#prognostic factors

[persephoneflouwers]

Lewis Capaldi, you have ONE job tonight

[tanadrin]

I'm confused as to why you think Trump can be beaten. He only lost in 2020 because he was blamed for an unfolding catastrophe, and it was still a pretty narrow loss. In 2024 he can just point to how comparatively better everything was during his presidency and people will go along with it. None of his bad behavior or horrifying political aims means anything, because either people don't care, or the media doesn't care.

Well, for one I think he can be beaten because even the polls (which IMO underrated Biden) now show Harris ahead. For two, the Washington August jungle primary, which is a pretty historically useful leading indicator for the November elections, is consistent with a national environment that favors the Democrats. For three, the numbers that did show Trump ahead require you to believe some fairly odd things about the American electorate that have not been true in any recent election, including primary elections and special elections held so far this year. For four, while there are a lot of narratives about why Trump lost in 2020, I don’t think retro-prognostication based on a single factor is actually a cogent way to analyze elections. For five, his campaign is currently flailing, his VP pick is wildly unpopular, he got no convention bounce, and many voters seem thoroughly sick of him.

So yeah, I’m feeling pretty confident that doomers like you have no idea what they’re talking about. Harris could lose—hell, a gamma ray burst from a surprise supernova could sterilize the earth before November—but right now her odds are decent. She is, by most measures, even slightly favored.

Also I expect you to send me €300 for having to be yet another doomer’s Election Therapist. Unfortunately for you, I am not on the Krankenkasse, so I’ll need that by cash, bank transfer, or PayPal.

[covid-safer-hotties]

Emerging signs of Alzheimer-like tau hyperphosphorylation and neuroinflammation in the brain post recovery from COVID-19 - Published Sept 29, 2024

Abstract Coronavirus disease 2019 (COVID-19) has been suggested to increase the risk of memory decline and Alzheimer's disease (AD), the main cause of dementia in the elderly. However, direct evidence about whether COVID-19 induces AD-like neuropathological changes in the brain, especially post recovery from acute infection, is still lacking. Here, using postmortem human brain samples, we found abnormal accumulation of hyperphosphorylated tau protein in the hippocampus and medial entorhinal cortex within 4–13 months post clinically recovery from acute COVID-19, together with prolonged activation of glia cells and increases in inflammatory factors, even though no SARS-COV-2 invasion was detected in these regions. By contrast, COVID-19 did not change beta-amyloid deposition and hippocampal neuron number, and had limited effects on AD-related pathological phenotypes in olfactory circuits including olfactory bulb, anterior olfactory nucleus, olfactory tubercle, piriform cortex and lateral entorhinal cortex. These results provide neuropathological evidences linking COVID-19 with prognostic increase of risk for AD.

[sysmedsaresexist]

DSM 5-TR Risk and Prognostic Factors for DID

Important DSM wording and description updates!

[dreaminginthedeepsouth]

Mike Luckovich, Atlanta Journal Constitution

* * * *

Why Ronna McDaniel’s hiring and “firing” by NBC matters.

March 25, 2024

ROBERT B. HUBBELL

Opening thoughts

In the span of 72 hours, NBC announced the hiring and partial “firing” of former Republican National Committee chair Ronna McDaniel. McDaniel’s hiring sparked a firestorm of protest within NBC internally and by viewers of MSNBC and NBC that caused the network’s executive to announce that she would not appear “on air” on the MSNBC cable network. (As of Sunday evening, it appears she will continue to appear on NBC as a political contributor.)

NBC’s decision to hire McDaniel was deeply troubling on many levels. The backlash by viewers and journalists at MSNBC and NBC was instructive and encouraging. But this story also serves as a morality tale for the challenges we will face in the next seven months as the media and pundits normalize and dismiss the attempted coup and insurrection.

Indeed, the hiring and partial retraction of McDaniel’s employment occurred amidst a renewed round of handwringing by pundits and consultants who are freaking out about the possibility of Biden losing in November. That fear is rooted in a stubborn refusal to acknowledge the stakes of the 2024 election and an obsessive compulsion with “favorability ratings.”

It’s a good thing none of those pundits or consultants were in charge of the Continental Army during the American Revolution when George Washington’s battlefield record was six victories, seven losses, and four draws. The modern-day pundits would have surrendered after the first loss, and America would be a colony of the United Kingdom today.

We will be forced to endure a constant barrage of defeatism from the political class in the months to come. Why? They are reserving their pre-emptive “I told you so” rights so that if things turn out badly, they can claim to be geniuses. If Biden wins, no one will remember or hold them accountable for their defeatism.  For the pundits, it’s a “Heads I win, tails you lose” proposition.

So, let’s burst the “I am a genius” balloons of the pundits now. The 2024 presidential election will be a close race. It takes no great skill or insight to wring your hands and say you have a bad feeling about the election. At this point, pundits and prognosticators are dead weight, holding back those of us who refuse to retreat at the first hint of trouble.

Most of the analysis by the self-proclaimed experts is incredibly superficial—about a quarter inch deep. For example, a reader sent me an “economic outlook” from the large Wall Street bank managing her retirement account. The Wall Street bank said that the markets are beginning to anticipate a Trump victory because Biden’s unfavorability ratings remain high.

The reader’s retirement advisers apparently do not understand that Americans actually vote for president and that elections are not determined by “favorability ratings.” Voters are not securities traded in an efficient market. They are people motivated by a multitude of factors.

