Sternal pain - treatment options?
I have a 48 year old patient, a marathon runner, who has been experiencing deep sternal pain for the last 5 years. Severe pain is triggered during running, on both sides of her chest and no symptoms felt at rest. Cardiovascular tests, including stress test, revealed an AV conduction issue and although a pacemaker was inserted, there was no improvement in the patient's symptoms. Then the patient had a hiatal hernia repair with no improvement. Then she had injections for costochondritis, manubriosternal joint with steroids and lidocaine, intercostal nerve block at T7, all was ineffective. I would be happy to hear for any opinions my colleagues have.
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Child and Adolescent Psychiatry
United Kingdom
As a former BMA representative, I have been shocked by the approach of focusing on pay when the biggest impact on doctors' morale comes from poor conditions of work, with the ever increasing demands of the employer added to increasing reluctance to offer basic supports (such as funding courses and providing decent facilities for rest times within institutions). These points might justify industrial action.
Aubrey Bristow is quite correct and I would add that there are very few careers in the private sector that offer the reliable pay progression by length of service enjoyed in the public sector. Ultimately, we all pay for healthcare through taxation and there is no evidence that, if fully informed of the facts on doctors' pay and pensions, the UK population would want to pay more tax to support medical pay.
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Internal Medicine, Immunology and Allergy
Colombia
Sérum viscosity ,it is a laboratory exam,and should be ordered whenever the Rouleaux fenómenom is reported positive in a peripheral blood smear ,in an older patient with increased gamaglobulins ( IgM >40 g/l,IgG>60 g/l,or IgA >50g/l
Viscosity ,can be measured with the Ostwald viscosimeter,and it is reported in cP ( centipoise),or in relative termos in comparisonto water ( 0.894cP).The normal sérum viscosity, equals 1.5 cP.
Waldenstrom macroglobulinemia ( WM),or Múltiple Mieloma MM),are classical examples of Paraproteinemias associated with increased sérum viscosity.
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Internal Medicine, Cardiology
Italy
I medici dovrebbero lavorare in gruppo come nei reparti ospedalieri:1)formare una equipe, 3-4 medici con segretaria, fare turni per le chiamate domiciliari cosi oltre a parlare si andrà a visitare il pazienti e i propri pazienti in attesa in ambulatorio verranno visti dai colleghi rimasti. Basta solo parlare al telefono indirizzando da subito i paz. In pronto saoccorso se si sospetta una urgenza: esiste ancora l’esame obiettivo. Non demandare ai giovani medici solo i festivi e le notti: così non si vedono mai le urgenze e si diventa medici da tavolino ovvero degli psicologi travestiti da medico. 2) il medico che esce da 6 anni di corso dovrebbe essere in grado da subito da fare il medico di famiglia: non opera, non aggiusta fratture, non assiste parti che fa? Il comodo suo e non un importante servizio professionale. Per gli aspetti burocratici massimo sei mesi di apprendistato. 3) aggiornamento continuo con corsi ad opera degli Ordini dei Medici e continuo contatto con gli Specialisti, si sono inserite troppe agenzie spurie che si sono indebitamente ritagliate dei compiti surrettizi..4) per le Specialità nessuna sostanziale variazione rispetto ad ora. Durante il corso di 6 anni al mattino in ospedale o ambulatori( dal terzo anno) e al pomeriggio lezioni accademiche:prepararsi alle visite e diagnosi e non solo Medicina intellettuale.
Dott Francesco STELLA,già medico ospedaliero con funzione anche di P.S.; specialista in Medicina Interna e in Cardiologia.
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Major Drug Shortages Not Likely After Tornado Damages Pfizer Plant, FDA Says
MONDAY, July 24, 2023 (HealthDay News) -- Tornado damage to a Pfizer drug-making plant in North Carolina is unlikely to trigger drug shortages across the country, the U.S. Food and Drug Administration says.
"We do not expect there to be any immediate significant impacts on supply, given the products are currently at hospitals and in the distribution system," FDA Commissioner Robert Califf, M.D., said in an agency news release posted Friday. "Our initial analysis has identified less than 10 drugs for which Pfizer's North Carolina plant is the sole source for the U.S. market; however, a number of these are specific formulations for which there should be substitutes or for which many weeks' worth of stock should be available in Pfizer's other warehouses."
