Chronic pruritus is defined as itching that lasts for 6 weeks or longer.
Chronic pruritus accounts for about 7 million physician visits annually in the US and affects approximately 22% of people during their lifetime. Chronic pruritus is associated with impaired sleep and reduced quality of life.
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Mechanisms of Action and Common Adverse Effects of 3 Classes of Antiobesity Medication
AMPA indicates α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; GABA, γ-aminobutyric acid; GIP, glucose-dependent insulinotropic polypeptide; GLP-1, glucagon-like peptide 1.
Use of 24-Hour History for Insomnia Assessment.
Insomnia manifests as a sleep problem but affects — and is affected by — daytime behaviors. A thorough insomnia history helps evaluate symptoms and behaviors both at night and during the day. Shown are key parts of an insomnia assessment across a 24-hour day.
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Transmission of Taste Information.
Fibers innervating the taste buds transmit signals to the gustatory region of the nucleus of the tractus solitarius (NTS), then to the thalamus and the gustatory cortex (pathway depicted in red). Each taste bud is innervated by primary intragemmal gustatory fibers, which extensively branch and connect with multiple taste buds, interacting with many TRCs. This results in electrical activity that reflects the input from numerous TRCs. Taste buds in the fungiform papillae are innervated by sensory neurons of the geniculate ganglion, traveling through the chorda tympani branch of the facial nerve (cranial nerve [CN] VII). Taste buds in the posterior third of the tongue are innervated by sensory neurons of the petrosal ganglion, traveling through the lingual branch of the glossopharyngeal nerve (CN IX).
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alpha-gal syndrome is a type of food allergy to mammalian (red) meat products.
Alpha-gal syndrome is associated with tick bites, most commonly from the Lone Star tick in the US, but also from different types of ticks in other areas of the world. During a bite, a tick injects a type of sugar molecule (galactose-alpha-1,3-galactose), also called alpha-gal, which leads to formation of an antibody. Because alpha-gal is present on cells of most mammals, including cows, pigs, lambs, and goats, when affected individuals eat these animal products, an allergic reaction may occur.
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W
hile high blood pressure is more common in adults, it can affect children too.
Each time the heart beats, it pumps blood through tubes called arteries to all parts of the body. As blood moves through these arteries, it pushes against the walls of the arteries—this is known as blood pressure.
Pediatric hypertension, or high blood pressure in children, occurs when a child’s blood pushes too forcefully against the artery walls. Children are at a higher risk if there is a family history of high blood pressure, if they are carrying too much weight, or if they do not stay active.
Most children with hypertension do not have symptoms. Because hypertension is “silent,” the American Academy of Pediatrics recommends checking children’s blood pressure at pediatrician visits starting at age 3 years, or even earlier for children who had a low birth weight…
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Model of Systemic Inflammation, Immune Dysregulation, and a Structurally Hostile Tumor Microenvironment (TME) Associated With High Tumor Burden and Related Implications on the Chimeric Antigen Receptor (CAR) T-Cell Therapeutic Cycle. Systemic and local implications of high tumor burden and its association with CAR T-cell therapy. A, Patients with advanced-stage disease may display a tumor-burdened immune system consisting of high levels of circulating immunosuppressive factors and immune cells, resulting in a global suppression of T cells. The latter may affect the CAR T-cell manufacturing process and final effector CAR T-cell quality. B, The CAR T-cell products generated from patients with a highly tumor-burdened immune system may display defective capacity to overcome the tumor load by means of impaired expansion capacity and reduced persistence.
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Assessment of Thyrotoxicosis
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Natural History of Chronic Hepatitis D. Chronic hepatitis D is associated with a more rapid progression to cirrhosis and a higher risk of hepatocellular carcinoma than HBV monoinfection. Identifying patients in whom fibrosis progresses rapidly would be crucial for determining the prognosis, but mechanisms of fibrotic progression are poorly understood. Histologic findings (hematoxylin and eosin stain) are shown. Liver fibrosis is assessed with the use of Metavir staging, which ranges from F0 (no fibrosis) to F4 (cirrhosis). Some HDV genotypes may influence disease activity. Persistent HDV viremia is a factor in disease progression and a predictor of death. In liver disease in general, factors associated with fibrosis are male sex, older age at infection, excessive alcohol consumption, obesity, diabetes, and immunodeficiency.
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Heart Failure With Preserved Ejection Fraction (HFpEF) Differential Diagnosis
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Perioperative Direct Oral Anticoagulant (DOAC) Dosing Schedule
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Bed bugs are small parasitic insects that eat only one thing—human blood—and they get it only one way: by biting people.
A bed bug does not eat much or often. If many bed bugs are present, occupants are more likely to see and be bothered by them. Bites may be red, swollen and itchy, and new bites may be seen each morning. Fortunately, bed bugs do not transmit any diseases.
Bed bugs are found worldwide from fancy hotels to ordinary homes. Because bed bugs seem to leave some people alone (even if they sleep in the same bed) and some people have almost no reaction to the bites, it is often difficult for people to accept that their home has bed bugs.
Magnesium and Cell Function.
Magnesium is an important cofactor for numerous enzymes. All ATPase reactions require Mg2+–ATP, including those involved in RNA and DNA biologic functions. It opposes calcium actions and acts as a second messenger. Magnesium influences circadian-clock genes, which control circadian rhythm in biologic systems. ADP denotes adenosine disphosphate.
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Buridan’s Assay and Nephrogenic Diabetes Insipidus.
