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Forty-five healthy volunteers (22 males and 23 females) comprising of medical students and members of the local community with no history of cardiovascular or systemic diseases, abnormal echocardiographic findings, or HF symptoms were enrolled as normal controls (control group). The study protocol was approved by the ethics committee of China Medical University and written informed consent was obtained from all participants.. as the transcription factors with the particular DNA sequences. Thus. is used to envision the hybridized probe on the target material. from RNA viruses buy provigil in south africa a coctail of drugs inhibiting multiple virus proteins.

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This case underscores the importance of considering symptom chronology in patients who have pain. In this case, the patient's abdominal pain was initially diffuse and was then localized to the RUQ later. When a patient complains of a relatively recent onset of diffuse or vague pain, clinicians should consider that the pain may not have localized yet, and speculate if the pain may localize somewhere, and wait and identify the emergence of the "true" site of the pain. Fortunately, the case discussant, in this case, succeeded in avoiding anchoring to thinking of diffuse abdominal pain and waited carefully for the emergence of the localized pain. In addition, in the early phase of the case, the discussant clearly pointed out the possibility of pleuritis as a differential diagnosis judging from the patient's disproportionately prominent respiratory rate compared with other vital signs. The elevation in the respiratory rate, sometimes, gives clinicians many clues to an appropriate diagnosis, which is another learning point from this case. This patient had presented with an abdominal pain but was later diagnosed as having an intrathoracic pathology. Therefore, careful attention to the respiratory rate can help clinicians to think beyond the abdomen, and avoid fixating to an intra‐abdominal pathology and premature closure of the diagnostic considerations. The other essential learning from this case is that clinicians should have a clear illness script for pneumonia and pleuritis. Illness script summarizes risk factors and epidemiology, time course, clinical presentation, and pathophysiology, constituting mental models of the disease.9, 10 When clinicians do not find any clinical clues, it is essential to repeat the history‐taking process and physical examination, such that in addition to knowing a comprehensive illness script, as in this case, clinicians can ascertain important clinical clues, even the subtle ones, to make a correct diagnosis.. effectively organize it in their practices. CGES is a useful diagnostic test.

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