Bowen test undertaking Excel Symptom Diary Case49 Case50 .

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The Excel Symptom Diary - guide. 1999 a patient made a hand crafted journal with point scores, that when summed up indicated consistently topping side effect about at regular intervals. Bend lost in harddisk crash. 2001-2003 pilot venture
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Marie Kroun, MD – Odense, Danmark LymeRICK (Eng.) : Project side (Danish) : ILADS : Bowen test extend Excel Symptom Diary Case#49 & Case#50

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The Excel Symptom Diary - direct 1999 a patient made a natively constructed journal with point scores, that when summed up demonstrated consistently cresting side effect about at regular intervals. Bend lost in harddisk crash. 2001-2003 pilot extend #1-#33; all patients were asked for to make a rundown of every one of their side effects and score from everyday utilizing an individual scale. Around 1/3 made a natively constructed journal. More demonstrated recurrent indication example, and more demonstrated change amid anti-microbial treatment! Be that as it may, because of various side effects scored and diverse scales utilized - it was inconceivable for me to look at patients, what\'s more it was a gigantic employment to enter every one of the scores physically into an outline to draw bends and get review over the course. I HAD TO INVENT A DIARY THAT COULD DRAW CURVES INSTANTANEOUSLY – along as scores are entered. I HAD TO DEFINE A COMMON USEFUL SCALE , where KEY INTEGER SCORES where clarified in WORDS, which people identify with much superior to NUMBERS, which PC requirements for the bends … SCORE WITH DECIMAL POINTS: 0 = ordinary condition, typical capacity 1 = somewhat strange marginally decreased capacity 2 = tolerably unusual, decently lessened capacity 3 = exceedingly irregular very diminished capacity [3+ can be utilized, if a patient deteriorate than we suspected possible] Is there at least one CYCLEs? Take after intercession: score 1-3 months pre-treatment, amid treatment and 3 months post-treatment => think about and read result on bends Total score demonstrates handicap level: 60 point ~ score maximal 3 point on 20 manifestations, the patient is for all intents and purposes not able to work!

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Case #49 - Key focuses/history 43-year old man, already sound and fit, abnormal state hustling cyclist 1999 tickbite on right shoulder, built up a discrete red rash at the nibble site , however did not contact specialist, in this manner no anti-toxin treatment. 2000 sudden 12 kg unexplained weight increase 2000 hoisted soluble phosphatase, fluctuating with action 2001/05 fatique and stomach torment, trunk X-beam i.a. 2001/06 serious migraine for 10 days, and "something" with his eyes; phadiatop hypersensitivity board i.a. … . Long interim no notes … . 2005/11 leg torment, trunk torment, expanded BP, ECG left hypertrophy 2006/01 cerebrum infarct in left frontal projection, 4 x 3 x 2 cm 2006/01 NEUROBORRELIOSIS ; spinal liquid: cell number 77 ; spinal protein somewhat expanded; Borrelia IgG positive in CSF & SERUM; serum Borrelia-IgM slighly positive ( notwithstanding numerous years length since tickbite and likely EM ) - yet the neurologist portray borreliosis as fortuitous, not bring about! - see a short reference list on Borrelia related with vasculitis and infarct on slide 7 2006/01 IV ceftriaxone 2g day by day for 10 days; "Fabulous impact" 2006/03 expanding indications, his GP begins PENICILLIN 1.5 MIO x 3 2006/04 considered enhanced; still positive spinal borrelia titer, be that as it may, serum borrelia titer has turned negative – " no compelling reason to trust despite everything you have dynamic borreliosis " 2006/05/31 stops penicillin and begins Excel journal & enters extend as #49

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Symptom journal demonstrates steadily expanding side effects subsequent to halting penicillin 2006/07/04 Q-RIBb titer 1:128 2006/07/12 is denied IV anti-toxin treatment in healing center ID; begins metronidazol, later azithromycin => unmistakable change on totalcurve 2006/10/24 (3 months) enhanced, less GCS, however little moving extracellular filamentous structures. Rash still present, yet ambiguous: 0049-20061024-skin.jpg 2006/12 skin biopsy from rash: perivascular lymphocytic aggravation with a couple plasma cells, good with ACA , yet not the only one symptomatic; this after 5 mo. of M+A and clinically moved forward! Healing center paper expresses that nothing had helped the patient Except for 1. IV ceftriaxone Tx. – in any case, this in negated by the aggregate indication score design demonstrating clear change of over half side effect decrease after 3 mo. Tx. (did the pt. not demonstrate the journal to the DRs?) 2007/04 IV ceftriaxone 2g every day for 2 weeks, doxycyline 100 mg x 2 for 3 weeks. He has proceeded with doxycycline by means of GP. Case #49 - Key focuses/history – case journal , his actual information entered (anon. DK form)

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Case 49# shapshots & recordings from microscopy of buffy-coat 0049-20061024 170 Mb, 16 min 0049-0070305 58 Mb, 8 min

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Case#49: Symptom journal – add up to bend Improvement amid treatment on totalscore: Before Tx: 35-40, fluctuating; long "second herx", then after 4 mo Tx. Diminished to ~ 10, stabile; IV ceftriaxone: down to 5, stabile