The investment advisers do not appear to believe that women (or men) care about having their reproductive liberty controlled by religious zealots, allowing weapons of war to be carried in public without a permit, rolling back climate protections after the hottest year on record, disenfranchising Black voters, denying equal dignity to LGBTQ people, or allowing Americans to choose their leaders.

Nor do the investment advisers appear to be concerned that one of the candidates for president has 91 felony indictments, will sit through one criminal trial before the election, has promised to be a dictator, is threatening to blow up the strongest military alliance in the world, and appears (again) to be supported by Russia in his bid for the presidency.

We are in uncharted waters. Old maps do not apply. But pundits, pollsters, and Wall Street gurus insist on looking back to templates and spreadsheets that applied in “normal” times.

We are living through an exceptional moment in which we can make our own rules. Recognizing that fact and having the audacity to break “the old rules” to create a new template for success is critical to controlling the outcome of the 2024 election. Don’t allow yourself to be weighed down by consultants re-litigating the 1992, 2000, 2008, or 2016 elections.

I could go on, but you get the point. We control our destiny—but only if we ignore people who tell us we are sheep, shares of stock, or widgets. We are not. We are Americans wielding the awesome power granted us by the Constitution.

But how is Ronna McDaniel’s hiring and firing related to the shortsighted defeatism of the consulting class? Read on!

Rona McDaniel’s hiring illustrates the normalization of the insurrection and coup among the media and political class.

There is a direct line between normalizing the coup and panicking about Biden’s prospects in 2024. Hear me out.

Ronna McDaniel was aware of the fake elector's plot in real-time and did nothing to stop the attempted coup. Worse, she participated in a call to pressure local elections officials in Michigan to refuse to certify election results based on non-existent fraud. When the media reported on her participation in the election interference plot, she accused MSNBC of ‘spreading lies’ and employing ‘prime time propagandists.’” She repeatedly claimed that the 2020 election was “rigged.”

Regardless of whether Ronna McDaniel has criminal liability for the attempted coup, she cheered loudly for its success and smeared journalists who spoke the truth about the first-ever effort to prevent the peaceful transfer of power. That alone should ban her for life from any role at a legitimate news platform.

It is reprehensible that Comcast / NBC would hire Ronna McDaniel as a political consultant after her election denialism and active involvement in at least one overt act to overturn the Constitution. And yet, dozens of executives at NBC apparently view the attempted coup as part of the game of hardball election politics. They are ready to forgive and forget despite the lack of accountability for Trump and his advisers—including members of the RNC.

By reducing the attempted coup and insurrection to mere “partisan politics,” NBC is misleading the American people about the stakes in 2024 by denying the reality of what happened in 2020. And if you ignore the stakes, if you ignore the unprecedented nature of the 2024 election, then perhaps it isn’t unreasonable to say, “Well, in 1992, George H.W. Bush’s favorability ratings were X and he lost.” But Bill Clinton in 1992 isn’t Donald Trump in 2024. The world has forever changed because of the insurrection and the incipient fascism that is roiling beneath the surface.

We cannot allow NBC to continue in its misguided view of what is at stake in 2024. Read on!

The backlash against NBC was partially successful.

Hundreds of readers of this newsletter—and tens of thousands of Americans (an estimate) let NBC know that they strenuously objected to the presence of Ronna McDaniel on the network. Journalists at NBC and MSNBC also spoke out. The combined pressure worked—at least at MSNBC. See WaPo, Former RNC chair Ronna McDaniel faces sharp criticism after NBC hiring. (This article is accessible to all.)

According to WaPo, the president of MSNBC, Rashida Jones, sent an internal memo assuring MSNBC staff that Ronna McDaniel would not be forced on the hosts at MSNBC as an on-air contributor or commentator. Good! The pressure campaign worked.

But it is not enough.

McDaniel appeared on NBC’s Meet the Press on Sunday and attempted to dismiss her previous election denialism by saying that as chair of the RNC she “had to take one for the team.” One reasonable interpretation of that statement could be, “I lied because I was paid to lie.”

Chuck Todd was part of an NBC panel that dissected McDaniel’s interview on Meet the Press by Kristen Welker. Chuck Todd said,

Our bosses owe you [Welker] an apology for putting you in this situation because I don’t know what to believe. . . . I have no idea whether any answer she gave to you was because she didn’t want to mess up her contract. There’s a reason why there’s a lot of journalists at NBC News uncomfortable with this, because many of our professional dealings with the RNC over the last six years have been met with gaslighting, have been met with character assassination.

Good for Chuck Todd! (Not usually on my list of “go to” sources.) Let’s hope he speaks for a substantial portion of the NBC News staff—and that NBC management is listening.

The deluge of comments from listeners had an immediate effect on the editorial and staffing decisions at MSNBC! There is a lesson in that for all of us! We can fight the normalization of the coup and insurrection. Indeed, we must! Otherwise, voters will be misinformed about the stakes of the 2024 election.

There is more to be done.

As of Sunday evening, Ronna McDaniel appears to remain at NBC as a “contributor.” Thanks to a reader (Susan O. S.) for identifying the executives at NBC who oversee the news function at the NBC network (not to be confused with the cable-based MSNBC). The email addresses are:

President, NBC: Rebecca.Blumenstein@nbcuni.com

SVP of Politics: carrie.budoff@nbcuni.com

Keeping Ronna McDaniel “off the air” at a legitimate media outlet is imperative. She lied before she joined NBC and smeared NBC’s journalists for telling the truth. She participated in at least one act designed to overturn the election. She should not be trusted with any news platform that reaches persuadable voters—because we have no reason to believe that she will tell the truth going forward.

