Haus Hospital

[NewMedica]

Gastroenterology Department Case Series Global:

A 22 yr old female from the city of Bulda presented to Haus hospital in the capital with symptoms of abdominal bloating ongoing for over 5 months. She was consistently constipated and was prescribed fiber, Senna and Dulcolax which did improve symptoms but her symptoms would then become diarrhea predominant. She states the only thing which does help is when she defecates. She is diagnosed with IBS-D and treated with Amitiza. Peppermint oil is also used for symptomatic relief in the clinic.


A 37 yr old white male from Europa presented to a satellite clinic with symptoms of weight loss of almost 15 lbs. He is afraid he has cancer. He also has a history of anxiety treated with Fluoxetine and some hypertension treated with Norvasc 5mg daily. Clinical studies show he is anemic at 10 and also has vitamin D deficiency at 20. He was previously tested for anti IgA transglutaminase antibody which was positive. He has been trying a gluten free diet however is not having success. He will be scheduled for colonoscopy.


Center of Inflammatory and Immunologic Studies: Dr. Ver and Dr. Hannah run the clinic. They have created serologic testing to diagnose Ulcerative colitis vs Crohns disease which will not be marketed internationally (GUTPharma Inflam TM) which assess p-ANCA levels and antibodies to E coli porins. There is also an elective of testing for Saccharomyces antibodies. p-ANCA being more consistent with UC and the E coli consistent with Crohns. ED can also use lactoferrin or calprotectin in the stool to detect inflammatory bowel disease (LabsNE TM).

the gastroenterology department and center of inflammatory Immunologic studies are only part of the Haus Hospital and its local satellites

Physicians
Dr. Ver - gasteroenterologist, immunologist
Dr. Hannah - emergency physician (international disaster team member)
Dr. Vindas - gastroenterologist
Dr. Andrew - internal medicine (international disaster team member)

[NewMedica]

ACCEPTING INTERNATIONAL PATIENTS

Code: Select all

Please fill out the form if you would like to send patients from your country for treatment
Patient age:
Patient country:
Patient sex:
Patient symptoms:
Patient allergies:

Will respond with diagnosis and treatment performed from Haus hospital

[NewMedica]

Cardiovascular Institute Case and Guidelines
A 55 yr old male from the United Kingdom region has a PMHx of hyperlipidemia, type 2 diabetes and obesity (BMI 35). He recently had a bare metal stent placed in his right coronary artery. He is wanting to get surgery done on his right knee 2 weeks later.
He was denied the service.

Guideline: In NewMedica if a patient had a stent placement they must be on dual antiplatelet therapy with ASA and plavix or brillinta for at least 4 weeks with bare metal stent or for 6 months to a full year if its drug eluting stent. If the surgery is emergent then the patient can have the plavix/brillinta stopped for 7 days before but must continue ASA indefinately.

[NewMedica]

Division of Hannah Gastroenterology
Center for Esophageal Disorders: Dr. Vinda and Dr. Arkanash are the lead GI specialists who have opened this center.
Patients are mainly from New Medica with quite a few from the UK as well.
A 56 yr old female from New Medica with PMhx of HTN, T2DM and COPD on Lisinopril, Jardiance and Spiriva has Achalasia diagnosed over 2 years ago. She has trouble eating steak, drinking soda. She is currently just on acid suppression therapy with Pantoprazole however this has not helped. Dr. Vinda saw the patient and did a pH monitoring of the esophagus which was negative for reflux. She was placed on propranolol which improved her symptoms.

[NewMedica]

Asthma Society of New Medica and Greater UK (ASNMUK)
Diagnosis of Asthma based on society guidelines is FEV1 increase by 12% after bronchodilator administration in a subject. A new measure using nitrous oxide to measure inflammation in the lungs is being used by New Medica hospitals based on guideline recommendations. A measure of 50ppb is diagnostic of airway inflammation.

Asthma categories
ASNMUK researchers Dr. Amiru Khan and Dr. Hattie developed the asthma categories and their treatment recommendations
Mild intermittent = < 2x/wk day time symptoms and < 2x/month night symptoms. Tx is with Symbicort as needed
Mild persistent = > 2x/wk day time symptoms and > 2x/month night symptoms. Tx is with inhaled steroid (mometasone, budesonide, fluticasone)
Moderate persistent = daily symptoms during the day and > 2x/wk night symptoms. Tx with ICS and long acting beta
severe = constant symptoms require ICS + Long acting beta + systemic steroids (prednisone). Research into using Spiriva or LAMA is also being done

There are over 300,000 people in New Medica with Asthma

[NewMedica]

