Sleepiness, tiredness and fatigue are complaints which must be thoroughly analyzed to eliminate blur and ambiguity.
Physiological sleepiness (“sleep pressure”) increases while being awake and additionally underlies the circadian rhythm with a lower threshold to fall asleep during night time.
Excessive daytime sleepiness (EDS) is considered normal only after sleep deprivation. Clinically, EDS manifests by frequents daytime napping and/or reduced alertness with automatic behavior or - in its extreme form - in recurrent attacks of sudden, uncontrollable compulsion to sleep also in inappropriate situations (= “sleep attacks”).
EDS is “objectively” addressed by measuring the mean sleep latency to four to five nap opportunities throughout the day using the multiple sleep latency test (MSLT) or the maintenance of wakefulness test (MWT).
EDS denotes both, a ready entrance into sleep as well as difficulty in staying awake during daytime or accordingly in inappropriate situations. These two partially independent aspects of EDS are separately assessed by the “passive” MSLT and the “active” MWT respectively.
For that reason the MSLT and MWT only weakly correlate with each other when tested over a broad range of patients with EDS. It is important to keep in mind, that these tests are importantly influenced by a great variety of factors such as mood, anxiety, and motivation.
“Vigilance” comprises wakefulness, alertness and attention and therefore is more than just the reciprocal to sleepiness. Cognitive performance tasks such as Steer Clear Reaction Time Test (SCRTT) or driving simulators require the complete integrity of vigilance to achieve normal results. Hypersomnia is usually broadly defined as the combination of abnormally prolonged night-time sleep (regularly >10 h) with EDS during ≥1 months.
On the other hand, the term hypersomnia has also been used in a narrower scene for the isolated abnormality of a prolonged night-time sleep need (>10 h). “Tiredness”, also in colloquial language often used for sleepiness, in a broader sense also describes the feeling of lack of energy, motivation and initiative.

These patients seek rest rather than sleep. They often cannot fall asleep when given the opportunity in spite of feeling tired, and hence, in an MSLT, do not show an abnormally short sleep latency. Furthermore, tiredness (and fatigue) as opposed to sleepiness has a mental (“central”) and physiological (bodily or “peripheral”) component, which the patients can readily distinguish. Patients with insomnia, mild sleep apnea syndrome, or depression rather suffer from mental tiredness than sleepiness during the day.
The simple subjective self-assessment using the Epworth Sleepiness Scale (ESS) quite reliably differentiates between sleepiness and mental tiredness (without sleepiness), which makes it a widely used test. The term “fatigue” is also heterogeneously used.
In physiology the “fatigue” implied a “time on task performance decrement” to describe decreasing muscle force during a sustained physical effort. In clinical medicine one distinguishes physical (“peripheral”) from mental (“central”) fatigue and the term usually denotes a chronic and more abnormal situation than tiredness.
In a broad sense “fatigue” implies a deficiency in coping satisfactorily with mental and physical work load. The chronic fatigue syndrome entails both mental as well as a physical fatigue (so called “leaden paralysis” of limbs). Depressive states are often associated with insomnia and fatigue, but there are also cases with hypersomnia rather than insomnia ( non organic hypersomnia , “atypical depression” or “hypersomnolent depression”)
Sometimes these patients have a tendency to spend much of the day lying in the bed without actually sleeping (so called clinophilia). The basic and clinical aspects of fatigu

Alcohol septal ablation (ASA, TASH, Sigwart procedure) is a percutaneous, minimally-invasive treatment performed by an interventional cardiologist to relieve symptoms and improve functional status in severely symptomatic patients with hypertrophic cardiomyopathy (HCM) who meet strict clinical, anatomic and physiologic ...

A detailed description of the causes and diagnosis of pleural effusion. The presentation includes a discussion of the causes and exudative and transudative pleural effusions. Light's criteria and its modification are described along with definition and clinical implication of pleural fluid acidosis, glucose, adenosine deaminase, hemorrhagic pleural effusion and protein and LDH as well.

Acute hemothorax due to aortic rupture in aortic dissection with lung collapse and mediastinal shift.

DMC specialist Dr. Andrew Xavier treats a patient's stroke and aneurysm at DMC Detroit Receiving Hospital.. ~ Detroit Medical Center

The journey of egg and sperm. There are a lot of casualties (deaths) among the sperm as they swim toward the egg. First, many get lost in the maze of a woman's uterus where they also have to contend with acidic vaginal secretions.

Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop." Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded. Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

There's no single best approach to uterine fibroid treatment — many treatment options exist. If you have symptoms, talk with your doctor about options for symptom relief. Watchful waiting Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can live with. If that's the case for you, watchful waiting could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause, when levels of reproductive hormones drop. Medications Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include: Gonadotropin-releasing hormone (Gn-RH) agonists. Medications called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a Gn-RH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using Gn-RH agonists. Gn-RH agonists typically are used for no more than three to six months because symptoms return when the medication is stopped and long-term use can cause loss of bone. Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear. It also prevents pregnancy. Tranexamic acid (Lysteda). This nonhormonal medication is taken to ease heavy menstrual periods. It's taken only on heavy bleeding days. Other medications. Your doctor might recommend other medications. For example, oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids. Your doctor may also suggest that you take vitamins and iron if you have heavy menstrual bleeding and anemia

دكتور مصطفى ياقوت محاضرة القدم السكرى A lecture presented by Dr. Mostafa Yakoot to the Annual Congress of the Vascular Surgery, Alexandria 10/2009. Based on the original article published in JWC by: Yakoot M, Abdelatif M, Etman M.

Callus Peel is a luxury, spa foot treatment that removes hard, callused skin leaving your feet feeling soft and revitalised. The treatment is a 15 minute...

A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias (ah-RITH-me-ahs). Arrhythmias are problems with the rate or rhythm of the heartbeat.Feb 28, 2012

The language is chinese mandarin(Putonghua)

Scissor gait is a form of gait abnormality primarily associated with spastic cerebral palsy.

Thoracoscopic Management of Lung Abscess Before Empyema

In the Dialysis Unit you have an opportunity to provide Dialysis care for a variety of patients, including those with End-Stage Chronic Kidney disease and acutely ill patients requiring dialysis and plasmapheresis.
The Chronic Dialysis Nurse focuses on patients receiving Hemodialysis, Peritoneal Dialysis, or Home Hemodialysis. Our patients range in age from newborns to young adults. The Hemodialysis patient receives their dialysis treatment in the clinic 3-5 times a week. The Peritoneal Dialysis and Home Hemodialysis treatments are provided in the patient’s home once the parent/caregiver is trained to operate the machine. They are followed monthly in clinic. The patient receiving Chronic Dialysis is supported by a multidisciplinary team that consists of a physician, nurses, social worker, nutritionist, pharmacist, child-life therapist, teacher, and counselor. The group works together to meet the medical and emotional needs of the patient and caregiver. Care is specialized to meet the needs of each individual patient.
The Acute Dialysis Nurse focuses on acute dialysis related therapies such as: Continuous Renal Replacement Therapy (CRRT); therapeutic plasmapheresis; or acute peritoneal dialysis. The acute dialysis team works with the multi-disciplinary inpatient nephrology team to provide acute dialysis services to the critically ill ICU patients. The work environment is highly technical and fast-paced.
The Dialysis Unit operates on 12hr shifts 7a – 7p; 7 days a week. Night call is required and shared by the nurses. We provide a detailed orientation plan to the nurse to become proficient in providing hemodialysis, peritoneal dialysis, continuous renal replacement therapy and plasmapheresis. Previous experience in dialysis or pediatrics is not required.

Enema how to apply Animation

Before the angioplasty procedure begins, you will receive some pain medicine. You may also be given medicine that relaxes you, and blood thinning medicines to prevent a blood clot from forming. You will lie on a padded table. Your doctor will insert a flexible tube (catheter) through a surgical cut into an artery. Sometimes the catheter will be placed in your arm or wrist, or in your upper leg or groin area. You will be awake during the procedure. The doctor will use live x-ray pictures to carefully guide the catheter up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps the doctor see any blockages in the blood vessels that lead to your heart. A guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel and restores proper blood flow to the heart. A wire mesh tube (stent) may then be placed in this blocked area. The stent is inserted along with the balloon catheter. It expands when the balloon is inflated. The stent is left there to help keep the artery open

If you're pregnant or might become pregnant, it's critically important to get enough folic acid, the synthetic form of vitamin B9, also known as folate. Folic acid helps prevent neural tube defects (NTDs) – serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly).

Depression is a very serious mental illness that affects millions worldwide. Could a small brain implant cure it?

Identify the anatomy and explain the physiology of the breast on diagrams and sonograms.

Describe and demonstrate the protocol for sonographic scanning of the breast, including the clock and quadrant methods, and targeted examinations based on mammographic findings.

Describe the various diagnostic pathways that may lead to a sonographic breast examination, and explain how the ultrasound findings are correlated with other imaging modalities.

Identify and describe sonographic images of benign and malignant features and common breast pathologies.

Explain biopsy techniques for breast tumors.

Define and use related medical terminology.

Explain the Patient Privacy Rule (HIPAA) and Patient Safety Act (see reference