Thyreotoxische Krise und Myxödemkoma

2018 ◽  
Vol 143 (06) ◽  
pp. 397-405 ◽  
Author(s):  
Malte Milkau ◽  
Friedhelm Sayk
Keyword(s):  
Thyroid Dysfunction ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Diagnostic Tools ◽  
Thyroid Storm ◽  
Thyreotoxische Krise ◽  
Myxedema Coma ◽  
Clinical Forms ◽  
Medical Emergencies ◽  
Significant Mortality

AbstractThyroid storm and myxedema coma are the most severe clinical forms of thyroid dysfunction. While both hyper- and hypothyroidsm are common diseases, thyroid storm and myxedema coma are rare. Due to their unspecific signs and symptoms they are often difficult to diagnose. Both disorders are medical emergencies, which still show a significant mortality. The following article summarizes diagnostic tools and treatment options for these disorders

Diagnoses in Opposition: Thyroid Storm and Myxedema Coma

1992 ◽  
Vol 3 (2) ◽  
pp. 300-308 ◽  
Author(s):  
Loretta Spittle
Keyword(s):  
Patient Outcomes ◽  
Signs And Symptoms ◽  
Management Team ◽  
Thyroid Storm ◽  
Normal Thyroid ◽  
Myxedema Coma ◽  
Normal Thyroid Function ◽  
Life Threatening ◽  
Nursing Diagnoses

An overview of normal thyroid function is presented to facilitate the understanding of the pathophysiology of two life-threatening thyroid disorders: thyroid storm and myxedema coma. Signs and symptoms, medical management, nursing diagnoses and interventions, and expected patient outcomes are discussed, as is the important role of the nurse as an integral member of the management team

Thyroid Gland Disorder Emergencies

2013 ◽  
Vol 24 (3) ◽  
pp. 325-332
Author(s):  
Jessica Hampton
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Gland ◽  
Pharmacological Treatment ◽  
Thyroid Dysfunction ◽  
Acute Illness ◽  
Thyroid Storm ◽  
Myxedema Coma ◽  
Rapid Action ◽  
The Us ◽  
Careful Assessment

Although thyroid dysfunction will develop in more than 12% of the US population during their lifetimes, true thyroid emergencies are rare. Thyroid storm and myxedema coma are endocrine emergencies resulting from thyroid hormone dysregulation, usually coupled with an acute illness as a precipitant. Careful assessment of risk and rapid action, once danger is identified, are essential for limiting morbidity and mortality related to thyroid storm and myxedema coma. This article reviews which patients are at risk, explains thyroid storm and myxedema coma, and describes pharmacological treatment and supportive cares.

Wilson disease in children and adolescents

2020 ◽  
Vol 105 (5) ◽  
pp. 499-505 ◽  
Author(s):  
Meranthi Fernando ◽  
Indra van Mourik ◽  
Evangeline Wassmer ◽  
Deirdre Kelly
Keyword(s):  
Liver Disease ◽  
Wilson Disease ◽  
Multidisciplinary Approach ◽  
Neuropsychiatric Symptoms ◽  
Treatment Options ◽  
Copper Metabolism ◽  
Signs And Symptoms ◽  
Diagnostic Tools ◽  
Age Group ◽  
Children And Young People

Wilson disease (WD) is a rare, recessively inherited disorder of copper metabolism mainly affecting liver and brain. In childhood, it is known to have a predominant hepatic phenotype. It is likely that the low awareness for WD-associated neuropsychiatric signs and symptoms in this age group means that neurological Wilson’s disease is underdiagnosed in children and young people. Practitioners should be alert for this complication in children with or without liver disease. Management of children with WD requires a dedicated multidisciplinary approach involving hepatologists, geneticists, neurologists and psychiatrists to ensure subtle neuropsychiatric symptoms are identified early and addressed appropriately. This review highlights recent advances in hepatic and neuropsychiatric symptoms of WD in childhood, specific diagnostic tools and pitfalls and summarises existing and potential future treatment options.