OB/GYN Department of Weiker Clinic, Haus Hospital Affiliate
Guidelines developed by Dr. Amanda Suh and Dr. Imrana Hasu New Medica gynecology department guidelines for prenatal visits. This is a policy strongly encouraged by the New Medica department of Health.
1) All women should be screened for HIV, Syphilis and
2) All women < 25 yr of age or if hx shows they are highly risky sexually need to be screened for chlamydia and gonorrhea
3) All women encouraged to have Folic acid and Iron supplementation
4) All women need to have urinalysis during first prenatal visit and ensure there is no UTI. Tx is with cephalexin 250mg daily for 7 days (FemUro TM New Medica Pharmacies).
5) All women who have herpes lesions at 36 wks gestation need to be on Acyclovir 400mg TID or Valacyclovir 500mg BID until they give birth.

Gestational Diabetes has a 4% prevalence in New Medica. Dx is with 50g oral glucose challenge test and if its > 135 then we do a 3 hr glucose tolerance test and if abnormal values then they are diagnosed.

All women in New Medica are also encouraged to take folic acid 0.4mg/day or 4mg/day if they have a hx of prior pregnancy with neural tube defect. New Medica will try to implement this policy throughout United Kingdom and beyond.

Russ Regional Clinic Primary Care Case A 26 yr old african female from the United Kingdom presents with abdominal pain with a past medical history of tubal surgery done in another country. Transvaginal ultrasound does not show any intrauterine sac, however her BhCG is at 2000. Eventually she is diagnosed with ectopic pregnancy. The patients vital signs are stable so she is treated with Methorexate. Recent research at the University of Kaus revealed that Methotrexate inhibits folic acid synthesis and proper DNA development which is how it kills the placenta. The patient was successfully treated and her vaginal bleeding and abdominal pain resolved.

[NewMedica]

Humara Womens Center
International Womens Pharmacy This is a pharmacy developed for women around the world for contraception purposes. New Medica government funded. The following Medications are available for purchase for whatever is affordable for the woman.

Medications
Long acting Reversible Contraception
1) Levonorgestrel Intra Uterine Device - this contains progestin to prevent uterine proliferation and only impacts the uterine enviornment and does not cause disruption of the ovulation itself
2) Etonorgestral device - this is implanted in the womans arm and has systemic effects which prevents a woman from menstruation
3) Cupper IUD - this will cause local inflammation but will also have side effect of bleeding. Women encouraged to take Iron

Progestin Only - these medications cause decreased bone mineral density and weight gain

Combined Estrogen and Progestin - these medications cause anovulation however side effects are caused by estrogen and thromboembolism is a risk factor. New Medica Department of Health recommends against usage for women over the age of 35 or those with cardiovascular disease or history of clotting.

Emergency Contraception - All pharmacies are required to carry Levonorgestral pills, Ulipristal

Funded by the Ilias Pharmacy international new Medica and in partnership with the following pharmaceutical companies: Zit Pharmacy, Umble Pharmaceuticals and Pharma Inc

Code: Select all

Purchase Form
Country:
Medication Desired:
Payment (must be greater than 1 in the countries currency):
Does your country want membership in the new medica health association?

[NewMedica]

Case Study Bacterial GI and Diverticulitis The NewMedica Military medic service under the direction of general Akbar Salami have devised a diagnostic criteria for diverticulitis and also for various gastrointestinal infections.

Diverticulitis diagnostic criteria An example was a soldier in the NewMedica army stationed elsewhere who developed left lower quadrant pain and had elevated WBC at over 13k and a mild fever at 100.3F. CT abdomen and pelvis was ordered showing diverticulitis.
Diagnostic - CRP > 50 + LLQ pain.

Bacterial infection Rotavirus is prevalent in New Medica children, the government has developed a process of immunization at 2,4,6 months. Some side effects from rotavirus are necrotizing enteritis, biliary atresia and chronic diarrhea. Campylobacter and Shigella are common bloody diarrhea causes. Campylobacter is caused by poultry while shigella is human fecal contamination.

[NewMedica]

New Medica Reproductive Guidelines - These guidelines are in regards to oral contraceptive pills. Contraindications:
1) women over age 35 who are smokers
2) migraine headaches
3) heart disease, diabetes, hx of stroke
4) Excessive blood pressure

Infectious Disease Case: A 35 yr old young UK citizen was in New Medica forest for a weekend hike when he came to the hospital with low platelet count, elevated AST and ALT and low sodium level. He was given doxycycline and symptoms resolved. His rickettsiae was positive.

