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Dr. D.S. Merchant's Articles in Psychology

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Atrial fibrillation (AF) with a rapid ventricular response A previously healthy 22-year-old woman presents to the emergency department (ED) with acute shortness of breath. Her shortness of breath became worse with exertion and was associated with pleuritic chest pain for 2 days. She has had a fever, nonproductive cough, nausea, vomiting, and arthralgia. On presentation, she is febrile with a temperature of 101.5°F (38.6°C), a blood pressure of 88/54 mm Hg, a pulse of 104 bpm, a respiratory rate of 28 breaths/min, and an oxygen saturation of 88% while breathing room air. Her oxygen saturation improved to 92% with supplemental oxygen given at 2 L/min. She is in moderate respiratory distress; however, she can speak in full sentences. Her physical examination reveals absent breath sounds throughout the right thorax, with decreased breath sounds halfway up the left thorax. Other findings include egophony, decreased fremitus, and dullness to percussion on the right thorax. She has no jugular venous distention, edema on her lower extremity, or rash. Acute Liver Failure Acute liver failure (ALF), also known as fulminant hepatic failure, is a rare manifestation of liver disease and constittes a medical emergency. The syndrome arises from loss of hepatic parenchyma that may result from a variety of insults to the liver. Despite advances in medical management and the availability of liver transplantation, mortality rates in patients with ALF remain substantial. It has been estimated that in the United States, 2000 deaths a year are attributable to ALF. Worst Menopause Symptoms May Start in Brain "This is an important new concept: Menopause doesn't just originate in the ovary, but also in the brain," said Laura Goldsmith, a professor of obstetrics and gynecology and women's health at the New Jersey Medical School of the University of Medicine and Dentistry of New Jersey. Hoodia Gordonii Helps you Lose Weight Hoodia gordonii looks like a cactus, but it's actually a succulent from the Kalahari Desert in southern Africa. Bushmen from the area have been using hoodia for centuries to help ward off hunger during long trips in the desert. Hoodia Gordonii Cactus According to the British Heart Foundation 17% of men and 21% of women are obese, while 46% of men and 32% of women are overweight. Morbidity and Mortality Meeting In Gilgit she was being treated as a case of genital Tuberculosis without any objective genitourinary complaints or symptoms, She took ATT for 2 months and then stopped b/c of drug induced Acute Hepatitis. Hoodia Diet Pills- An Excellent Weight Loss Pill According to Phytopharm, the company that holds the patent on the process to extract ?P57' an active ingredient from hoodia, human subjects taking hoodia roots reduced their calorie intake by as much as 2k calories a day. So figures are impressive, and so far the overall results are satisfactory. The Clinical Approach to Acid-Base Disorders Methods to Interconvert pH and [H+]:The 0.1 pH Change Rule: PH Conversion Factor [H+] nmol/L 6.90 100 / 0.8 125 7.00 100 100 7.10 100 X 0.8 80 7.20 100 X 0.8 X 0.8 64 The Clinical Approach to Acid-Base Disorders Methods to Interconvert pH and [H+]:The 0.1 pH Change Rule: PH Conversion Factor [H+] nmol/L 6.90 100 / 0.8 125 7.00 100 100 7.10 100 X 0.8 80 7.20 100 X 0.8 X 0.8 64 Pulmonary Function Testing Pulmonary Function Issues Related to Measured Values: • Overinflation of Lungs – Emphysema - COPD - Permanently – Asthma - Acutely • ? RV + Ratio RV/TLC • FEV1/ FVC ratio falls below 80% - Also flow rates fall – With age (lungs less compliant) – Falls with obstructive diseases; e.g. asthma/bronchitis • Asthma - obstructive disease ? increased collapsing force of large airways – obstruction to expiratory flow ? lung volume – bronchodilators may return flow to normal • Early COPD - characterized by irreversible ? in small airway resistance that reduces expiratory flow – not very responsive to dilators • Severe COPD - ? small & large airway resist – severe flow limitations – bronchodilators ? little help – chronic bronchitis and emphysema • Emphysema - loss of elastic recoil ? ? small airway collapse during expiration, thereby ? resistance – Max Expiratory Flow ? – Bronchodilators have no effect – ? FRC + TLC Respiratory Disease and Lung Function Data Collection: • Questionnaire data were collected by trained interviewers who gathered information on race/ethnicity, medical history, socioeconomic status, use of medication, and smoking history. • Participants were also asked whether they had taken any of the following pain medications in the last month and, if so, how often they had used each: aspirin (including Anacin, Bufferin, Ecotrin, Ascriptin, or Midol), acetaminophen (including Tylenol, Anacin-3), and ibuprofen (including Advil, Nuprin, Medipren). Guillain Barre Syndrome Me score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). • The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. Guillain Barre Syndrome Me score on the Glasgow Outcome Scale at eight weeks (a score of 5, indicating a favorable outcome, vs. a score of 1 to 4, indicating an unfavorable outcome). • The mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are high, especially among patients with pneumococcal meningitis. Hyponatremia by eHealthGuide.info Hyponatremia: Plasma Na < 135meq /L • Almost always due to •ADH Secretion • Appropriate • Inappropriat • One Exception: Primary Polydipsia • supression of ADH Secretion BUT still overwhelms kidney’s diluting ability • Free water retention & Hyponatremia Epidemiology of Hyponatremia: Hyponatremia is among the most common electrolyte disorders encountered in clinical medicine, with an incidence of 0.97% and a prevalence of 2.48% in hospitalized adult patients when plasma [Na+ ] concentration below 130 mEq/L is the diagnostic criterion. Clinical Manifestations: • < 125 mEq/l • • Malaise - Muscle cramps • Nausea, Vomiting, Headache • Hypotension – Tachycardia • < 110 mEq/L • • Confusion, convulsions, coma Drug Resistance In Tuberculosis Inadequate Prescribing Practice: • In 1995 25% of new cases of TB were initially treated with 2-3 drugs regimen • 2 Surveys by AKUH among GP & Interns • Once resistance develops, prescribing errors, usually by inexperienced physicians can exacerbate situation. • Review of patients referred to National Jewish Hospital (Denver) for management of complex MDR-TB documented an average of 3.93 prescribing errors per patient.
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