagia: The Scoop on Poop Eating in Dogs," Dr. Sophia Yin fact sheet Related Articles how to stop your dog from eating poop: www.akc.org/content/health/articles/why-dogs-eat-poop/ www.dogsnaturallymagazine.com/16-reasons-dogs-eat-poop-and-what-to-do-about-it/ Related Videos how to stop your dog from eating poop: https://bondivet.com/dogs/health/78-w... https://www.youtube.com/watch?v=fOiTK... How to teach your dog to stop eating poop, How to teach your dog to stop eating poop at the dog park, How to teach your dog to stop eating cat poop, How to teach your puppy from eating poop, How to teach your dog to stop eating rabbit poop, How to teach your dog to stop eating deer poop,

[saltyloverrebel]

Rauvolfia Serpentina 1x, Homeopathic Medicine for High Blood Pressure

Schwabe Rauvolfia Serpentina 1x, Homeopathic Medicine for High Blood Pressure is indicated for management of high blood pressure and associated symptoms like irregular heart beats, increased emotional excitability, irritability and restlessness.   Clinical indications of Schwabe Rauvolfia Serpentina 1x Tablet High blood pressure Associated symptoms   Composition of Schwabe Rauvolfia Serpentina 1x…