[Kingdom of Intermaria]

Please fill out the form if you would like to send patients from your country for treatment
Patient age: 22
Patient country: Federation of the Aituia
Patient sex: Male
Patient symptoms: Stroke after drinking milk, headache and random heart attack (All of these are not in real-life)
Patient allergies: Cow Milk

Will respond with diagnosis and treatment performed from Haus hospital

[NewMedica]

Please fill out the form if you would like to send patients from your country for treatment
Patient age: 22
Patient country: Federation of the Aituia
Patient sex: Male
Patient symptoms: Stroke after drinking milk, headache and random heart attack (All of these are not in real-life)
Patient allergies: Cow Milk

Will respond with diagnosis and treatment performed from Haus hospital

Dept cardiology, emergency medicine (Dr Vivek Jahnda, Dr. Haus Will)
Medical Summary A 22 yr old male from Aituia presented to Haus hospital with symptoms of left sided upper extremity weakness, slurred speech and blurry vision. These symptoms developed minutes after the patient drank some cows milk. Upon review of his medical record from Aituia medical authorities pt does have an allergy to cows milk. His glucose was within normal limits, CBC indicated elevated white count and electrolytes were normal except for elevated Cr and decreased GFR. CT of the head did not reveal a true stroke and pt was given an IM epinephrine shot which recovered his symptoms. Pt stayed in the hospital due to lingering concerns as pt continued to have some numbness and weakness. The next day the pt developed intense chest pressure and shortness of breath. EKG was obtained indicating inferior infarction and pt was rushed to the cath lab and stent was placed in the RCA. Pt was started on ASA, Plavix, Statin, beta blocker, losartan. This was a puzzle as this is a relatively healthy male. Upon further evaluation it was revealed that he did indeed have a small stroke of the right mca which caused his symptoms. Blood cultures did reveal the patient had s aureus infection and actually had emboli of infectious material causing his stroke and myocardial infarction. Pt was given broad spectrum antibiotics (vanc + Rocephin). He will be discharged with dual antiplatelet therapy, beta blocker, statin and losartan with follow up at Haus clinic.

[Bakivaland]

Patient age: 24
Patient country: Bakivaland
Patient sex: Female
Patient symptoms: Fever, congestion, diarrhea, bloody stools, bloody nose, weakness, fatigue, cough, jaundice, irritability, sneezing,
slurred speech
Patient allergies: Penicillin, Anticonvulsants, Aspirin, Dairy, and Blackberries

[NewMedica]

Patient age: 24
Patient country: Bakivaland
Patient sex: Female
Patient symptoms: Fever, congestion, diarrhea, bloody stools, bloody nose, weakness, fatigue, cough, jaundice, irritability, sneezing,
slurred speech
Patient allergies: Penicillin, Anticonvulsants, Aspirin, Dairy, and Blackberries

Dept: Emergency Department, Rheumatology and Infectious Diseases (Dr. Hannah and Dr. William Khur)
24 yr old female presented from Bakivaland with persistent nasal congestion for over 3 weeks. She had been treated by previous physicians with Flonase and oral antihistamines without effect. She was also prescribed antibiotics without relief. She presents to Haus hospital for expert consultation. Broad testing shows she has elevated ANCA levels and surgical biopsy of the kidneys have revealed granulomatous disease involving the microscopic vessels in the kidneys. Presumptive diagnosis of Wegners Granulomatosis which explains most if not all of her symptoms. The diarrhea has been chronic in nature related with IBS-C (irritable bowel constipation type). The patient has been admitted to the Rheumatology department and will stay for a total of 7 days with Rheumatology consultation. She will be treated with Rituximab and high dose steroids. Pt will be discharged back to Bakivaland with recommendations to follow up with her physician in her native country.

[Aursi]

Please fill out the form if you would like to send patients from your country for treatment
Patient age: 19
Patient country: Aursi
Patient sex: Male
Patient symptoms: Went unconscious after playing games for 76 hours continuously, and can't be waken up now.
Patient allergies: Peanuts

Will respond with diagnosis and treatment performed from Haus hospital

[West Bromwich Holme]

Please fill out the form if you would like to send patients from your country for treatment
Patient age: 38
Patient country: U.S citizen residing in West Bromwich Holme (only has U.S. citizenship), resident for 6 years
Patient sex: Female
Patient symptoms: Patient was knocked over on a motorcycle, suffered severe pain and damage to legs, also seems to have difficulty with some short-term memory, speech is OK, still has Maryland accent. She was involved in major road accident at 3.25pm London time GMT in Kirkwhelbury, Virginia, West Bromwich Holme
Patient allergies: None

Will respond with diagnosis and treatment performed from Haus hospital

[NewMedica]