In Buridan’s assay, a food- and water-restricted mouse is provided with two equally accessible reward spouts that contain liquid food in one and water in the other. Panels A and B are adapted from Richman et al.2 In Panel A, the “energy landscape” with wells for hunger and thirst represent a model explaining choice. If hunger and thirst are equal, the wells have equal depth and the initial choice between eating and drinking in this mouse model is random. As one urge starts to become satisfied, the landscape shifts, favoring the other urge; the mouse acts accordingly and alternates between drinking and eating until both urges are fully satisfied, as shown in Panel B. Richman et al. monitored the activity of mice deprived of food and water. After an olfactory cue, the mice could lick toward either food or water. The x axis in Panel B denotes trials across a session, and the y axis shows the cumulative number of licks after each olfactory cue.
Types of Flat Head Syndrome
There are 2 types of flat head shapes, although some infants can have both forms. In plagiocephaly, the back of the head is flat on one side. In severe cases, this may cause the ear on that side of the head to appear pushed forward and/or lead to an uneven appearance of the face, neck, or jaw. In brachycephaly, the back of the head is flat and the head appears wider than normal.
Flat head syndrome does not affect brain development or intelligence. Approximately 1 in every 8 healthy infants younger than 1 year have flat head syndrome, although most have a mild form. Diagnosis is made by a clinician based on physical examination.
Rates of flat head syndrome increased after the 1994 recommendation that infants sleep on their backs to prevent sudden infant death syndrome (SIDS).
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Comparison of Pros and Cons of Vascular Access Types
aWith rope ladder cannulation.
bAfter successful maturation and use.
cReduced complications requiring hospital admission.
dNeeds procedure to start using AVF.
eWith use of early-cannulation graft.
fShort-term patency improvement with acetylsalicylic acid/dipyridamole or fish oil.
gLow thrombosis risk short term, but higher risk long term.
hAutogenous arteriovenous graft needs procedures to maintain patency.
iDepends on prescription, including dialysis duration and blood pump speed of dialysis machine.
jCentral vein stenosis and CVC lumen thrombosis.
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Mechanisms of Respiratory Failure in Patients with Botulism.
The botulinum neurotoxin can lead to respiratory failure by affecting the muscles involved in respiration, the muscles involved in maintaining airway tone, or the muscles involved in airway clearance. In addition, autonomic dysfunction may contribute to the development of respiratory failure.
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Clinical Manifestation of Age-Related Macular Degeneration (AMD) A, Early AMD with multiple medium-sized drusen (asterisks) without pigment abnormalities. Drusen shown as yellowish material on color fundus image (left panel), variable signal on fundus autofluorescence (middle panel), and dome-shaped elevations on optical coherence tomography (OCT) (right panel). Note increase in size from early AMD (A) to intermediate AMD (B). B, Intermediate AMD with large drusen (asterisks) and pigment abnormalities. C, Late-stage AMD. Area of geographic atrophy (pink arrowheads) with well-demarcated borders on fundus autofluorescence (middle panel) that correspond to the area of photoreceptors and retinal pigment epithelium loss on OCT (right panel). D, Exudative neovascular AMD. Asterisks indicate drusen; black arrowheads, small hemorrhage; white arrowheads, leakage on fluorescein angiography (middle panel)
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Topical nonprescription pain medications are over-the-counter drugs applied to the skin to treat pain.
Topical pain medications can effectively treat pain caused by several acute and chronic conditions.
Topical Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Topical NSAIDs include diclofenac and methyl salicylate. These may be applied as a gel, cream, lotion, ointment, patch, or topical solution pump.
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Opill is a progestin-only pill that contains the progestin hormone (norgestrel) but not estrogen. Progestin-only pills prevent pregnancy by stopping sperm from entering the uterus and may prevent egg release from the ovary in some individuals. Opill will likely be available over the counter in US pharmacies in 2024.
Progestin-only pills should be taken daily at the same time of day. Individuals who miss a dose by more than 3 hours are recommended to use a backup birth control method (such as a condom) and should take the missed dose as soon as possible.
If taken as recommended, progestin-only pills are highly effective at preventing pregnancy. Common side effects include irregular, lighter, or more frequent periods. Less commonly, people may experience nausea, vomiting, headache, or fatigue while taking progestin-only pills.
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Stages of HPV-Mediated Carcinogenesis
This depicts the necessary, sequential stages of HPV-mediated carcinogenesis: HPV infection, intraepithelial precancer, and cancer. The images illustrate what a clinician might see on physical examination at each stage of carcinogensis. HPV genotype is a major influence on risks of progression to precancer and cancer compared with immune control and regression to negative results on HPV testing. Familiar and overlapping microscopic (cytologic and histologic) morphologic grading as well as visual classifications have been used to indicate the increasing severity of HPV-induced changes. However, morphologic and visual grading classifications have imperfect reproducibility and accuracy, and many diagnoses are equivocal. Molecular tests (eg, p16/Ki67 dual stain) are increasingly used to identify the likelihood of prevalent and incipient precancer.
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Syphilis is an infection caused by the bacterium Treponema pallidum.
Syphilis is a sexually transmitted infection that is acquired through genital, oral, or anal sex. Syphilis can also be passed to a fetus during pregnancy, causing congenital syphilis. Early diagnosis and treatment of syphilis is important to prevent progression of the disease and avoid transmission to others. Syphilis infections can be decreased by use of condoms during sex.
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