The stakes are simply too high, and the time is too short for NBC to “see what happens” if NBC “gives her chance.” McDaniel has proven who she is; we should believe her.

Let NBC know how you feel about its cynical willingness to play politics with our democracy.

[Robert B. Hubbell Newsletter]

[mcatmemoranda]

Rheumatoid Arthritis:

Refer to rheumatologist.

●Nonpharmacologic measures – Nonpharmacologic measures, such as patient education, psychosocial interventions, and physical and occupational therapy, should be used in addition to drug therapy. Other medical interventions that are important in the comprehensive management of RA in all stages of disease include cardiovascular risk reduction and immunizations to decrease the risk of complications of drug therapies.

●Initiation of DMARD therapy soon after RA diagnosis – We suggest that all patients diagnosed with RA be started on disease-modifying antirheumatic drug (DMARD) therapy as soon as possible following diagnosis, rather than using antiinflammatory drugs alone, such as nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids (Grade 2C). Better outcomes are achieved by early compared with delayed intervention with DMARDs.

●Tight control of disease activity – Tight control treatment strategies to "treat to target" are associated with improved radiographic and functional outcomes compared with less aggressive approaches. Such strategies involve reassessment of disease activity on a regularly planned basis with the use of quantitative composite measures and adjustment of treatment regimens to quickly achieve and maintain control of disease activity if targeted treatment goals (remission or low disease activity) have not been achieved. (

●Pretreatment evaluation – Laboratory testing prior to therapy should include a complete blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), aminotransferases, blood urea nitrogen, and creatinine. Patients receiving hydroxychloroquine (HCQ) should have a baseline ophthalmologic examination, and most patients who will receive a biologic agent or Janus kinase (JAK) inhibitor should be tested for latent tuberculosis (TB) infection. Screening for hepatitis B and C should be performed in all patients. Some patients may require antiviral treatment prior to initiating DMARD or immunosuppressive therapy, depending upon their level of risk for hepatitis B virus (HBV) reactivation.

●Adjunctive use of antiinflammatory agents – We use antiinflammatory drugs, including NSAIDs and glucocorticoids, as bridging therapies to rapidly achieve control of inflammation until DMARDs are sufficiently effective. Some patients may benefit from longer-term therapy with low doses of glucocorticoids.

●Drug therapy for flares – RA has natural exacerbations (also known as flares) and reductions of continuing disease activity. The severity of the flare and background drug therapy influence the choice of therapies. Patients who require multiple treatment courses with glucocorticoids for recurrent disease flares and whose medication doses have been increased to the maximally tolerated or acceptable level should be treated as patients with sustained disease activity. Such patients require modifications of their baseline drug therapies.

●Monitoring – The monitoring that we perform on a regular basis includes testing that is specific to evaluation of the safety of the drugs being; periodic assessments of disease activity with composite measures; monitoring for extraarticular manifestations of RA, other disease complications, and joint injury; and functional assessment.

●Other factors affecting target and choice of therapy – Other factors in RA management that may influence the target or choice of therapy include the disabilities or functional limitations important to a given patient, progressive joint injury, comorbidities, and the presence of adverse prognostic factors.

Osteoarthritis

General principles – General principles of osteoarthritis (OA) management include providing continuous care that is tailored to the patient according to individual needs, goals, and values and should be patient-centered. Treatment can be optimized by OA and self-management education, establishing treatment goals, and periodic monitoring.

●Monitoring and assessment – The management of OA should include a holistic assessment which considers the global needs of the patient. Patient preferences for certain types of therapies should also be assessed, as compliance and outcomes can be compromised if the care plan does not meet the patient's preferences and beliefs.

●Overview of management – The goals of OA management are to minimize pain, optimize function, and beneficially modify the process of joint damage. The primary aim of clinicians should include targeting modifiable risk factors. Due to the modest effects of the individual treatment options, a combination of therapeutic approaches is commonly used in practice and should prioritize therapies that are safer.

●Nonpharmacologic therapy – Nonpharmacologic interventions are the mainstay of OA management and should be tried first, followed by or in concert with medications to relieve pain when necessary. Nonpharmacologic therapies including weight management and exercises, braces and foot orthoses for patients suitable to these interventions, education, and use of assistive devices when required.

●Pharmacologic therapy – The main medications used in the pharmacologic management of OA include oral and topical nonsteroidal antiinflammatory drugs (NSAIDs). Other options include topical capsaicin, duloxetine, and intraarticular glucocorticoids. Our general approach to pharmacotherapy is described below.

•In patients with one or a few joints affected, especially knee and/or hand OA, we initiate pharmacotherapy with topical NSAIDs due to their similar efficacy compared with oral NSAIDs and their better safety profile.

•We use oral NSAIDs in patients with inadequate symptom relief with topical NSAIDs, patients with symptomatic OA in multiple joints, and/or patients with hip OA. We use the lowest dose required to control the patient's symptoms on an as-needed basis.

•We use duloxetine for patients with OA in multiple joints and concomitant comorbidities that may contraindicate oral NSAIDs and for patients with knee OA who have not responded satisfactorily to other interventions.

•Topical capsaicin is an option when one or a few joints are involved and other interventions are ineffective or contraindicated; however, its use may be limited by common local side effects.

•We do not routinely use intraarticular glucocorticoid injections due to the short duration of its effects (ie, approximately four weeks).

•We avoid prescribing opioids due to their overall small effects on pain over placebo and potential side effects (eg, nausea, dizziness, drowsiness), especially for long-term use and in the older adult population.