Meanwhile, Pfizer officials said the company is working to repair the damage and mitigate any shortage of drugs made at the facility.
"Clearly nature is strong. So, too, is ingenuity and the human spirit. A great deal of work needs to be done, but I assure everyone, most importantly the people of the Rocky Mount community, that we will put Pfizer's full power behind this effort," Pfizer Chairman and CEO Albert Bourla, M.D., said in a company statement. "We will work in lockstep with our partners and local authorities to restore and rebuild the site and the community."
The FDA said it cannot release any information about the specific drugs made or stored at the plant because of disclosure laws.
The Pfizer plant is closed as the damage is assessed. Most of the damage was caused to the warehouse, which stores raw materials, packaging supplies, and finished medicines, the company said. Pfizer is exploring alternative manufacturing locations, and there does not appear to be any major damage to the medicine production areas, the company added.
Copyright © 2020 HealthDay. All rights reserved.
JAK Signaling May Be Behind Polymyalgia Rheumatica
MONDAY, July 10, 2023 (HealthDay News) -- Janus tyrosine kinase (JAK) signaling may be involved in the pathogenesis of polymyalgia rheumatica (PMR), and tofacitinib may be an effective treatment, according to a pilot study published online June 29 in PLOS Medicine.
Xinlei Ma, from Zhejiang University in Hangzhou, China, and colleagues examined pathogenetic features of PMR and assessed the efficacy and safety of the JAK inhibitor tofacitinib in patients with PMR. The analysis included 11 treatment-naive PMR patients and 20 healthy controls. In a second cohort, 76 patients with PMR were randomly assigned to tofacitinib or glucocorticoid treatment in an open-label trial, with 67 completing the 24-week intervention.
The researchers found that gene expression patterns of peripheral blood mononuclear cells in patients with newly diagnosed PMR were significantly different from 20 healthy controls using RNA sequencing. The most notable pathways affected were inflammatory response and cytokine-cytokine receptor interaction, with marked increases in expression of IL6R, IL1B, IL1R1, JAK2, TLR2, TLR4, TLR8, CCR1, CR1, S100A8, S100A12, and IL17RA, which could trigger JAK signaling. In vitro, tofacitinib suppressed the IL6R and JAK2 expression of CD4⁺T cells from patients with PMR. Among a second cohort of patients with newly diagnosed PMR randomly assigned to tofacitinib or glucocorticoid, all patients in both groups had PMR disease activity scores <10, and C-reactive protein and erythrocyte sedimentation rate were significantly decreased in both groups at weeks 12 and 24, with no severe adverse events.
"We think tofacitinib may have a high response rate in the new diagnosed PMR patients who were naive to glucocorticoid or biological agents," the authors write.
Copyright © 2020 HealthDay. All rights reserved.
Innovative technologies improving stroke care and physician burnout
Zoë Sebastian from RapidAI shares how novel solutions are making a meaningful impact on the delivery of care, reducing physician burnout, and ultimately improving patient outcomes in stroke care and beyond.
Over the past three years, we have become increasingly attune to the extreme levels of physician burnout around the world. While at the time, people, even those within healthcare, largely attributed these extreme levels of burnout to the enormous strain caused by COVID-19, many physicians felt that the pandemic was only one of many (albeit the most extreme) factors contributing to a problem that had been growing for years. Another of the largest contributors to physician burnout and frustration being workflow. 80% of physician burnout is due to workflow issues
Some studies suggest that as much as 40% of a clinician’s time is wasted each day through redundant or manual processes, unnecessary repetition, and inefficiencies like poor utilisation of resources. The impact of these workflow challenges can manifest in many different ways, including poor care-team communication, slower decision-making and time to treatment, and errors and mistakes that indirectly or directly impact patient outcomes. While each hospital and department faces unique workflow challenges, some technologies are showing great promise in measuring how care teams align to deliver better care.
“Being able to view images for patients referred from other sites sounds quite easy, but it can be very difficult – particularly for hugely time-sensitive clinical scenarios like hyper acute stroke management where time is brain,” said Dr Blight. Since implementing RapidAI’s specialty- specific stroke technology that eliminates the need to go through complex NHS network structures and allows him and his team to share patient scans between network hospitals and care teams more quickly, Dr Blight said it has significantly reduced delays in decision-making...Read more
Can innovative tech help with the biggest pain point in your work?
