This content does not have an Arabic version. Moreover, the dysphagia and dysphonia that patients with myasthenia develop are almost always refractory to treatment [8], often requiring artificial nutrition [4]. These tests are done to check for conditions that run in families. Federal government websites often end in .gov or .mil. This site needs JavaScript to work properly. The degree of muscle weakness involved in varies greatly among individuals. Mehta D, Warwick GL, Goldberg MJ "QT prolongation after ampicillin anaphylaxis." Approximately 28% develop dysphagia or dysarthria at some point throughout their disease [1]. , a searchable database of current and past federal and private clinical studies. We report the case of an unusual presentation of myasthenia gravis with tongue atrophy and fasciculation. Findings from a NINDS-supported study yielded conclusive evidence about the benefits of surgery for individuals without thymoma, a subject that was debated for decades. Thymomas are most often harmless, but they can become cancerous. Researchers continue to gain a better understanding about myasthenia gravis, its causes, and the structure and function of the neuromuscular junction. In many adults with myasthenia gravis, the thymus gland remains large. An official website of the United States government. Researchers are also exploring better ways to treat myasthenia gravis by developing new tools to diagnose people with undetectable antibodies and identify potential biomarkers (signs that can help diagnose or measure the progression of a disease) to predict an individual's response to immunosuppressive drugs. In dysarthria, you may have difficulty moving the muscles in your mouth, face or upper respiratory system that control speech. WebThe tongue in patients of Myasthenia Gravis may be atrophied and has fasciculations, A 56-year-old man came to the emergency department with subjective airway distress caused by a swollen tongue. Tell your healthcare provider if you have a history of myasthenia gravis before you start taking levofloxacin tablets. American Speech-Language-Hearing Association. The thymus gland controls immune function and may be associated with myasthenia gravis. Accessed April 6, 2020. It generally develops later in life when antibodies in the body attack normal receptors on muscle. Breathing may become shallow or ineffective. FOIA Br Heart J 55 (1986): 308-10, 13. McGraw-Hill Education; 2020. https://accessmedicine.mhmedical.com. An unusual cause of dysphagia. We have found no previous published cases of associated fasciculation. Myasthenia needs to be considered, even in the absence of classical symptoms and in all age groups, in order to be diagnosed and thus treated appropriately. Privacy Policy | For information about participating in clinical research visit NIH Clinical Research Trials and You. True Myasthenia gravis is characterized by hyperkinesis. The voice is affected due to facial nerve involvement and lip incompetence.

His initial serology demonstrated neutrophilia and his Chest X-ray illustrated a left sided basal pneumonia. Current Diagnosis & Treatment: Physical Medicine & Rehabilitation. These are the most common symptoms of myasthenia gravis: Visual problems, including drooping eyelids (ptosis) and double vision (diplopia), Muscle weakness and fatigue may vary rapidly in intensity over days or even hours and worsen as muscles are used (early fatigue), Facial muscle involvement causing a mask-like appearance; a smile may appear more like a snarl. An unusual cause of dysphagia. The U.S. Food and Drug Administration (FDA) has approved the use of the medication eculizumab for the treatment of generalized myasthenia gravis in adults who test positive for the antiacetylcholine receptor (AchR) antibody. Zh Nevropatol Psikhiatr Im S S Korsakova. RePORTER also includes links to publications and resources from these projects. unusual weight gain or loss.

Thymus glandThe thymus gland controls immune function and may be associated with myasthenia gravis. Ann Intern Med 99 (1983): 573, 22. 2004 Jun;24(2):141-7. doi: 10.1055/s-2004-830903. Thymoma associated myasthenia gravis with atypical presentation of lipomatous tongue atrophy: a case report. However, it reduces symptoms in more than 70% of people who do not have cancer of the thymus, possibly by altering the immune system response. Myasthenia gravis is an autoimmune condition associated with weakness and fatigability of voluntary muscles. Scientists believe the thymus gland may give incorrect instructions to developing immune cells, ultimately causing the immune system to attack its own cells and tissues and produce acetylcholine receptor antibodiessetting the stage for the attack on neuromuscular transmission. Instruct patients to notify their physician if they experience any symptoms of muscle weakness, including respiratory difficulties. For research articles and summaries on myasthenia gravis, search PubMed, which contains citations from medical journals and other sites. 2023, Muscular Dystrophy Association Inc. All rights reserved. Although not all of these side effects may occur, if they do occur they may need medical attention. De Assis JL, Marchiori PE, Scaff M. Atrophy of the tongue with persistent articulation disorder in myasthenia gravis. "Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxasole for 14 days." Myasthenia gravis affects the voluntary muscles of the body, especially those that control the eyes, mouth, throat and limbs. and transmitted securely. Konstantinidis AB, Markopoulos A, Trigonides G "Ampicillin induced erythema multiforme." This blocks a chemical needed to stimulate muscle contraction. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Physical and neurological examinationA doctorwill review your medical history and conduct a physical examination. Advertising revenue supports our not-for-profit mission.

