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The Initial Metabolic Medicine Hospital Consult
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
There are situations where the findings are conflicting. For example, the muscle wasting could be mild, but the fat depletion severe, or the other way around. My approach is to define the most severe degree of malnutrition supported by any physical finding. By using this method, even one region of muscle or fat depletion would suffice. The only caveat is that there shouldn’t be another reason for the depletion (i.e., a denervation causing muscle loss due to atrophy).
The atmosphere
Published in Andrew M. Luks, Philip N. Ainslie, Justin S. Lawley, Robert C. Roach, Tatum S. Simonson, Ward, Milledge and West's High Altitude Medicine and Physiology, 2021
Andrew M. Luks, Philip N. Ainslie, Justin S. Lawley, Robert C. Roach, Tatum S. Simonson
There is evidence that the dehydration resulting from these rapid fluid losses does not produce as strong a sensation of thirst as at sea level. As a result, it is necessary for climbers to drink large quantities of fluids at high altitude to remain hydrated even though they have little desire to do so. For people climbing seven hours a day at altitudes over 6000 m, 3–4 L of fluid are required to maintain a urine output of 1.5 L day−1 (Pugh 1964b). Even so, it appears that people living at very high altitude are in a state of chronic volume depletion (Blume et al. 1984). In a group of subjects living at an altitude of 6300 m during the American Medical Research Expedition to Everest, serum osmolality was significantly increased compared with sea level even though ample fluids were available and the lifestyle in terms of exercise and diet was not exceptional (Blume et al. 1984).
Duodenal atresia and stenosis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Afif N. Kulaylat, Colin G. DeLong, Simon Clarke, Robert E. Cilley
Duodenal obstruction may be diagnosed prenatally by fetal ultrasound or fetal magnetic resonance imaging (MRI). A dilated stomach and duodenum are seen on imaging studies. Neonates with congenital duodenal obstruction most often present with obvious symptoms on the first day of life. Feeding intolerance and vomiting, which is usually bilious, are noted from the outset. Vomiting may be non-bilious when preampullary obstruction is present. Dehydration and electrolyte depletion rapidly ensue if the condition is not recognized and IV therapy begun. Parenteral nutrition is frequently initiated as feeding is often delayed after repair. Secondary complications, such as aspiration and respiratory failure, may also be present. The presence of a “double bubble” on a plain abdominal radiograph is essentially diagnostic of duodenal atresia. Air may be seen distally in the gastrointestinal tract with incomplete obstructions (e.g. stenosis) or an unusual double ampulla that opens both above and below the stenosis. Contrast radiography is confirmatory and may be especially helpful in confirming the diagnosis. Differentiating intrinsic duodenal obstruction from malrotation with volvulus is also facilitated with contrast radiography. Duodenal obstruction is treated less urgently than malrotation by some surgeons and therefore differentiating between the two entities is critical. Assuming that the diagnosis of malrotation with midgut volvulus has been excluded, workup and evaluation of other potential associated anomalies may proceed.
You Make Me Sick: Abuse at Work and Healthcare Utilization
Published in Human Performance, 2022
Merideth Thompson, Dawn Carlson, Wayne Crawford, K. Michele Kacmar, Sally Weaver
We theorize that being physically, mentally, and emotionally exhausted results from a depletion of energetic coping resources due to abusive supervision and diminished WFB. In turn, burnout and associated stress relate to an individual’s inability to recover from the workday (Melamed et al., 1999) and increase that person’s susceptibility to bodily disorders such as diabetes (Raison & Miler, 2003). The depletion of these resources undermines the individual’s physical functioning and thus he or she is more likely to experience a chronic illness (Melamed et al., 2006b). Further, as men are raised to be more achievement oriented, emphasize their work roles (Stroud et al., 2002), and be more likely to be family providers (Eagly & Wood, 2016), men will experience lower WFB, greater burnout, and higher rates of chronic illness diagnoses due to abusive supervision compared to women. Taken together, we predict the following: Hypothesis 7a: Burnout is positively related to chronic illness diagnosis.Hypothesis 7b: Gender moderates the indirect effect of abusive supervision on chronic illness diagnosis, through work-family balance and burnout, such that the indirect effect is stronger for men than women.
Diagnosis of coronary artery disease: potential complications of imaging techniques
Published in Acta Cardiologica, 2022
Evangelos Sdogkos, Andrew Xanthopoulos, Grigorios Giamouzis, John Skoularigis, Filippos Triposkiadis, Ioannis Vogiatzis
A small percentage of patients with CI-AKI will eventually develop chronic nephropathy and need dialysis. Patients at higher risk are those with an estimated glomerular filtration rate (eGFR) ≤30 mL min−1 1.73 m−2 or a risk score ≥11 (Mehran Risk Score). This score is used for risk stratification of nephropathy in patients receiving iodine contrast media. In addition to low eGFR and to an increased amount of contrast agent administration, risk factors for the development of chronic nephropathy include hypotension or shock, the use of intra-aortic balloon pump (IABP), congestive heart failure, age >75 years, anaemia, and diabetes [10]. Prevention centres around avoiding volume depletion and treatment is mainly supportive and aimed at volume and electrolyte balance. Adequate hydration, use of low-osmolar or iso-osmolar contrast media, and minimisation of contrast volume (ratio of total contrast volume to eGFR < 3.7) are recommended. Some patients may eventually require renal replacement therapy (approximately 0.3%) but this need is usually transient [11].
Well-being, job satisfaction, stress and burnout in speech-language pathologists: A review
Published in International Journal of Speech-Language Pathology, 2021
Claire Ewen, Helen Jenkins, Craig Jackson, Jagjeet Jutley-Neilson, John Galvin
Described as an extreme form of occupational stress, (Cooper et al., 2001), “burnout” is experienced particularly by those working in the helping professions. It was characterised by Maslach and Jackson (1981) as including emotional exhaustion, depersonalisation and feelings of reduced personal accomplishment. This classification was updated by the World Health Organization (2018), to include 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy. The consequences of high levels of stress and burnout include physiological responses e.g. headache, musculoskeletal disorders, heart disease (Cox & Jackson, 2005) and psychological responses e.g. anxiety, depression (Fernandes & Da Rocha, 2009). Stress and burnout can have behavioural responses, including absenteeism, difficulties recruiting and a higher turnover of staff (Denham & Shaddock, 2004; Gallego et al., 2015; Leka, Griffiths, & Cox, 2004).