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CEREBRAL VASCULITIS & BRAIN INFARCT related with Borrelia disease (only a couple … ) Brogan et al. Ann Emerg Med 1990 May; 19(5): 572-6. The developing clinical range of Lyme ailment: Lyme cerebral vasculitis, another illness element. Concede et al. Neuroradiology 1993; 35(7): 529-31. Lyme infection exhibiting as a stroke in the vertebrobasilar region : MRI Keil et al. Nervenarzt 1997 Apr; 68(4): 339-41. [ Vasculitis course of neuroborreliosis with thalamic infarct ][German] May et al. Stroke 1990 Aug; 21(8): 1232-5. Stroke in neuroborreliosis . (case + survey of 11 litterature cases) Schmitt et al. Nervenarzt 1999 Feb;70(2):167-71. [ Neuroborreliose mit ausgeprägter zerebraler Vaskulitis und multiplen Hirninfarkten ][German] Wilke et al. Curve Dis Child 2000 Jul;83(1):67-71. Fundamentally interminable and cerebrovascular course of Lyme neuroborreliosis : case reports and writing survey. Oksi et al. Cerebrum. 1996 Dec;119 (Pt 6):2143-54. Incendiary mind changes in Lyme borreliosis . A provide details regarding three patients and survey of writing. From dynamic: "The goal of this review was assessment of neuropathological, microbiological, and attractive reverberation imaging (MRI) discoveries in three patients with the Borrelia burgdorferi contamination and neurological sickness from whom cerebrum tissue examples were accessible. Perivascular or vasculitic lymphocytic aggravation was identified in all examples . ..... We presume that cerebral lymphocytic vasculitis and multifocal encephalitis might be related with B. burgdorferi contamination. The nearness of B. burgdorferi DNA in tissue tests from ranges with fiery changes demonstrates that immediate attack of B. burgdorferi might be the pathogenetic instrument for central encephalitis in LNB."

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Case#50: Key focuses/history 37 year old once in the past extremely fit and games dynamic representative, voyaging everywhere throughout the world 2005/04 he creates respiratory manifestations and muscle hurts after introduction to formaline vapor in a texture in China. The territory is known similar to the craddle of numerous scourges like flu, SARS, corono infection Many mosquito nibbles while in China, no jungle fever prophylaxis taken (okay zone) Many known tickbites in past history, yet he had not been symptomatic after this before Never observed any rashes of 5 cm in distance across or greater 2005/05 and later: SERUM antibodies (FL-ELISA) for Borrelia burgdorferi negative

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Slight increment in body temperature (sub-febrilia) accompagnied fluctuating muscle throbs – recommended a "flu like" ailment Concurrent with the episodes of mucles hurts, Creatin Kinase (CK) qualities were evelvated (even more than 4000), measured a few circumstances, however unconstrained decrease occured in the middle of the torment assaults; the CK rises were most likely NOT incited by broad preparing, on the grounds that CK esteem expanded additionally, when the patient had not done any preparation! MYOSITIS has been discovered related with contaminations like Borrelia ( PubMed ), and additionally numerous infection diseases like flu , parvovirus , coxsackie - and however recommended – titer comes about for the these infections are absent in his research facility report … . a rheumatologist finishes up "conceivable somatoform issue" and rejects the patient?! He tries glyco-supplements and feel some change - BUT the patients condition continuously declines He needs to go on long haul sickleave Case#50: Key focuses/history

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Despite the past negative serum borrelia titer, the patient still presume conceivable borreliosis, because of side effects alike (rundown on next slide) Pt. definitely realizes that a negative SERUM borrelia titer does not 100% outrule dynamic borreliosis , as 6 of 12 culture confirmed late instances of Borreliosis were missed by the FL-ELISA test [J. Clin. Microbiol. 1995; 33(9): 2260-4 PDF ] 2006/03 a neurologist concurs and alludes him to healing facility for a lumbar cut and measure of spinal antibodies for borrelia Lumbar cut was done, bringing about ordinary spinal cell tally and protein The patient is told the consequences of all tests were typical 2006/06 he requests the Q-RIBb test, that exclusive I\'m doing in Denmark - hence he begins Excel side effect journal and selects in my long haul inquire about venture, and send me all the important past information for my survey; However, I miss the correct measures from the spinal and serum borrelia titer and approach the patient to request these again from the doctor\'s facility It would seem his spinal and serum borrelia titer was not done after all – spinal liquid was spared in a cooler ???!!! Case#50: Key focuses/history

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Case#50: Symptom list Fatigue Weight misfortune (3 kg/5 days) notwithstanding typical admission of sustenance and drink Temperature measures now ordinary between 36,4 og 37,5 (rectal) [no longer subfebrilia ] Muscle throbs – corrosive feeling, solidness Marked neck agony and firmness (loss of muscle volumen) Backpain proposing conceivable plate prolapse, however typical output outrules this Sore tenderpoint (neck, knee) Blood weight somewhat higher than before Pulse swings, palpitations Short of breath Sinus issues Dizziness/issues with adjust Numbness, diminished sensibility in fingers Prickl

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