Polymyalgia Rheumatica Mimicking an Iliopsoas Abscess
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First-Year Experience of Medical Emergency Care, a New Healthcare Chain for Acute Life-Threatening Medical Conditions at the ED
Research Article Published: 13 Dec, 2018 Journal of Cardiology Forecast First-Year Experience of Medical Emergency Care, a New Healthcare Chain for Acute Life-Threatening Medical Conditions at the ED Bergh N2,3*, Hellberg J1,3, Rehnström K1, Karlsson T4, Ekerstad N5,6 and Karlson BW1,2 1Department of Acute and Internal Medicine, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla- Vänersborg, Sweden 2Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3Department of Cardiology, Sahlgrenska University Hospital, Sahlgrenska, Gothenburg, Sweden 4Health Metrics Unit, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 5Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, Sweden 6Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden Abstract Background: There is a high inflow of patients at most medical emergency departments (ED). In 2013 the Medical Emergency Care (MEC) healthcare chain was introduced at the NU-hospital group, Sweden, in order to better identify, alerting and treat the critically ill adult medical patients. Aim: The primary aim of this retrospective study was to characterize medical patients who were judged and handled as critically ill according to the concept of MEC during the first year following its introduction. OPEN ACCESS Methods: This is a single-center, consecutive cohort study of all patients initially taken care of at the ED using the concept of MEC at the NU Hospital group, Västra Götaland health care region, * Correspondence: Sweden, between February 26 2013 and February 28 2014. Niklas Bergh, Department of Molecular and Clinical Medicine, Department Results: A total of 856 patients were registered as MEC patients, representing 3.2% of all adult medical ED patients. -
Rotator Cuff Tendon Ruptures and Degeneration As the First Manifestation of Polymyalgia Rheumatica Disease - a Case Report
Open Access Austin Journal of Clinical Case Reports Case Report Rotator Cuff Tendon Ruptures and Degeneration as the First Manifestation of Polymyalgia Rheumatica Disease - A Case Report Bazoukis G1*, Michelongona P2, Papadatos SS1, Pagkalidou E1, Grigoropoulou P1, Fragkou A1 and Abstract Yalouris A1 Polymyalgia Rheumatica (PMR) is a common rheumatic disease of the 1Department of Internal Medicine, General Hospital of elderly. Although it is a well-established disease, its causes and pathophysiology Athens “Elpis”, Greece remain unclear. In our case report we present an 83-year-old female presented 2Department of Internal Medicine, General Hospital of at the emergency department because of fever and diarrhea. Her medical Korinthos, Greece history included a recent orthopedic surgery because of tendons rupture of the *Corresponding author: George Bazoukis, rotator cuff. Her blood exams showed increased inflammatory markers and a Department of Internal Medicine, General Hospital of three-digit ESR. The diagnosis of PMR was set after the exclusion of infectious Athens “Elpis”, Greece and other diseases that mimic PMR symptoms. To the best of our knowledge, it is the first time that rotator cuff tendons rupture and degeneration is the first Received: June 05, 2016; Accepted: August 02, 2016; manifestation of PMR disease. Clinicians should be aware of the degeneration Published: September 08, 2016 of the shoulder and hip extra-articular structures in PMR and they should keep in mind that it can be the first manifestation of the disease. Keywords: Polymyalgia rheumatica; Rotator cuff denegeration; Tendon rupture Introduction and infraspinatus muscles as well as significant tendinopathy of the subscapularis and long head of biceps muscles. -
James Albers, MD Phd Kirsten Gruis, MD Revised 10/2010
James Albers, MD PhD Kirsten Gruis, MD Revised 10/2010 RADICULOPATHY I. Focal Radiculopathy A. Definitions: 1. Pathological process affecting dorsal (sensory) and/or ventral (motor) spinal roots 2. Clinically includes roots, DRG (dorsal root ganglion) and spinal nerves. B. Clinical Characteristics: 1. Pain may be out of proportion to objective deficit. 2. If chronic, radiculopathy can be asymptomatic. 3. Features favoring radiculopathy vs plexopathy/mononeuropathy a. Proximal pain (neck, low back) b. Pain with movement (tilting neck, lumbar extension) c. Pain with cough, sneeze, Valsalva C. Variables in localization: 1. Nerve damage varies in severity 2. Dermatomal and Myotomal distributions overlap: a. Masks objective deficits b. Enlarges positive phenomena (pain) 3. Pain may also be referred. 4. Involvement of multiple roots may confuse localization. 5. Variable anatomy, especially motor 4. If pain reproduced by palpation then higher suspicion for musculoskeletal disorder mimicking radiculopathy (see Table 1 and 2). However, pain to palpation does not exclude a radiculopathy or abnormal EDX test. 5. 32% of patients referred for EMG lab for lumbosacral radiculopathy have a musculoskeletal disorder. Page 1 of 11 Table 1 Musculoskeletal conditions that commonly mimic cervical radiculopathy Condition Clinical symptoms/signs Fibromyalgia syndrome Pain all over, female predominance, often sleep problems, tender to palpation in multiple areas Polymyalgia rheumatica >50 years old, pain and stiffness in neck, shoulder and hips, high erythrocyte -
Preserved Physical Fitness Is Associated with Lower 1-Year Mortality in Frail Elderly Patients with a Severe Comorbidity Burden
Journal name: Clinical Interventions in Aging Article Designation: Original Research Year: 2019 Volume: 14 Clinical Interventions in Aging Dovepress Running head verso: Åhlund et al Running head recto: Åhlund et al open access to scientific and medical research DOI: 198591 Open Access Full Text Article ORIGINAL RESEARCH Preserved physical fitness is associated with lower 1-year mortality in frail elderly patients with a severe comorbidity burden This article was published in the following Dove Medical Press journal: Clinical Interventions in Aging Kristina Åhlund1,2 Introduction: Physical deterioration in connection with a care episode is common. The aim Niklas Ekerstad3,4 of this study was, in frail elderly patients with a severe comorbidity burden, to analyze 1) the Maria Bäck2,5 association between physical fitness measurements and 1-year mortality and 2) the association Björn W Karlson6,7 between preserved physical fitness during the first three months after discharge from emergency Birgitta Öberg2 hospital care and 1-year prognosis. Methods: Frail elderly patients ($75 years) in need of inpatient emergency medical care were 1Department of Physiotherapy, NU included. Aerobic capacity (six-minute walk test, 6MWT) and muscle strength (handgrip strength Hospital Group, Trollhättan, Sweden; 2Department of Medical and Health test, HS) were assessed during the hospital stay and at a three-month follow-up. The results Sciences, Division of Physiotherapy, were analyzed using multivariate Cox regression; 1) 0–12-month analysis and 2) 0–3-month Linköping University, Linköping, For personal use only. Sweden; 3Department of Research and change in physical fitness in relation to 1-year mortality. The analyses were adjusted for age, Development, NU Hospital Group, gender, comorbidity and frailty. -
Are Frail Elderly Patients Treated in a CGA Unit More Satisfied with Their Hospital Care Than Those Treated in Conventional Acute Medical Care?
