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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
A recent explanation by Howes in 2012 suggests that hiccups may have evolved along with other reflexes developed in mammals that allow them to coordinate suckling milk and breathing. Hiccups are only found in mammals, and are most common in infants, becoming rarer as mammals age. This may suggest that they evolved to allow air trapped in the stomach of suckling infants to escape, allowing more milk to be ingested.
The hypothesis suggests that the air bubble in the stomach stimulates the sensory limb of the reflex at receptors in the stomach, esophagus and along the diaphragm. This triggers the hiccup, which creates suction in the chest, pulling air from the stomach up and out through the mouth, effectively burping the animal.
This theory is supported by the strong tendency for infants to get hiccups, the component of the reflex that suppresses peristalsis in the esophagus, and the existence of hiccups only in milk-drinking mammals.
Hiccups may be triggered by a number of common human conditions. In rare cases, they can be a sign of serious medical problems.
The effects of myoclonus in an individual can vary depending on the form and the overall health of the individual. In severe cases, particularly those indicating an underlying disorder in the brain or nerves, movement can be extremely distorted and limit ability to normally function, such as in eating, talking, and walking. In these cases, treatment that is usually effective, such as clonazepam and sodium valproate, may instead cause adverse reaction to the drug, including increased tolerance and a greater need for increase in dosage. However, the prognosis for more simple forms of myoclonus in otherwise healthy individuals may be neutral, as the disease may cause few to no difficulties. Other times the disease starts simply, in one region of the body, and then spreads.
Research on myoclonus is supported through the National Institute of Neurological Disorders and Stroke (NINDS). The primary focus of research is on the role of neurotransmitters and receptors involved in the disease. Identifying whether or not abnormalities in these pathways cause myoclonus may help in efforts to develop drug treatments and diagnostic tests. Determining the extent that genetics play in these abnormalities may lead to potential treatments for their reversal, potentially correcting the loss of inhibition while enhancing mechanisms in the body that would compensate for their effects.
A 2014 meta-analysis of three small trials evaluating probiotics showed a slight improvement in management of chronic idiopathic constipation, but well-designed studies are necessary to know the true efficacy of probiotics in treating this condition.
Children with functional constipation often claim to lack the sensation of the urge to defecate, and may be conditioned to avoid doing so due to a previous painful experience. One retrospective study showed that these children did indeed have the urge to defecate using colonic manometry, and suggested behavioral modification as a treatment for functional constipation.
Chronic idiopathic constipation is similar to constipation-predominant irritable bowel syndrome (IBS-C); however, people with CIC do not have other symptoms of IBS, such as abdominal pain. Diagnosing CIC can be difficult as other syndromes must be ruled out as there is no physiological cause for CIC. Doctors will typically look for other symptoms, such as blood in stool, weight loss, low blood count, or other symptoms.
To be considered functional constipation, symptoms must be present at least a fourth of the time.
Possible causes are:
- Anismus
- Descending perineum syndrome
- Other inability or unwillingness to control the external anal sphincter, which normally is under voluntary control
- A poor diet
- An unwillingness to defecate
- Nervous reactions, including prolonged and/or chronic stress and anxiety, that close the internal anal sphincter, a muscle that is not under voluntary control
- Deeper psychosomatic disorders which sometimes affect digestion and the absorption of water in the colon
There is also possibility of presentation with other comorbid symptoms such as headache, especially in children.
Chronic critical illness is a disease state which affects intensive care patients who have survived an initial insult but remain dependent on intensive care for a protracted period, neither dying nor recovering. The most characteristic clinical feature is a prolonged requirement for mechanical ventilation. Other features include profound weakness associated with critical illness polyneuropathy, increased susceptibility to infection, metabolic changes and hormonal changes. There may be protracted or permanent delirium, or other marked cognitive impairment. The physical and psychological symptoms of the disease are very severe, including a propensity to develop post traumatic stress syndrome.