•We do not routinely recommend nutritional supplements such as glucosamine, chondroitin, vitamin D, diacerein, avocado soybean unsaponifiables (ASU), and fish oil due to a lack of clear evidence demonstrating a clinically important benefit from these supplements. Other nutritional supplements of interest that may have small effects on symptoms include curcumin (active ingredient of turmeric) and/or Boswellia serrata, but the data are limited.

●Role of surgery – Surgical treatment is dominated by total joint replacement, which is highly effective in patients with advanced knee and hip OA when conservative therapies have failed to provide adequate pain relief.

●Factors affecting response to therapy – The discordance of radiographic findings to pain supports the notion that the mechanisms of pain are complex and likely multifactorial. The placebo effect is also known to impact response to therapy.

●Prognosis – Although there is great variability among individuals and among different phenotypes of OA, courses of pain and physical functioning have been found to be predominantly stable, without substantial improvement or deterioration of symptoms over time.

[expertacademicassignmenthelp]

Diabetes

Introduction to Diabetes

Diabetes, a metabolic disorder characterized by chronic hyperglycemia, arises from abnormalities in insulin secretion, insulin action, or both. The condition’s prevalence has reached epidemic proportions globally, with significant health, economic, and social implications.

Types of Diabetes

Type 1 Diabetes: This autoimmune disease results from the destruction of pancreatic beta cells, leading to absolute insulin deficiency. Genetics and environmental triggers play pivotal roles in its pathogenesis. Despite being less common than Type 2 diabetes, its onset during childhood or adolescence significantly impacts individuals’ lives.

Type 2 Diabetes: Predominantly a disorder of insulin resistance, Type 2 diabetes accounts for the majority of diabetes cases worldwide. Lifestyle factors, genetic predisposition, and obesity contribute to its development. Its insidious onset often leads to delayed diagnosis and increased risk of complications.

Gestational Diabetes: Occurring during pregnancy, gestational diabetes poses risks to both maternal and fetal health. Hormonal changes and insulin resistance characterize its pathophysiology. Effective screening and management are crucial to prevent adverse outcomes.

Other Types of Diabetes: Variants like MODY, LADA, and secondary diabetes present unique challenges in diagnosis and management, requiring tailored approaches to care.

Epidemiology and Prevalence

Diabetes prevalence varies across demographics, with disparities observed in age, gender, ethnicity, and socioeconomic status. The escalating burden of diabetes underscores the urgent need for targeted prevention and management strategies.

Symptoms and Causes

Hyperglycemia-induced symptoms like polyuria, polydipsia, and unexplained weight loss serve as clinical indicators for diabetes diagnosis. Understanding the complex interplay of genetic, environmental, and lifestyle factors elucidates the condition’s etiology.

Complications

Diabetes complications encompass a spectrum of microvascular and macrovascular disorders, significantly impacting quality of life and life expectancy. From diabetic retinopathy to cardiovascular disease, nephropathy, neuropathy, and diabetic foot complications, the ripple effects of uncontrolled diabetes are profound.

Diagnosis and Tests

Accurate diagnosis relies on comprehensive evaluation, including fasting glucose, oral glucose tolerance tests, and hemoglobin A1c measurements. Screening recommendations aim to identify at-risk individuals early, facilitating timely intervention and risk reduction.

Management and Treatment

Diabetes management strategies encompass pharmacotherapy, lifestyle modifications, patient education, and multidisciplinary care. Individualized treatment plans address glycemic control, blood pressure management, lipid optimization, and prevention of complications.

Prevention

Prevention initiatives target modifiable risk factors through health promotion, public health interventions, and community engagement. Emphasizing the role of nutrition, physical activity, and behavioral changes empowers individuals to mitigate their diabetes risk.

Outlook and Prognosis

Prognostic factors such as glycemic control, adherence to therapy, comorbidity burden, and psychosocial support influence long-term outcomes. Enhanced collaboration among healthcare providers, policymakers, and stakeholders is essential to improve diabetes prognosis globally.

Living With Diabetes

Coping with diabetes requires resilience, self-management skills, and social support networks. Empowering individuals through education, self-monitoring tools, and peer support enhances their capacity to navigate the challenges of daily diabetes management.

Impact on Individuals and Society

Diabetes exerts a profound socioeconomic burden, encompassing healthcare costs, productivity losses, and reduced quality of life. Addressing the psychosocial dimensions of diabetes care is integral to fostering holistic well-being and societal resilience.

Future Directions and Research

Advancements in diabetes research, including precision medicine, digital health technologies, and novel therapeutics, offer promising avenues for disease management and prevention. Collaborative research endeavors aim to translate scientific discoveries into tangible clinical benefits.

Conclusion

In conclusion, diabetes represents public health challenge necessitating a comprehensive, patient-centered approach. By fostering awareness, promoting early detection, and advancing evidence-based interventions, we can mitigate the impact of diabetes on individuals, families, and communities worldwide.

Medical students encounter significant academic challenges during their studies, balancing coursework, clinical rotations, research, and personal commitments. Expert Academic Assignment Help offers tailored assistance to meet their needs, providing study materials, tutoring, assignment help, and exam preparation. Beyond academics, it fosters a supportive environment for mentorship and guidance. In essence, Expert Academic Assignment Help is a valuable resource for medical students, empowering them to excel academically and develop into competent healthcare professionals. Contact at expertassignment46@gmail.com for assistance.

[eugeniogalindo]

Staging of Leukemia

Unlike most solid tumors, leukemia is not classified by stage based on tumor size or spread. Different staging systems exist for each leukemia subtype. Overall, leukemia staging consists of multiple criteria including the type, count, and degree of maturation of specific blood cells, as well as the presence of enlarged lymph nodes.