Nondiabetic Endocrine Emergencies 2: Hypoparathyroidism, Hyperparathyroidism, Myxedema Coma, And Thyroid Storm

2018 ◽  
Author(s):  
Jason J Lewis ◽  
Richard E Wolfe
Keyword(s):  
Multiorgan Failure ◽  
Signs And Symptoms ◽  
Metabolic Effects ◽  
Thyroid Storm ◽  
Emergency Setting ◽  
Course Of Illness ◽  
Myxedema Coma ◽  
Adrenergic Activity ◽  
Parathyroid Disease ◽  
History Of

Acute emergent presentations of the thyroid and parathyroids are rarer occurrences in the emergency department but essential to diagnose and treat early in the course of illness. Disorders of the parathyroids are typically related to circulating calcium levels and the metabolic effects thereof, whereas thyroid deficiency or excess can lead to profound shock, coma, hypothermia, hyperthermia, and death. The diagnosis of parathyroid disease should be considered in patients presenting with signs and symptoms consistent with hyper- or hypocalcemia. Myxedema coma should be considered in any patient presenting with evidence of severe sepsis or shock, particularly when there is a history of hypothyroidism. Thyroid storm should be suspected in any patient with unexplained increased adrenergic activity, hyperpyrexia, or multiorgan failure. Empirical treatment must begin prior to definitive diagnosis in all cases. This review demonstrates how to recognize and manage acute presentations of hypo- and hyperparathyroidism, myxedema coma, and thyroid storm in the emergency setting. Patients with nondiabetic endocrine emergencies may present in extremis, and immediate stabilization, typically without confirmatory testing, is necessary. Early intervention is key in treating such presentations. This review contains 3 figures, 8 tables and 28 references Key words: disorders of the parathyroids, hyperparathyroidism, hypoparathyroidism, hypothyroidism, myxedema coma, thyroid storm, thyrotoxicosis

Upashaya and Anupashaya - A Bird’s Eye View

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Sreeharsha N. ◽  
Gurubasavaraj Yalagachin ◽  
Kavita M. V. ◽  
Divyasree C. H.
Keyword(s):  
Signs And Symptoms ◽  
Symptomatic Treatment ◽  
Diagnostic Tools ◽  
Detailed Knowledge ◽  
Early Signs ◽  
Therapy Result

The approach of the treatment in any disease begins with Roga Pareeksha and Rogi Pareeksha. Once these two concepts are clear, Vyadhi Vinishchaya will be perfect. This enables the Vaidya to choose appropriate Chikitsa. The five entities of Roga Pareeksha are Nidana (aetiology), Purvaroopa (early signs and symptoms), Roopa (cardinal features), Upashaya (symptomatic treatment) and Samprapti (pathogenesis). When Vaidya has doubtful diagnosis of a disease after thorough examination, he will carry out symptomatic first hand simple therapy, result of which will clarify his ambiguity in diagnosis. For example the pain in the Janu Sandhi may raise the doubt in the physician regarding its diagnosis as Amavata or Sandhivata. The Sthanika Taila Prayoga as Upashaya will result in clarity of diagnosis. Hence Upashaya (Pathya) and Anupashaya (Apathya) are the diagnostic tools in Vyadhi Vinishchaya. This creates a pavement for the path of thinking that Ahara, Vihara and Oushadha which relieve the Lakshanas of any Vyadhi are considered as Upashaya and those which aggravate or worsen are called as Anupashaya. This concept can be practically utilised to advice the Rogi regarding Pathya and Apathya in the specific disesase and it also helps to diagnose the disease without confusion. Hence a detailed knowledge of Upashaya (Pathya) and Anupashaya (Apathya) is essential in Chikitsa.

scholarly journals Fructose and Mannose in Inborn Errors of Metabolism and Cancer