Strict definitions of chronic critical illness vary. One definition is the requirement for mechanical ventilation for 21 days or more. It is estimated that 5-10% of patients who require mechanical ventilation as part of their initial illness will go on to develop chronic critical illness. Overall prevalence has been estimated at 34.4 per 100 000 of the population. Most adult patients do not survive chronic critical illness, and furthermore even those who are discharged from hospital frequently die soon after discharge. One-year mortality in adults is 48-68%. However, children fare better with two-thirds surviving to 5 years or beyond.
While risk factors vary with age and gender, most of the common chronic diseases in the US are caused by dietary, lifestyle and metabolic risk factors that are also responsible for the resulting mortality. Therefore, these conditions might be prevented by behavioral changes, such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases. Social factors, e.g., socioeconomic status, education level, and race/ethnicity, are a major cause for the disparities observed in the care of chronic disease. Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations. Those barriers to medical care complicate patients monitoring and continuity in treatment.
In the US, Minorities and low-income populations are less likely to access and receive preventive services necessary to detect conditions at an early stage.
The majority of US health care and economic costs associated with medical conditions are for the costs of chronic diseases and conditions and associated health risk behaviors. Eighty-four percent of all health care spending in 2006 was for the 50% of the population who have one or more chronic medical conditions (CDC, 2014).
Crucial in the decision to breed would be the primary cause of FCKS in the litter, which may or may not be genetic. Some recovered FCKS adults have produced FCKS offspring in their turn (or lines that consistently produce flat kittens), and breeding from them is therefore inadvisable. However, repeat matings in which FCKS has appeared does not always result in further FCKS kittens. Queens and studs who consistently throw complete litters of kittens with the condition are generally neutered since a genetically linked cause for the condition can be introduced into lines that do not produce it by breeding with lines in which it is common. Isolated instances of single flat kittens in an otherwise healthy litter are unlikely to have a genetic component in the condition, and neutering of parents of such kittens is not usually necessary in pedigree breeding, especially since this may have detrimental effects on the gene pool.
If the cause of flattening is colic related to over-production of milk then this would not be cause for neutering. The only way to determine if the cause is digestive would be if the condition was alleviated in all cases by pinching the phrenic nerve and/or use of liquid paraffin to relieve colic resulting in improvement in the condition.
Line-breeding or inbreeding is highly inadvisable in lines where FCKS has appeared, and the practice may cause the condition to appear in lines where it has not previously been recorded.
Oesophageal diseases include a spectrum of disorders affecting the oesophagus. The most common condition of the oesophagus in Western countries is gastroesophageal reflux disease, which in chronic forms is thought to result in changes to the epithelium of the oesophagus, known as Barrett's oesophagus.
Acute disease might include infections such as oesophagitis, trauma caused ingestion of corrosive substances, or rupture of veins such as oesophageal varices, Boerhaave syndrome or Mallory-Weiss tears. Chronic diseases might include congenital diseases such as Zenker's diverticulum and esophageal webbing, and oesophageal motility disorders including the nutcracker oesophagus, achalasia, diffuse oesophageal spasm, and oesophageal stricture.
Oesophageal disease may result in a sore throat, throwing up blood, difficulty swallowing or vomiting. Chronic or congenital diseases might be investigated using barium swallows, endoscopy and biopsy, whereas acute diseases such as reflux may be investigated and diagnosed based on symptoms and a medical history alone.
It is difficult to determine whether a kitten that goes flat will survive or not. A good indicator is the weight of the kitten: those that continue to gain weight generally have a better chance of survival. Supplement feeding is therefore recommended in all cases, together with vitamin supplements, although many of these kittens will not accept hand feeding. Liquid Paraffin to alleviate colic seems to be significant in assisting normal feeding and weight-gain.
Another indicator to the severity of the case is the use of the stomach when breathing: normal kittens use only the ribcage, a flat-chested kitten may manage to breathe only using the ribcage, or may suck the gut upwards with every breath – if the latter is the case then the likelihood of survival seems to be lower, though still not sufficient to warrant immediate euthanasia. If the condition is stable (i.e. the flatness does not increase over time) or improving, the kitten is more likely to survive. If the condition worsens over several days, survival is less likely.
