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Fever in Respiratory Diseases
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
One third of the patients present with a flu-like illness with fever, sore throat, and malaise lasting typically 2 to 10 weeks, but in some patients for more than 3 months. One quarter of patients have no abnormal physical findings. Chest roentgenograms showed an unusual pattern of patchy densities with a “ground glass” appearance in 81% and in less than 10% there were seen diffuse, small, linear or nodular opacities. Physiologically 72% demonstrate restriction and 86% have impaired diffusing capacity.32
Search for causes of disease occurrence: Why does disease occur?
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
First and foremost, were all variables (cause, effect, etc.) well defined qualitatively and quantitatively? Was exposure well defined and quantified? Are health problems defined satisfactorily from the point of view of clinimetrics? What is fatigue? What is malaise? What is a lack of concentration? Frequently, very soft and nonspecific clinical data are presented as evidence, and only physicians can help the court make a ‘right’ decision. Did cause really precede effect? Did the plaintiff begin to lose weight before or after using a suspect household cleanser? Many cases are motivated by greed and come from poorly defined areas; others are much more serious. Is the causal link under review strong and specific enough?
Nephrology
Published in Shibley Rahman, Avinash Sharma, MRCP Part 2 Best of Five Practice Questions, 2018
Shibley Rahman, Avinash Sharma
A 43-year-old man has had vague malaise for three weeks. Physical examination is normal, except for a blood pressure of 150/95 mmHg and pitting oedema of the legs to the knees. Dipstix urinalysis shows protein (+++) but no glucose, blood, ketones, nitrite or urobilinogen. Additional laboratory testing reveals a 24-hour urine protein of 4.1 g/day. His serum creatinine is 100 μmol/L. Liver function is normal; however, his hepatitis B surface antigen test is positive.
Fatigue in ANCA-associated vasculitis (AAV) and systemic sclerosis (SSc): similarities with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). A critical review of the literature
Published in Expert Review of Clinical Immunology, 2022
Charmaine van Eeden, Mohammed S. Osman, Jan Willem Cohen Tervaert
The lack of drug interventions has resulted in implementing non-pharmacological management strategies for patients with ME/CFS. Energy conservation is an important feature in ME/CFS management as patients who overexert and surpass their energy stores have subsequent ‘crashes’ resulting in multiple days in bed trying to recover. This feature is captured in the most recent classification criteria for ME/CFS [33,122], under post-exertional malaise. Exercise is only advised in patients who are coping with their current daily activities, in severely ill patients, that act of taking a shower may be all the exercise they can handle [20]. Patients, who have learned how to pace their activity and take breaks to conserve their energy, have been shown to reduce their overall fatigue severity [20,123]. Improved sleep habits and pacing mental activities may also aid in symptoms of fatigue and cognitive dysfunction [20]. Pain, cardiovascular, and gastrointestinal symptoms should be addressed on a symptomatic basis. Patient support is key in ME/CFS, validation of their symptoms and monitoring of their mental health is important in establishing patients who are able to successfully cope with their diagnosis [20].
Breast implant illness: scientific evidence of its existence
Published in Expert Review of Clinical Immunology, 2022
JW Cohen Tervaert, N Mohazab, D Redmond, C van Eeden, M. Osman
Locally, about half of the SBI patients with ‘breast implant illness’ (BII) have breast pain, tenderness, and/or burning sensations. Patients with BII develop changes in breast shape, symmetry, firmness, and/or size. Intriguingly, some of these symptoms have been reported to occur after trauma to the breasts and/or after mammography [9]. BII patients also experience systemic symptoms (see Figure 1) as described in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) [10,11], which are universally present. In contrast to other forms of fatigue, both BII and CFS/ME patients are severely symptomatic when they wake up, and their symptoms are not alleviated by rest. These patients have a substantial reduction in their ability to engage pre-illness levels of occupational, educational, social and/or personal activities. Importantly, most patients report post-exertional malaise, or symptom flares or ‘crash’ after physical or cognitive exertion lasting days to sometimes weeks.
Shingles: a harbinger of chronic HIV infection
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
S. Zachariah, A. Sullivan, A. Donato
HIV can be difficult to diagnose due to the non-specific and variable presentation during the early stages of disease. As many as 50% of initial HIV-infected patients suffer from flu-like or mononucleosis-like illness [5]. Symptoms can include fever, malaise, generalized rash, and generalized lymphadenopathy. More advanced stages of HIV present as life-threatening malignancies and opportunistic infections, otherwise known as acquired immunodeficiency syndrome (AIDS) defining illnesses. An AIDS defining illness is defined as CD4 < 200 cells/µL or several opportunistic infections, including pneumocystis pneumonia, cytomegalovirus disease, and invasive cervical cancer (but not including recurrent herpes zoster) [6]. When an AIDS defining illness is encountered, it should prompt consideration for an underlying HIV infection.