About signs and symptoms: Can semiotics expand the view of clinical medicine?

1996 ◽  
Vol 17 (4) ◽  
pp. 363-377 ◽  
Author(s):  
John Nessa
Keyword(s):  
Clinical Medicine ◽  
Signs And Symptoms

scholarly journals Altered Febrile Responses in Older Adults: A Systematic Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 224-224
Author(s):  
Barbara Holtzclaw
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Body Temperature ◽  
Animal Studies ◽  
Clinical Medicine ◽  
Signs And Symptoms ◽  
Set Point ◽  
Age Related ◽  
Research Findings ◽  
Fever Response

Abstract Human and animal studies support generalizations that older adults are less able than younger adults to mount an effective febrile response. Beyond difficulties this presents for assessing signs and symptoms of infection, concern exists that older adults may lack fever’s protective immuno-stimulant benefits. Fever is a systemic physiological host response to a pyrogen resulting in release of proinflammatory cytokines that produce a regulated elevation of thermoregulatory set-point. Heat is generated, by shivering and molecular activity, and conserved, by vasomotor activity, elevating and maintaining body temperature at the higher set-point level. Because immunological, vasomotor, and kinetic activities raise body temperature, age-associated alterations have been hypothesized to explain blunted febrile responses in older adults. Purpose: A systematic review was done to 1) determine factors underlying presumed origins and alterations in older adults’ febrile responses. 2) assess for gaps and controversies in emerging research that could inform care decisions. Comparisons of disciplinary assumptions, perspectives, and cross-disciplinary interpretations sought relevance to interdisciplinary care. Methods: Search of literature databases: Medline (OVID), and CINAHL (EBSCO). PubMed, and included relevant animal and human research findings since 2000 from physiology, gerontology, immunology, infectious disease, clinical medicine, and nursing. Findings: Altered innate immunity in sepsis shows early hyper-reactive response, prolonged inflammatory activity, and fever response contributing to cardiovascular and neurological morbidity, not temperature elevation. Morbidly was attributed to disease not age. Conclusions: Hazards of blunted febrile temperatures include undetected infections and possible loss of immune benefits. Significant evidence of age-related diminished febrile temperature’s immune consequences shown with animal models.

Anxiety

2013 ◽  
Author(s):  
Edward Shorter
Keyword(s):  
Clinical Medicine ◽  
Signs And Symptoms ◽  
Chronic Illnesses ◽  
Human Condition ◽  
Second Phase ◽  
Psychiatric Facility ◽  
Free Standing ◽  
Anxiety Neurosis ◽  
History Of ◽  
Two Phases

In 1970 Aubrey Lewis, the past master of the Maudsley Hospital, England’s premier psychiatric facility, was 70 years old. In his long decades of experience, he was puzzled by the rise of anxiety as a popular stand-alone diagnosis. The evolution of the term, he said, had gone through two phases. The first was using anxiety “as a qualifying term for the agitated depression of melancholia.” Anxious melancholia meant melancholia out of control. In the second phase, anxiety became “a qualifying term for a neurosis in which subjective feelings of alarm are associated with visceral disturbances.” This would be Freud’s anxiety neurosis. He noted that the number of articles on anxiety in the scientific literature had increased from three in 1927 to 222 in 1960—and was still rising. As Lewis wrote in 1970, anxiety was about to undergo a third phase in its evolution: Anxiety, or panic, attacks would shortly occupy center stage. Anxiety, another part of the nervous syndrome, has a distinctive story line: For most of the history of psychiatry, it was considered part of some other disorder, or not really attended to at all. Clinicians paid no particular heed to whether their patients were worried or fearful: These emotions were part of the human condition. Augustin Jacob Landré-Beauvais, professor of clinical medicine at the Salpêtrière Hospice in Paris, in his great catalogue of signs and symptoms written in 1809, takes it for granted that anxiety will be present in infectious illnesses. “Anxiety accompanies the better part of acute illnesses and some chronic illnesses, and is produced by various causes,” he said, and considered it an advance warning of an attack among “hypochondriacs, hysterics, and epileptics.” Then throughout the nineteenth century anxiety became part of the nervous package. As the nervous syndrome disaggregated in the early twentieth century, anxiety was spun off to become a free-standing disorder, “anxiety neurosis” in psychoanalytic parlance. More recently, anxiety tout court has morphed into panic disorder, and we shall shortly watch panic stride to the center of the stage.

scholarly journals From Clinical Clues to Final Diagnosis: The Return of Detective Work to Clinical Medicine in Cardiac Amyloidosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hani Sabbour ◽  
Khwaja Yousuf Hasan ◽  
Firas Al Badarin ◽  
Haluk Alibazoglu ◽  
Andrew L. Rivard ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Clinical Medicine ◽  
Imaging Techniques ◽  
Diagnostic Algorithm ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Diagnostic Tools ◽  
Case Examples ◽  
Non Invasive ◽  
High Index Of Suspicion