Please fill out the form if you would like to send patients from your country for treatment
Patient age: 19
Patient country: Aursi
Patient sex: Male
Patient symptoms: Went unconscious after playing games for 76 hours continuously, and can't be waken up now.
Patient allergies: Peanuts

Will respond with diagnosis and treatment performed from Haus hospital

A 19 yr old male from Aursi is airlifted from Aursi and taken to NewMedica Mouri Hospital which is an affiliate of Haus hospital. He was taken into the critical care bay in a coma. Fingerstick glucose shows extremely low glucose (40-50) and neuro imaging indicates inflammation of the meninges. History reveals the patient had been playing video games non stop and had not eaten anything other than a few energy drinks with zero sugar. He was also in contact with a friend who had Meningitis. Patient is given IV dexamethasone, IV Rocephin and IV acyclovir. Patient was also treated with IV fluids and given dextrose. He had to be hospitalized for over a month. He recovered slowly and had physical therapy performed at the Haus Rehab Institute. Patient will be transferred back to Aursi for further workup and management.

[NewMedica]

NewMedica Health Department A 33 yr old male is in the clinic with a cc of palpitations, sweating and a BP at 180/100mmHg for at least 3 days in a row. He feels extremely anxious. He comes from a small town in NewMedica and is a farmer. Electrolyte testing is generally normal however urine testing does show elevated HMA and VMA levels and CT imaging of his abdomen and pelvis shows a large tumor of his right adrenal gland. He is sent to surgery at St Hellen's Center in the capital and the tumor is removed. Biopsy does show that there are excess chromaffin cells. Patient will have follow up.

Rare Disease Research institute A small 6 yr old female from a nation in the united kingdom was transferred to the famous New Medica HausVa Institute which specializes in researching and treating rare diseases. The patient had albanism and severe low white count. She was also suffering from tracheitis and had 3-4 bouts of pneumonia treated with Levaquin which had caused her to have inflammation and further worsening of joint pains. Microscopic analysis of her blood does show that her white cells are dysfunctional with massive granules in the cytoplasm. The patient has been accepted to the hospital system and will remain here for several weeks to months for treatment. She also developed seizures and had severe neuropathic pain in her feet and hands. She is being treated with pulmonary rehabilitation, and is being treated by a specialist with chemotherapeutic agents and stem cell replacement of her cells.

[NewMedica]

Division of Infectious Disease A 45 yr old male from the United Kingdom presents with symptoms of joint pain in both his knees and his left hand. He also feels extremely fatigued and has some tenderness at the back of his neck. He is an avid woodsman and was recently in New Medica National Forest. Evaluation of the patient with the New Medica immunoassay reveals IgG levels against Lyme Disease which is likely cause of his symptoms. Patient is discharged home with 4 weeks of doxycycline 100mg BID. The center of infections and other immune functions (CIOIM) has been researching the presence of borellia bergdorferi in the forests.

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

New Medica Military and Bioterrorism Research New medica military academy has been undergoing research to see if lxodes tick which carries the bacteria can be used for bioterrorism. Some ticks have been taken to the lab and the infectious agent extracted to be used in bullets ect. New Medica scientists have created b bergdorferi encased bullets (Bio1 Bullets). Only 30 have been produced for research purposes.

[NewMedica]

Unis Hospital Endocrinology Department A 34 yr old male presented to the emergency department of Haus Hospital after having a traumatic brain injury by a catastrophic car accident. He was transferred to Unis Hospital (known for their trauma and neuro care). The patient underwent neurosurgery and further rehabilitation. He presents years later to the Unis Hospital Endocrinology department, referred because he has severe thirst and has been drinking over 5L of fluids trying to quench his thirst. Testing reveals he is urinating over 25L of free water with extremely low osmolality urine. Further imaging studies do show that his posterior pituitary had been damaged and he now has Diabetes Insipidus. He is being treated with vasopressin and is being monitored by the department.

Vasopressin is also used in shock and is in the toolkit for the New Medica International Emergency Unit

[NewMedica]

Haus Hospital Cardiovascular Clinic
Thousands of people have acute coronary disease in New Medica. Over 120-140,000 people a yr and the number is ever growing with increased amounts of fatty foods, sedentary lifestyle, and stress. On review by the Haus Cardiovascular Clinic, there are only 5 major hospitals equipped in New Medica with the ability to do PCI and 35 clinics that have cardiology staff at the hospitals equipped to deal with myocardial infarctions.

------------------------------------------------------------------------------------------
Guidelines and Information developed by the National Heart Association and Haus Cardiovascular Clinic.

