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Life-threatening hypokalemic paralysis associated with distal renal tubular acidosis. Diagnostics approach to the patient with hyponatremia: traditional versus physiology-based options. Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Concentration-dependent effect of hypocalcaemia on 208 mortality of patients with critical bleeding requiring massive transfusion: a cohort-study. Post prandial plasma glucose level less than the fasting level in otherwise healthy individuals during routine screenings. Evaluation and management of adult hypoglycemic disorders: an endocrine society clinical practice guideline. The contribution of the kidney to the removal of lactic acid load under normal and acidotic conditions in the conscious rat. A review of clinical presentation, biochemical features, and pathophysiologic mechanisms. Lactic acidosis secondary to severe anemia in a patient with paroxysmal nocturnal hemoglobinuria. Recurrent life-threatening events and lactic acidosis caused by chronic carbon monoxide poisoning in an infant. Type B lactic acidosis as a severe metabolic complication in lymphoma and leukemia: a case series from a single institution and literature review. Hypoglycemia and lactic acidosis associated with fruc to se-1,6 diphosphatase defciency. Pyruvate dehydrogenase defcit associated to the C515T mutation in exon 6 of the E1alpha gene. Serum lactate as a predic to r of mortality in emergency department patients with infection. Blood lactate moni to ring in critically ill patients: a systematic health technology assessment. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Clinical practice guideline: management of hyperbilirubinemia in newborn infant 35 or more weeks of gestation. The renal excretion of endogenous creatinine in man: comparison with exogenous creatinine and inulin. Acute renal failure in critically ill patients: a multinational, multicentre study. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies. Clinical practice guidelines for chronic kidney disease evaluation classifcation and stratifcation. Prevention of contrast induced neophropathy: Recommendations for high risk patient undergoing cardiovascular procedures. A more accurate method to estimate glomerular fltration rate from serum creatinine: a new predictive equation. Quantifying pulmonary oxygen transper defcits in critically ill patients, Acta Anaesthesiol Scand 1995; 39: 2744. The utility of troponin measurement to detect myocardial infarction: review of the current fndings. Signs and symp to ms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Sex differences in patient-reported symp to ms associated with myocardial infarction. Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Regulation and signifcance of atrial and brain natriuretic peptides as cardiac homones. Chronic heart failure: the management of chronic heart failure in adults in primary and secondary care. Diagnostic and prognostic impact of brain natriuretic peptide in cardiac and non-cardiac diseases. Plasma brain natriuretic peptide levels and blood pressure tracking in the Framingham heart study.
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A controlled study is warranted to compare nerve palsy typically occurs during the first week of therapy oral with parenteral antibiotic therapy for the treatment of and, in most cases, appears to be benign; in an otherwise stable acrodermatitis chronica atrophicans. One report suggested that coinfected patients parable parenteral antibiotic (table 2) [142, 256]. A second small study found little dif ifestations of Lyme disease, there will be slow or even incom ference in symp to m frequency for coinfected patients, com plete resolution of that manifestation. A small proportion of such patients will was associated with more fatigue and certain other symp to ms have mild residual weakness of facial muscles . Because of the lack of persistence of antibodies to residual, irreversible neurologic damage. Chronic joint swelling in these circum but there is no convincing evidence that Bar to nella infections stances, if not treated with other approaches (such as synov can be transmitted to humans by a tick bite . Put simply, Objective clinical manifestations are uncommon after treat there is a relatively high frequency of the same kinds of symp ment of patients with Lyme disease. In patients treated for early or late Lyme disease, nosed arthritis cases among adults was 21. A study the frequency of subjective symp to ms is at least partially de in England found a point prevalence of 11. On the basis of an intention- to -treat analysis of 1 study frequently associated with feelings of depression and anxiety, of patients treated for erythema migrans, subjective symp to ms fatigue, and somatic symp to ms . A recent study of the were present in 35% of patients at day 20, in 24% at 3 months, general adult United States population estimated a point prev and in 17% at 12 months (P! Coinfection, however, does not appear A recent meta-analysis attempted to determine whether the to worsen long-term outcome . Unfortunately, the findings of this meta-analysis over the frequency and cause of this process and even over its cannot be considered reliable, because the majority of the stud existence. In addition, patients were included in these cephalopathy, as having chronic Lyme disease, instead of using studies who were not treated with antibiotics at all, who were the preferred terminology of late Lyme disease. Recall bias was also a potential limitation of the cognitive complaints, and/or fatigue without objective abnor studies evaluated, given the possibility that a person with Lyme malities on physical examination. Thus, than would another person with the same symp to ms who was the study populations have varied. Subjects in the prospective studies were well char following symp to ms: widespread musculoskeletal pain, cogni acterized. Most had localized or disseminated early Lyme dis tive complaints, radicular pain, paresthesias, or dysesthesias, ease associated with erythema migrans (the most common pre provided the symp to ms interfered with the ability to function sentation of definite B. The symp to ms also had to begin within 6 months after were promptly treated with appropriate antibiotic regimens. A con component of the definition, 90% of the patients in this par trolled, prospective study would be preferable to a meta-analysis ticular trial also complained of fatigue . All patients in for determination of whether the frequency of symp to ms after this trial reported some cognitive impairment at baseline, and treatment for Lyme disease exceeds that of similar symp to ms 170% gave cognitive dysfunction as their primary symp to m in persons without Lyme disease.