Journal name: Patient Preference and Adherence Article Designation: Original Research Year: 2018 Volume: 12 Patient Preference and Adherence Dovepress Running head verso: Ekerstad et al Running head recto: Comparison of acute treatment in CGA units and in conventional wards open access to scientific and medical research DOI: http://dx.doi.org/10.2147/PPA.S154658 Open Access Full Text Article ORIGINAL RESEARCH Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Niklas Ekerstad1,2 Objectives: Our aim was to study whether the acute care of frail elderly patients directly Göran Östberg3 admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a con- Maria Johansson3 ventional acute medical care unit in terms of patient satisfaction. Björn W Karlson3,4 Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, CGA units and in conventional wards. Trollhättan-Uddevalla-Vänersborg, Setting: This study was conducted in the NÄL-Uddevalla county hospital in western Sweden. 2 Department of Medical and Health Participants: In this follow-up to the TREEE study, 229 frail patients, aged $75 years, in need Sciences, Division of Health Care Analysis, Linköping University, of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in 3 For personal use only. Linköping, Division of Internal and the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. -
Rheumatism and the Thyroid
130 Journal of the Royal Society of Medicine Volume 86 March 1993 Rheumatism and the thyroid D N Golding MA MD FRCPI The Old Forge, Woodside Green, Bishop's Stortford, Herts CM22 7UL Keywords: thyrotoxicosis; rheumatism; hypothyroidism; Hashimoto's disease Muscle weakness and myopathy are well-known Paradoxically the serum muscle enzymes (such as Presidential features of thyrotoxicosis. It is less well-known that creatine kinase) are more likely to be elevated in the Address muscle weakness, pain and even swelling of small mild myopathy associated with hypothyroidism than given to joints are not uncommon in hypothyroidism. Recently in the clinically more severe thyrotoxic myopathy6. Section of it has become apparent that a seronegative poly- Capsulitis of the shoulders is seen in some hypo- Rheumatology & arthritis of small joints may occur in patients with thyroid patients, though is commoner in thyrotoxicosis. Rehabilitation, Hashimoto's disease (even when euthyroid), and that A bilateral case has been described in a myxoedem- 13 May 1992 this condition may be responsible for other rheumatic atous patient with proximal myopathy and an acute features, such as neck and chest pain. phase response7. In hypothyroidism muscular pain is often associated with marked fatigue (the 'after tennis Historical note feeling') and prolonged morning stiffness (thought That rheumatic features can be associated with thyroid to be due to deficiency of alpha-glucosidase in this disorders has been known for some time: for example, condition), which may give a mistaken diagnosis in 1873 Sir William Gull described two cases of 'A of polymyalgia rheumatica. It must however be cretinoidal state supervening in Adult Women', remembered that polymyalgia rheumatica may coexist describing neck stiffness and joint pain; and early with hypothyroidism8- and indeed the prevalence of British reports were described in a recent paper by hypothyroidism in patients with polymyalgia is about in 5%, significantly greater than in controls. -
Conditions Related to Inflammatory Arthritis
Conditions Related to Inflammatory Arthritis There are many conditions related to inflammatory arthritis. Some exhibit symptoms similar to those of inflammatory arthritis, some are autoimmune disorders that result from inflammatory arthritis, and some occur in conjunction with inflammatory arthritis. Related conditions are listed for information purposes only. • Adhesive capsulitis – also known as “frozen shoulder,” the connective tissue surrounding the joint becomes stiff and inflamed causing extreme pain and greatly restricting movement. • Adult onset Still’s disease – a form of arthritis characterized by high spiking fevers and a salmon- colored rash. Still’s disease is more common in children. • Caplan’s syndrome – an inflammation and scarring of the lungs in people with rheumatoid arthritis who have exposure to coal dust, as in a mine. • Celiac disease – an autoimmune disorder of the small intestine that causes malabsorption of nutrients and can eventually cause osteopenia or osteoporosis. • Dermatomyositis – a connective tissue