Kittens with FCKS may die (or have to be euthanased) very soon after onset. There are two points at which breeders report kittens that were otherwise doing well deteriorating and dying: at 10 days of age and at 3 weeks. Generally if the kitten is still flat, but survives the 3-week developmental stage, its prognosis is good. Many will have returned to a normal shape by this time. Those retaining some degree of flatness often grow out of the condition at any point in the ensuing 6 months, and the vast majority of survivors appear to lead normal lives with no side-effects, either physical or immunological.
FCKS kittens that survive but who have not been given any drug treatment or support other than supplementary feeding, generally recover over a period of 4–10 weeks, and are usually normal by 12 weeks of age, though some take as long as 6 months to normalise. In the very small number of kittens reported so far treated with steroids, antibiotics and liquid paraffin (to address colic) recovery is usually seen within a matter of days. Given the number of different types of FCKS these kittens (all with the minor form of the condition) may not be representative of all cases. More data is required for statistical analysis.
A small proportion of severe FCKS kittens are left with long-term respiratory problems, kyphosis, and in some cases cardiac issues caused by the compression of the thorax during the early developmental stages (particularly where the condition has been coupled with Pectus Excavatum). Cardiac issues are generally audible on physical examination; further indications include the kitten becoming breathless after play, less active than siblings, and failure to grow and develop normally.
Individuals who smoke or are exposed to smog or other airborne pollutants can develop a condition known as COPD. In this disorder, there is constant irritation of the breathing tubes (trachea) and the small airways. The constant irritation results in excess production of mucus which makes breathing difficult. Frequently, these individuals wake up in the morning with copious amounts of foul smelling mucus and a cough which lasts all day. Wheeze and heavy phlegm are common findings. COPD is a lifelong disorder and there is no cure. Eventually most people develop recurrent pneumonia, lack any type of endurance, and are unable to work productively. One of the ways to avoid chronic bronchitis is to stop or not smoke.
Even though anatomically part of the GI tract, diseases of the mouth are often not considered alongside other gastrointestinal diseases. By far the most common oral conditions are plaque-induced diseases (e.g. gingivitis, periodontitis, dental caries). Some diseases which involve other parts of the GI tract can manifest in the mouth, alone or in combination, including:
- Gastroesophageal reflux disease can cause acid erosion of the teeth and halitosis.
- Gardner's syndrome can be associated with failure of tooth eruption, supernumerary teeth, and dentigerous cysts.
- Peutz–Jeghers syndrome can cause dark spots on the oral mucosa or on the lips or the skin around the mouth.
- Several GI diseases, especially those associated with malabsorption, can cause recurrent mouth ulcers, atrophic glossitis, and angular cheilitis (e.g. Crohn's disease is sometimes termed orofacial granulomatosis when it involves the mouth alone).
- Sideropenic dysphagia can cause glossitis, angular cheilitis.
As of 2013 tension headaches affect about 1.6 billion people (20.8% of the population) and are more common in women than men (23% to 18% respectively). Despite its benign character, tension-type headache, especially in its chronic form, can impart significant disability on patients as well as burden on society at large.
A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. Clinical preventive services include screening for the existence of the disease or predisposition to its development, counseling and immunizations against infectious agents. Despite their effectiveness, the utilization of preventive services is typically lower than for regular medical services. In contrast to their apparent cost in time and money, the benefits of preventive services are not directly perceived by patient because their effects are on the long term or might be greater for society as a whole than at the individual level.
Therefore, public health programs are important in educating the public, and promoting healthy lifestyles and awareness about chronic diseases. While those programs can benefit from funding at different levels (state, federal, private) their implementation is mostly in charge of local agencies and community-based organizations.
Studies have shown that public health programs are effective in reducing mortality rates associated to cardiovascular disease, diabetes and cancer, but the results are somewhat heterogeneous depending on the type of condition and the type of programs involved. For example, results from different approaches in cancer prevention and screening depended highly on the type of cancer.
The rising number of patient with chronic diseases has renewed the interest in prevention and its potential role in helping control costs. In 2008, the Trust for America's Health produced a report that estimated investing $10 per person annually in community-based programs of proven effectiveness and promoting healthy lifestyle (increase in physical activity, healthier diet and preventing tobacco use) could save more than $16 billion annually within a period of just five years.
One of the most common areas of the body associated with irritation is the vagina. Many women complain of an itch, dryness, or discharge in the perineum at some point in their lives. There are several causes of vaginal irritation including fungal vaginitis (like candida) or trichomoniasis. Often, herpes simplex infection of the mouth or genitalia can be recurrent and prove to be extremely irritating.
Sometimes, the irritation can be of the chronic type and it can be so intense that it also causes painful intercourse. Aside from infections, chronic irritation of the vagina may be related to the use of contraceptives and condoms made from latex. The majority of contraceptives are made of synthetic chemicals which can induce allergies, rash and itching. Sometimes the lubricant used for intercourse may cause irritation.
Another cause of irritation in women is post menopausal vaginitis. The decline in the female sex hormones leads to development of dryness and itching in the vagina. This is often accompanied by painful sexual intercourse. Cracks and tears often develop on outer aspects of the labia which becomes red from chronic scratching. Post menopausal vaginitis can be treated with short term use of vaginal estrogen pessary and use of a moisturizer.
Low back pain that lasts at least one day and limits activity is a common complaint. Globally, about 40% of people have LBP at some point in their lives, with estimates as high as 80% of people in the developed world. Approximately 9 to 12% of people (632 million) have LBP at any given point in time, and nearly one quarter (23.2%) report having it at some point over any one-month period. Difficulty most often begins between 20 and 40 years of age. Low back pain is more common among people aged 4080years, with the overall number of individuals affected expected to increase as the population ages.
It is not clear whether men or women have higher rates of low back pain. A 2012 review reported a rate of 9.6% among males and 8.7% among females. Another 2012 review found a higher rate in females than males, which the reviewers felt was possibly due to greater rates of pains due to osteoporosis, menstruation, and pregnancy among women, or possibly because women were more willing to report pain than men. An estimated 70% of women experience back pain during pregnancy with the rate being higher the further along in pregnancy. Current smokers – and especially those who are adolescents – are more likely to have low back pain than former smokers, and former smokers are more likely to have low back pain than those who have never smoked.
The annual prevalence in the general population of chronic pelvic pain syndrome is 0.5%. 38% of primary care providers, when presented with a vignette of a man with CPPS, indicate that they have never seen such a patient. However, the overall prevalence of symptoms suggestive of CP/CPPS is 6.3%. The role of the prostate was questioned in the cause of CP/CPPS when both men and women in the general population were tested using the (1) National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) —with the female homolog of each male anatomical term use on questionnaires for female participants— (2) the International Prostate Symptom Score (IPSS), and (3) additional questions on pelvic pain. The prevalence of symptoms suggestive of CPPS in this selected population was 5.7% in women and 2.7% in men, placing in doubt the role of the prostate gland. New evidence suggests that the prevalence of CP/CPPS is much higher in teenage males than once suspected.
Overall, the outcome for acute low back pain is positive. Pain and disability usually improve a great deal in the first six weeks, with complete recovery reported by 40 to 90%. In those who still have symptoms after six weeks, improvement is generally slower with only small gains up to one year. At one year, pain and disability levels are low to minimal in most people. Distress, previous low back pain, and job satisfaction are predictors of long-term outcome after an episode of acute pain. Certain psychological problems such as depression, or unhappiness due to loss of employment may prolong the episode of low back pain. Following a first episode of back pain, recurrences occur in more than half of people.
For persistent low back pain, the short-term outcome is also positive, with improvement in the first six weeks but very little improvement after that. At one year, those with chronic low back pain usually continue to have moderate pain and disability. People at higher risk of long-term disability include those with poor coping skills or with fear of activity (2.5 times more likely to have poor outcomes at one year), those with a poor ability to cope with pain, functional impairments, poor general health, or a significant psychiatric or psychological component to the pain (Waddell's signs).
Malnutrition–inflammation complex (syndrome), abbreviated as "MICS" and also known as "malnutrition–inflammation–cachexia syndrome", is a common condition in chronic disease states such as chronic kidney disease (where it is also known as uremic malnutrition or protein–energy malnutrition) and chronic heart failure.
The MICS is believed to be a cause of survival paradoxes seen in these distinct patient populations, also known as reverse epidemiology populations.
Chronic respiratory acidosis may be secondary to many disorders, including COPD. Hypoventilation in COPD involves multiple mechanisms, including decreased responsiveness to hypoxia and hypercapnia, increased ventilation-perfusion mismatch leading to increased dead space ventilation, and decreased diaphragm function secondary to fatigue and hyperinflation.
Chronic respiratory acidosis also may be secondary to obesity hypoventilation syndrome (i.e., Pickwickian syndrome), neuromuscular disorders such as amyotrophic lateral sclerosis, and severe restrictive ventilatory defects as observed in interstitial lung disease and thoracic deformities.
Lung diseases that primarily cause abnormality in alveolar gas exchange usually do not cause hypoventilation but tend to cause stimulation of ventilation and hypocapnia secondary to hypoxia. Hypercapnia only occurs if severe disease or respiratory muscle fatigue occurs.
In renal compensation, plasma bicarbonate rises 3.5 mEq/L for each increase of 10 mm Hg in "Pa"CO. The expected change in serum bicarbonate concentration in respiratory acidosis can be estimated as follows:
- Acute respiratory acidosis: HCO increases 1 mEq/L for each 10 mm Hg rise in "Pa"CO.
- Chronic respiratory acidosis: HCO rises 3.5 mEq/L for each 10 mm Hg rise in "Pa"CO.
The expected change in pH with respiratory acidosis can be estimated with the following equations:
- Acute respiratory acidosis: Change in pH = 0.008 X (40 − "Pa"CO)
- Chronic respiratory acidosis: Change in pH = 0.003 X (40 − "Pa"CO)
Respiratory acidosis does not have a great effect on electrolyte levels. Some small effects occur on calcium and potassium levels. Acidosis decreases binding of calcium to albumin and tends to increase serum ionized calcium levels. In addition, acidemia causes an extracellular shift of potassium, but respiratory acidosis rarely causes clinically significant hyperkalemia.
In recent years the prognosis for CP/CPPS has improved with the advent of multimodal treatment, phytotherapy, protocols aimed at quieting the pelvic nerves through myofascial trigger point release and anxiety control, and chronic pain therapy.
In the United States, the annual incidence is 18 cases of acute pancreatitis per 100,000 population, and it accounts for 220,000 hospitalizations in the US. In a European cross-sectional study, incidence of acute pancreatitis increased from 12.4 to 15.9 per 100,000 annually from 1985 to 1995; however, mortality remained stable as a result of better outcomes. Another study showed a lower incidence of 9.8 per 100,000 but a similar worsening trend (increasing from 4.9 in 1963-74) over time.
In Western countries, the most common cause is alcohol, accounting for 65 percent of acute pancreatitis cases in the US, 20 percent of cases in Sweden, and 5 percent of those in the United Kingdom. In Eastern countries, gallstones are the most common cause of acute pancreatitis. The causes of acute pancreatitis also varies across age groups, with trauma and systemic disease (such as infection) being more common in children. Mumps is a more common cause in adolescents and young adults than in other age groups.
The prognosis depends on prompt diagnosis (less than 12–24 hours and before gangrene) and the underlying cause:
- venous thrombosis: 32% mortality
- arterial embolism: 54% mortality
- arterial thrombosis: 77% mortality
- non-occlusive ischemia: 73% mortality.
In the case of prompt diagnosis and therapy, acute mesenteric ischemia can be reversible.