Acute lymphoblastic leukemia (ALL) staging is based on the type and maturity of affected blood cells. The two main types of ALL are B-cell and T-cell ALL. Each type is staged according to the maturity of the blood cells. For example, B-cell ALL is classified as early pre-B, pre-B, common, or mature B-cell. T-cell ALL is classified as pre-T or mature T-cell.

There are two staging systems for acute myeloid leukemia (AML). The French-American-British (FAB) system consists of eight stages based on blood cell type and maturity. Stages M0 to M5 refer to cancers that develop from immature white blood cells like myeloblasts and promyelocytes. Stage M6 refers to acute erythroid leukemia, where malignancy originates from immature red blood cells, whereas stage M7 develops from megakaryoblasts, or platelet-forming cells. Alternatively, the World Health Organization (WHO) stages AML based on prognostic factors such as genetic abnormalities, comorbidities, and cellular differentiation.

Doctors can stage chronic lymphocytic leukemia (CLL) using the Rai or the Binet system. The Rai system is used in the United States. Comprising five stages, it assesses the severity of CLL based on three criteria: lymphocyte count, enlargement of lymph nodes, liver, or spleen, and development of blood disorders like anemia or thrombocytopenia. Rai stage 0, or low-risk CLL, is characterized by high lymphocyte count only, whereas stage 1 also includes enlarged lymph nodes. The liver or spleen may become enlarged in stage 2. Anemia and thrombocytopenia may develop in stages 3 and 4, or high-risk CLL.

In Europe, the Binet staging system focuses on enlargement of lymphoid tissue. Stage A describes CLL cases where some lymph nodes are swollen, stage B includes swollen lymphoid tissues in more than three areas, and stage C - like high-risk CLL in the Rai system - features anemia or thrombocytopenia.

The staging system for chronic myeloid leukemia (CML) is composed of phases that describe the number of immature white blood cells, also known as blasts, found in the bone marrow and bloodstream. Chronic CML is the earliest stage, where blasts account for less than 10 percent of total blood cells and patients present mild symptoms. In accelerated CML, blast growth progresses rapidly and results in more severe symptoms, such as weight loss. The most aggressive stage of CML is the blast phase, where blasts account for at least 20 percent of all blood cells and patients exhibit symptoms as severe as those with AML.

Doctors conduct various tests to accurately stage leukemia. They use diagnostic methods such as blood tests, bone marrow biopsy, and imaging modalities. A complete blood count, or CBC, determines the number of different cells in the bloodstream, and plays an important role in evaluating the severity of leukemia. Similarly, a bone marrow biopsy, taken from the patient’s hip bone, allows doctors to detect and identify the type of leukemia cells present in the bone marrow. Imaging modalities like x-rays and positron emission tomography (PET) scans can locate leukemia metastases in other parts of the body.

[chaoscoining]

🔥 How many special interests do you have at the moment?

🐒 What’s your favorite line from your special interest if it’s a video game/movie/tv show/etc?

✖️️ Is there something you don’t like about your special interest?

💖 Current special interest?

My main spin is psychology, with a secondary spin of LIOM. Honestly it's strange to me to see people gaining and losing spins, since mine are pretty lifetime.

I mostly dislike how misinformed people are, and how popular culture tends to misconstrue many disorders. I also really don't appreciate how little info we have on many disorders, and how many are taught about disorders clinically rather than as things real people and brains experience, preventing them from making connections that help people.

Monkey under the cute due to CW for traumatic experiences:

DSM-IV-TR, Page 334, under Dissociative Identity Disorder - Risk and Prognostic Factors

" Ongoing sexual, physical, and emotional trauma often leads to significant difficulties in later functioning. "

It's just so funny to me how blunt it is while being incredibly obvious. Like, damn, you think?

[myrawjcsmicasereports]

 Kussmaul’s Sign- In a patient with Severe PAH by Javaid Ahmad Dar in  Journal of Clinical Case Reports Medical Images and Health Sciences

Case Report

The patient is a 33 years old male who had a history of acute pulmonary embolism three and a half years back. He had received thrombolysis with alteplase and was subsequently on oral anticoagulants. After one year of the index episode, the patient started to experience progressive worsening of breathlessness. Further evaluation led to the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Patient was offered pulmonary endarterectomy which he declined and preferred medical management. He did not show clinical improvement and eventually developed refractory heart failure. And patient presented to Emergency department (ED) with worsening of breathlessness. On presentation to the ED, patient was in distress with pulse of 110/min, BP of 100/60 with no evidence of pulsus paradoxus, Respiratory rate of 22/min and chest was revealing bilateral basal crepts and CVS examination revealed pansystolic mummer at left parasternal edge. JVP was elevated and showed only one prominent outward crest, which is a prominent CV wave and one dominant downward trough, a prominent Y descent, and there was a paradoxical rise in the JVP on inspiration (video 1) which is an important clinical sign in heart failure commonly known by the eponym Kussmaul’s sign. The prominent CV wave in this paitent reflected sever Tricuspid regurigitation (TR). On echo, patient had severe RV dysfunction with severe TR with Pulmonary hypertension. Patient was treated with intravenous diuretics, and pulmonary vasodilators and improved symptomatically and was referred for work up for heart-lung transplantation.