Cardiac amyloidosis is frequently misdiagnosed, denying patients the opportunity for timely and appropriate management of the disease. The purpose of this review and case studies is to raise awareness of the diagnostic “red flags” associated with cardiac amyloidosis and the currently available non-invasive strategies for diagnosis. The review focuses on the identification of one of the two main types of cardiac amyloidosis, transthyretin amyloid cardiomyopathy, and non-invasive tools to distinguish this from light-chain amyloidosis. A diagnostic algorithm centered around the use of non-invasive imaging and laboratory analysis is presented. The algorithm generates four differential diagnoses for patients presenting with signs and symptoms consistent with cardiac amyloidosis. Case examples are presented, representing the four potential outcomes of diagnosis using the algorithm. The review provides a guide on how to recognize the often-overlooked presentations of this disease in clinical practice. Non-invasive imaging techniques and diagnostic tools that do not require the involvement of a specialty center have allowed for the improved diagnosis of cardiac amyloidosis. Timely diagnosis of this life-threatening disease is essential for optimal management and it is imperative that clinicians have a high index of suspicion for patients presenting with “red flag” symptoms.

Management of Superficial Mycotic Infections: A Review

2016 ◽  
Vol 2 (3) ◽  
pp. 152-156
Author(s):  
Anu Anto ◽  
Bincy CM ◽  
Mincy C Das ◽  
Babitha M
Keyword(s):  
Medication Adherence ◽  
Clinical Medicine ◽  
Fungal Infections ◽  
Life Quality ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Daily Practice ◽  
High Relapse Rate ◽  
Mycologic Cure ◽  
Mycotic Infections

Superficial mycotic infections of skin and nails are the most common diseases seen in our daily practice and the main causative groups are dermatophytes, yeasts and moulds. The degree of immunosuppression and the number of immunosuppressed patients are increasing at an unprecendented pace, hence the management of dermatophytoses will be a challenge to mankind in the years to come.The increasing number of antifungal agents, reformulations of existing agents and novel treatment strategies have all improved the management of fungal infections, but still the infections are associated with high mortality. Currently, topical azoles and allylamines are used for the treatment of Cutaneous mycoses with disadvantages like long duration of therapy, which leads to poor compliance and a high relapse rate. Assessment of efficacy, Quality of life (QOL) and Medication adherence are important issues in all areas of clinical medicine, including dermatology. Here the clinical efficacy was assessed based on signs and symptoms severity score and global clinical response, Dermatology life quality by Finlay and Khan’s 10 question Dermatology Life Quality Index (DLQI) and adherence by medication adherence questionnnaire. Both Terbinafine (250–500 mg/day for 2–6 weeks) and Itraconazole (100–200 mg/day for 2–4 weeks) appear to be effective for limited disease (tinea corporis/cruris/pedis). However, an appropriate dose and duration of administration which can produce mycologic cure and prevent recurrence remains elusive. This review also highlights the huge research gaps in the management of cutaneous dermatophytosis which need to be plugged to provide better and effective care to the patients.

scholarly journals An Introduction to Coastal Wilderness Medicine: BEACCHEs

2019 ◽  
Vol 34 (s1) ◽  
pp. s142-s143
Author(s):  
Upuli Pahalawatta ◽  
Amanda Dawson
Keyword(s):  
Clinical Medicine ◽  
Medical Officer ◽  
Signs And Symptoms ◽  
Clinical Environment ◽  
First Responder ◽  
Central Coast ◽  
Workload Management ◽  
Effective Program ◽  
Ocean Environment ◽  
Qualitative Responses

Introduction:Beginning Education at Central Coast Hospitals (BEACCHEs) was developed as an experiential wilderness experience to assist with student exposure to new hazards when commencing at a coastal regional hospital. The coast has several hazards which are specific to the area.Aim:To provide students with first responder education for situations commonly encountered on the Central Coast.Methods:Sessions on first responder training specific to coastal and remote locations included: first aid and surf safety with the Ocean Beach Surf-Lifesaving Club and anti-venom education with the Australian Reptile Park. Education was provided regarding the transition from academic to clinical medicine including support and workload management. A two-day workshop was held on the Central Coast. Pre- and post-workshop surveys were conducted with a combination of matrix questions, Likert response scales, and long answer questions. Ethics was obtained. Both quantitative and qualitative responses were analyzed.Results:Excellent feedback regarding this program was received. All students reported an increase in knowledge in all three domains of critical medicine and evacuation issues, student health and workload management, and Central Coast community and environment. The areas of greatest knowledge in each of these domains were the management of surf incidents, signs and symptoms of PTSD, and Central Coast marine and ocean environment. A confidence increase was seen in responding effectively to an emergency, particularly, in response to improvisation in the field. All findings were statistically significant with all P-values <0.01.Discussion:The addition of BEACCHEs to the orientation of medical students at the Central Coast Medical School has demonstrated to be an effective program for allowing students to adjust more quickly to the new clinical environment. Following the success of this program, BEACCHEs is expected to become part of the new Junior Medical Officer orientation in 2019.