Metabolites ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 479
Author(s):  
Elizabeth L. Lieu ◽  
Neil Kelekar ◽  
Pratibha Bhalla ◽  
Jiyeon Kim
Keyword(s):  
Metabolic Disease ◽  
Inborn Errors Of Metabolism ◽  
Metabolic Diseases ◽  
Treatment Options ◽  
Biochemical Properties ◽  
Biological Molecules ◽  
Diagnostic Tools ◽  
Inborn Errors ◽  
Mannose Metabolism

History suggests that tasteful properties of sugar have been domesticated as far back as 8000 BCE. With origins in New Guinea, the cultivation of sugar quickly spread over centuries of conquest and trade. The product, which quickly integrated into common foods and onto kitchen tables, is sucrose, which is made up of glucose and fructose dimers. While sugar is commonly associated with flavor, there is a myriad of biochemical properties that explain how sugars as biological molecules function in physiological contexts. Substantial research and reviews have been done on the role of glucose in disease. This review aims to describe the role of its isomers, fructose and mannose, in the context of inborn errors of metabolism and other metabolic diseases, such as cancer. While structurally similar, fructose and mannose give rise to very differing biochemical properties and understanding these differences will guide the development of more effective therapies for metabolic disease. We will discuss pathophysiology linked to perturbations in fructose and mannose metabolism, diagnostic tools, and treatment options of the diseases.

scholarly journals QOLP-37. QUALITATIVE RESEARCH IN LOWER GRADE GLIOMA: UNDERSTANDING SIGNS, SYMPTOMS, AND DISEASE IMPACTS DURING EXPECTANT MANAGEMENT

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi206-vi206
Author(s):  
Audra Boscoe ◽  
Ted Wells ◽  
Christina Graham ◽  
Caitlin Pohl ◽  
Brooke Witherspoon ◽  
...  
Keyword(s):  
Treatment Options ◽  
Expectant Management ◽  
Signs And Symptoms ◽  
Molecular Therapy ◽  
Patient Specific ◽  
Lower Grade ◽  
Concept Elicitation ◽  
Post Surgery ◽  
Lower Grade Glioma ◽  
Isocitrate Dehydrogenase Mutation

Abstract BACKGROUND Patients with lower grade glioma (LGG) (i.e., grade II or III) have limited treatment options. After surgical resection of their tumor, patients will undergo either a period of expectant management (watch and wait) or treatment with adjuvant chemotherapy and/or radiotherapy. Approximately 80% of patients with LGG have an isocitrate dehydrogenase mutation, which is a viable target for molecular therapy. This offers a therapeutic intervention that could potentially delay the need for chemotherapy and/or radiotherapy in select patients. Several prognostic and patient-specific factors contribute to the decision to recommend expectant management, including concerns about the side effects of chemotherapy and radiotherapy. The aim of this project was to understand patients’ signs and symptoms during the expectant management period and how LGG impacts their lives. METHODS Concept elicitation interviews were conducted in the US with patients with LGG as well as key opinion leaders (KOLs) with experience treating patients with LGG. Interview data were analyzed using Atlas.ti, and patient data were reviewed against KOL data. RESULTS Seven patients with ≥ 3 months of expectant management experience and three KOLs were interviewed. During their expectant management periods, patients reported 12 signs/symptoms, mostly related to deficits in cognition. Patients reported 16 impacts across four categories, with a substantial proportion of the impacts identified as negatively affecting emotional function. The signs/symptoms and impacts reported by patients were generally also reported by KOLs. During expectant management, patients typically resume their original quality of life post-surgery, but may also experience anxiety. Patients and KOLs indicated a preference for expectant management and delaying chemotherapy or radiotherapy. CONCLUSIONS Patient and KOL interviews characterized the LGG experience and indicated a preference for expectant management, which may be supported by therapies that delay the initiation of chemotherapy and/or radiotherapy.