Discussion

Kussmaul’s sign is characterized by paradoxical increase in right atrial pressure on inspiration due to decrease in RV compliance as in pericardial diseases like chronic constrictive pericarditis, cardiac tamponade, advanced heart failure and pulmonary hypertension. In this patient’s JVP, only prominent upstroke and downstroke is against the constrictive pericarditis which is the most common condition in which Kussmaul’s sign is  seen. Constrictive Pericarditis has prominent X and Y descends in contrast to only prominent Y descend here. In this patient with a history of previous history of CTEPH, Kussmaul’s sign reflects advance disease with severe RV dysfunction. In patients with pulmonary hypertension, Kussmaul’s sign is thought to result due to decreased RV compliance, however in a study in patients with severe PAH, Kussmaul’s sign was shown to reflect severe pulmonary vascular physiology and correlated independently as a poor prognostic factor.1 In a meta-analysis in patients presenting with acute myocardial infarction, Kussmaul’s sign has been found to be very specific for RV involvement and portends an increased preload requirement with intravenous fluids.2 Correctly identifying these clinical signs in a patient presenting to ED, adds in the appropriate management of the patient. This would be most appropriate in patients presenting with inferior wall MI’s where Kussmaul’s sign identifies a subset of patients with RV involvement who have a much sinister prognosis. And in heart failure population, Kussmaul’s sign is common in patients referred for heart transplantation and is associated with adverse cardiopulmonary hemodynamics.3

[doctorsudiptymohanty]

Genomic Contextualization: Personalized Treatment Protocols in Modern Internal Medicine

 Introduction

Genomic contextualization is a cornerstone of modern internal medicine, enabling the development of personalized treatment protocols that are tailored to an individual's unique genetic profile. This approach leverages advances in genomic technologies, bioinformatics, and data analytics to provide precise and effective healthcare. Here, we delve into the concept of genomic contextualization and its implications for personalized treatment protocols in internal medicine.

 The Role of Genomics in Personalized Medicine

Genomics plays a pivotal role in personalized medicine by providing a detailed understanding of an individual's genetic makeup. This information can be used to predict disease susceptibility, diagnose conditions accurately, and select the most effective treatments. The Human Genome Project and subsequent genomic initiatives have laid the foundation for this approach, enabling the identification of genetic variants associated with various diseases.

Whole exome sequencing (WES) and targeted sequencing are particularly useful in clinical practice, as they balance cost and benefit by focusing on protein-coding regions of the genome. These techniques have been integrated into clinical genetics laboratories and large-scale projects such as the 1000 Genome Project and the Exome Aggregation Consortium (ExAC) to catalog population variants and identify diseases associated with rare genetic variants.

 Genomic Contextualization and Disease Management

Genomic contextualization involves correlating an individual's genetic profile with clinical-pathological indexes to devise personalized diagnostic, prognostic, and therapeutic strategies. This approach is particularly beneficial in managing complex diseases such as cancer, diabetes, and endocrine disorders.

In oncology, for example, precision medicine involves identifying oncogenes and tumor suppressor genes to design targeted therapies. Multi-regional sequencing of tumors reveals genetic heterogeneity, allowing for the selection of patients who may benefit from biomarker-driven therapies. Studies like the NCI MATCH trial and the TAPUR study demonstrate the potential of this approach in improving patient outcomes by matching genetic aberrations with targeted therapies.

 Pharmacogenomics and Personalized Treatment

Pharmacogenomics, a subfield of precision medicine, studies how genetic variations affect an individual's response to medications. This knowledge enables healthcare providers to select medications and adjust dosages based on a patient's genetic makeup, maximizing therapeutic benefits while minimizing adverse reactions. For instance, in diabetes management, pharmacogenomics can guide the use of metformin and other antidiabetic drugs, ensuring optimal efficacy and safety.

 Integration of Advanced Technologies and Data Analytics

The integration of advanced technologies such as next-generation sequencing (NGS), machine learning, and artificial intelligence (AI) is crucial for genomic contextualization. These tools facilitate large-scale genomic sequencing, predictive modeling, and the analysis of vast datasets to identify disease patterns and predict treatment responses.

Machine learning algorithms can analyze genomic data in conjunction with clinical and environmental factors to develop personalized treatment algorithms. Telehealth platforms and digital health applications enable real-time monitoring of patient health metrics, medication adherence, and lifestyle modifications, further enhancing patient-centered care.

 Ethical and Regulatory Considerations

While genomic contextualization offers significant benefits, it also raises ethical and regulatory concerns. Ensuring patient data privacy and security is paramount, given the sensitive nature of genetic information. Regulatory frameworks must be established to govern the use of genomic data in healthcare, ensuring compliance with laws such as HIPAA and preventing the misuse of genetic information.

 Future Directions and Challenges

The future of genomic contextualization in internal medicine is promising but also presents several challenges. There is a need for continued research to refine these approaches and address issues such as data quality, class imbalance, and the integration of diverse data sources.

Expanding genomic research, biomarker discovery, and therapeutic innovations will be essential for enhancing treatment efficacy and disease prevention. Additionally, educating healthcare professionals in genomics and precision medicine will be critical for the widespread adoption and effective implementation of these personalized treatment protocols.

 Conclusion

Genomic contextualization is revolutionizing internal medicine by enabling the development of personalized treatment protocols that are tailored to an individual's unique genetic profile. By integrating genomic information with advanced technologies and data analytics, healthcare providers can offer precise and effective care, improving patient outcomes and enhancing the quality of life for individuals with complex medical conditions. As this field continues to evolve, addressing ethical and regulatory concerns while ensuring the accuracy and reliability of genomic data will be essential for maximizing the benefits of personalized medicine.