1) Causes of chest pain type syndromes: type 1 MI, type 2 MI, pulmonary embolism, pneumonia, aortic dissection

2) EKG is essential for the diagnosis along with classic symptoms of crushing chest pain, substernal chest pain ect. HEART score is also used to determine the likelihood of cardiovascular dz.

3) EKG diagnosis is an essential part of myocardial infarction detection.

4) All victims of MI should not be on NSAIDS and should have a target K level at 4 and Mg 2. There is a myocardial bundle in most hospital systems (Beta blocker, ACE/ARB, Statin, ASA, Plavix). Suggested BB are metoprolol or carvediolol. ACE/ARB are lisinopril and valsartan. Plavix vs Brillinta.

[NewMedica]

Haus Hospital Gynecology department: A 25 yr old female presents to the clinic with her second pregnancy. She is 15 wks pregnant and urinalysis reveals over 125,000 E coli bacteria. She does not have any symptoms but will be treated with Cephalexin 500mg BID for 5 days. Research has shown that progesterone causes increased urinary reflux causing increased risk of pyelonephritis in pregnant women. New Medica Association on Gynecology and Women health has determined that all women between who are 12-16 wks gestation need to have a UA. If this patient had high risk behaviors then she needs to be tested for syphilis as well (New Medica Guideline).

Dr. Von William and Dr. Isha Sarah: These physicians have determined that prior C sections in women is related to increased risk of placental implantation due to scarring in the muscle of the uterus. New Medica hospitals are trying to institute ultrasounds of uterus to detect this.

[NewMedica]

New Medica Emergency Medicine & United Kingdom Cardiology Institute

Myocardial infarction guidelines: These guidelines are required policy in all New Medica hospitals. All hospitals are PCI capable. These guidelines will also extend to international relief missions which New Medica is involved in
-------------------

MI Package (TM) developed by Ion Medical Inc.

- Beta Blocker (Atenolol, Metoprolol)
- Statin (Rosuvastatin, Simvastatin)
- Anticoagulation (ASA + Plavix/Brillinta)
- Nitroglycerin
- Heparin (60U/kg)

------------------------------------------------------------------------------------------------------------------
Guidelines for Statin Therapy
1) Anyone with hx of stroke, peripheral arterial disease, stable angina, hx of acute coronary syndrome - must be on high intensity statin (< 75 age) or moderate (>75 age)

2) 10 yr ASCVD Risk between 7.5%-10% need to be on moderate to low

3) Diabetes + age > 40 need to be on high (ASCVD > 20%) or mod (ASCVD < 20%)

4) LDL > 190 then they have to be on high intensity

[NewMedica]

Infectious Disease Case A 15 yr old white female from a foreign country presents with fatigue, painful nodules on her forearms and arthritis of her left knee and wrist joint. She is evaluated at the local clinic and found to have elevated inflammatory markers. She is also noted to have a heart murmur. Testing is done with anti-streptolysin O and found to be positive. This patient came from a country which did not believe in antibiotics and after developing strep infection she had rheumatic fever. Pt was treated with Penicillin, given high dose Naproxen and also given tylenol for fever. There has been an uptick in patients with rheumatic fever due to lack of antibiotic treatment in patients.

New Medica HIV and Bio Center, York. New medica has a small incidence of HIV infection, however several patients have long standing HIV. One complication which researchers have noted is the affect of HIV on the CNS causing dementia, depression and motor defecits. Particularly in pts who have CD4 counts < 200 and who have been having the disease for over 20 yrs. Most pts are over 50 yrs old. New Medica has developed 1 hospital system with a specialty clinic for long HIV similar to the Long COVID clinics in the nation

[Poxo]

Patient age: 68
Patient country: Poxovite citizen, on visit to a nearby country
Patient sex: Male
Patient symptoms: Presented with severe epigastric pain and nausea. Reveals that he has been suffering from a mild headache for the past 3 days and was taking Aspirin regularly. Pain was of acute onset and worsened with each day. Gives history of black, tarry stools and the pain aggravating on taking meals. Was airlifted to the nearest tertiary care center (Haus Hospital) on the insistence of the Poxovite Embassy as adequate facilities could not be found for his treatment.
Patient allergies: None

Will respond with diagnosis and treatment performed from Haus hospital.

[BOI U ABOUT TO GET SPANKED]

Patient age: 43
Patient country: BOI U ABOUT TO GET SPANKED
Patient sex: Male
Patient symptoms: lack of breath, nausea, temperature and pain in the right side above the waist. Has a history of recreational drug use, and excessive eating. Quit smoking 4 years ago and has cut down on weight. Rapid heart rate is also a symptom.
Patient allergies: penicillin, caviar