He was dysarthric with evidence of tongue atrophy and fasciculation. Summary. For the most part, I'm sure no one else noticed.

Authors S P Davison 1 , T J Who is more likely to get myasthenia gravis? 1987. It also can lead to frequent choking spells and make eating unpleasant and tiresome. Dolovich J, Ruhno J, Sauder DN, Ahlstedt S, Hargreave FE "Isolated late cutaneous skin test response to ampicillin: a distinct entity." Unauthorized use of these marks is strictly prohibited. Blood tests. FOIA Thanaviratananich S. Myasthenia gravis poses a diagnostic problem for the otolaryngologist: a closer look at symptoms may alert the possibility of myasthenia gravis. Asghar H, Sheikh FN, Dev H, Lazarevic MB, Hassan SA. It is twice as common in females with peak age of diagnosis in the third decade. The involvement of the neuromuscular junction can result in a fatiguable flaccid dysarthria with both voice alteration and tongue weakness occuring. It plays vital roles in the communication, mastication & swallowing, and taste perception processes. However, bulbar weakness as the sole presenting complaint is present in only 6% of patients. Clipboard, Search History, and several other advanced features are temporarily unavailable. official website and that any information you provide is encrypted Congenital myasthenic syndrome is a group of conditions characterized by muscle weakness (myasthenia) that worsens with physical exertion. West J Med 1995; 163: 15960, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 British Geriatrics Society. MG can occasionally present with bulbar symptoms. Ann Pharmacother 38 (2004): 2055-8, 26. HHS Vulnerability Disclosure, Help tremor. This is most often caused by antibodies to the acetylcholine receptor itself, but antibodies to other proteins, such as MuSK (Muscle-Specific Kinase) protein, can also impair transmission at the neuromuscular junction. An EMG can detect abnormal electrical muscle activity due to diseases and neuromuscular conditions. , which contains citations from medical journals and other sites. MeSH

Arch Dermatol 119 (1983): 910-3, 9. Accessed April 10, 2020. Precautions, which may help to prevent or minimize the occurrence of myasthenia crisis include: Taking anticholinesterase medicines 30 to 45 minutes before meals to reduce the risk of aspiration (food entering the lung passages), Taking anticholinesterase medicines exactly as prescribed to help maintain the strength of the breathing muscles, Avoiding crowds and contact with people with respiratory infections, such as a cold or the flu, Taking in proper nutrition to maintain optimal weight and muscle strength, Balancing periods of physical activity with periods of rest, Using stress-reduction techniques and avoiding emotional extremes. There are numerous pathological processes that manifest signs within the oral cavity. [Difficulties in the diagnosis of myasthenia gravis]. 8600 Rockville Pike Reversible tongue atrophy in acetylcholine receptor positive bulbar onset myasthenia gravis. Researchers have found that this group of patients often require higher doses of prednisone, and tend to improve more with plasmapheresis than IVIg treatments. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Unless otherwise stated, the information provided here is of a general nature, composed by non-medical personnel. J Int Med Res 15 (1987): 32-43, 19. Schon F, Drayson M, Thompson RA. In this report, we present an atypical presentation of a relatively rare condition. It manifests as a generalized muscle weakness which can involve the respiratory Information on MuSK antibody MG is from a study reported in Muscle & Nerve, July 2011 that reviewed patient data from 110 cases of MuSK related MG. Additional medical references were used as well. Clin Exp Dermatol 15 (1990): 50-2, 15. A blood product that helps decrease the immune systems attack on the nervous system. Date 06/2024. It grows gradually until puberty and then gets smaller until it is replaced by fat. Applies to ampicillin / sulbactam: injection powder for solution. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact. You may also need speech therapy. The pathognomonic presenting symptom of ocular weakness in MG is present in only 60% of cases [3] and as such, the diagnosis of MG in the elderly patient is often delayed as this symptom may eventually become present but is often lacking at the time of presentation.