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Data show that androgens are important in maintaining the structural and metabolic integrity of female genital tissues, so critical in sexual arousal. Also, studies have shown that tes to sterone replacement improves sexual desire, arousal, and orgasm. Oophorec to my can greatly diminish serum androgens and has been associated with sexual dysfunction even with adequate estrogen replacement therapy. Hypertension, hypercholesterolemia, diabetes mellitus, and smoking all contribute to vascular injury of the small vessels of the vagina and cli to ris. Subsequent decreased blood flow to the vagina and cli to ris during arousal leads to a blunted sexual response. In addition, poorly controlled diabetes can cause a peripheral neuropathy that can affect the nerves innervating the vagina and cli to ris. This peripheral neuropathy can progress to decreased sensation in the vagina and cli to ris, anorgasmia, or, in rare instances, vaginal or cli to ral pain. Injury to nerves and vessels of the vagina and cli to ris can occur during pelvic surgery. Approximately 600,000 hysterec to mies are performed annually in the United States, most for benign disease. Most studies indicate that sexual satisfaction improves after hysterec to my, but there are inherent confounding variables in these studies. For example, a woman undergoing hysterec to my for menorrhagia or pelvic pain may suffer from low sexual satisfaction before her hysterec to my, because of the disease process itself. Surgery alleviates these overwhelming symp to ms, and the patient is more receptive to sexual activity. Ironically, although frequency of intercourse increases after hysterec to my, the patient may have an irreversibly diminished quality of sexual satisfaction. This rationale, however, is undermined by our current ability to detect and cure preinvasive cervical cancer. In a woman, issues such as poor body image, low self-esteem, and inability to communicate with her partner are as important as organic disease in the etiology of her sexual dysfunction. In addition, psychological disorders such as depression, anxiety, and obsessive-compulsive disorder are frequently associated with female sexual dysfunction. This results from both the symp to ms and manifestations of the illnesses, and the side effects of medications used to treat them. Finally, prior sexual experiences, especially negative experiences such as sexual abuse, can have a profound lifelong negative impact on sexual function. Frequently, vaginismus is a complaint with a psychogenic cause, especially in a patient with a his to ry of sexual abuse. Evaluation of the psychosocial aspects of sexual dysfunction should be performed by a qualified sex therapist or by a psychologist experienced in the treatment of sexual dysfunction. The evaluation and treatment of female sexual dysfunction is optimized by a collaborative effort between a physician and sex therapist using a biopsychosocial model. In addition to a thorough medical evaluation, the patient should undergo evaluation by a psychologist or sex therapist who is familiar with female sexual dysfunction. After the physiologic and psychological causes of dysfunction are identified, a treatment regimen can be initiated. In the majority of cases, both pharmacologic therapy and sexual counseling are necessary. Estrogen replacement therapy at standard dosages is an integral component of treating sexual dysfunction in naturally or surgically menopausal women. In postmenopausal women, estrogen replacement res to res cli to ral and vaginal vibration and sensation to levels close to those of premenopausal women. All routes of estrogen administration (oral, transdermal, or to pical) provide relief of complaints due to vaginal atrophy, such as dryness, pain, and burning during intercourse.
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