Not Just Acid Reflux: The Need to Think Worst First

A previously healthy, well-appearing 42-year-old female living in a modern, high-rise apartment in downtown Los Angeles calls 9-1-1 at 5:30 am complaining of worsening of a burning, epigastric pain she had been experiencing for the last three days. She reports associated nausea and non-bloody, non-bilious vomiting, and that she couldn’t manage to get comfortable in bed until she finally decided to call for help at daybreak. During her 9-1-1 call, she reports “pain, like heartburn, that just woke me up again and I had to throw up, … and then I was sweating so much.” Using the Los Angeles Tiered Dispatch System, the 9-1-1-telecommunicator couldn’t discern whether the patient was actually having abdominal or chest pain and opted to dispatch a chest pain (age> 40) dispatch code, launching a paramedic unit from the busy downtown fire station. Upon arrival, paramedics find a young, fit-appearing Hispanic female sitting in her living room, reporting a “burning sensation in her throat.” She tells medics that she has a history of acid reflux but states that she wasn’t having any relief with her usual Tums. She also states that she usually feels like this after drinking alcohol, and that she had a few drinks last night and smoked some marijuana. Her vital signs are within normal limits, her abdominal exam was benign, and she requests “something to help with her reflux,” but she ultimately refuses transport to the ED. No fu...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

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This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. METHOD: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV's primitive physiologic structure using computer-aided de...
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
CONCLUSIONS: DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients. PMID: 31205100 [PubMed - in process]
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
CONCLUSIONS: The varied pharmacologic mechanisms of NBP involve many complex molecular mechanisms; however, there many unknown pharmacologic effects await further study. PMID: 31205106 [PubMed - in process]
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
Publication date: Available online 18 June 2019Source: Neuroscience &Biobehavioral ReviewsAuthor(s): Rita Pasion, Fernando BarbosaAbstractThe comorbidity between discrete clinical diagnosis occurs in higher levels than prevalence rates, indicating that mental disorders are systematically overcategorized. Dimensional models – as the Internalizing-Externalizing Spectrum – claim for a common latent structure of psychopathology. The current meta-analysis aims to evaluate whether the externalizing and internalizing latent factors of the psychopathological spectrum display common and distinctive neurobiological s...
Source: Neuroscience and Biobehavioral Reviews - Category: Neuroscience Source Type: research
Publication date: Available online 18 June 2019Source: Neuroscience LettersAuthor(s): Fabiano V. Costa, Julia Canzian, Flavia V. Stefanello, Allan V. Kalueff, Denis B. RosembergAbstractThe ability to detect noxious stimuli is essential to survival. However, pathological pain is maladaptive and severely debilitating. Endogenous and exogenous opioids modulate pain responses via opioid receptors, reducing pain sensibility. Due to the high genetic and physiological similarities to rodents and humans, the zebrafish is a valuable tool to assess pain responses and the underlying mechanisms involved in nociception. Although morphi...
Source: Neuroscience Letters - Category: Neuroscience Source Type: research
Publication date: Available online 18 June 2019Source: NeuroscienceAuthor(s): Kimberly Gómez, Alejandro Sandoval, Paulino Barragán-Iglesias, Vinicio Granados-Soto, Rodolfo Delgado-Lezama, Ricardo Felix, Ricardo González-RamírezAbstractHigh voltage-activated (HVA) Ca2+ (CaV) channels are oligomeric complexes formed by an ion-conducting main subunit (Cavα1) and at least two auxiliary subunits (Cavβ and CaVα2δ). It has been reported that the expression of CaVα2δ1 increases in the dorsal root ganglia (DRGs) of animals with mechanical allodynia, and that the transcr...
Source: Neuroscience - Category: Neuroscience Source Type: research
In this study, we determined whether spinal SGK1 signaling contributes to the development of morphine analgesic tolerance. Chronic morphine administration markedly induced phosphorylation of SGK1 in the spinal dorsal horn neurons. Intrathecal injection of SGK1 inhibitor GSK-650394 reduced the development of morphine tolerance with a significant leftward shift in morphine dose-effect curve. Furthermore, spinal inhibition of SGK1 suppressed morphine-induced phosphorylation of nuclear factor kappa B (NF-κB) p65 and upregulation of NMDAR NR1 and NR2B expression in the spinal dorsal horn. In contrast, intrathecal administ...
Source: Neuroscience - Category: Neuroscience Source Type: research
We describe a case of a 70-year old man with sensorimotor chronic inflammatory demyelinating polyneuropathy (CIDP) with small-fibre involvement resulting in severe diffuse neuropathic pain which was refractory to immunotherapy and anti-neuropathic medication. His pain was successfully treated with implantation of a spinal cord stimulation (SCS) system comprising bilateral cervical and lumbar epidural leads. Following SCS programming, he experienced a 50% reduction in average pain severity with substantial improvement in quality of life, persisting at 18 months after surgery. SCS has been employed to treat a variety of ne...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
AbstractNeural injury, inflammation, or diseases commonly and adversely affect micturition reflex function that is organized by neural circuits in the CNS and PNS. One neuropeptide receptor system, pituitary adenylate cyclase-activating polypeptide (PACAP;Adcyap1), and its cognate receptor, PAC1 (Adcyap1r1), have tissue-specific distributions in the lower urinary tract. PACAP and associated receptors are expressed in the LUT and exhibit changes in expression, distribution, and function in preclinical animal models of bladder pain syndrome (BPS)/interstitial cystitis (IC), a chronic, visceral pain syndrome characterized by ...
Source: Journal of Molecular Neuroscience - Category: Neuroscience Source Type: research
It ’s becoming more common for pregnant women in the United States to use cannabis: Between 2002 and 2017, the prevalence of past-month cannabis use increased from 3.4% to 7.0% among pregnant women overall and from 5.7% to 12.1% during the first trimester, according to areport published today inJAMA.These and other findings, which were based on the responses of women to the National Survey on Drug Use and Health (NSDUH), highlight “the importance of screening and interventions for cannabis use among all pregnant women,” wrote Nora Volkow, M.D., director of the National Institute on Drug Abuse, and colleag...
Source: Psychiatr News - Category: Psychiatry Tags: cannabis use Daniel Corsi gestational diabetes JAMA Michael Silverstein National Survey on Drug Use and Health Nora Volkow pregnancy preterm birth Source Type: research
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