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General Considerations Because a discussion of reproductive issues may be difficult for some women, it is important to obtain the history in a relaxed and private setting. The patient should be clothed, particularly if she is meeting the provider for the first time. Ordinarily, the patient should be interviewed alone. Exceptions may be made for children, adolescents, and mentally impaired women, or if the patient specifically requests the presence of a caretaker, friend, or family member. However, even in these circumstances, it is desirable for the patient to have some time to speak with the clinician privately. The manner of address should be formal using the title Mrs., Ms., Miss, or Dr. with the patient’s surname, unless the patient requests otherwise. In some settings, it may be appropriate for nursing staff to be involved with history taking. A nurse may be perceived as less threatening, and may be able to take the history in a less hurried manner.1 The provider can verify the history and focus on areas of concern. Alternatively, it may be helpful to ask the patient to complete a self-history form on paper or by computer prior to speaking with the provider. This allows the provider to devote time to addressing positive responses, and ensures that important questions are not missed. Hasley2 showed that responses to a computer-based questionnaire designed to update a patient’s gynecologic history were equivalent to those obtained during a personal interview. Several studies involving patients in non-gynecologic settings have shown that patients are more likely to provide sensitive information when responding to a computer-based questionnaire as opposed to a personal interview or even a paper questionnaire.3 In order to increase a patient’s level of comfort during the interview, questions should be asked in an open-ended and nonjudgmental way. Assumptions should not be made about aspects of the patient’s background such as sexual orientation. At the conclusion of the interview, patients should be asked whether there are concerns that they would like to discuss that were not addressed previously in the interview.
"Axillary Artery to Vein AV Graft for Dialysis Access"
Houston Methodist DeBakey Heart & Vascular Center, presents a cardiovascular procedure featuring Maham Rahimi, MD, M. Mujeeb Zubair, MD, and Louis Gomez, MD, as they demonstrate “Axillary Artery to Vein AV Graft for Dialysis Access".
Surgery: Maham Rahimi, MD, M. Mujeeb Zubair, MD, and Louis Gomez, MD
Narration: M. Mujeeb Zubair, MD
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The infection is generally transmitted by direct contact with the mucus or sores of someone else with strep. Common symptoms include sore throat, fever, and swollen lymph nodes in the neck. Rarely, complications can involve the heart or kidneys. Treatment is important to reduce complications. Oral antibiotics like penicillin, amoxicillin, cephalexin, or azithromycin are commonly used. Other medicines such as acetaminophen or ibuprofen can help with pain and fever.
A palatal view of a maxillary premolar during a crown lengthening procedure. Crown lengthening is a surgical procedure performed by a dentist to expose a greater amount of tooth structure for the purpose of subsequently restoring the tooth prosthetically.
The majority of all headaches are tension related headaches. The blockage of blood circulation along with contraction/shortening of muscles is what causes this condition. This simple technique can take away most tension related headaches in seconds.
Lipid-Lowering Agents HMG-CoA reductase inhibitors (statins) These agents inhibit the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase. Note the following: Low-density lipoprotein (LDL) reduction of 25%-60% Examples include Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin Contraindications include hypersensitivity, active liver disease, pregnancy, lactation, coadministration with strong CYP3A4 inhibitors (selected statins) Vitamin B3 Vitamin B3 inhibits very-low-density lipoprotein (VLDL) synthesis. Note the following: LDL reduction of 10% High-density lipoprotein (HDL) increase of 20% Example includes Niacin (nicotinic acid) Contraindications include hypersensitivity, liver disease, active peptic ulcer, severe hypotension, arterial bleeding Fibrates Fibrates enhance lipoprotein lipase, resulting in increased VLDL catabolism, fatty acid oxidation, and triglycerides elimination. They decrease hepatic extraction of free fatty acids. Note the following: LDL reduction of 15% Triglyceride reduction of 35% Examples include Gemfibrozil, fenofibrate, fenofibrate (micronized), fenofibric acid Contraindications include active liver disease, renal disease, primary biliary cirrhosis, gallbladder disease 2-Azetidiones These agents inhibit sterol transporter at brush border and, consequently, intestinal absorption of cholesterol. LDL reduction of 15% Example includes Ezetimibe Contraindications include hypersensitivity, coadministration with statins (if active liver disease) Bile acid sequestrants These agents lower cholesterol and LDL via bile duct sequestration. Note the following: LDL reduction of 15% Examples include Cholestyramine, colesevelam, colestipol Contraindications include biliary/bowel obstruction, serum triglycerides >300-500 mg/dL, history of hypertriglyceridemia-induced pancreatitis
Multiple sclerosis (MS) is a disease of the central nervous system estimated to affect 2.3 million people worldwide. It is a chronic disease in which the immune system abnormally attacks the insulation and support around the nerve cells (myelin sheath) in the brain, spinal cord and optic nerves, causing inflammation and consequent damage. MS is a leading cause of non-traumatic disability in young people, usually striking between 20 and 40 years of age. There is no cure for MS, but research continues to better understand and treat the disease.
Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS). The CNS is made up of the brain, spinal cord and optic nerves. Within the CNS, the immune system causes inflammation that damages myelin — the fatty substance that surrounds and insulates the nerve fibers — as well as the nerve fibers themselves, and the specialized cells that make myelin. When myelin or nerve fibers are damaged or destroyed in MS, messages within the CNS are altered or stopped completely. Damage to areas of the CNS may produce a variety of neurological symptoms that will vary among people with MS in type and severity The damaged areas develop scar tissue which gives the disease its name – multiple areas of scarring or multiple sclerosis. The cause of MS is not known, but it is believed to involve genetic susceptibility, abnormalities in the immune system and environmental factors that combine to trigger the disease. People with MS typically experience one of four disease courses. There are over a dozen treatments to help modify the MS disease process.
The hip is a "ball-and-socket" joint. In a normal hip, the ball at the upper end of the thighbone (femur) fits firmly into the socket, which is part of the large pelvis bone. In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally.