About all

Chest pain symptoms checker: Chest pain in adults – Mayo Clinic

Содержание

Lower Back Pain – familydoctor.org

  • Diagnosis

    You may have a HERNIATED DISC. You may also have SCIATICA, caused by irritation of the sciatic nerve.


    Self Care

    See your doctor. Get plenty of rest and use an anti-inflammatory medicine, such as ibuprofen, to relieve pain. If your pain is severe, if you have lost feeling or movement in your legs, or if you have lost control of your bladder or bowels (incontinence), see your doctor or go to the emergency room right away.


  • Diagnosis

    You may have a FRACTURED SPINE.


    Self Care

    EMERGENCY
    Call an ambulance right away. Do not try to drive to the emergency room, and try to move as little as possible.


  • Diagnosis

    Your pain may be from MUSCLE SPASM (this can often feel like your back is “locked up”), a PULLED MUSCLE, or a HERNIATED DISC.


    Self Care

    Apply heat, use an anti-inflammatory medicine, such as ibuprofen, and get some rest. If you don’t get better in 2-3 days, or if your symptoms get worse, see your doctor.


  • Diagnosis

    You may have SPONDYLOLISTHESIS, when one vertebra in the spine slips over another, or SPONDYLOSIS, a type of arthritis resulting from wear and tear of the spine.


    Self Care

    See your doctor. Use anti-inflammatory medicines, such as ibuprofen, to relieve pain.


  • Diagnosis

    You may have a kidney infection, such as PYELONEPHRITIS. You may also have KIDNEY STONES, which can start a kidney infection, and may cause sharp, continuous abdominal or back pain. You may also notice blood in your urine and have very painful urination with or without a fever.


    Self Care

    URGENT
    See your doctor right away.


  • Diagnosis

    You may have ANKYLOSING SPONDYLITIS, a form of arthritis that affects the spine. Other forms of ARTHRITIS can also cause back pain and stiffness.


    Self Care

    Use an anti-inflammatory medicine, such as ibuprofen, and apply heat to the affected area. If you do not improve, or if your pain is severe or gets worse, see your doctor.


  • Diagnosis

    PREGNANCY causes stretching of the tendons (a cord of tissue connecting muscle to bone) or ligaments (tissue connecting bones to each another) around the uterus, and increases the pressure on your lower back.


    Self Care

    Apply mild heat to the back only. See your doctor if the pain continues or if fever or bleeding accompanies the pain.


  • Diagnosis

    You may have a HERNIATED DISC or SPINAL STENOSIS, a narrowing of the spaces within the spine.


    Self Care

    See your doctor. Get plenty of rest and use an anti-inflammatory medicine, such as ibuprofen, to relieve pain. If your pain is severe, if you have lost feeling or movement in your legs, or if you have lost control of your bladder or bowels (incontinence), see your doctor or go to the emergency room right away.


  • Diagnosis

    You may have a serious condition, including certain types of CANCER.


    Self Care

    See your doctor for evaluation.


  • Self Care

    For more information, please talk to your doctor. If you think the problem is serious, call your doctor right away.


  • Symptom Checker at Patient. Check common symptoms online.


    If you’re feeling under the weather but aren’t sure what it could be, an online symptom checker can help you identify whether you need to seek immediate medical attention.


    Online symptom checkers are calculators that ask users to input details about their signs and symptoms of sickness, along with their gender, age and location.
    Using computerised algorithms, the self diagnosis tool will then give a range of conditions that might fit the problems a user is experiencing.
    They can also advice someone whether to seek advice from a healthcare professional and the level of urgency in which to do so.

    How do I know if I’m sick?


    Using an online symptom checker is simple. For instance, you might be a 45 year old woman from the UK who is currently experiencing headache,
    a fever and a sore throat.


    Inputting this information into the symptom checker will give you some likely ‘common’ diagnoses.
    These include: strep throat,
    tonsillitis,
    sinusitis and
    flu.


    But the self-diagnosis calculator will also give a list of rarer but more serious diagnoses in a tab called ‘red flags’.
    Here you’ll find links to our patient information leaflets about much less common conditions, such as
    temporal arteritis,
    meningitis and toxic shock syndrome. If, after reading the information,
    you think one of these serious conditions could apply to you,
    you should seek medical advice immediately.

    Patient’s symptom checker


    Patient uses a self-diagnosis tool called The Isabel Symptom Checker.
    It was released in 2012 by chief executive officer and co-founder Jason Maude,
    and has been continually improved and updated ever since.


    In 1999 Maude’s young daughter, Isabel, contracted the life-threatening conditions necrotising fasciitis and toxic shock syndrome.
    But doctors had diagnosed her with nothing more than a severe case of chickenpox. Luckily, despite some close calls and a two month stay in hospital,
    Isabel pulled through. Her diagnosis had been missed by doctors because it was so rare.


    So Maude set about creating a tool that would bring up a list of all the possible diseases for an entered set of symptoms, no matter how unlikely.
    His aim: to ensure that in future more dangerous conditions would not be missed by healthcare professionals and parents would not have to go through what he and his wife experienced.

    What’s the difference between a sign and a symptom?


    ‘Sign’ and ‘symptom’ are often used interchangeably, but if we’re going to be pedantic, they do actually mean different things.


    If you’re feeling ill it might not be immediately obvious to somebody looking at you that you’re sick.
    For instance, if you’re experiencing pain, fatigue or dizziness, only you know what that feels like. These are symptoms – which can only be described by the person experiencing them.


    Signs, on the other hand, can be observed by an outsider too. For example, indicators to other people that you’re unwell,
    such as: sweating, sneezing or looking pale. Or, things that can be measured, such as a high blood pressure reading or a fever determined with a thermometer, count as signs.

    How safe and accurate are symptom checkers?


    Most doctors agree that online symptom checkers are can encourage people with life-threatening symptoms to seek urgent attention,
    potentially saving lives. They’re also useful for reassuring patients who may have sought urgent care when they didn’t need to.


    However, one study suggested that online symptom checkers tend to be over-cautious,
    which could lead to an increase in unnecessary appointments,
    rather than a reduction. Another piece of research from the United States found
    that doctors are twice as likely to make a correct diagnosis as online symptom checkers.


    While these self diagnosis tools can certainly be useful for determining whether a trip to hospital is necessary,
    they can’t match the expertise of an experienced health professional.

    Disclaimer


    This symptom checker is provided by Isabel Healthcare Limited. Isabel Symptom Checker (“Isabel”) and any content accessed through Isabel is for informational purposes only, and is not intended to constitute professional medical advice,
    diagnosis or treatment. EMIS shall be in no way responsible for your use of Isabel, or any information that you obtain from Isabel. You acknowledge that when using Isabel you do so at your own choice and in agreement with this disclaimer.
    Do not ignore or delay obtaining professional medical advice because of information accessed through Isabel.
    Seek immediate medical assistance or call your doctor for all medical emergencies. By using Isabel you agree to the
    terms and conditions.

    10 Causes of Right and Left Sided Chest Pain & Relief Options

    Acid reflux disease (gerd)

    GERD (gastroesophageal reflux disease) in infants refers to the passage of stomach contents into the throat causing troublesome symptoms, such as feeding intolerance, inadequate oral intake of calories and/or poor weight gain. Vomiting or visible regurgitation ..

    Chest pain from reduced cardiac blood flow (angina pectoris)

    Angina pectoris is chest pain that is felt when heart muscle needs more blood than it is currently getting. This may result from coronary artery disease (CAD). CAD happens when the arteries that supply blood to heart muscle become hardened and narrowed. This is due to the buildup of cholesterol and other material, called plaque, on their inner walls.

    Rarity: Common

    Top Symptoms: chest pain, chest pain, tight, heavy, squeezing chest pain, moderate chest pain, deep chest pain, behind the breast bone

    Symptoms that always occur with chest pain from reduced cardiac blood flow (angina pectoris): chest pain

    Symptoms that never occur with chest pain from reduced cardiac blood flow (angina pectoris): productive cough

    Urgency: Primary care doctor

    Stomach ulcer

    A peptic ulcer is a sore in the lining of the stomach or the first part of your small intestine (the duodenum), which causes pain following meals or on an empty stomach.

    Rarity: Uncommon

    Top Symptoms: fatigue, nausea, loss of appetite, moderate abdominal pain, abdominal cramps (stomach cramps)

    Symptoms that never occur with stomach ulcer: pain in the lower left abdomen

    Urgency: Primary care doctor

    Atypical chest pain

    Atypical chest pain describes the situation when someone’s chest pain is unlikely to be related to heart or lung disease. There are many other possible causes that could explain chest pain, like sore chest wall muscles or psychological factors like stress and anxiety.

    Rarity: Common

    Top Symptoms: chest pain, shortness of breath

    Symptoms that always occur with atypical chest pain: chest pain

    Symptoms that never occur with atypical chest pain: fever

    Urgency: Primary care doctor

    Myocarditis

    Myocarditis is an inflammation of the heart muscle, also called the myocardium.

    It is a rare complication of any viral, bacterial, parasitic, or fungal infection. Reaction to drugs, medications, chemicals, or even radiation can bring about myocarditis.

    Anyone with a weakened immune system or pre-existing heart condition is susceptible.

    Symptoms include fatigue, chest pain, and shortness of breath, especially following a viral upper respiratory illness. Swelling of the feet and legs from poor circulation may be seen.

    If symptoms are severe, take the patient to the emergency room or call 9-1-1. Myocarditis weakens the heart so that it cannot pump blood as it should. Blood clots, stroke, heart attack, abnormal heart rhythm (arrhythmia,) and sudden cardiac death can result without treatment.

    Diagnosis is made by electrocardiogram (ECG,) chest x-ray, MRI, echocardiogram, and blood tests.

    Short-term treatment is with rest and medication, depending on what kind of illness brought about the myocarditis. Sometimes, devices to support the heartbeat may be surgically implanted.

    Long-term treatment may involve medicines such as ACE inhibitors, ARBs, beta blockers, and diuretics.

    Rarity: Rare

    Top Symptoms: fatigue, headache, shortness of breath, muscle aches, chest pain

    Urgency: Hospital emergency room

    Acute costochondritis (chest wall syndrome)

    Acute costochondritis is the inflammation of the flexible cartilage that connects each rib to the breastbone. Costochondritis is caused by excessive coughing or by straining the upper body, as with weightlifti..

    Heart attack

    Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. Often this leads to an irregular heartbeat – called an arrhythmia – that causes a severe decrease in the pumping function of the heart.

    Rarity: Uncommon

    Top Symptoms: chest pain, shortness of breath, tight, heavy, squeezing chest pain, being severely ill, nausea

    Urgency: Emergency medical service

    Pericarditis (inflammation surrounding the heart)

    Pericarditis is a condition in which the membrane, or sac, around the heart is inflamed. This sac is called the pericardium.

    Rarity: Rare

    Top Symptoms: fatigue, chest pain, being severely ill, fever, deep chest pain, behind the breast bone

    Symptoms that always occur with pericarditis (inflammation surrounding the heart): being severely ill

    Urgency: Hospital emergency room

    Pulmonary embolism

    An embolus is a blood clot that forms in the bloodstream, breaks loose, and is carried by the blood to become lodged elsewhere in the circulatory system. If this clot (embolus) blocks part of the bloodstream in the lungs (pulmonary system,) this condition is called pulmonary embolis..

    Collapsed lung (pneumothorax)

    A pneumothorax occurs when air or gas leaks into the space (called the pleural space), separating the lung from the chest wall. It puts pressure on the lung, causing the lung to collapse.

    Symptoms include sudden, sharp chest pain that worsens with de..

    Causes, Symptoms, Diagnosis & Treatments

    Overview

    The four main coronary arteries are the right coronary artery (RCA), left coronary artery (LCA), left anterior descending artery (LAD) and left circumflex artery.

    What is coronary artery disease?

    Coronary artery disease is a narrowing or blockage of your coronary arteries usually caused by the buildup of fatty material called plaque. Coronary artery disease is also called coronary heart disease, ischemic heart disease and heart disease.

    Where are the coronary arteries? What do they do?

    Coronary arteries are the blood vessels that supply oxygen-rich blood to your heart muscle to keep it pumping. The coronary arteries are directly on top of your heart muscle. You have four main coronary arteries:

    • The right coronary artery.
    • The left coronary artery.
    • The left anterior descending artery.
    • The left circumflex artery.

    What happens to the arteries in coronary artery disease?

    Coronary artery disease is caused by atherosclerosis. Atherosclerosis is the buildup of plaque inside your arteries. Plaque consists of cholesterol, fatty substances, waste products, calcium and the clot-making substance fibrin. As plaque continues to collect on your artery walls, your arteries narrow and stiffen. Plaque can clog or damage your arteries, which limits or stops blood flow to your heart muscle. If your heart does not get enough blood, it can’t get the oxygen and nutrients it needs to work properly. This condition is called ischemia. Not getting enough blood supply to your heart muscle can lead to chest discomfort or chest pain (called angina). It also puts you at risk for a heart attack.

    How does plaque build-up in the arteries?

    Coronary artery disease happens in everyone. The speed at which it develops differs from person to person. The process usually starts when you are very young. Before your teen years, the blood vessel walls start to show streaks of fat. As plaque deposits in your artery’s inner walls, your body fights back against this ongoing process by sending white blood cells to attack the cholesterol, but the attack causes more inflammation. This triggers yet other cells in the artery wall to form a soft cap over the plaque.

    This thin cap over the plaque can break open (due to blood pressure or other causes). Blood cell fragments called platelets stick to the site of “the injury,” causing a clot to form. The clot further narrows arteries. Sometimes a blood clot breaks apart on its own. Other times the clot blocks blood flow through the artery, depriving the heart of oxygen and causing a heart attack.

    The process of how plaque builds up in your coronary arteries.

    Who gets coronary artery disease?

    You have an increased risk of coronary artery disease if you:

    • Have a high cholesterol level (especially a high LDL “bad” cholesterol level and a low HDL “good” cholesterol level).
    • Have high blood pressure.
    • Family history of heart disease.
    • Have diabetes.
    • Are a smoker.
    • Are a man over 45 years of age or a post-menopausal woman.
    • Are overweight.
    • Are physically inactive.
    • Are Black, Mexican American, Native American, Native Hawaiian or an Asian American. The increased risks are caused by higher rates of high blood pressure, obesity and diabetes in these populations.

    If you have these risk factors, talk with your healthcare provider. They may want to test you for coronary artery disease.

    Symptoms and Causes

    Location of symptoms of a heart attack.

    What are the symptoms of coronary artery disease?

    You may not know you have coronary artery disease since you may not have symptoms at first. The buildup of plaque in your arteries takes years to decades. But as your arteries narrow, you may notice mild symptoms that indicate your heart is pumping harder to deliver oxygen-rich blood to your body. The most common symptoms are chest pain or shortness of breath, especially after light physical activity like walking up stairs, but even at rest.

    Sometimes you won’t know you have coronary artery disease until you have a heart attack. Symptoms of a heart attack include:

    • Chest discomfort (angina) described as heaviness, tightness, pressure, aching, burning, numbness, fullness, squeezing or a dull ache. The discomfort can also spread to or only be felt in your left shoulder, arms, neck, back or jaw.
    • Feeling tired.
    • Dizziness, lightheadedness.
    • Nausea.
    • Weakness.

    Symptoms of a heart attack in women can be slightly different and include:

    • Discomfort or pain in the shoulders, neck, abdomen (belly) and/or back.
    • Feeling of indigestion or heartburn.
    • Unexplained anxiety.
    • Cold sweat.

    What should I do if I have symptoms of coronary artery disease?

    Because the symptoms of coronary artery disease can be symptoms of a heart attack, you need to seek immediate help. Call 911 if you think you are having symptoms of a heart attack.

    If a blood clot in a coronary artery has broken loose and moved into your brain, it can cause a stroke, although this is rare. Symptoms of a stroke include:

    • Drooping on one side of your face. Look at your smile in a mirror or ask someone to check your smile.
    • Arm weakness or numbness.
    • Difficulty speaking/slurred speech.

    If you experience any of these symptoms, call 911. Every minute you spend without treatment increases your risk of long-term damage.

    Diagnosis and Tests

    How is coronary artery disease diagnosed?

    First, unless your condition is an emergency (you’re having a heart attack or stroke), your cardiologist (heart doctor) will ask you about your symptoms, take your medical history, review your risk factors and perform a physical exam.

    Diagnostic tests may include:

    • Electrocardiograph tests (EKG): This test records the electrical activity of the heart. Can detect heart attack, ischemia and heart rhythm issues.
    • Exercise stress tests: This is a treadmill test to determine how well your heart functions when it’s working the hardest. Can detect angina and coronary blockages.
    • Pharmacologic stress test: Instead of using exercise to test your heart when it is working its hardest, medication is given to increase your heart rate and mimic exercise. This test can detect angina and coronary blockages.
    • Coronary calcium scan: This test measures the amount of calcium in the walls of your coronary arteries, which can be a sign of atherosclerosis.
    • Echocardiogram: This test uses sound waves to see how well the structures of your heart are working and the overall function of your heart.
    • Blood tests: Many blood tests are ordered for factors that affect arteries, such as triglycerides, cholesterol, lipoprotein, C-reactive protein, glucose, HbA1c (a measure of diabetic control) and other tests.
    • Cardiac catheterization: This test involves inserting small tubes into the blood vessels of the heart to evaluate heart function including the presence of coronary artery disease.

    Other diagnostic imaging tests may include:

    • Nuclear imaging: This test produces images of the heart after administering a radioactive tracer.
    • Computed tomography angiogram: Uses CT and contrast dye to view 3D pictures of the moving heart and detect blockages in the coronary arteries.

    Management and Treatment

    How is coronary artery disease treated?

    Your healthcare provider will talk to you about the best treatment plan for you. Follow your treatment plan to reduce your risk of problems that can result from coronary artery disease, like heart attack and stroke.

    Lifestyle changes

    The first step in treating coronary artery disease is to reduce your risk factors. This involves making changes in your lifestyle.

    • Don’t smoke. If you smoke or use tobacco products, quit. Ask your healthcare providers about ways to quit, including programs and medications.
    • Manage health problems like high cholesterol, high blood pressure and diabetes.
    • Eat a heart-healthy diet. Talk to your healthcare provider or a registered dietitian about ways to change your diet to reduce your risk of heart disease. Good dietary choices include the Mediterranean and DASH diets.
    • Limit alcohol use. Limit daily drinks to no more than one drink per day for women and two drinks per day for men.
    • Increase your activity level. Exercise helps you lose weight, improve your physical condition and relieve stress. Most people can reduce their risk of heart attack by doing 30 minutes of walking five times per week or walking 10,000 steps per day. Talk to your healthcare provider before you start any exercise program.

    Medications

    Your healthcare provider will recommend medications to best manage your risk factors for heart disease. Types of heart-related medications that may be selected for you include:

    • Medication to lower your cholesterol levels, such as statins, bile acid sequestrants, niacin and fibrates.
    • Medications to lower blood pressure, such as beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers.
    • Medications to stop angina, such as nitrates/nitroglycerin or ranolazine.
    • Medications to reduce the risk of blood clots, such as anticoagulants (including aspirin) and antiplatelets.

    If you have diabetes and coronary artery disease, you’ll be prescribed medications to lower your blood sugar level.

    It’s important to take all medications as prescribed, including those for heart disease and all other health conditions. Talk to your healthcare provider if you have any questions or concerns about which medications to take or how to take them.

    Procedures and surgery

    Interventional procedures are nonsurgical treatments to get rid of plaque buildup in the arteries and prevent blockages. Common procedures are balloon angioplasty and stenting. These procedures are done with a long, thin tube called a catheter. It is inserted into an artery in the wrist or the top of the leg through a small incision and guided to the blocked or narrowed area of the artery. The balloon widens the diameter of the artery to restore blood flow to the heart. A stent (a small metal spring-like scaffold) is left in place to keep your artery open.

    Coronary artery bypass graft (CABG) surgery involves creating a new path for blood to flow when there is a blockage in the coronary arteries. In most cases, the surgeon removes blood vessels from your chest, arm or leg, and creates a new pathway to deliver oxygen-rich blood to the heart.

    If traditional treatment options are not successful, your cardiologist may recommend other treatment options, such as enhanced external counterpulsation (EECP). In this procedure, inflatable cuffs (like blood pressure cuffs) are used to squeeze the blood vessels in your lower body. This helps improve blood flow to the heart and helps create natural bypasses (collateral circulation) around blocked coronary arteries. Enhanced external counterpulsation is a possible treatment for those with chronic stable angina who can’t have an invasive procedure or bypass surgery and don’t get relief from medication.

    Collateral circulation around a blocked coronary artery.

    What are the complications of coronary artery disease?

    Coronary artery disease can lead to the following other heart conditions:

    You can reduce your chance of developing these heart conditions if you follow your cardiologist’s treatment plan.

    Prevention

    Can coronary artery disease be prevented?

    You can certainly make changes that will lower your chance of developing coronary artery disease, but this condition is not 100% preventable. This is because there are two kinds of risk factors: Those that can’t be changed (nonmodifiable) and those that can be (modifiable).

    Nonmodifiable risk factors include older age, male gender, a family history of heart disease and genetic factors. See the question, “who gets coronary artery disease” earlier in this article for more information.

    However, there are many risk factors that you can modify. These are mostly lifestyle changes like losing weight if you’re overweight, stopping smoking if you smoke, keeping your blood pressure and cholesterol level at their goal numbers and managing diabetes. See “lifestyle changes” under the treatment section of this article for more examples.

    Keep in mind that the more risk factors you have, the higher the chance of having heart disease. Fortunately, you can choose to help yourself and reduce the risk of disease by taking control over your risk factors that can be changed.

    Outlook / Prognosis

    What should I expect if I have coronary artery disease? Can it be cured?

    Technically coronary artery disease can’t be cured. If you’ve been diagnosed with coronary artery disease, follow your healthcare provider’s treatment plan to help prevent your condition from getting worse. Your treatment plan may include procedures and surgery to increase the blood supply to your heart, lifestyle changes to target your risk factors and medications.

    If your coronary artery disease has led to a heart attack, your healthcare provider can recommend a cardiac rehabilitation program to reduce your risk of future heart problems, regain strength and improve the quality of your life.

    It’s important to keep all follow-up appointments and have all tests ordered by your healthcare provider. These are needed to keep track of your condition, monitor how well your treatment plan is working and make adjustments if needed.

    Living With

    What is acute coronary syndrome?

    Acute coronary syndrome is the name given to types of coronary disease that are associated with a sudden blockage in the blood supply to your heart. Some people have symptoms before they have acute coronary syndrome, but you may not have symptoms until the condition occurs. Some people never have any symptoms. Changes caused by acute coronary syndrome can be seen on an electrocardiogram (ECG) and in blood tests. Acute coronary syndrome is defined by the location of the blockage, length of time the artery is blocked and amount of damage and is defined as:

    • Unstable angina: This may be a new symptom or can happen if you have stable angina that changes to unstable angina. You may start to have angina more often, when you are resting, or it may be worse or last longer. The condition can lead to a heart attack. If you have unstable angina, you will need medication, such as nitroglycerin or a procedure to correct the problem.
    • Non-ST segment elevation myocardial infarction (NSTEMI): This is a type of heart attack (MI) that does not cause major changes on an ECG. But, a blood test will show that there is damage to your heart muscle.
    • ST segment elevation myocardial infarction (STEMI): This type of heart attack (MI) is caused by a sudden blockage of the blood supply to the heart.

    These are life-threatening conditions that require emergency medical care.

    How is angina different from a heart attack?

    Both angina and heart attack are a consequence of coronary artery disease. The symptoms of a heart attack (myocardial infarction/MI) are similar to angina. But, angina is a warning symptom of heart disease, not a heart attack.

    Angina Heart Attack
    Caused by a drop in blood supply to the heart due to the gradual build-up of blockage in the arteries. Caused by a sudden lack of blood supply to the heart muscle. The blockage is often due to a clot in a coronary artery.
    Does not cause permanent damage to the heart. Can cause permanent damage to the heart muscle.
    Symptoms last a few minutes and usually stop if you rest or take medication. You may have chest pain or discomfort, shortness of breath, palpitations, fast heartbeat, dizziness, nausea, extreme weakness and sweating. Symptoms are often triggered by strenuous activity, stress, eating or being in the cold. Symptoms usually last more than a few minutes and do not completely go away after taking nitroglycerin. Symptoms include chest pain or discomfort; pain or discomfort in other areas of the upper body; trouble breathing or shortness of breath; sweating or “cold” sweat; feeling full, like you are choking or indigestion; nausea or vomiting; lightheadedness; extreme weakness; anxiety; fast or irregular heartbeat.
    Emergency medical attention is not needed. Call your doctor if you have not had symptoms before or if your symptoms have gotten worse or happen more often. Emergency medical attention is needed if symptoms last longer than 5 minutes.

    A note from Cleveland Clinic

    Coronary artery disease is a narrowing or blockage of your coronary arteries usually caused by the buildup of fatty material called plaque. Coronary artery disease can lead to angina and heart attack. Fortunately, if you know the risk factors and symptoms for disease, you can be seen at regular intervals and your management plan can be adjusted.

    There’s a lot you can do to prevent or slow the progression of coronary artery disease. Work with your healthcare provider to make lifestyle changes that will help you live your life to the fullest.

    Symptom Checker – MU Health Care

    MU Health Care offers multiple options for fast, convenient care, including video visits, Quick Care and Urgent Care.

    This information does not replace the advice of a medical professional. You should consult your primary care provider if you have medical questions.

    Abdominal pain

    Abdominal pain can have many causes. Often the specific symptoms help determine the cause of the pain. If your pain is accompanied by mild to moderate symptoms such as diarrhea, nausea or vomiting, you should visit Urgent Care. If your pain is severe or worsening, you should visit an Emergency Room.

    Urgent Care   Emergency Room

    Allergies

    For most people, allergies mean itchy eyes and a drippy nose, and those can be treated at Quick Care. But for a few people, allergies to things such as bee stings or nuts cause a whole-body reaction that is best treated at Urgent Care or the Emergency Room when they are life-threatening.

    Quick Care   Urgent Care   Emergency Room

    Animal bites

    Because animal bites can require stitches and cause infections and other complications, it’s best to seek treatment at Urgent Care, which offers lab services. If a child has a bite to the face or neck, it’s best to visit the Emergency Room.

    Urgent Care   Emergency Room

    Asthma

    If you or your child has asthma, you know how scary it can be when you can’t catch your breath. Our Urgent Care facility can provide the breathing treatments needed to help alleviate symptoms. If symptoms include severe shortness of breath, please visit the nearest Emergency Room.

    Urgent Care   Emergency Room

    Bladder and urinary tract infection

    Most urinary tract infections (UTIs) are bladder infections. A bladder infection usually is not serious if it is treated right away. Quick Care can treat women and transgender men suffering from bladder and urinary tract infections, while our Urgent Care clinic and video visits can treat everyone — men, women and children.

    Quick Care   Urgent Care   video visits

    Bleeding

    Non-severe bleeding and bleeding that stems from cuts and burns can be treated at our Urgent Care clinic. However, if you are experiencing severe or uncontrolled bleeding, visit the Emergency Room.

    Urgent Care   Emergency Room

    Breathing di­fficulty

    Breathing difficulties (that are not associated with a known condition such as asthma) can quickly escalate into life-threatening situations, so you should visit an Emergency Room.

    Emergency Room

    Broken bones

    Urgent Care can treat many broken bones. If the bone is breaking through the skin, it’s best to visit the nearest Emergency Room.

    Urgent Care   Emergency Room

    Chest pain or suspected heart attack

    Please seek immediate medical attention for chest pain or other heart attack symptoms. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Choking

    Please seek immediate medical attention for someone who is choking. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Cold, cough, congestion

    Coughs, congestion and cold symptoms can be treated at Quick Care or with video visits. People with severe symptoms should seek care at Urgent Care.

    Quick Care   video visits   Urgent Care

    COVID-19

    If you need testing, visit the link below. If you have severe symptoms, including difficulty breathing, go to the Emergency Room or call 911.

    Testing Info   COVID-19 Info

    Cuts and burns

    Most cuts and burns are best treated at Urgent Care. However, if they are serious and accompanied by uncontrolled bleeding, please seek care at an Emergency Room.

    Urgent Care   Emergency Room

    Diabetic emergencies

    Please seek immediate medical attention for someone who is suffering a diabetic emergency. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Diarrhea, nausea and vomiting

    Seek care at Urgent Care. If your symptoms are uncontrolled (severe), please seek care at the nearest Emergency Room. These conditions also can be treated via video visits.

    Urgent Care   video visits   Emergency Room

    Drug overdose

    Please seek immediate medical attention for someone who is suffering a drug overdose. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Ear pain/infection

    Ear pain can be treated at Quick Care or with video visits.

    Quick Care   video visits

    Eye irritation and pink eye

    Most eye irritation, including pink eye, can be treated at Quick Care or with video visits. More severe eye issues are best treated at Urgent Care.

    Quick Care   video visits   Urgent Care

    Fever

    Fever can be treated at Quick Care, Urgent Care or with video visits.

    Quick Care   Urgent Care   video visits

    Flu symptoms

    Flu can be treated at Quick Care, Urgent Care or video visits. Quick Care offers flu testing and vaccination. For severe symptoms and at-risk patients such as the very young or the elderly, go to the Emergency Room.

    Quick Care   Urgent Care   video visits

    Headaches and migraine

    These can be treated with video visits or at Urgent Care.

    Urgent Care   video visits

    Head injuries

    Minor head injuries are best treated at Urgent Care. However, if they are serious or accompanied by severe headaches, please seek care at an Emergency Room.

    Urgent Care   Emergency Room

    Insect bites and head lice

    Most insect bites as well as head lice can be treated at Quick Care. However, if the bite is accompanied by severe swelling, please visit Urgent Care.

    Urgent Care   Quick Care

    Joint or muscle injuries

    These can be treated at Urgent Care.

    Urgent Care

    Possible poisoning

    Contact the Poison Control Center at 800-222-1222 if you suspect someone has been poisoned. If the person is unresponsive, visit the nearest Emergency Room.

    Poison Control   Emergency Room

    Rashes and skin infections

    Simple rashes can be treated at Quick Care. More severe rashes and skin infections can be treated at Urgent Care.

    Quick Care   Urgent Care

    Sexually transmitted infections

    These can be treated at Urgent Care.

    Urgent Care

    Seizures

    Please seek immediate medical attention for someone who is experiencing a seizure. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Sinus pain/infection

    Sinus pain can be treated at Quick Care, Urgent Care or with video visits.

    Quick Care   Urgent Care   video visits

    Sore throat

    Sore throat can be treated at Quick Care, Urgent Care or with video visits.

    Quick Care   Urgent Care   video visits

    Sprains and strains

    Sprains and strains can be treated at Urgent Care or with video visits.

    Urgent Care   video visits

    Stroke symptoms (e.g. blurred vision or slurred speech)

    Please seek immediate medical attention for someone who is experiencing symptoms of a stroke. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Unconsciousness

    Please seek immediate medical attention for someone who is unconscious. Call 911 or visit the nearest Emergency Room.

    Emergency Room

    Evaluation of symptom checkers for self diagnosis and triage: audit study

    1. Hannah L Semigran, research assistant1,
    2. Jeffrey A Linder, associate professor 2,
    3. Courtney Gidengil, instructor3, natural scientist4,
    4. Ateev Mehrotra, associate professor15
    1. 1Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
    2. 2Division of General Medicine and Primary Care, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA
    3. 3 Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA, USA
    4. 4RAND Corporation, Boston, MA, USA
    5. 5Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
    1. Correspondence to: A Mehrotra [email protected]

    Abstract

    Objective To determine the diagnostic and triage accuracy of online symptom checkers (tools that use computer algorithms to help patients with self diagnosis or self triage).

    Design Audit study.

    Setting Publicly available, free symptom checkers.

    Participants 23 symptom checkers that were in English and provided advice across a range of conditions. 45 standardized patient vignettes were compiled and equally divided into three categories of triage urgency: emergent care required (for example, pulmonary embolism), non-emergent care reasonable (for example, otitis media), and self care reasonable (for example, viral upper respiratory tract infection).

    Main outcome measures For symptom checkers that provided a diagnosis, our main outcomes were whether the symptom checker listed the correct diagnosis first or within the first 20 potential diagnoses (n=770 standardized patient evaluations). For symptom checkers that provided a triage recommendation, our main outcomes were whether the symptom checker correctly recommended emergent care, non-emergent care, or self care (n=532 standardized patient evaluations).

    Results The 23 symptom checkers provided the correct diagnosis first in 34% (95% confidence interval 31% to 37%) of standardized patient evaluations, listed the correct diagnosis within the top 20 diagnoses given in 58% (55% to 62%) of standardized patient evaluations, and provided the appropriate triage advice in 57% (52% to 61%) of standardized patient evaluations. Triage performance varied by urgency of condition, with appropriate triage advice provided in 80% (95% confidence interval 75% to 86%) of emergent cases, 55% (47% to 63%) of non-emergent cases, and 33% (26% to 40%) of self care cases (P<0.001). Performance on appropriate triage advice across the 23 individual symptom checkers ranged from 33% (95% confidence interval 19% to 48%) to 78% (64% to 91%) of standardized patient evaluations.

    Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.

    Introduction

    Members of the public are increasingly using the internet to research their health concerns. For example, the United Kingdom’s online patient portal for national health information, NHS Choices, reports over 15 million visits per month.1 More than a third of adults in the United States regularly use the internet to self diagnose their ailments, using it both for non-urgent symptoms and for urgent symptoms such as chest pain.2 3 While there is a wealth of online resources to learn about specific conditions, self diagnosis usually starts with search engines like Google, Bing, or Yahoo.2 However, internet search engines can lead users to confusing and sometimes unsubstantiated information, and people with urgent symptoms may not be directed to seek emergent care.3 4 5 6 Recently there has been a proliferation of more sophisticated programs called symptom checkers that attempt to more effectively provide a potential diagnosis for patients and direct them to the appropriate care setting.3 6 7 8 9 10 11 12 13

    Using computerized algorithms, symptom checkers ask users a series of questions about their symptoms or require users to input details about their symptoms themselves. The algorithms vary and may use branching logic, bayesian inference, or other methods. Private companies and other organizations, including the National Health Service, the American Academy of Pediatrics, and the Mayo Clinic, have launched their own symptom checkers. One symptom checker, iTriage, reports 50 million uses each year.14 Typically, symptom checkers are accessed through websites, but some are also available as apps for smart phones or tablets.

    Symptom checkers serve two main functions: to facilitate self diagnosis and to assist with triage. The self diagnosis function provides a list of diagnoses, usually rank ordered by likelihood. The diagnosis function is typically framed as helping educate patients on the range of diagnoses that might fit their symptoms. The triage function informs patients whether they should seek care at all and, if so, where (that is, emergency department, general practitioner’s clinic) and with what urgency (that is, emergently or within a few days). Symptom checkers may supplement or replace telephone triage lines, which are common in primary care.15 16 17 18 To ensure the safety of medical mobile apps, the US Congress is considering the regulation of apps that “provide a list of possible medical conditions and advice on when to consult a health care provider.”19 20

    Symptom checkers have several potential benefits. They can encourage patients with a life threatening problem such as stroke or heart attack to seek emergency care.21 For patients with a non-emergent problem that does not require a medical visit, these programs can reassure people and recommend they stay home. For approximately a quarter of visits for acute respiratory illness such as viral upper respiratory tract infection, patients do not receive any intervention beyond over the counter treatment,22 and over half of patients receive unnecessary antibiotics.23 24 25 Reducing the number of visits saves patients’ time and money, deters overprescribing of antibiotics, and may decrease demand on primary care providers—a critical problem given that the workload for general practitioners in the United Kingdom increased by 62% from 1995 to 2008.17 However, there are several key concerns. If patients with a life threatening problem are misdiagnosed and not told to seek care, their health could worsen, increasing morbidity and mortality. Alternatively, if patients with minor illnesses are told to seek care, in particular in an emergency department, such programs could increase unnecessary visits and therefore result in increased time and costs for patients and society.

    The impact of symptom checkers will depend to a large degree on their clinical performance. To measure the accuracy of diagnosis and triage advice provided by symptom checkers, we used 45 standardized patient vignettes to audit 23 symptom checkers. The vignettes reflected a range of conditions from common to less common and low acuity to life threatening.

    Methods

    Search strategy for symptom checkers

    Between June 2014 and November 2014 we searched for symptoms checkers that were in English, were free, were publicly available, were for humans (compared with veterinary use), and did not focus on a single type of condition (for example, only orthopedic problems). To find symptom checkers that were available as apps in the Apple app store and Google Play, we used two search phrases (“symptom checker”, “medical diagnosis”) used in a recent study on symptom checkers and examined the first 240 search results by hand.12 We chose 240 because this cut-off has been used in previous studies that have searched smartphone app stores.26 To find online symptom checkers, we entered the same two search phrases in Google and Google Scholar and examined the first 300 results. In previous research, the probability of relevant search results identified using Google declines substantially after the first 300 results.27 We supplemented our searches by asking the developers of two symptom checkers if they knew of other competing products.

    In total we identified 143 symptom checkers. We excluded 102 that used the same medical content and logic as another tool (and therefore would have identical performance) (see list in supplementary appendix). We excluded a further 25 that only focused on a single class of illness (for example, orthopedic problems), 14 that only provided medical advice (for example, what symptoms are typically associated with a certain condition) and did not provide diagnosis or triage advice, and two that were not working. After these exclusions, we evaluated 23 symptom checkers.

    Symptom checkers’ characteristics

    We categorized symptom checkers by whether they facilitated self diagnosis, self triage, or both; type of organization that operated the symptom checker; and the maximum number of diagnoses provided and whether they were based on Schmitt or Thompson nurse triage guidelines, which are decision support protocols commonly used in telephone triage for pediatric and adult consultations, respectively.28 29 We grouped government and health plans together because both may have a financial incentive to deter unnecessary visits. In the supplementary appendix we provide data when available about estimated total visitors to select symptom checkers.

    Clinical vignettes

    To evaluate the diagnosis and triage performance of the symptom checkers, we used 45 standardized patient vignettes. We used clinical vignettes to assess performance because they are a common method to test physicians and other clinicians on their diagnostic ability and management decisions. We purposefully selected standardized patient vignettes from three categories of triage urgency: 15 vignettes for which emergent care is required, 15 vignettes for which non-emergent care is reasonable, and 15 vignettes for which a medical visit is generally unnecessary and self care is sufficient. We chose vignettes across the severity spectrum because patients use symptom checkers for symptoms that require both urgent and non-urgent care.3 We included vignettes for both common and uncommon conditions because we believe that the clinical community would be particularly interested in performance for less common but potentially life threatening problems.

    The standardized patient vignettes were identified from various clinical sources, including materials used to educate health professionals and a medical resource website with content provided by a panel of physicians.30 The source for each vignette also provided the associated correct diagnosis. Symptom checkers generally require users to enter a list of symptoms or ask a series of questions about their symptoms. Each vignette was simplified into a core set of symptoms for easy entry, and in some situations we supplemented the data provided by the vignette because a symptom checker asked about a symptom not addressed in the vignette (see the supplementary appendix for details on source, core symptoms, and supplemental symptoms for each vignette).

    We categorized the 45 vignettes as either “common” or “uncommon” diagnoses based on the prevalence of the diagnosis among ambulatory visits in the United States (for full details see the supplementary appendix).31

    Assessing diagnosis and triage results

    Each standardized patient vignette was entered into each website or app, and we recorded the resulting diagnoses and triage advice. An author (HS) with no clinical training entered all the vignettes. A random sample of 25 vignettes was entered into symptom checkers by another person without clinical training and the inter-rater reliability between the two in capturing the symptom checker’s recommendations for diagnosis and triage was high (Cohen’s κ 0.90). In some cases we could not evaluate a vignette because some symptom checkers focus only on children or on adults or the symptom checker did not list or ask for the key symptom in the vignette. To avoid penalizing these symptom checkers, we referred to standardized patient vignettes that successfully yielded an output as “standardized patient evaluations.”

    To assess diagnostic accuracy, we noted whether the correct diagnosis was listed first or listed at all. For several vignettes, two symptom checkers presented a large number of diagnoses (as much as 99). Because such a long list of potential diagnoses is unlikely to be useful for patients, we considered a diagnosis to be listed at all only if it was within the first 20 diagnoses provided by a symptom checker. It is possible that many patients only focus on the top diagnoses listed. Therefore we also looked at whether the correct diagnosis was listed in the first three diagnoses given. We judged the diagnosis incorrect if the symptom checker indicated that the condition could not be identified.

    We categorized the triage advice into three groups: emergent, which included advice to call an ambulance, go to the emergency department, or see a general practitioner immediately; non-emergent, which included advice to call a general practitioner or primary care provider, see a general practitioner or primary care provider, go to an urgent care facility, go to a specialist, go to a retail clinic, or have an e-visit; and self care, which included advice to stay at home or go to a pharmacy. If multiple triage locations were suggested (for example, emergency department or specialist), we used the most urgent suggestion. We chose to do so because in almost all of the cases the most urgent triage suggestion was listed first. If a symptom checker was unable to reach a decision on diagnosis for a given standardized patient vignette but provided triage advice, we still assessed the appropriateness of this triage advice. Symptom checkers that required users to select the correct diagnosis before giving triage advice were not included in assessing the accuracy of triage with the exception of iTriage, which always suggested emergent triage advice.

    Patient involvement

    There was no patient involvement in this study.

    Analysis

    We calculated summary statistics for diagnostic accuracy and triage advice with 95% confidence intervals based on binomial distribution using Stata/MP 13.0. Given our focus on symptom checkers as a whole, we did not make statistical comparisons of accuracy between individual symptom checkers. We used χ2 tests to compare the diagnosis and triage accuracy by level and urgency and by type of symptom checker. We conducted a sensitivity analysis of triage advice, excluding several symptom checkers that always or usually recommended emergent care.

    Results

    Study sample

    The 23 identified symptom checkers were based in the United Kingdom, United States, the Netherlands, and Poland (table 1⇓): 11 symptom checkers provided both diagnoses and triage advice, eight only provided diagnoses, and four only provided triage advice. The 45 standardized patient vignettes included 26 common and 19 uncommon diagnoses. Performance was assessed on a total of 770 standardized patient evaluations for diagnosis and 532 standardized patient evaluations for triage. Across the symptom checkers, 10 did not ask for demographics (age and sex).

    Table 1

     Symptom checkers included in the study

    Accuracy of diagnosis

    Overall, the correct diagnosis was listed first in 34% (95% confidence interval 31% to 37%; table 2⇓) of standardized patient evaluations. Performance varied by urgency of condition. The correct diagnosis was listed first for 24% (19% to 30%) of emergent standardized patient evaluations, 38% (32% to 34%) of non-emergent standardized patient evaluations, and 40% (34% to 47%) of self care standardized patient evaluations (P<0.001 for comparison, table 2). There was no difference between symptom checkers that asked for and did not ask for demographic information (34%, 95% confidence interval 30% to 39% and 34%, 28% to 39%, P=0.88; table 3⇓). The correct diagnosis was, however, listed first more often in standardized patient evaluations for common diagnoses than for uncommon diagnoses (38%, 34% to 43% and 28%, 23% to 33%, P=0.004; table 2⇓).

    Table 2

     Accuracy of diagnosis decision and triage advice for all symptom checkers, stratified by severity of standardized patient (SP) vignette and by frequency of the condition’s diagnosis

    Table 3

     Accuracy of diagnosis given and triage advice for all symptom checkers given certain characteristics of the tools

    Performance varied across symptom checkers. Listing the correct diagnosis first in standardized patient evaluations ranged from 5% for MEDoctor (95% confidence interval 0% to 13%) to 50% for DocResponse (33% to 67%; table 4⇓). Few differences were observed by the symptom checkers’ characteristics (table 3⇑).

    Table 4

     Accuracy of diagnosis decision and triage advice for each symptom checker

    Across all symptom checkers the correct diagnosis was listed in the first three diagnoses in 51% (95% confidence interval 47% to 54%) of standardized patient evaluations and in the first 20 diagnoses in 58% (55% to 62%) of standardized patient evaluations (table 2). Diagnostic accuracy for listing the correct diagnosis in the top three and top 20 was higher for self care conditions than for emergent conditions and was also higher for common conditions than for uncommon conditions. There was no significant difference in listing the correct diagnosis in the top 20 between symptom checkers that listed more than 11 diagnoses compared with those that only listed 1-3 diagnoses (59%, 53% to 65% v 53%, 46% to 59%, P=0.12; table 3). The accuracy of listing the correct diagnosis in the top 20 across the 23 individual symptom checkers ranged from 34% (95% confidence interval 17% to 52%) to 84% (73% to 95%, table 4⇑).

    Accuracy of triage advice

    Appropriate triage advice was given in 57% (95% confidence interval 52% to 61%) of standardized patient evaluations (table 2⇑). Performance on triage advice was higher for emergent care standardized patient evaluations than for non-emergent and self-care standardized patient evaluations: 80% (75% to 86%) v 55% (47% to 63%) v 33% (26% to 40%), P<0.001). Appropriate triage advice was higher for uncommon diagnoses than for common diagnoses: 63% (57% to 70%) v 52% (46% to 57%), P=0.01).

    iTriage, Symcat, Symptomate, and Isabel always suggested users seek care and therefore never advised self care (table 4⇑). After excluding these four symptom checkers, appropriate triage advice was given in 61% (95% confidence interval 56% to 66%) of standardized patient evaluations (see supplementary table 5).

    Symptom checkers that used the Schmitt or Thompson nurse triage protocols were more likely to provide appropriate triage decisions than those that did not: 72% (95% confidence interval 60% to 84%) v 55% (50% to 59%), P=0.01; table 3⇑. Accurate triage advice varied by operator of symptom checker (provider groups and physician associations 68% (58% to 77%), private companies 59% (53% to 65%), health plans or governments 43% (34% to 51%), P<0.001).

    Discussion

    Using standardized patient vignettes we measured the diagnostic and triage accuracy of symptom checkers. Although there was a range of performance across symptom checkers, overall they had deficits in both diagnosis and triage accuracy. On average, symptom checkers provided the correct diagnosis within the first 20 listed in 58% of standardized patient evaluations, with the best performing symptom checker listing the correct diagnosis in 84% of standardized patient evaluations. Symptom checkers advised the appropriate level of care about half the time, but this varied by clinical severity. The correct triage decision was much higher for standardized patient evaluations requiring emergent care (80%) than for those for which self care was appropriate (34%).

    Comparisons with other studies

    Our results on diagnostic accuracy and appropriate triage are roughly similar to previous work on the performance of single symptom checkers for a limited set of diagnoses.6 7 8 32 An orthopedic symptom checker listed the correct diagnosis for knee pain 89% of the time, and Boots WebMD listed the correct diagnosis 70% of the time for ear, nose, and throat symptoms.7 8 One study that also used two common acute standardized patient vignettes to evaluate WebMD reported a diagnostic accuracy rate of 50%.6

    Whether this level of performance for diagnosis and triage we observed is acceptable depends on the standard for comparison. If symptom checkers are seen as a replacement for seeing a physician, they are likely an inferior alternative. It is believed that physicians have a diagnostic accuracy rate of 85-90%, though in some studies using clinical vignettes, performance was lower.33 34 However, in-person physician visits might be the wrong comparison because patients are likely not using symptom checkers to obtain a definitive diagnosis but for quick and accessible guidance. Also, instead of diagnostic accuracy the key assessment of symptom checkers may be appropriate triage. Distinguishing between Rocky Mountain spotted fever and meningitis may be less important than ensuring patients seek emergent care.

    If symptom checkers are seen as an alternative for simply entering symptoms into an online search engine such as Google, then symptom checkers are likely a superior alternative. A recent study found that when typing acute symptoms that would require urgent medical attention into search engines to identify symptom-related web sites, advice to seek emergent care was present only 64% of the time.3

    Perhaps the most appropriate comparison to symptom checkers is telephone triage lines, which are widely used in developed nations.15 16 17 18 In general patients use symptom checkers and telephone triage for similar complaints.13 Also, many nurse phone triage lines use the same underlying clinical logic as the symptom checkers evaluated in this study. For example, some health plan nurse triage lines use the Healthwise symptom checker, and the Schmitt and Thompson protocols were originally developed for phone triage and now provide the underlying logic for several symptom checkers that we evaluated. The accuracy of telephone triage recommendations, as compared to in-person physician recommendations, ranged from 61% in a study of pediatric abdominal pain to 69% in a multicenter observational study.35 36 A recent study of NHS Symptom Checkers and NHS Direct’s telephone triage line found triage advice from both to be comparable.9 Given their similar clinical logic, triage performance, and their negligible operation costs, symptom checkers could potentially be a more cost effective way of providing triage advice than nurse-staffed phone lines.17

    Implications for using symptom checkers

    Both symptom checkers and telephone triage have been promoted as a means of reducing unnecessary office visits.15 16 17 18 37 The impact of symptom checkers on how people seek care depends on how patients respond to advice, and this is unknown. In one study, users expressed skepticism about the diagnosis ultimately suggested by a symptom checker.6 The risk averse nature of symptom checkers’ triage advice is a concern. In two thirds of standardized patient evaluations where medical attention was not necessary, we found symptom checkers encouraged care. Overly risk adverse advice is not limited to symptom checkers. Telephone triage advice can also encourage unnecessary care seeking.32 35 For instance, the NHS’s telephone triage line, which is not staffed by health professionals, has been implicated in increasing visits to emergency departments in the UK.38 Some patients researching health conditions online are motivated by fear, and the listing of concerning diagnoses by symptom checkers could contribute to hypochondriasis and “cyberchondria,” which describes the escalated anxiety associated with self diagnosis on the internet.39 40 41 42 43 Together, confusion, risk adverse triage advice, and cyberchondria could mean that symptom checkers encourage patients to receive care unnecessarily and thus increase healthcare spending. Understanding how patients interpret and use the advice from symptom checkers and the impact of symptom checkers on care seeking should be a key focus for future research.

    The symptom checkers in this study represent the first generation of such tools, and there are several potential advances that may improve their performance in future versions. Incorporating local epidemiological data may help inform diagnoses. For instance, addition of real time information about the local incidence of illness in the community greatly improved the performance of a diagnostic tool for group A streptococcal pharyngitis.10 Diagnosis and triage rates could also be improved if symptom checkers incorporated individual clinical data from medical claims or the electronic medical record. Demographic information is critical for both diagnostic and triage decisions for programs such as symptom checkers.11 One surprising finding in our study was that symptom checkers that asked for demographic background information did not perform better. However, it is possible that this demographic information was not effectively incorporated into the symptom checkers’ algorithms.

    Strengths and limitations of this study

    Despite the growing use of symptom checkers, we believe our study is the first to assess the clinical performance across a large number of symptom checkers and wide range of conditions.

    There were key limitations to this study. We cannot be sure we identified all publicly available symptom checkers, despite a thorough search of relevant databases and consultation with experts in this discipline. We used clinical vignettes in which the symptoms and diagnoses were typically clear, and few vignettes included comorbid conditions, resulting in a possible overestimation of the true clinical accuracy of symptom checkers.33 Some standardized patient vignettes contained specific clinical language (for example, mouth ulcers, tonsils with exudate), and actual patients with the same condition might struggle with the words to use to describe their symptoms or use different terms. Therefore, our analysis represents an indirect assessment of how well symptom checkers would perform with actual patients. We do not know how well physicians or other providers would diagnose or triage when presented with these standardized patient vignettes, preventing a direct comparison between symptom checkers and physicians. When symptom checkers suggested several care sites (for example, emergency department or general practice), our triage assessment was based only on the highest acuity site of care listed, and this may contribute to our finding that triage advice is risk averse.

    Symptom checkers are part of a larger trend of both patients and physicians using the internet for many healthcare tasks and therefore it seems likely that the use of symptom checkers will only increase. Patients are chatting online with physicians,44 emailing their doctors for medical advice,45 receiving care through e-visits,46 47 and downloading health apps to smartphones.48 In addition to the public, physicians and other practitioners are also using conceptually similar tools to aid in the diagnosis and triage of their patients.49 50

    Physicians should be aware that an increasing number of their patients are using new internet based tools such as symptom checkers and that the diagnosis and triage advice patients receive may often be inaccurate. For patients, our results imply that in many cases symptom checkers can give the user a sense of possible diagnoses but also provide a note of caution, as the tools are frequently wrong and the triage advice overly cautious. Symptom checkers may, however, be of value if the alternative is not seeking any advice or simply using an internet search engine. Further evaluations and monitoring of symptom checkers will be important to assess whether they help people learn more and make better decisions about their health.

    What is already known on this topic
    • The public is increasingly using the internet for self diagnosis and triage advice, and there has been a proliferation of computerized algorithms called symptom checkers that attempt to streamline this process

    • Despite the growth in use of these tools, their clinical performance has not been thoroughly assessed

    Notes

    Cite this as: BMJ 2015;351:h4480

    Footnotes

    • Contributors: All authors conceived and designed the study. HLS acquired the data and drafted the manuscript. HLS and AM analysed and interpreted the data. CG, JAL, and AM critically revised the manuscript for important intellectual content. HLS and AM carried out the statistical analysis. AM provided administrative, technical, and material support and supervised the study. AM acts as guarantor.

    • Funding: This study was funded by the US National Institute of Health (National Institute of Allergy and Infectious Disease grant No R21 AI097759-01).

    • Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: all authors are affiliated with Harvard Medical School. Harvard Medical School’s Family Health Guide is used as the basis for one of the symptom checkers evaluated. This symptom checker is available both in print and online (www.health.harvard.edu/family_health_guide/symptoms). None of the authors have been or plan to be involved in the development, evaluation, promotion, or any other facet of a Harvard Medical School related symptom checker; the authors have no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

    • Ethical approval: Not required

    • Data sharing: No additional data available.

    • Transparency: The guarantor (AM) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    References

    1. Fox S, Duggan M. Health Online 2013. Internet and American life project. Pew Research Center and California Health Care Foundation, 2013:4.

    2. Elliot AJ, Kara EO, Loveridge P, et al. Internet-based remote health self-checker symptom data as an adjuvant to a national syndromic surveillance system. Epidemiol Infect2015:1-7.

    3. DocBot: a novel clinical decision support algorithm. Engineering in Medicine and Biology Society (EMBC), 2014 36th Annual international conference of the IEEE; 2014 26-30 Aug 2014.

    4. Reuters. Aetna brings new iTriage employer technology to mid-sized businesses, 2013.

    5. Richards D, Meakins J, Tawfik J, et al. Nurse telephone triage for same day appointments in general practice: multiple interrupted time series trial of effect on workload and costs. BMJ2002;325.1214

    6. 113th US Congress. Medical Electronic Data Technology Enhancement for Consumers’ Health (MEDTECH), 2014.

    7. Schmitt BD. Pediatric telephone protocols: office version. American Academy of Pediatrics, 2012.

    8. Thompson DA. Adult telephone protocols, 3rd edn. American Academy of Pediatrics, 2013.

    9. CDC, NAMCS, NHAMCS. Annual number and percent distribution of ambulatory care visits by setting type according to diagnosis group: United States, 2009-2010, 2010.

    10. Donnelly L. A&E Crisis cause by NHS 111 phoneline, senior medic suggests. Telegraph 14 Jan, 2015.

    11. Usborne S. Cyberchondria: the perils of internet self-diagnosis. Independent. 17 Feb, 2009.

    12. Edney A. The FDA sets its sights on medical Apps: Bloomberg Businessweek, 20 Sep, 2013.

    Our Nine Favorite Online Symptom Checkers

    YOU WAKE UP IN THE MIDDLE OF THE NIGHT with stomach pain, fever, and sweats. Was it the questionable sushi from the gas station? Or the coughing kids you sat next to on your public transit adventure yesterday? You can’t call the doctor’s office at 3 am, so you reach for your trusty smartphone and check in with Dr. Internet. We’ve all done this, and the results can often be more than intimidating, it’s either definitely cancer, you’re pregnant, or just a rash.

    Symptom checkers have two primary functions: to facilitate self-diagnosis and assist with triage. Coupled with the recent exponential growth in medical technology and modern digital engineering, they are becoming more widely adopted, trusted and accurate every day. Lock some medical experts and software engineers in a room for a few days and they’ll spawn an app that provides a conjectured diagnosis based on the various possible responses the user (patient) provides. The algorithms vary across each checker, using branching logic, Bayesian inference, or other proprietary methods. All the tech mumbo jumbo aside, everyone is jumping on this train and many of us can’t imagine what life was like without the internet to help us navigate our ailments.[/vc_column_text]

    Your Search History Indicates?

    While there are literally pages of symptom checker apps in the Google Play Store and iTunes, now Google has added a new layer of results for mobile queries it identifies as symptom or illness related.

    According to this recent interview with Google’s product manager Veronica Pinchin stated:

    Previously, you had to know the name of the conditions, treatment, or specific medical term to find high-quality information. But with symptom search, you can use your own language to describe what you’re feeling and see a list of high-quality medical results.

    Even Microsoft’s Bing is working on ways to predict a user’s ailment by analyzing their search history, researchers reported that they could identify from 5 to 15 percent of pancreatic cases with false-positive rates of as low as one in 100,000.

    How Comfortable Are We With Symptom Checkers?

    According to a survey conducted by Phillips North America, 40 percent of Americans are comfortable using websites and apps to check their own symptoms. In addition, one in 10 Americans feel that web-based health information has saved their lives. With accuracy improving quickly, even doctors are incorporating them into their websites and electronic medical records. By encouraging patients to learn more about their symptoms and possible causes prior to the office visit, this saves everyone time & money, significantly improving efficiency all around. Aside from decreasing demand for primary care providers, symptom checkers also deter the overuse of prescribing antibiotics.

    A study published by BMJ in 2015 titled Evaluation of Symptom Checkers for Self Diagnosis and Triage, took an in-depth look at symptom checker accuracy and use by testing 23 commonly used symptom checkers. Researchers found that of the 23 symptom checkers analyzed, 34 percent provided the correct initial diagnosis in standardized patient evaluations, 54 percent provided the correct diagnosis out of the first 20 potential diagnoses given, and 57 percent provided the appropriate triage advice (triage advice included recommendations on when to seek emergent care, non-emergent care or self-care).

    As you can see, symptom checkers have both benefits and drawbacks in diagnosis and triage advice, as they are not always correct. Researchers of the BMJ study found that symptom checkers can encourage patients with a life-threatening problem, such as a stroke or heart attack, to seek emergency care. For patients with non-emergent problems, symptom checkers can offer reassurance and recommend self-care techniques to avoid unnecessary hospital visits and treatments at home. Researchers found, however, that these tools are generally risk-averse, meaning patients are urged to seek care more often than not, even when self-care is realistic. It is important to note that symptom checkers have also been found to do the opposite, misdiagnosing patients with a life-threatening problem, worsening their illness.

    Nine Free Symptom Checkers We Tested

    Which symptom checkers are best? We tried out nine free popular online and smartphone symptom checkers to help you decide which is best for you.

    1. Mayo Clinic (Online)

    With nearly 1.2 million views annually, the Mayo Clinic Symptom Checker offers a list of both adult and child symptoms, then triages the user after selecting the general symptom. The patient is then directed to very specific related factors. The user can add as many specific symptoms as desired. Finally, a list of possible causes and a comparison of the associated factors are offered.

    Another unique feature about the Mayo Clinic symptom checker is a sidebar of when to seek medical care and the option to learn all about the projected injury or illness.

    Unfortunately, there is not a current mobile or tablet version, meaning the user has to have a computer with Internet access to use the tool. We also found that the symptom checker seems to only include text in English, not images or videos, which can be exhausting to read through and add confusion.

    Pharmacy Times reported Mayo Clinic 59% accurate in diagnosis decision and triage advice.

    2. iTriage (Online and Smartphone App)

    With a reported 50 million users each year, iTriage is a popular choice among patients and doctors. Continually upgraded, iTriage Symptom Checker allows users to add demographics and multiple associated symptoms in addition to a primary symptom.

    One pro about this symptom checker is the option to start by entering symptoms using an avatar locater (if the patient isn’t sure what symptoms are present) or using a Symptoms List feature to start. After selecting the initial symptom, the user will be directed into another tab that displays the causes for the symptom. The patient can get a brief overview of the projected ailment and see helpful images or videos. The patient can also enter in a location that will direct him or her to a medical provider that can assist in the assumed cause. Users can also create a My iTriage account to save the information into a database much like a personal electronic record.

    iTriage, however, can be confusing as there are often several potential causes, overwhelming the user.

    Pharmacy Times reported iTriage 64% accurate in diagnosis decision and triage advice.

    3. WebMD Symptom Checker (Online and on Google Play for Android)

    Like iTriage, the WebMD Online Symptom Checker uses an avatar feature that allows the patient to pinpoint the location of pain or discomfort and then promotes the user to be more specific with a list of symptoms.

    We found the WebMD checker to be very elaborate, asking specific questions with each added symptom. In addition, the patient can add multiple symptoms at a time. The result is a list of potential causes, which can be individually selected and reviewed, printed for a personal record, given to health care providers or saved for future reference.

    Pharmacy Times reported WebMD 51% accurate in diagnosis decision and triage advice.

    4. AskMD (Smartphone App)

    AskMD, a smartphone application for iPhone and Android on platform Sharecare, is a relatively newer compared to many other symptom checkers and is actually recommended by Dr. Oz, medical TV personality. According to an article written by Dr. Oz, AskMD is based on over 20 years of medical research and utilizes Pattern Recognition Technology”.

    We found several benefits to AskMD, including the ability to refer patients to specialists in their area, and keeping doctors and insurance information in one spot. AskMD summarizes and saves consultation information, allowing patients to share it with family and medical providers. Because it uses smartphone technology, AskMD is the only symptom checker we found to have a microphone voice feature if the user is unable to type and for ease of use.

    Unfortunately, AskMD is only available on smartphones and there is no avatar feature, so users have to manually search for one symptom at a time.

    Pharmacy Times reported AskMD 68% accurate in diagnosis decision and triage advice.

    5. Everyday Health Symptom Checker (Online)

    Developed by an emergency physician, teacher, and author, Dr. Stephen Schueler, the Everyday Health Symptom Checker is one of the most unique online symptom checkers we have reviewed. It’s an interactive video take on a real emergency room interview.

    Dr. Schueler himself interactively talks the user through symptoms, asking questions that will prompt the patient into a new interview question video based on answers given. Once the video interview is complete, Dr. Schueler will tell the patient whether or not a doctor’s visit is necessary and how urgent the visit is. The user will then be instructed on where to go for care, what tests may be performed and receive options to find specific health care providers specializing in the predicted cause.

    The Everyday Health Symptom Checker featured many advantages. The video feature helps users better understand symptoms before going click crazy which can end up making users think they have a deadly disease instead of just the common cold. The specific questions also included photos if applicable, helping users better identify symptoms.

    6. Symptify (Online and Smartphone App)

    Developed by ER doctors and software engineers, Symptify is a standard symptom checker but does have features that can benefit users to empower them to make better health decisions, according to the site. Patients can freely type in whatever is bothering him or her or can choose from a list of common complaints. The user will then be prompted to answer questions pertaining to provide symptoms that are more specific. Symptify creators wanted users to stop using search engines alone to make a diagnosis, and have a place to better store the most relevant content into one consultation.

    We found some pros of Symptify that others didn’t have, like a feature that allows users to send their predicted causes directly to their chosen medical providers before arrival so that the facility can better prepare for arrival with questions and appropriate intervention prior to arrival. In addition, the diagnosis and information are very basic and in layperson terms for everyone to understand.

    7. Symcat (Online)

    Symcat is an online symptom checker much like the others we reviewed but uses real, current patient data to tell users what illness or injury other users who experienced the same symptoms had. The online tool has patients manually enter in all symptoms at once while suggesting other related symptoms. With each additional symptom added, Symcat gives the user a list of possible causes with percentages of how likely the user is experiencing the cause.

    Users are then asked for medical history and asked additional questions specific to the information provided to help patients find the probable illness and direct him or her to the type of care needed.

    We found a few advantages to Symcat that others did not include, such as a final care guide, which compares the cost and wait time of care options and allows the user to schedule an appointment right then and there on ZocDoc. In addition, we like how thorough the medical history questions were compared to other symptom checkers.

    Unfortunately, the design of Symcat is not visual, there is no avatar, photos, and videos to help guide users and the text-only format can get difficult to read.

    Pharmacy Times reported Symcat 71% accurate in diagnosis decision and triage advice.

    8. Isabel Symptom Checker (Online and Smartphone App)

    The Isabel Symptom Checker, or the one that doctors use is claimed to be much more sophisticated than other symptom checkers, as it uses the latest searching technologies and a database of over 6,000 diseases in everyday language terms with the same elaborate system used by nurses and doctors. Isabel took 12 years of development, and was designed to be used when patients feel unconfident in their doctor’s diagnosis, or when patients want to make sense of the vast amount of medical knowledge on the Internet with a trusted and accurate source.

    The Isabel Symptom Checker allows users to enter an infinite number of symptoms instead of limiting users to a certain amount in addition to the option of entering chronic illnesses or symptoms. It then decides on the top 10 probable causes and offers web resources for each cause to help users better understand their condition. Patients can email, print or save the results and find care within their area.

    Isabel, however, did have some downfalls. Like Symcat, it is not visual and does not include an avatar or any visual elements. In addition, Isabel directs users to web resources, such as Wikipedia, that can be filled with an overwhelming amount of information that the patient may or may not wish to sift through.

    Pharmacy Times reported Isabel 69% accurate in diagnosis decision and triage advice.

    9. FamilyDoctor.org (Online)

    A health tool developed by the American Academy of Family Physicians is much like the other text-based symptom checkers we reviewed, but uses flowcharts to allow users to easily track symptoms and come up with a possible diagnosis.

    Like mentioned, it does not include any visual body locator features and is very text-heavy, but for users who understand flowcharts, it is a very useful tool.

    Pharmacy Times reported FamilyDoctor.org 56% accurate in diagnosis decision and triage advice.

    Online symptom checkers all utilize algorithms, current engineering and technology, and medical knowledge to offer direction on where to take your symptoms. It’s safe to assume that even the best ones aren’t always accurate, which is why a visit or call to a primary care physician is the safest bet. Online symptom checkers, however, are a great tool to help guide patients to the right direction.

    Online symptom checkers don’t stop with humans, pet symptom checkers are also becoming commonplace, such as PetMed. Remember though, it is always best to check with your doctor or vet when any symptoms or issues arise.

    Which online symptom checkers do you use most? We love to hear your thoughts in the comments below. 

    About Mackenzie

    Mackenzie is a lover of world travel, photography, design, style and Chinese cooking. She is passionate about working towards a purpose, recently graduated from Indiana University with a degree in Media and Marketing, and is currently residing in Manhattan.

    Contact Mackenzie at [email protected]

    90,000 Pulmonary and extrapulmonary tuberculosis – Ravijuhend

    This patient guide is based on the 2017 Estonian treatment guide “Management of patients with pulmonary and extrapulmonary tuberculosis” and the topics presented therein together with recommendations. In this manual, you will find the recommendations that are most important from the patient’s point of view. The guide provides an overview of the main problems associated with the disease.

    The manual is intended for people with tuberculosis, as well as for their families and healthcare professionals.This guide will help patients and their loved ones cope better with their illness, provide answers to frequently asked questions about treatment and daily problems, and can support patients and their loved ones during the treatment process. The Patient Guide provides an overview of tuberculosis as a disease, the tests used for diagnosis, treatment, and the organization of a daily regimen during a controlled treatment process.

    The guidelines were compiled by experts in the field, along with former patients who have previously experienced and recovered from tuberculosis.The importance of the topics described in the manual and the clarity of the text were appreciated by patients with TB and their loved ones. Patient feedback and feedback has been instrumental in the development of this manual and has helped to improve it.

    You can learn more about the topics covered in this patient guide by following the links at the end of the guide.

    • During tuberculosis treatment, strictly adhere to the treatment regimen prescribed by your doctor. Take medication regularly, in the prescribed amount and at the correct time .
    • Do not change the dose of medication you are taking or the frequency of taking it yourself. Always check with your doctor.
    • If you feel unwell or if any side effects occur, immediately inform your doctor or other healthcare professional who monitors your treatment.
    • If you feel better during TB treatment, do not interrupt treatment anyway.It is very important that you take your medications for the entire period of treatment prescribed by your doctor.
    • During tuberculosis treatment, you need to eat well and maintain a healthy lifestyle.
    • When planning a pregnancy, check with your doctor first. You should be aware that TB medicines can weaken the effects of contraception.
    • Avoid alcohol as much as possible.Drinking alcohol during treatment increases the risk of side effects (including liver damage). If you drink alcohol, do so in moderation.
    • Give up all types of tobacco products (including hookahs and electronic cigarettes). Smoking interferes with the protective functions of the lungs and therefore slows down recovery.
    • Avoid excessively hot steam when using the sauna.
    • Avoid sunbathing and tanning beds.Due to the side effects of TB drugs, there is a high risk of pigmentation and sunburn.
    • Inform your loved ones about the illness and ask them to go for a medical examination.
    • If you have recovered from tuberculosis, but you still have symptoms suggestive of tuberculosis, contact your family doctor right away or make an appointment with a pulmonologist.

    Tuberculosis is an infectious disease caused by a bacteria called Mycobacterium tuberculosis .The causative agents of tuberculosis are spread by airborne droplets. When a tuberculosis patient coughs, sneezes, singing or talking, together with droplets of saliva, tuberculosis pathogens are thrown into the air, which can be inhaled by other people nearby. As a result, a person can become infected with tuberculosis. One untreated TB patient can infect up to 10-15 people a year.

    Not all people who have come into contact with an infectious (i.e. contagious) TB patient can develop TB.The more tuberculosis pathogens are thrown into the air by the carrier of the disease and the denser and longer contact with him, the more the likelihood of spread of tuberculosis increases. Of all those who have close contact with an infectious TB patient (family members, friends and colleagues who are with the patient every day), approximately one third will become infected. It is impossible to get sick with TB, for example, by shaking hands, using the same dishes or the same toilet room.

    Tuberculosis can damage all human organs, but most often the lungs are the focus of the disease.Of other organs, the disease can most often affect the pleura of the lungs, bones and joints, as well as the kidneys. This form of tuberculosis, in which the lungs themselves are not damaged, is called extrapulmonary tuberculosis, and patients with this disease are usually not contagious. At the same time, in the case of patients with extrapulmonary tuberculosis, it is very important to adhere to the prescribed course of treatment and bring treatment to the end.

    All people can become infected with TB, regardless of their financial income or social status.Thus, the assumption that TB only affects people with a low standard of living is incorrect.

    In 2016, 190 patients were diagnosed with TB in Estonia, of which 166 contracted TB for the first time. In 31 patients, tuberculosis was found not only in the lungs, but also in other organs. Extrapulmonary tuberculosis alone was diagnosed in 2016 in 15 patients. Children rarely get sick in Estonia; up to 10 cases of the disease are diagnosed a year.

    • Tuberculosis is an airborne infectious disease caused by a bacterium Mycobacterium tuberculosis .
    • Tuberculosis most commonly affects the lungs, but it can also affect other organs in the body.

    In case of infection (infection) with tuberculosis, viable, but inactive tuberculosis bacteria enter the human body. In most cases, the body’s protective immune system is able to prevent the spread of bacteria in the body. People who become infected with tuberculosis feel healthy, have no symptoms of the disease, and do not spread tuberculosis to others.Infection with tuberculosis can be diagnosed with a blood test (determination of the level of interferon gamma of the causative agent of tuberculosis M. tuberculosis in the blood) or with a tuberculin test (tuberculin test).

    The risk of contracting tuberculosis after infection is approximately 5-15%. The risk of getting sick is highest precisely within two years after infection, but you can get sick many years later if, for any reason, the person’s immune system weakened and can no longer keep the multiplication of tuberculosis bacteria.Therefore, it is very important that people who have become infected with tuberculosis know how to track their symptoms, which are characteristic of tuberculosis, and if they are found, they immediately go to a doctor.

    In some cases, a person who has contracted tuberculosis is prescribed prophylactic treatment in order to prevent the further process of becoming ill with tuberculosis. Preventive treatment most often involves one anti-TB drug and treatment lasts six to nine months.

    People infected with tuberculosis:
    • are not sick and have no symptoms of the disease
    • do not spread tuberculosis to other people
    • may develop tuberculosis in the future if their immune system weakens

    Tuberculosis can be contracted both immediately after infection and several years later.In a disease, the general condition of the human body plays an important role – malnutrition, mental stress, alcoholism, drug addiction, chronic diseases, and immune deficiency (including HIV infection) contribute to the disease. If the immune system of a person infected with tuberculosis is significantly weakened (for example, due to infection with HIV or another disease), then viable tuberculosis bacteria in the body will begin to multiply and become the cause of tuberculosis. In the case of tuberculosis, the person develops characteristic symptoms and the person can spread the tuberculosis bacteria to others.

    The risk of contracting tuberculosis after infection is higher in the following cases:

    • in HIV-infected people
    • for people with a transplanted organ or people on the waiting list for a transplant
    • in people with chronic renal failure who are receiving dialysis treatment
    • in people with silicosis (a rare lung disease that occurs when silica is inhaled)
    • for diabetics
    • in people taking certain types of biological medications
    • in persons in close contact with infectious people with tuberculosis
    People with tuberculosis:
    • are sick and may have symptoms of the disease
    • can spread tuberculosis to other people

    In case of tuberculosis, the type of symptoms depends on which organ was affected by the tuberculosis bacterium.

    If the lungs are affected, the following symptoms may appear:

    • cough lasting more than two weeks
    • expectoration with purulent sputum or blood
    • chest pain

    The following symptoms can often occur:

    • weakness, feeling of exhaustion
    • decrease in appetite and body weight
    • temperature rise
    • increased sweating at night, chills

    Photo: Scanpix

    Sometimes TB can be asymptomatic.

    In case of symptoms characteristic of tuberculosis, you should immediately contact your family doctor or pulmonologist. In case of suspicion of tuberculosis, you can go directly to the pulmonologist dealing with tuberculosis without asking for a referral from your family doctor. Tuberculosis screening tests are also free of charge for those without health insurance.

    If tuberculosis is suspected in a child, then for the next examinations you need to consult a doctor dealing with infectious diseases of children.

    • In pulmonary tuberculosis, the most common symptom is a cough that lasts more than two weeks, to which general symptoms can join.
    • In case of symptoms typical of tuberculosis, you should immediately contact your family doctor or pulmonologist.

    If there is a suspicion of pulmonary tuberculosis, the doctor should ask the person about the symptoms of the disease and check if there have been any previous contacts with tuberculosis patients.Most often, X-rays are taken afterwards and at least two sputum samples are taken at different times. These sputum samples are sent for examination to detect the appearance of tuberculosis bacteria. In the event that a person cannot give a sputum test himself, expectoration can be caused (provoked) and for this inhalation with saline is done. Another option is to refer the person for a bronchoscopy or for a bronchial tract viewing procedure. Since young children do not know how to take a sputum test, instead of sputum, they examine the fluid obtained after rinsing the stomach.

    Photo: Scanpix

    A sputum test is primarily examined under a microscope. If, during examination under a microscope (so-called microscopy), tuberculosis bacteria are found in the sputum, this means that there is an extensive secretion of bacteria and such a patient can be considered infectious. The attending physician can receive the results of microscopy the very next day after the tests. The sputum is then examined using the culture method, and it can take up to eight weeks to obtain the results of such an examination.The inoculation method can be used to definitively confirm the presence of tuberculosis bacteria if the excretion of bacteria was small. A patient in whom tuberculosis bacteria are found in sputum only using the culture method can also be infectious and infect others with tuberculosis bacteria.

    In general, such patients are considered less infectious than those patients in whom tuberculosis bacteria are found in sputum immediately, upon the first examination under a microscope.Searching for tuberculosis bacteria in sputum using the culture method will help to finally confirm the diagnosis of tuberculosis. The inoculation method also determines the drug resistance of tuberculosis bacteria, and this will be the basis for drawing up a treatment regimen.

    When diagnosing tuberculosis, rapid tests are also used, the results of which are clarified within a few days. Since it is impossible to determine the sensitivity of the tuberculosis pathogen to all drugs used in treatment with the help of express tests, an examination with a microscope and a seeding method is carried out in parallel.

    In case of suspicion of tuberculosis, blood tests are also checked, sometimes computed tomography is done to assess more accurately the damage to the lungs or other organs, and its volume.

    In Estonia, in case of suspected tuberculosis, all examinations are free of charge, regardless of the availability of health insurance.

    For the diagnosis of pulmonary tuberculosis, the following are carried out:

    • Chest X-ray
    • sputum analysis

    In Estonia, tuberculosis screening tests are free of charge for a patient, regardless of whether they have health insurance.

    If the tuberculosis bacterium is susceptible to the main drug against tuberculosis (that is, the drug destroys the bacterium), then the course of treatment lasts from six to nine months and treatment is started simultaneously with four to five different drugs. Most often, drugs are used in the form of tablets, but at the beginning of treatment, an injectable drug may also be present in the scheme. With proper medication, your doctor may reduce your daily medication after two or three months.

    In case of drug sensitivity, the main drugs are:

    • isoniazid
    • rifampicin
    • ethambutol
    • pyrazinamide
    • streptomycin

    Photo: Scanpix

    Tuberculosis is almost always curable, but full recovery requires strict adherence to the course of treatment prescribed by your doctor. The well-being of a patient with a drug-sensitive tuberculosis pathogen usually improves after a few weeks after starting treatment.Often during this period, a person is no longer infectious. Still, it is very important to remember that multiplying pathogens of tuberculosis persist for some time in the body, even when the patient no longer has any problems and does not feel sick anymore. Therefore, for complete recovery, strict adherence to the tuberculosis treatment regimen is necessary throughout the entire period of treatment.

    Untreated tuberculosis is still dangerous for people around, and especially for children and those with weakened immunity.

    • Tuberculosis is curable in most cases.
    • The duration of the course of treatment depends on the sensitivity of the causative agent of tuberculosis; in the case of tuberculosis sensitive to essential drugs, it lasts 6-9 months.
    • In Estonia, TB detection tests are free of charge for a patient, regardless of whether they have health insurance.

    If the causative agent of tuberculosis cannot be destroyed with a specific drug, then this means that the bacterium is not sensitive to the drug, i.e.that is, it is resistant. If the causative agent of tuberculosis is resistant to the main two drugs for tuberculosis, isoniazid and rifampicin, then this form of the disease is called multidrug-resistant tuberculosis. Treatment for MDR-TB is more difficult and takes significantly longer than for drug-sensitive TB (one and a half to two years).

    A person can become ill with drug-resistant tuberculosis in two ways:

    • already initially infected with drug-resistant bacteria
    • Drug resistance can develop during treatment when a patient does not take the prescribed drugs in the correct amount, with the necessary frequency and for a long time.

    Five to seven drugs are used at the same time to treat MDR TB, and these drugs can cause more side effects.

    In 2016, MDR TB was diagnosed in 24 patients in Estonia, of whom 17 contracted TB for the first time.

    • If the patient is not properly adhered to the course of treatment, then he may develop resistance to the causative agent of the disease (tuberculosis bacteria).
    • In this case, the duration of the course of treatment is lengthened and there should be more drugs in the treatment regimen.

    In the process of treating tuberculosis, the so-called Directly Observed Treatment (DOT) is used. DOT means that the patient must take the medication every day in the presence of the nurse, who directly checks if the medication has been taken.Usually tuberculosis treatment begins in the hospital, but after the infectious period passes, treatment can be continued on an outpatient basis, i.e. at home.

    Photo: Scanpix

    DOT tries to make it as convenient and accessible for the patient as possible. For example, a patient may be compensated for by public transportation to a hospital to receive medication. If the patient is allowed home treatment, but he cannot come to the nurse who monitors the treatment of tuberculosis, then the medicine is brought to the patient’s home.In the last months of the course of treatment, when the patient feels well and is no longer infectious, he can return to work or school and lead a normal life.

    During treatment, the pulmonologist constantly monitors the patient’s course of treatment and the recovery process. For this, new examinations of the composition of sputum are carried out every month, X-rays are repeated and, if necessary, blood tests are done.

    Tuberculosis is a particularly dangerous infectious disease that is dangerous both for the patient himself and for those around him.Based on this, those who refuse tuberculosis treatment or interrupt the course of treatment in Estonia can be sent for compulsory treatment for up to six months (182 days) to the Jamejala Tuberculosis Treatment Unit in Viljandi hospitals.

    • Tuberculosis treatment begins in the hospital, but most of the treatment is carried out on an outpatient basis using directly observed treatment (DOT). In this method of treatment, the patient takes medication on a daily basis in the presence of a healthcare professional or in a medical facility or at home.
    • During treatment, the necessary tests and examinations are carried out every month.
    • Doctors have the right to refer patients who refuse treatment for tuberculosis or who interrupt treatment for compulsory treatment.

    Tuberculosis medications can cause side effects. It is important that the patient monitors the occurrence of side effects during treatment and immediately informs the attending physician about them.Medicines for the treatment of side effects are provided by the attending physician to patients free of charge. Certain vitamins are given along with TB medicines to reduce the risk of side effects.

    Safe side effects of drugs Dangerous side effects of drugs
    Nausea, lack of appetite, mild abdominal pain Itchy skin, rash
    General fatigue, impotence Yellowing of the skin / eyeballs
    Disorders of the digestive tract (diarrhea, bloating) Recurrent nausea and severe abdominal pain
    Metal taste in mouth Hearing or vision impairment
    Orange color of urine and other body fluids (saliva, tears) Dizziness, imbalance
    Mild joint pain Attack of muscle spasms in the limbs
    Skin redness when exposed to the sun Hallucinations

    Lifestyle during TB treatment

    If the patient has been transferred to outpatient treatment, then he can lead a normal life, leave the house and communicate with friends and acquaintances.It is important to adhere to the prescribed treatment regimen and the principles of a healthy diet. For a better course of the treatment process, it is advisable to give up unhealthy habits, such as drinking alcohol and cigarettes.

    If the patient is no longer infectious, has no symptoms of the disease and the drugs do not cause side effects, then he can return to work or school and during treatment for tuberculosis. It is important to remember that it is imperative that the patient continue to receive DOT visits when returning to work or school.Therefore, during the treatment of tuberculosis, in general, the patient cannot leave for a long time from the place of treatment.

    If the patient is not able to work during the treatment, then a certificate of incapacity for work is issued for him for this period. Compensation for the certificate of incapacity for work can be obtained in 240 calendar days and, if necessary, at the end of this period, you can apply for the appointment of a status of incapacity for work. To do this, you must submit an application for an assessment of the work ability to the unemployment fund.A patient attending a high school can apply for a sabbatical during the period of treatment.

    Photo: Scanpix

    During TB treatment:

    • Smoking interferes with the protective functions of the lungs and therefore slows down recovery
    • Alcohol consumption during treatment can cause serious side effects
    • after the period of infectious danger has passed, it is possible to restore sexual life
    • pregnancy during this period is not desirable, and you should take into account that anti-tuberculosis drugs can weaken the effect of contraception.
    • Avoid sunbathing and tanning beds, as the side effects of drugs may cause age spots and increase the risk of sunburn
    • Saunas are not prohibited, but very hot steam is contraindicated.
    • You can eat all foods, good nutrition helps the healing process
    • During treatment, you must adhere to the treatment regimen prescribed by your doctor, eat well and avoid alcohol.
    • After a period of infectious disease and no side effects have occurred, it is possible to return to work or school, but the obligation to attend DOT treatment visits remains.
    • If necessary, a certificate of incapacity for work is issued for the duration of tuberculosis treatment, and you can also apply for a work ability allowance.

    Case management after tuberculosis treatment

    A patient who has suffered tuberculosis caused by a tuberculosis agent that is sensitive to treatment, completed the full cycle of treatment prescribed by the attending physician, and recovered, does not need regular medical supervision after recovery.And yet it is very important that this patient knows how to monitor his own health and in case of symptoms of tuberculosis, he must turn to a pulmonologist or family doctor.

    A patient who has had multidrug-resistant tuberculosis, who has HIV and does not adhere to the exact prescribed medication regimen, after recovery should be followed up for two years with a frequency of every six months. For observation, the patient must visit a pulmonologist and during each visit he will be asked questions about possible symptoms, take X-rays and check the sputum for the content of tuberculosis bacteria.

    Photo: Scanpix

    • After recovering from tuberculosis, you no longer need to see a doctor regularly.
    • If a patient has suffered multidrug-resistant tuberculosis, or is infected with HIV, or does not fully adhere to the drug regimen, then after recovery, he should be followed up for two years with a frequency of every six months.

    A patient with tuberculosis can protect their loved ones from the danger of infection if he:

    • Takes tuberculosis medication strictly as prescribed by a doctor
    • when coughing, turns his head away and covers his mouth with his hand or paper towel
    • will ask all persons in contact with him to see a doctor for a health check

    In the case of each patient, the circle of persons in close contact with him, for whom the risk of infection is very high, is ascertained.To do this, the nurse observing a patient with tuberculosis asks him about those contacts who may be infected and who have a high risk of also contracting tuberculosis. Finding out the contacts allows you to call people at risk for a medical examination and to detect new cases of tuberculosis as early as possible.

    If the patient himself does not want to inform his contacts about his illness, then this can be done by a medical officer. Informing the contacts and the invitation to the examination should be delicate, and the name of the sick patient should not be mentioned.Both for the patient himself and for all persons in contact, all examinations related to tuberculosis are carried out free of charge, regardless of whether the person has health insurance. You do not need a referral from your family doctor for the examination.

    For most people in contact, X-rays are taken and a blood test (determined by the level of interferon gamma M. tuberculosis) or a test for tuberculin. Sometimes a sputum composition is examined.

    In some cases, prophylactic treatment is prescribed for persons who have come into contact with a patient with a drug-sensitive pathogen of tuberculosis, who have been found to be infected with tuberculosis.The goal of preventive treatment is to prevent tuberculosis. During preventive treatment, you need to take one essential TB drug almost every day for six to nine months. Before prophylactic treatment is prescribed, tests are always carried out to prevent tuberculosis.

    Preventive treatment is prescribed, if necessary, after infection with tuberculosis:

    • mothers of children under 5 years old
    • for HIV-infected people in contact
    • 90,016 people taking certain type of biological medications

      90 016 people whose immune system is weakened due to any disease or its treatment

      90,016 people with a transplanted organ or people who are in the waiting list for a transplant

    Those who have come into contact with a patient with multidrug-resistant tuberculosis and are infected as a result are not prescribed preventive treatment, since effective treatment regimens have not yet been developed for this case.To observe them, X-rays are taken every two years. Also, all persons in contact with a patient with multidrug-resistant tuberculosis are trained to monitor their symptoms of tuberculosis.

    • Informing the contacts and the invitation to the examination should be delicate, and the name of the sick patient should not be mentioned.
    • For all persons in contact, all examinations related to tuberculosis are carried out free of charge, regardless of whether the person has health insurance.
    • In some cases, preventive treatment is prescribed, the purpose of which is to prevent tuberculosis. The duration of preventive treatment is six to nine months.
    1. Ai J-W, Ruan Q-L, Liu Q-H, Zhang W-H. Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerg Microbes Infect. 2016 Feb; 5 (2): e10.
    2. Landry J, Menzies D.Preventive chemotherapy. Where has it got us? Where to go next? Int J Tuberc Lung Dis Off J Int Union Tuberc Lung Dis. 2008 Dec; 12 (12): 1352–64.
    3. Malaysia Health Technology Assessment Section Ministry of Health Malaysia. Management of Tuberculosis (3rd Edition). 2012.
    4. Ministry of Science and Innovation, Spain. Clinical Practice Guideline on the Diagnosis, Treatment and Prevention of Tuberculosis. 2010.
    5. National Institute for Health and Care Excellence.Tuberculosis. 2016.
    6. Public Health Agency of Canada. Canadian Tuberculosis Standards 7th Edition. 2014.
    7. TB CARE I. International Standards for Tuberculosis Care, Edition 3. The Hague: TB CARE I; 2014.
    8. Viiklepp, P. Tuberkuloosihaigestumus Eestis 2012-2013. Tallinn: Tervise Arengu Instituut; 2014
    9. World Health Organization. Global Tuberculosis Report 2016. Geneva: World Health Organization.
    10. World Health Organization.Systematic screening for active tuberculosis: principles and recommendations. 2013.
    1. On Health Information Portal
    2. On the website of the Finnish Lung Health Society
    3. On the medical portal inimene.ee
    4. On the medical portal kliinik.ee
    5. On the portal of the Institute for Health Development hiv.ee
    6. Information brochures on tuberculosis published by the Institute for Health Development

    Nutritional advice can be found on the Institute for Health Development website www.toitumine.ee.

    Medical institutions that can be contacted in case of suspicion of tuberculosis

    You do not need to ask a family doctor for a referral to receive an examination, and all examinations related to the detection of tuberculosis are free for those patients who do not have health insurance.

    Tallinn
    Polyclinic for tuberculosis treatment at the Pulmonary Center of the North Estonia Regional Hospital
    Hiiu 39, Tallinn
    Reception of adults and children – patients from Tallinn, Harju County and Raplamaa.
    Reception phone 617 2929
    Children’s office – phone 617 2951

    Tartu
    Admission to adults – patients from Tartu, Tartu County, Jõgeva County, Valgamaa, Põlvamaa
    Polyclinic for Lung Diseases of the University of Tartu Clinic, Riia 167, Tartu
    Pulmonologist’s office – phone 731 8949
    Reception of children – patients from Tartu, Tartu County, Võrumaa, Jõgevamaa, Valgamaa, Põlvamaa
    Children’s Clinic of the University of Tartu Clinic, Lunini 6, Tartu
    Children’s office in Tartu – phone 731 9531

    Jõgeva
    Jõgeva Hospital, Piiri 2, Jõgeva
    Reception phone number 776 6220

    Kohtla-Jarve
    Polyclinic Ida-Viru Central Hospital, Ravi 10d, Kohtla-Järve
    Reception phone number 339 5057, 331 1133

    Narva
    Narva Hospital Infectious Diseases Department, Haigla 5, Narva
    Reception phone 357 2778
    Pulmonologist’s office – phone 354 7900

    Haapsalu
    Läänema Hospital, Vaba 6, Haapsalu
    Reception phone number 72 5800,
    Pulmonologist’s office – phone – 472 5855

    Kuressaare
    Kuressaare Hospital, Aia 25, Kuressaare
    Reception phone number 452 0115

    Paide
    Järvama Hospital, Tiigi 8, Paide
    Registry phone 384 8132
    Pulmonologist’s office – phone 384 8117

    Pylva
    Põlva Hospital, Uus 2, Põlva
    Registry phone 799 9199

    Pärnu
    Pärnu Hospital, Ristiku 1, Pärnu
    Reception phone 447 3300
    Pulmonologist’s office – phone 447 3382

    Rakvere
    Rakvere Hospital, Lõuna Põik 1, Rakvere
    Reception phone 322 9780
    Pulmonologist’s office – phone 327 0188

    Viljandi
    Viljandi Hospital, Pärsti Rural Municipality, Viljandi County
    Reception phone 434 3001
    Pulmonologist’s office – phone 435 2053

    Voru
    South Estonian Hospital, Meegomäe village, Võru parish
    Reception phone 786 8569
    Pulmonologist’s office – phone 786 8591

    90,000 More than half of children who have recovered from COVID retained symptoms for months – RBK

    Symptoms include insomnia, chest, muscle and joint pain, chronic fatigue, runny nose, and loss of attention.More than 58% of children who have recovered complained of at least one of them even four months after recovery

    Photo: Evgeny Biyatov / RIA Novosti

    More than half of children who have recovered from coronavirus infection complained of persisting symptoms of the disease for several months after recovery.This is stated in a study conducted by scientists from Italy, Russia and the UK. Preprint published on medrxiv.org.

    Experts studied the effect of the disease in 129 patients who were ill from March to November last year under 18 years old, their average age was 11 years. 42% of children showed no symptoms four months after cure. However, 35.7% of children after 120 days revealed one or two symptoms of COVID-19, 22.5% complained of three or more symptoms.

    Video

    Most often, after recovery, minors complained of insomnia (it was recorded in 18.6% of cases), signs of a respiratory illness, including pain and tightness in the chest (14.7%), nasal congestion (12.4%).Children also had fatigue, muscle and joint pain, loss of concentration.

    Experts argue about the need to vaccinate children against COVID-19

    90,000 Cardiologist recommendations after suffering COVID-19 – Family Doctor clinic.

    There is a high risk of cardiovascular complications after a previous coronavirus infection.

    90,700 Most frequent patient complaints: 90,701

    • weakness

    • increased heart rate, irregular pulse

    • it is impossible to take a deep breath

    • pressing chest pains

    • dyspnea

    These symptoms occur regardless of the severity of the disease.

    Myocardial damage in Covid-19 occurs in a complex manner: the effect of the virus itself on myocardial cells (heart) + cell damage with cytokines (inflammatory proteins) + blood clotting disorders + blood supply disturbance + myocardial cell hypoxia + damage to the endothelium (inner layer) of coronary vessels.

    If you have complaints, you should definitely visit a cardiologist.

    What kind of research to do?

    1.To pass a general blood test, C reactive protein – to exclude the preserving laboratory-inflammatory syndrome. If myocarditis is suspected, take additionally for rheumatoid factor and Troponin.

    2. Donate blood for vitamin D, iron, ferritin (with a low level of these indicators, weakness and tachycardia will bother you for a long time).

    3. Make an ECG (to assess the heart rate, heart rate at rest, focal changes in the myocardium).

    4.Echocardiography (exclude organic changes in the heart, fluid in the pericardium of the heart, signs of myocarditis, assess the contractility of the heart)

    5. Make a Holter ECG 24 hours (may be recommended by your doctor additionally).

    6. If myocarditis is suspected, MRI of the heart with contrast is the gold standard of diagnosis.

    Are you worried about shortness of breath and tachycardia?

    This is not necessarily myocarditis.Asthenic syndrome against the background of a long stay at home and detraining is much more common.

    And the main thing is not to panic! Stress makes tachycardia worse.

    After examination by a cardiologist

    Timely professional diagnostics of possible complications will allow you to quickly cope with them.

    Take care of yourself and your heart!

    Publications on the topic of the month “How to overcome postcoid syndrome”

    Tuberculosis in children: symptoms, reasons, when to see a doctor, treatment

    1.What is the difference between TB infection and TB disease?
    2. Signs and symptoms.
    3. When to see a doctor.
    4. Treatment.
    5. Key points to remember.

    6. Common questions from parents.

    Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis. In 70% of cases, TB affects the lungs, but it can also affect other parts of the body, such as the lymph nodes, brain, kidneys, or spine.In children, tuberculosis is more common, which affects several parts of the body, and in children, tuberculosis is usually more serious.

    Tuberculosis is very common in some states. Tuberculosis spreads through the air, but it is not easy to catch it. People with weakened immune systems are most at risk of developing tuberculosis.

    Tuberculosis can be successfully treated with a course of antibiotics.

    What is the difference between TB infection and TB disease?

    90,700 People can have TB infection, but they do not necessarily get TB.

    1. Tuberculosis infection

    People with TB infection have TB bacteria in their bodies, but their immune systems are strong enough to contain the bacteria and keep them from spreading. This means that bacteria can remain inactive for many years.
    People with TB infection do not have TB symptoms and do not feel sick. They are not contagious.
    There is a risk that the tuberculosis bacteria will become active at a later stage and cause tuberculosis, especially in people with poor immune systems.

    2. Tuberculous disease

    With tuberculosis, the body is no longer strong enough to keep bacteria under control.
    The bacteria spreads and causes the symptoms of tuberculosis.

    Children with TB infection are more likely to develop real TB disease because their immune systems are not as developed as that of an adult.
    People with tuberculosis in their lungs or throat can infect others by coughing and releasing bacteria into the air; however, children with tuberculosis are usually not contagious.
    Signs and symptoms
    If your child has TB, he may have fever, fatigue, night sweats, and weight loss. If he has pulmonary tuberculosis, your child will have a cough and chest pain.
    Symptoms of TB elsewhere in the body depend on the affected area. Symptoms can be very different. Some children with TB have no symptoms.

    3. When to see a doctor?

    If your child has been in contact with someone with TB or you suspect they have TB, see your GP.The doctor will order some tests to determine if your child has contracted tuberculosis:

    1. Mantoux test (tuberculin skin test): Mantoux is done to determine if a child has been exposed to TB bacteria. A small amount of liquid is injected into the skin through the scratch. The doctor will look at the skin test after two to three days to see if there has been a reaction (swelling on the skin).
    2. Quantiferon test: This blood test measures how the immune system responds to the bacteria that cause tuberculosis.

    Both skin tests and blood tests can show that a child is infected with tuberculosis. However, they do not determine if a child has active tuberculosis. Further testing is then necessary to find out if the TB is active, which will require a thorough examination by a doctor, x-rays and sputum analysis.

    4. Treatment of tuberculosis and tuberculosis infection

    Both TB infection and TB disease are treated with antibiotics.Antibiotics used to treat tuberculosis include isoniazid, rifampicin, pyrazinamide, and etembutol.


    Tuberculous infection.
    If your child has a TB infection, he should take antibiotics for at least six months to kill the bacteria and prevent TB. Usually only one type of antibiotic is needed.

    Tuberculosis disease: Treatment is often done with four different types of antibiotics, which must be taken together for two months, and then 2 antibiotics (usually isoniazid and rifampicin) are used for the next four months.Getting TB outside the lungs may require longer courses of antibiotics.

    Treatment side effects

    Sometimes antibiotics used to treat TB can cause side effects. Side effects are less common in children than in adults. They can be like this:

    1. Your child may feel unwell and lose appetite.
    2. Antibiotics can damage the liver, but this is very rare in children.
    3. Rifampicin can turn body fluids (eg, urine, tears, saliva) orange, but this is harmless to the body and will disappear when the rifampicin cycle ends.
    4. Ethambutol can cause vision problems, and children taking this antibiotic may need regular eye exams. Although this side effect is very rare, if you are concerned about your child’s vision, you should inform your doctor or nurse immediately.
    5. TB antibiotics can interfere with any other medicines your child takes. This should be discussed with your doctor or pharmacist.

    When to take antibiotics

    1. Isoniazid and rifampicin work best on an empty stomach. These tablets should be taken 30 to 45 minutes before meals, preferably before breakfast.
    2. Pyrazinamide and ethambutol work best with or after meals.

    5.Key Points to Remember

    • Tuberculosis infection means your child has tuberculosis bacteria in the body, but they are inactive and your child will not have symptoms.
    • When you get TB, your body no longer keeps TB bacteria under control, and your child becomes ill.
    • Tuberculosis predominantly affects the lungs, but can also affect the lymph nodes, brain, spine, etc.
    • Tuberculosis can be successfully treated.A child with tuberculosis may need to take antibiotics for six months or longer.