scholarly journals Thrombocytopenia in Virus Infections

2021 ◽  
Vol 10 (4) ◽  
pp. 877
Author(s):  
Matthijs Raadsen ◽  
Justin Du Toit ◽  
Thomas Langerak ◽  
Bas van Bussel ◽  
Eric van Gorp ◽  
...  
Keyword(s):  
Viral Infection ◽  
Viral Infections ◽  
Clinical Medicine ◽  
Adaptive Immune System ◽  
Signs And Symptoms ◽  
Common Finding ◽  
Virus Infections ◽  
Antiviral Immune Response ◽  
Low Platelet Count ◽  
Predicting Outcome

Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.

scholarly journals Development of a Conceptual Model of Disease Progression for Use in Economic Modeling of Chronic Obstructive Pulmonary Disease

2016 ◽  
Vol 37 (4) ◽  
pp. 440-452 ◽  
Author(s):  
Maggie Tabberer ◽  
Sebastian Gonzalez-McQuire ◽  
Hana Muellerova ◽  
Andrew H. Briggs ◽  
Maureen P. M. H. Rutten-van Mölken ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Disease Progression ◽  
Conceptual Model ◽  
Pulmonary Disease ◽  
Clinical Medicine ◽  
Signs And Symptoms ◽  
Economic Modeling ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Background. To develop and validate a new conceptual model (CM) of chronic obstructive pulmonary disease (COPD) for use in disease progression and economic modeling. The CM identifies and describes qualitative associations between disease attributes, progression and outcomes. Methods. A literature review was performed to identify any published CMs or literature reporting the impact and association of COPD disease attributes with outcomes. After critical analysis of the literature, a Steering Group of experts from the disciplines of health economics, epidemiology and clinical medicine was convened to develop a draft CM, which was refined using a Delphi process. The refined CM was validated by testing for associations between attributes using data from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). Results. Disease progression attributes included in the final CM were history and occurrence of exacerbations, lung function, exercise capacity, signs and symptoms (cough, sputum, dyspnea), cardiovascular disease comorbidities, ‘other’ comorbidities (including depression), body composition (body mass index), fibrinogen as a biomarker, smoking and demographic characteristics (age, gender). Mortality and health-related quality of life were determined to be the most relevant final outcome measures for this model, intended to be the foundation of an economic model of COPD. Conclusion. The CM is being used as the foundation for developing a new COPD model of disease progression and to provide a framework for the analysis of patient-level data. The CM is available as a reference for the implementation of further disease progression and economic models.

Drug Induced Changes in Cell Organelles

1968 ◽  
Vol 26 ◽  
pp. 110-111
Author(s):  
Sarah A. Luse
Keyword(s):  
Clinical Medicine ◽  
Cell Organelles ◽  
Riboflavin Deficiency ◽  
Drug Induced ◽  
New Era ◽  
Health And Disease ◽  
In The Beginning ◽  
Cellular Pathology ◽  
Induced Changes ◽  
The Impact

In the mid-nineteenth century Virchow revolutionized pathology by introduction of the concept of “cellular pathology”. Today, a century later, this term has increasing significance in health and disease. We now are in the beginning of a new era in pathology, one which might well be termed “organelle pathology” or “subcellular pathology”. The impact of lysosomal diseases on clinical medicine exemplifies this role of pathology of organelles in elucidation of disease today.Another aspect of cell organelles of prime importance is their pathologic alteration by drugs, toxins, hormones and malnutrition. The sensitivity of cell organelles to minute alterations in their environment offers an accurate evaluation of the site of action of drugs in the study of both function and toxicity. Examples of mitochondrial lesions include the effect of DDD on the adrenal cortex, riboflavin deficiency on liver cells, elevated blood ammonia on the neuron and some 8-aminoquinolines on myocardium.

“Where is Dementia?” A Systematic Literature Review Exploring Neuroanatomical Aspects of Dementia

2017 ◽  
Vol 2 (15) ◽  
pp. 9-23 ◽  
Author(s):  
Chorong Oh ◽  
Leonard LaPointe
Keyword(s):  
English Language ◽  
Signs And Symptoms ◽  
Behavioral Symptoms ◽  
Journal Articles ◽  
People With Dementia ◽  
Different Types ◽  
Precise Diagnosis ◽  
Physical Changes ◽  
The Brain ◽  
Language Literature

Dementia is a condition caused by and associated with separate physical changes in the brain. The signs and symptoms of dementia are very similar across the diverse types, and it is difficult to diagnose the category by behavioral symptoms alone. Diagnostic criteria have relied on a constellation of signs and symptoms, but it is critical to understand the neuroanatomical differences among the dementias for a more precise diagnosis and subsequent management. With this regard, this review aims to explore the neuroanatomical aspects of dementia to better understand the nature of distinctive subtypes, signs, and symptoms. This is a review of English language literature published from 1996 to the present day of peer-reviewed academic and medical journal articles that report on older people with dementia. This review examines typical neuroanatomical aspects of dementia and reinforces the importance of a thorough understanding of the neuroanatomical characteristics of the different types of dementia and the differential diagnosis of them.

Mortality Rate Versus Funeral Rate in Clinical Medicine

1964 ◽  
Vol 46 (6) ◽  
pp. 788-791 ◽  
Author(s):  
Thomas C. Chalmers
Keyword(s):  
Mortality Rate ◽  
Clinical Medicine ◽  
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