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From the DSM 5

Risk and prognostic factors for DID

[xinhulian]

What is HER2 and How Does It Relate to Cancer?

The Basics of HER2

HER2, or Human Epidermal Growth Factor Receptor 2, is a protein that is found on the surface of cells and plays a crucial role in cell growth and division. In certain cancers, particularly breast cancer, HER2 can be overexpressed, leading to aggressive tumor growth. Its presence is a significant factor in determining the prognosis and treatment strategies for patients. Understanding the expression of HER2 is vital for effective treatment planning.

The Genetic Mechanism of HER2 Overexpression

HER2 overexpression often results from genetic mutations or amplifications in the HER2 gene located on chromosome 17. These changes lead to the production of excessive HER2 proteins, promoting uncontrolled cell proliferation. The mechanism behind overexpression can vary between individuals, making genetic testing essential to pinpoint specific alterations. Identifying these genetic factors enables clinicians to tailor treatments to target the HER2 pathway effectively.

How Does HER2 Affect Cancer Development?

Mechanisms Leading to Tumor Progression

HER2 activation triggers a cascade of signaling pathways that encourage cell growth, survival, and migration, contributing significantly to tumor progression. This abnormal signaling can lead to heightened aggressiveness in tumor behavior. Notably, tumors that express HER2 often exhibit a higher likelihood of metastasis, making the understanding of its role in cancer development critical for patient management.

Implications of HER2 in Breast Cancer

The relevance of HER2 is particularly pronounced in breast cancer, where approximately 20-25% of cases are HER2-positive. This status is associated with poorer survival rates and more aggressive disease. Awareness of HER2 status not only impacts the prognosis but also informs treatment strategies, including the adoption of targeted therapies that specifically address HER2 signaling pathways.

What Are the Diagnostic Approaches for HER2-Positive Cancers?

Testing Methods for HER2 Status

To determine HER2 status, several testing methods are available, including immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). These tests analyze tumor tissue samples and provide critical insights into the level of HER2 expression or gene amplification. Accurate testing is essential for selecting the appropriate treatment approaches and ensuring optimal patient outcomes.

Interpreting Results and Their Clinical Significance

Interpreting HER2 test results is complex and requires expertise. Positive results indicate the potential for targeted therapies, while negative results might lead to alternative treatment strategies. The clinical significance of these results is immense, as they directly inform patient management decisions and influence prognostic assessments. Clinicians must remain vigilant in reviewing and discussing HER2 status with their patients.

How Can HER2 Status Influence Treatment Decisions?

Personalized Medicine and Targeted Therapies

Herceptin (trastuzumab) and similar agents represent a class of targeted therapies designed for HER2-positive cancers. These therapies work by specifically targeting the HER2 protein, inhibiting its overactive signaling and resulting in reduced tumor growth. The implementation of personalized medicine strategies based on HER2 status has revolutionized treatment protocols, enhancing efficacy for many patients.

Types of Targeted Therapies for HER2-Positive Cancers

In addition to trastuzumab, various other therapies such as pertuzumab and neratinib have emerged as effective options for HER2-positive breast cancer. These treatments can be used as monotherapy or in combination to enhance therapeutic outcomes. Understanding these options enables clinicians to construct individualized treatment plans tailored to specific patient profiles.

Understanding Resistance to HER2-Targeted Treatments

Despite promising outcomes, resistance to HER2-targeted therapies remains a critical challenge. Multiple factors contribute to this resistance, including genetic mutations and alternative signaling pathway activation. Clinicians must consider the possibility of resistance when developing treatment strategies and may need to explore second-line options or combination therapies to overcome this hurdle.

Are There Current Innovations in Treating HER2-Positive Cancers?

Emerging Therapies and Clinical Trials

Current research is focused on investigating novel therapies aimed at improving outcomes for HER2-positive cancer patients. Clinical trials are exploring innovative compounds and combinations that may enhance therapeutic efficacy. Staying abreast of these developments is essential for specialists to provide cutting-edge care.

The Role of Biosimilars in Treatment

Biosimilars are increasingly becoming an integral part of the treatment landscape for HER2-positive cancers, offering cost-effective alternatives to established therapies. The introduction of these agents provides opportunities for better patient access and adherence while maintaining therapeutic equivalence. As biosimilars gain approval, they will likely reshape treatment paradigms.

Solutions for Enhancing Patient Outcomes

Novel Approaches at Celnovte's Solution Center

Exploring additional solutions, such as those available at Celnovte's Solution Center, can enhance patient outcomes in managing HER2-positive cancers. Innovative approaches aiming at improving therapeutic efficacy and addressing treatment challenges are vital as healthcare continues to evolve. Collaborative efforts between specialists and research initiatives are essential for advancing care.

Future Perspectives on HER2 Research and Treatments

Potential Directions for New Therapeutic Strategies

The future of HER2 research lies in discovering novel therapeutic strategies that can address current limitations in treatment. Focused efforts on understanding the biology of HER2-positive tumors will inform the development of more effective therapies. Continuous innovation is crucial to improving patient survival and quality of life.

Collaborative Efforts Needed in Research and Clinical Practice

Collaboration across various disciplines in oncology is critical for advancing HER2 research and the implementation of new treatments. Engaging stakeholders from academic institutions, pharmaceutical companies, and healthcare providers will facilitate the exchange of knowledge and resources necessary to drive progress. These collaborative efforts will ultimately benefit patients and enhance overall cancer care.

celnovte.com

[mcatmemoranda]

Clinical features – Ulcerative colitis is characterized by recurring episodes of inflammation limited to the mucosal layer of the colon. It commonly involves the rectum and may extend in a proximal and continuous fashion to involve other parts of the colon.