    6. Frequently asked questions from parents

    1. If my child has no symptoms but has TB infection, how will I know if he is infected? Does he need treatment if he has no symptoms?
    There are simple tests (including a chest x-ray and a skin test) that will show if your child is infected.You can discuss this with your healthcare provider. Even without symptoms, it is important that your child receives treatment.
    2. Will TB damage my child’s lungs?
    Tuberculosis can affect many different body systems. The degree of damage will depend on the severity of the disease in any particular system, including the lungs.

    The exact diagnosis and method of treatment can only be prescribed by the attending physician. Sign up for a consultation at one of our clinics – consultation is free – we successfully treat tuberculosis in children!

    For consultation, choose a branch convenient for you and sign up directly on the website:

    90,000 8 things about critical days that not every woman knows

    Despite the fact that most women menstruate with a frequency of once a month, not everyone still knows about how it all works.No, every woman imagines when her period will come and what to do in this situation. But there are facts about which almost no one ever speaks openly. Here are eight such facts.

    The length of the menstrual cycle is not constant

    Moreover, it differs not only from woman to woman, but also from month to month for the same woman. The average number of days between periods is 28, but the onset can be expected between 21 and 35 days. It is necessary to count from the first day after the end of the previous menstruation and from that moment to ovulation it can take from one to those weeks.But the second phase – after ovulation – lasts about 14 days for each woman. And yes, it is absolutely normal that periods come at different intervals from month to month, since they are influenced by a lot of factors.

    Some women may feel ovulation

    Ovulation is the release of an egg from the ovary into the abdomen as a result of the rupture of a mature follicle. For most women, it goes unnoticed, but it is completely normal to feel its symptoms.These symptoms may include mild abdominal pain, as well as an increase in basal body temperature and breast tenderness.

    Menstrual colic may not only be in the abdomen

    Specific “dull” pain in the muscles, which often accompany menstruation, are manifested not only in the abdomen. They can radiate in the lower back and in the hips and in general in the legs up to the knees. This is because the nerve endings in the abdominal region are connected and twitching at one end of this network of nerves often triggers a reaction at the other.

    Sex almost never relieves menstrual colic

    The myth that menstrual colic can be relieved by sex during menstruation is unknown by anyone and that only a very small percentage of women feel relief (and that may be due to self-hypnosis) … But scientists have definitely established that sex at this moment is highly likely to cause uterine spasms, especially if sperm gets inside. And yes, sex during menstruation can be just physiologically unpleasant, not enjoyable, for some women.

    During ovulation, men often find women more attractive

    True, this is not connected with the appearance – it is connected with the smell. Studies by a number of scientists have shown that men who sniffed the clothes women wore during ovulation significantly increased levels of testosterone, which is responsible for the desire to reproduce. Many women also report increased desire during ovulation. Both fit perfectly into the logic of Nature.

    Menstruation “settles” up to a year after stopping taking the pills

    Most of the pills that prevent pregnancy suppress ovulation and contain artificial hormones that “replace” natural ones, preventing new life from appearing.If you stop taking the pills, the body itself will begin to produce the necessary hormones itself and return ovulation, but this takes time. At least six months – this is the period that most doctors set aside for the body itself to “settle down” and before that time they will not undertake to diagnose menstrual irregularities (at least they should not). Theoretically, it is possible to become pregnant immediately after giving up the pills, although this does not happen very often.

    There are natural remedies for relieving menstrual symptoms

    True, their effect is mainly revealed only in studies, and in real life, all these percentages and “in most cases” are not of particular interest to anyone.But science’s sake – calcium soothes menstrual cramps and vitamin D improves mood. Magnesium reduces irritability and muscle pain. The complex of vitamins B has also proven itself well. Finally, many herbal teas are also “seen” in that they facilitate the course of menstruation, although science does not undertake to explain the mechanism of action in their case. It may well be that they are as effective as homeopathic medicines – that is, based on the placebo effect (self-hypnosis). However, herbal teas will not harm you 100%, you can safely drink them.

    Reduced chances of getting thrush during menstruation

    This is because menstrual blood raises the pH in the vagina, making it difficult for “living things”, including infections, to survive. However, in a number of cases, the “game of hormones” leads to the fact that, on the contrary, only during menstruation do infections develop, which manifests itself in a characteristic “fishy” smell and an increased level of secretions. In this case, you should consult a doctor.

    How to relieve PMS in women: drugs, diet, folk remedies

    The first simple advice from experts in this field is proper nutrition and diet for PMS in women.

    The beauty of the method is that you do not need to take medicine, you just need to revise the refrigerator, schedule a diet and go to the nearest supermarket for groceries.

    Unwanted foods: exacerbate PMS

    Certain foods exacerbate the negative symptoms of premenstrual conditions. These include fatty and fried foods. It is desirable to completely eliminate it or reduce it to a minimum.

    Drinking alcohol and carbonated drinks during PMS will also negatively affect your well-being.They will aggravate the pain sensation.

    And, of course, it is better to eat fewer sweets and pastries. Sweets increase insulin in the blood and contribute to changes in glucose levels, and this leads to irritability and sharp emotional outbursts.

    Foods that relieve PMS

    There are also products that have a beneficial effect on a woman’s body during the luteal phase and reduce PMS symptoms. These products can be classified into several groups.

    The first group will include products of plant origin with a high content of vitamin B 6 , which reduce vascular disorders and relieve headaches.Among them:

    • whole grains;
    • nuts;
    • 90,016 avocados;

    • bananas.

    The second group – foods with vitamin D and calcium , which are found in dairy products and can reduce pain in PMS. It is:

    • milk;
    • 90,016 cottage cheese;

    • kefir;
    • yogurt;
    • fermented baked milk.

    Mood swings, tearfulness and melancholy often cause eating disorders, leading to excessive consumption of sweets.This is due to a decrease in the level of the hormone of joy – serotonin. However, fast carbohydrates from baked goods cause metabolic disturbances and weight gain.

    You can replenish serotonin with products containing the essential amino acid tryptophan , which is involved in the production of the hormone of joy. To do this, you need to use:

    • dark chocolate;
    • dried dates;
    • 90,016 pineapple;

      90,016 fish of the salmon family;

    • boiled eggs.

    Evening primrose oil (primrose oil) also helps relieve PMS. It has an anti-inflammatory effect, reduces breast and abdominal pain, neutralizes bloating, relieves swelling and normalizes mood swings.

    In addition, some gynecologists advise taking magnesium tablets for PMS, since during menstruation the amount of this substance in the blood decreases sharply. Magnesium can affect hormones, and magnesium deficiency can lead to painful periods.

    Test ladder optk pv syndrome & quot; chest pain & quot;

    Test ladder OPTK pv syndrome
    “Chest pain”

    1. Which of the following
    diseases can cause acute
    unbearable chest pain

    1. Myocardial infarction

    2. Myocarditis

    3. Aortic dissecting aneurysm

    4. Fibrimioeitis

    2. Which of the following
    diseases can cause
    prolonged pain in the pond

    1.Shingles

    1. Spontaneous pneumothorax

    2. Osteochondrosis of the thoracic region
      spine

    3. Myocardial infarction

    3. Which of the following symptoms
    characteristic of

    3A. Myocardial infarction

    3B. Pulmonary embolism

      1. Intense constricting pain behind
        sternum with irradiation to the left arm

      2. Acute intense pain with
        the development of shock on the focus of shortness of breath, localization
        in the center of the sternum

      3. Sudden appearance in
        postoperative period

      4. The appearance of an attack after
        emotional stress

      5. Pain relief by taking narcotic
        analgesics

      6. The effectiveness of thrombolytic
        funds

    4.Which of the following symptoms
    typical for:

    4A. Pericarditis

    4B. Aortic dissecting aneurysm

    4.1. Intense pain
    has a wavy character “for
    sternum “, spreads along the
    spine

      1. Dull pain behind the breastbone, radiating
        in the neck, back

      2. Respiratory Pain Relation
        movements and body position

    5. Which of the following symptoms
    characteristic of

    5A.Intercostal neuralgia

    5 B. Hernia of the esophageal opening
    diaphragm

    5.1. Burning pain such as heartburn
    worse when lying down, after
    food

    5.2. Pains of various localization,
    intensified when turning, position
    lying

    5.3. Localization along the intercostal
    nerves

    5.4. Localization of pain in the lower
    chest section

    5.5. Pain relieves analgesics

      1. Pain relieves antispasmodics,
        local anesthetics

    6.Which of the following signs
    characteristic of

    6A. Neurocircular dystonia

    6B. Spinal osteochondrosis

    6.1. Pain in the region of the heart. stabbing
    character, without clear irradiation

    6.2. Pains of a different nature in
    precordial region, irradiation in
    intercostal region

    6.3. Pain dependence on axial
    and lateral load

    6.4. Increased pain when uncomfortable
    position

    6.5. Independence of pain from movement
    body

    6.6. The presence of sympathicotonic
    symptoms

    7. Which of the following signs
    characteristic of

    7A. Ischemic heart disease
    – angina pectoris

    7B. Pleurisy

    7.1. Constricting pain behind the breastbone,
    irradiation to the left shoulder, paroxysmal
    nature of pain

    7.2. Psycho-emotional stress
    cooling increases pain

    7.3. The effect of taking nitrates

    7.4. Increased pain when breathing

    7.5. Pain without clear irradiation
    stupid

    eight.Pain in the precordial region
    of various nature, irradiation on
    the course of the intercostal nerves, the connection of pain with
    physical activity, turns
    torso, “gentle posture”, facilitating
    situation suggests
    diagnosis ____________________________

    9. Dull pain of varying intensity,
    undulating character, with respiratory
    movements and body positions,
    radiating to the neck, no effect
    from the use of nitrates, antispasmodics,
    suggest a diagnosis
    ______________________________

    ten.Intense chest pain
    burning character, more often at night, wide
    irradiation zone, no effect from
    taking nitrates suggest
    diagnosis _______________________________

    11. Change of wave P m appearance
    pathological O wave, pronounced
    increased activity of AS, AT, CPK, ADH
    are characteristic
    for ______________________________________________

    12. Acute intense
    pain with the development of shock at the focal point of shortness of breath,
    a history of surgery allows
    guess
    _________________________________________________

    13.The relationship of pain with food intake
    aggravated by a violation of the diet,
    regime; pain relief when taking
    antispasmodics suggest
    ______________________________________

    14. Sharp pains in the left side
    chest, aggravated by breathing,
    conversation accompanied by pallor
    skin weakness; severe shortness of breath
    tympanic sound on the affected side,
    sharply weakened breathing allows
    make a diagnosis ____________________________

    15. Neuroleptoanalgesia,
    combined intravenous administration
    fentanyl and droperidol are used
    for stopping ________________________________

    ! b.Immediate
    the introduction of fibrinolytic agents,
    neuroleptoanalgesia is used for
    assisting with
    _____________________________________

    Situational task to the syndrome
    “Chest pain”

    Stage 1

    Patient K., 44 years old. Complaints about
    intense pain behind the sternum, radiating
    to the left, along the spine-night lamp, pains wear
    undulating character, last up to 30-40
    minutes, are poorly controlled by taking nitrates.
    History of hypertension,
    Ischemic heart disease, deterioration of health with
    emotional and physical stress.

    1. What can you think about?

    2. What data need to be clarified?

    3. What surveys should be carried out?

    Stage 2

    With an objective examination:
    Cyanosis of the face, A / D 180/110 mm. rt. Art., pulse on
    right hand – 70, on the left 84,

    The left border of the heart – 2 cm
    to the left of the midclavicular line. On
    aorta is systolic
    noise. A sharp expansion of the vascular
    beam.

    ECG: ST segment
    -I, II , a
    V α, chest leads
    raised, III, and VF
    – discordantly changed.

    Prong T -I, II,
    a V α, chest leads
    negative

    R wave – without
    changes.

    When re-examining the ECG
    data without dynamics.

    1. What is your diagnosis?

    Stage 3

    Status
    the patient has deteriorated sharply: the pain is increasing
    in its intensity, the zone
    irradiation, appeared and grow
    collapse symptoms. On echocardiography
    false contour of the aorta is visible

    1.
    Diagnosis

    2.
    Emergency help.

    Situational task to the syndrome
    “Chest pain”

    Stage 1

    Outpatient appointment:
    complaints of chest pain,
    radiate to the left, last minutes, last
    10-15 minutes, stopped when taking nitrates.
    The pain increases with emotional and
    nervous tension. History of ischemic heart disease,
    transferred small focal infarction
    myocardium.

    What needs to be clarified?

    Stage 2

    Pain is localized in the sternum,
    intensified in their intensity, sharply
    the zone of pain irradiation has expanded (in
    left fingertips, jaw),

    Within a few weeks
    takes nitrong, finoptin.State
    worsened 3 days ago. Deterioration
    disease associates in emotional
    tension.

    Objectively: the state of the average
    severity, frightened facial expression,
    skin of normal color, organs
    breathing without pathologies.

    Heart borders: left 1 cm
    to the left of the left midclavicular line.
    Right – the right edge of the sternum. Heart tones
    sharply muffled, single
    extrasystoles, accent 2 tones.

    On the pulmonary artery A / D 110/75 mm
    rt. Art. Pulse – 88 in 1 minute.

    1. What do you think about?

    2. What needs to be done?

    Stage 3

    On the ECG at 1.2, and V α ,
    chest – the ST segment is sharply raised,
    forms a monophase curve, the R wave in
    1,2, and V α. in the chest leads
    decreases.

    1. Diagnosis

    2. Tactic

    Stage 4

    After neuroleptoanalgesia
    the condition has improved, but after 10-15 minutes
    worsened again. Pale skin
    cyanotic, wet A / D 90/70
    mm Hg.Art. Pulse 96 in 1 minute.

    1. What can you think about?

    Situational task to the syndrome
    “Chest pain”

    Patient 34 years old, in hospital
    is about thrombophlebitis.

    Stage 1

    Complaints of sharp pain in the chest
    cage, pains grow in its
    intensity, severe shortness of breath. Pain
    localized in the center of the sternum.

    1. What can you think about?

    Stage 2

    On examination: swollen cervical
    veins, in the lungs dullness of percussion
    sound, on the left, there is also weakened breathing.