Stressful Life Events as a Trigger for Autoimmune Disease? A Case Report on Mucous Membrane Pemphigoid

Dental Update ◽  
2021 ◽  
Vol 48 (5) ◽  
pp. 379-382
Author(s):  
Robert Devine ◽  
Melanie Simms
Keyword(s):  
Mucous Membrane ◽  
Patient Outcomes ◽  
Stressful Life Events ◽  
Treatment Options ◽  
Rare Condition ◽  
Corticosteroid Treatment ◽  
Diagnostic Tools ◽  
Mucous Membrane Pemphigoid ◽  
Acute Presentation

This case discusses the acute presentation of a patient with mucous membrane pemphigoid to an emergency dental department. Mucous membrane pemphigoid is a rare condition, but its presentation can be severe and concerning for both the patient and clinician. The case presents the manifestations of florid desquamative gingivitis and extensive mucosal erosions due to burst bullae. We discuss the possible causes of the condition in this patient, likely to be the stress of recent cardiac surgery, as well as exploring the efficacy of diagnostic tools, treatment options and adverse effects of corticosteroid treatment. CPD/Clinical Relevance: Correct and timely diagnosis of vesiculobullous disorders has notable impacts on patient outcomes and quality of life.

Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

1999 ◽  
Vol 12 (2) ◽  
pp. 224-242 ◽  
Author(s):  
Shamez Ladhani ◽  
Christopher L. Joannou ◽  
Denise P. Lochrie ◽  
Robert W. Evans ◽  
Susan M. Poston
Keyword(s):  
Clinical Features ◽  
Treatment Options ◽  
Entire Body ◽  
Secondary Complications ◽  
Staphylococcal Scalded Skin Syndrome ◽  
Treatment And Prevention ◽  
Causative Agents ◽  
Underlying Diseases ◽  
Disease Understanding ◽  
Significant Mortality

SUMMARY The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.

scholarly journals The Challenges and Knowledge Gaps in Malaria Therapy: A Stakeholder Approach to Improving Oral Quinine Use in the Treatment of Childhood Malaria in Ghana

2018 ◽  
Vol 2018 ◽  
pp. 1-12
Author(s):  
Bartholomew Yir-Erong ◽  
Marcel Tunkumgnen Bayor ◽  
Isaac Ayensu ◽  
Stephen Yao Gbedema ◽  
Joshua Boateng
Keyword(s):  
Bitter Taste ◽  
Health Workers ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Modes Of Transmission ◽  
Malaria Therapy ◽  
Care Givers ◽  
Childhood Malaria

Background. The study was undertaken to elicit the knowledge, views, and perceptions of key stakeholders on malaria, its bioburden, and treatment options, in order to ascertain the knowledge gabs and challenges, especially in the use of oral quinine in childhood malaria. Methods. A cross-sectional survey was conducted using a well-structured Likert Scale and self-administered questionnaire. The principal site of the study was a government-run children’s hospital located in the Ashiedu Keteke Sub-Metro of Accra. The study population included health workers, parents, and guardians or care givers. The participants were 300, purposively selected, and consisted of both men (41%) and women (59%) who were twenty years and above, whether employed (42%), self-employed (37%), or unemployed (21%). Results. Majority of the participants (78%) demonstrated above average knowledge of malaria. However, their awareness of the causes, modes of transmission, signs, and symptoms as well as preventive mechanisms of malaria did not result in low incidence of malaria. About 77% of the respondents agreed they would seek treatment within 24 hours once signs and symptoms are detected. Though close to 50% undertook home treatment of malaria, majority eventually sought treatment at hospital or clinic. Above 92% of respondents knew that quinine is used to treat malaria and agreed its bitter taste greatly affects compliance, especially in children. Consequently, 95% of the respondents would be glad if its bitter taste is masked. Conclusion. The study demonstrated the availability of substantial knowledge of the devastating effects of malaria, especially in children. Therefore, there is the need to ensure the availability and utilization of effective paediatric formulations in the fight against malaria. From this study, fast dissolving oral thin film with a good mouth feel, would be the formulation of choice for quinine.

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