BIOSOFT HELP FILES

Superficial tenderness not compatible with known anatomy, Pain which is inconsistent and incompatible with simulated testing like axial loading of spine or pelvic rotation, Distraction causes inconsistent responses (SLR when seated), Non-organic regional disturbances (non-dermatomal sensory loss), Overreaction

(Patel and Ogle 2000)

See also under overweight and obesity

1)      Hypothyroidism

1)      Perception of weight loss – no objective weight loss but patient complains of weight loss when the patient feels having an appearance of haggard and wasted look, others say the person has lost weight and looks wasted, clinically significant weight loss is 2-pound loss in 1 month OR 5-10 pound loss in 6 months.

2)      Inadequate nutrition – risk factors – age, poverty, functional disability, drugs, number of meals, types of foods, portion size, taste of food, likes or dislikes of foods,

3)      Somatic depression syndrome

4)      Somatic anxiety syndrome

5)      Acute infections – acute gastroenteritis, UTI,

6)      Persistent vomiting – hiatus hernia, peptic ulcer disease, GERD

7)      Persistent diarrhea – malabsorption,

8)      Polyuria -

9)      Chronic infections – UTI, malaria,

10)    Chronic diseases – asthma, diabetes

11)    Rumination Syndrome –

1)      Unexplained persistent (that is more than 3 weeks) weight  loss (CXR to exclude lung Ca, UGIE to exclude upper GIT Ca)

2)      Weight loss in the elderly male (DRE and a PSA to exclude prostate Ca)

3)      Presence of terminal illness

4)      Presence of an active pressure ulcer

5)      Presence of nausea, vomiting, diarrhea

6)      Presence of fluid retention/edema

7)      Presence of underlying infection

8)      Losing weight despite excellent appetite and normal intake – inadequate caloric intake for the height and weight and activity level, unrecognized caloric expenditure for repetitive activity like wandering, movement disorders, large pressure ulcers, chronic underlying infections

(NCC-PC Referral Guidelines for Suspected Cancer  in Adults and Children)

(Illingworth 1983)

Active cancer (treatment within 6/12 or palliation) 2) Paralysis, paresis, immobilization of lower extremity 3) Localized tenderness along the distribution of deep veins 4) Entire leg swollen 5) Unilateral calf swelling of greater than 3 cm below tibial tuberosity 6) Unilateral pitting edema 7) Collateral superficial veins 8) Alternative diagnosis as likely as or more likely than DVT – Score 1 for each yes answer except number 8 which is scored as 2.  Score of 3 or more (high risk of DVT 75%), score of 1 -2 points (moderate risk 17%), score less than 1 (low risk of DVT 3%). (Well’s et.al. 1997)

1)      Asthma

2)      Cow’s milk protein allergy

3)      Dye allergies – tartrazine

4)      Bronchiolitis

5)      Foreign body

6)      Recurrent viral croup

1)      Life-threatening attacks of asthma

2)      Treatment-resistant asthma

3)      Family history of TB

4)      Contact history of TB

OBJECTIVE
To examine the associations of circulating 25-hydroxyvitamin D (25[OH]D) concentrations with cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes and diabetes from the large population-based UK Biobank cohort study.

RESEARCH DESIGN AND METHODS
A total of 67,789 individuals diagnosed with prediabetes and 24,311 with diabetes who had no CVD or cancer at baseline were included in the current study. Serum 25(OH)D concentrations were measured at baseline. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for cardiovascular outcomes and mortality after 10-14 years.

RESULTS
After multivariable adjustment, higher serum 25(OH)D levels were significantly and nonlinearly associated with lower risk of cardiovascular outcomes and all-cause mortality among participants with prediabetes and diabetes (all P nonlinearity < 0.05). Compared with those in the lowest category of 25(OH)D levels (<25 nmol/L), participants with prediabetes in the highest category of 25(OH)D levels (≥75 nmol/L) had a significant association with a lower risk of cardiovascular events (HR 0.78; 95% CI 0.71-0.86), coronary heart disease (CHD) (HR 0.79; 95% CI 0.71-0.89), heart failure (HR 0.66; 95% CI 0.54-0.81), stroke (HR 0.75; 95% CI 0.61-0.93), CVD mortality (HR 0.43; 95% CI 0.32-0.59), and all-cause mortality (HR 0.66; 95% CI 0.58-0.75). Likewise, these associations with cardiovascular events, CHD, heart failure, CVD mortality, and all-cause mortality were observed among participants with diabetes, except for stroke.

CONCLUSIONS
These findings highlight the importance of monitoring and correcting vitamin D deficiency in the prevention of CVD and mortality among adults with prediabetes and diabetes.

THEREFORE PRESCRIBE :