disease characterized by inflammation of the muscles and the skin. The condition is believed to be caused either by viral infection or an autoimmune reaction. • Diabetic finger sclerosis – a complication of diabetes, causing a hardening of the skin and connective tissue in the fingers, thus causing stiffness. • Duchenne muscular dystrophy – one of the most prevalent types of muscular dystrophy, characterized by rapid muscle degeneration. • Dupuytren’s contracture – an abnormal thickening of tissues in the palm and fingers that can cause the fingers to curl. • Eosinophilic fasciitis (Shulman’s syndrome) – a condition in which the muscle tissue underneath the skin becomes swollen and thick. People with eosinophilic fasciitis have a buildup of eosinophils—a type of white blood cell—in the affected tissue. -
A Roadmap for Improving Wikipedia 29/08 2017
Embargo Tuesday 29th August at 00:05 [UK time] Press release 29/08 A roadmap for improving Wikipedia The evolution of Wikipedia’s medical content: past, present and future 2017 Shafee T, Masukume G, Kipersztok L, Das D, Häggström M, Heilman J. (2017) Journal of Epidemiology & Community Health 71(10) Wikipedia is a key source of public health information Wikipedia needs expert input Health professionals need Wikipedia’s reach Image: Blausen medical CC BY-SA, via WikiJournal of Medicine (full res version) doi:10.15347/wjm/2014.010. Given its prominence as a source of scientific and medical information, improving Wikipedia is a public health “Wikipedia has over 44 million necessity. How can the medical and scientific community articles across 295 languages work towards enhancing the quality and quantity of its and climbing, but contributor medical articles? An international group of doctors and numbers are pretty flat.” researchers have outlined their recommendations in the Journal of Epidemiology and Community Health. The encyclopedia’s content, community and collaborations have changed a lot over the last 16 years. Now is also the time to plan improvements for its future. The Wikimedia Foundation, the charity that supports Wikipedia, is currently updating their strategy through to 2030. It’s therefore an ideal “At 16 years old, Wikipedia is opportunity for those with an interest in disseminating a teenager, and going through biomedical information to become involved in some changes.” Wikipedia. The authors identify four main areas that can be used to improve the encyclopedia. doi.org/10.1136/jech-2016-208601 Embargo Tuesday 29th August at 00:05 [UK time] Individual Wikipedia is built entirely by volunteers. -
SUPPLEMENTARY APPENDIX Mutation Status of Essential Thrombocythemia and Primary Myelofibrosis Defines Clinical Outcome
SUPPLEMENTARY APPENDIX Mutation status of essential thrombocythemia and primary myelofibrosis defines clinical outcome Julia Asp, 1,2 Björn Andréasson, 3,4 Ulrika Hansson, 5 Carina Wasslavik, 2 Johanna Abelsson, 3 Peter Johansson, 3,4 and Lars Palmqvist 1,2 1Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; 2Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg; 3Haematology and Coagulation Section, Department of Medicine, Sahlgrenska University Hospital, Gothenburg; 4Hematology Section, Department of Medicine, NU Hospital Group, Uddevalla; and 5Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden Correspondence: [email protected] doi:10.3324/haematol.2015.138958 Online supplement Mutation Status of Essential Thrombocythemia and Primary Myelofibrosis Defines Clinical Outcome Julia Asp, Björn Andréasson, Ulrika Hansson, Carina Wasslavik, Johanna Abelsson, Peter Johansson, and Lars Palmqvist Methods Patients The study was performed in accordance to the Declaration of Helsinki after ethical approval by the Research Ethics Board at the University of Gothenburg and the Sahlgrenska Academy, Gothenburg, Sweden. All patients diagnosed with ET or PMF according to the WHO 2008 classification between 2008 and 2013 in Western Sweden at the Sahlgrenska University Hospital or NU Hospital Group and reported to the Swedish national cancer register, INCA, were selected (n=186). 170 patients were included; 129 ET patients (73 females and 56 males, median age 67 years, range 27–90 years) and 41 PMF patients (21 females and 20 males, median age 70 years, range 32–85 years). 16 patients did not answer the request to participate in the study. Clinical, laboratory and outcome data was available for all patients. -
Polymyalgia Rheumatica: an Autoinflammatory Disorder?
Autoinflammatory disorders RMD Open: first published as 10.1136/rmdopen-2018-000694 on 4 June 2018. Downloaded from EDITORIAL Polymyalgia rheumatica: an autoinflammatory disorder? Alberto Floris,1 Matteo Piga,1 Alberto Cauli,1 Carlo Salvarani,2,3 Alessandro Mathieu1 To cite: Floris A, Piga M, Cauli A, Polymyalgia rheumatica (PMR) is an (figure 2A).6 Further, after low-dose gluco- et al. Polymyalgia rheumatica: elderly onset syndrome characterised by corticoid therapy initiation, patients with an autoinflammatory aching and stiffness in the shoulders and the PMR experience a rapid improvement of disorder?. RMD Open 2018;4:e000694. doi:10.1136/ pelvic girdle associated to increased levels symptoms, generally within 24–72 hours, and rmdopen-2018-000694 of acute phase reactants and rapid response more than 40% of them achieve complete to glucocorticoids.1 Although the cause of response within 3 weeks.1 Similarly, in rare ► Prepublication history for PMR remains unknown, most of the evidence monogenic AIDs, a rapid remission of symp- this paper is available online. suggest a multifactorial aetiology inducing an toms and significant reduction in frequency To view these files, please visit immunomediated pathogenesis.1 2 of inflammatory attacks is rapidly achieved the journal online (http:// dx. doi. org/ 10. 1136/ rmdopen- 2018- According to the ‘immunological with specific treatment, such as colchicine in 000694). continuum model’ proposed by McGonagle familial Mediterranean fever (FMF) and inter- in 2006, all immune-mediated diseases can -
20 Care of People with Musculoskeletal Problems
20 Care of people with musculoskeletal problems Applicable guidelines Relevant NICE guidelines and pathways: https://pathways.nice.org.uk/pathways/musculoskeletal- conditions SIGN guidelines (www.sign.ac.uk): 136 Management of chronic pain The British Institute of Musculoskeletal Medicine: www.bimm.org.uk The Primary Care Rheumatology Society: www.pcrsociety.org.uk Arthritis Research UK: www.arthritisresearchuk.org The British Association of Sport and Exercise Medicine: www.basem.co.uk/ The UK Anti-Doping website: https://ukad.org.uk/medications-and-substances/about-TUE/ The National Osteoporosis Society: www.nos.org.uk FRAX tool to evaluate fracture risk: www.shef.ac.uk/FRAX The Disabled Living Foundation: www.dlf.org.uk RCGP Inflammatory Arthritis Toolkit: www.rcgp.org.uk/clinical-and- research/resources/toolkits/inflammatory-arthritis-toolkit.aspx A resource to help GPs assess fitness for work: http://fitforwork.org Material for patient www.arthritisresearchuk.org has PILs available to download www.backcare.org.uk – charity for back health www.ccaa.org.uk – Children’s Chronic Arthritis Association www.bssa.uk.net – British Sjögren’s Syndrome Association CSA Cases Workbook for the MRCGP, 3e © 2019, Scion Publishing Ltd www.lupusuk.org.uk – lupus charity www.nass.co.uk – National Ankylosing Spondylitis Society www.nras.org.uk – National Rheumatoid Arthritis Society www.pmrandgca.org.uk – Polymyalgia Rheumatica and Giant Cell Arteritis Scotland www.sruk.co.uk – Scleroderma and Reynaud’s UK www.rsiaction.org.uk – national repetitive strain -
An Antenatal Health Care Intervention Can Reduce Gestational Weight Gain in Women with Obesity
Midwifery ∎ (∎∎∎∎) ∎∎∎–∎∎∎ Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/midw Mighty Mums – An antenatal health care intervention can reduce gestational weight gain in women with obesity Karin Haby, RD, MSc (Maternal health care dietitian)a,n, Anna Glantz, MD, Ph D (Senior Consultant in Obstetrics and Gynecology, Head of Antenatal Health Care)b, Ragnar Hanas, MD, Ph D (Assoc Prof, Senior Consultant)c, Åsa Premberg, RNM, Ph D (Senior lecturer)d a Antenatal Health Care, Primary Health Care, Research and Development Unit, Närhälsan, Gothenburg, Region of Västra Götaland, Sweden b Primary Health Care, Närhälsan, Gothenburg, Region of Västra Götaland, Sweden c The Sahlgrenska Academy, University of Gothenburg, Institute of Clinical Sciences and Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla, Region of Västra Götaland, Sweden d The Sahlgrenska Academy, University of Gothenburg, Primary Health Care, Research and Development Unit, Närhälsan, Gothenburg, Region of Västra Götaland, Sweden article info abstract Article history: Background: overweight and obesity are growing public health problems and around 13% of women Received 15 November 2014 assigned to antenatal health care (AHC) in Sweden have obesity (Body Mass Index, BMI Z30). The risk of Received in revised form complications during pregnancy and childbirth increase with increasing BMI. Excessive gestational 22 March 2015 weight gain (GWG) among obese women further increases the risks of adverse pregnancy outcomes. Accepted 29 March 2015 In this pilot-study from AHC in Gothenburg, a co-ordinated project with standardised care, given by midwives and supported by dietitian and aiming at reducing weight gain in obese pregnant women, is Keywords: evaluated.