Patients with ulcerative colitis usually present with diarrhea, which is frequently associated with blood. Associated symptoms include colicky abdominal pain, urgency, and tenesmus. Patients with mainly distal disease may have constipation accompanied by frequent discharge of blood and mucus.

Patients may also have fever, fatigue, and weight loss. Ulcerative colitis primarily involves the intestine but may be associated with several extraintestinal manifestations.

●When to suspect ulcerative colitis – Ulcerative colitis should be suspected in patients with chronic diarrhea for more than four weeks. The clinical presentation, including laboratory features, endoscopic appearance, and radiology findings, is not specific for ulcerative colitis, and may be seen in a number of other causes of colitis including Crohn disease, radiation colitis, ischemic colitis, infectious colitis, and colitis related to medications.

●Establishing the diagnosis – The diagnosis of ulcerative colitis is based on the presence of diarrhea for more than four weeks and evidence of chronic colitis on endoscopy and biopsy. Since these features are not specific for ulcerative colitis, establishing the diagnosis also requires the exclusion of other causes of colitis by history, laboratory studies, and by biopsies of the colon.

●Disease course – Patients with ulcerative colitis usually present with attacks of bloody diarrhea that lasts for weeks to months. The course of ulcerative colitis typically consists of intermittent exacerbations alternating with periods of complete symptomatic remission. However, a small percentage of patients have continuing symptoms and are unable to achieve remission. Overall, patients who present initially with proctitis have a more benign disease course and frequently respond to topical therapy, whereas those who present with more extensive disease require systemic therapy and have a higher risk of colectomy.

Extension of colonic disease is seen in up to 20 percent of patients within five years. Approximately 67 percent of patients have at least one relapse within 10 years following the diagnosis. The risk of relapse depends on the age at initial diagnosis. The likelihood and timing of colectomy depends on the extent of the disease and severity at presentation. Mucosal healing in response to treatment is an important predictor of long-term clinical outcomes.

●Complications – Complications associated with ulcerative colitis include severe bleeding, toxic megacolon, perforation, strictures, and the development of dysplasia and colorectal cancer. Patients with ulcerative colitis may have a slightly higher mortality as compared with the general population.

Defining disease severity and risk – Patients with mild to moderate ulcerative colitis (UC) are identified as low risk based on prognostic factors that suggest a nonaggressive form of disease: absence of deep mucosal ulcerations, no extraintestinal manifestations, and diagnosis at age >40 years. These patients usually have mild to moderate symptoms (≤6 stools daily with or without blood) and lack signs of systemic inflammation (ie, normal or minimal elevation in C-reactive protein and/or fecal calprotectin levels).

●Pretreatment evaluation – For patients with UC who present with symptoms of a disease flare (eg, diarrhea, rectal bleeding), some aspects of the initial evaluation (eg, laboratory and stool studies, lower endoscopy) are repeated to exclude other conditions as a cause for symptoms and to assess the extent and severity of disease.

●Goals of therapy – The treatment goal for patients with active UC is to achieve clinical and endoscopic remission by demonstrating complete mucosal healing. Response to therapy can be determined by assessing symptoms and laboratory testing and can be supplemented by endoscopy with biopsies as needed.

●Induction therapy for ulcerative proctitis or proctosigmoiditis – For low-risk patients with ulcerative proctitis or proctosigmoiditis, we suggest topical (rectal) mesalamine rather than oral mesalamine or observation (table 1) (Grade 2B). However, for patients who prefer to avoid the burden of daily topical treatment, it is also reasonable to use oral mesalamine or to observe and initiate treatments if disease progresses.

For patients with mild to moderate disease confined to the rectum, we typically initiate treatment with mesalamine suppository once daily (algorithm 1). For patients with mild to moderate disease extending above 18 cm from anal verge into the sigmoid colon, we treat with mesalamine enema once or twice daily.

For low-risk patients with ulcerative proctitis or proctosigmoiditis who do not have symptom improvement after four weeks of topical mesalamine therapy, subsequent options include adding a topical glucocorticoid (eg, suppository, enema), adding an oral 5-aminosalicylic acid (5-ASA) agent, and/or starting an oral glucocorticoid (eg, budesonide multimatrix). Selection of second-line therapy depends on patient preferences, product availability, clinician preferences, and prior response to therapy.

●Induction therapy for left-sided or extensive UC – For low-risk patients with left-sided or extensive mild to moderate UC, we suggest a combination of an oral 5-ASA agent plus rectal mesalamine for induction therapy rather than oral 5-ASA monotherapy (Grade 2B). We begin high-dose oral mesalamine (ie, >3 grams daily) and mesalamine enemas once daily.

●Maintenance therapy – We suggest long-term maintenance therapy for the following low-risk patients who have achieved clinical remission with medical therapy (Grade 2B):

•Patients with ulcerative proctitis and >1 disease flare per year

•Patients with ulcerative proctosigmoiditis

•Patients with UC proximal to the sigmoid colon (i.e., left-sided colitis and extensive colitis)

The choice of maintenance therapy depends on the specific agent used to induce remission, the distribution of disease, patient preferences, clinician preferences, and insurance coverage/cost. For low-risk patients with mild to moderate UC in remission, the goal of management is to prevent clinical and endoscopic relapse.

●Health maintenance – Routine health maintenance, including screening for and prevention of other diseases as well as monitoring for adverse effects of therapy, is an important aspect of the care of patients with inflammatory bowel disease.