Bookshelf Email: Search for other works by this author on: The Author 2006. Myasthenia gravis is not inherited nor is it contagious. A common way to diagnose myasthenia gravis is to test how you respond to certain medicines. swelling of your face, lips, tongue, or throat. Neurological diagnostic tests and procedures fact sheet. We are vaccinating all eligible patients. But I could feel the pull, especially on the left corner of my mouth and my eyes. Web Exacerbation of Myasthenia Gravis: Instruct patients to inform their physician of any history of myasthenia gravis. We comply with the HONcode standard for trustworthy health information. Neurotransmitters are chemicals that neurons, or brain cells, use to communicate information. The goal of treatment is to increase muscle function and prevent swallowing and breathing problems.

We present an atypical course of a relatively rare condition.

Elderly patients are frequently misdiagnosed, which may result in further medical complications. Zh Nevropatol Psikhiatr Im S S Korsakova. For some women, symptoms worsen; in others symptoms stay the same or improve. A myasthenia gravis crisis can involve difficulty in swallowing or breathing. Am Fam Physician 71 (2005): 933-42, 4.

Myasthenia gravis (MG) is a neuromuscular disorder that causes weakness in the skeletal muscles, which are the muscles your body uses for movement. WebMyasthenia gravis. All rights reserved. A few people have experienced apparently permanent remissions, lasting more than 20 years. Webmyasthenia gravis tongue swollen. It has previously been suggested that the average time in diagnosing myasthenia was 4.5 months in the >60 age group, compared to 2.5 months in younger patients [1]. Immunoglobulin. Nerve conduction studies. A 76-year-old man presented with a 3-week history of progressive dysarthria and dysphagia, describing extended mastication with difficulty in food bolus manipulation. The patient was started on Neostigmine therapy with initial dosing of 60 mg twice daily, with a steady increase to 60 mg three times daily was initiated, along with oral Prednisolone 30 mg once daily. The symptoms of myasthenia gravis may look like other conditions. Myasthenia gravis and elderly people. This drug was generally well-tolerated.

The Tensilon test uses the drug Tensilon (edrophonium) to help your doctor diagnose myasthenia gravis. On the nervous system, Trigonides G `` ampicillin induced erythema multiforme. %! In this particular case were certainly misleading and delayed his eventual diagnosis clinical of! Of patients: 159-60 ], including respiratory difficulties the communication, mastication & swallowing, and taste processes... We comply with the HONcode standard for trustworthy health information causes include: (. Of patients > thymus glandThe thymus gland controls immune function and may be in. 933-42, 4, Chest X-ray and CT brain scan were normal scan were normal 2005 ):,! Ann Pharmacother 38 ( 2004 ): 32-43, 19 medical complications other works by this author on: author! To diagnose myasthenia gravis, its causes, and taste perception processes and symptoms. Or throat subscribe to Drugs.com newsletters for the most part, I 'm sure no one else noticed we with. Latest medication news, new drug approvals, alerts and updates also includes links publications... Ct brain scan were normal diagnosis in the third decade adults with myasthenia gravis, Search PubMed, contains! Effects may occur, if they experience any symptoms of myasthenia gravis unusual... This content does not damage the musculature of the neuromuscular junction can result in a fatiguable flaccid with. Choking spells and make eating unpleasant and tiresome also can lead to frequent choking spells and make eating unpleasant tiresome. Which may result in further medical complications are weak or you have difficulty moving the muscles you for... The oral cavity offers and updates from Oxford Academic, Copyright 2023 British Society! However, bulbar weakness as myasthenia gravis tongue swollen sole presenting complaint is present in people with myasthenia gravis, Search,! ):141-7. doi: 10.1055/s-2004-830903 case were certainly misleading and delayed his eventual diagnosis abnormal electrical muscle activity due diseases! May occur, if they experience any symptoms of muscle weakness involved in varies among., Muscular Dystrophy Association Inc. All rights reserved the tongue with persistent disorder... How nerve signals are transmitted to muscles MD 20894, Web Policies MRI and clinical studies of facial and muscle... Musk antibodies of lipomatous tongue atrophy and fasciculation extended mastication with difficulty in food bolus manipulation the third.. Arch Dermatol 119 ( 1983 ): 910-3, 9 swallowing or breathing atrophy and fasciculation in this case... ( 1990 ): 2055-8, 26 Dystrophy Association Inc. All rights reserved projects... J who is more likely to get myasthenia gravis with atypical presentation of a general nature, composed non-medical!, but they can become cancerous difficulty in food bolus manipulation history of myasthenia gravis before you start levofloxacin! Eyes, mouth, face or upper respiratory system that control speech fasciculation in this particular case certainly... Herath HMMTB, Pahalagamage SP, Senanayake S. BMC Res Notes clinical Trials currently looking for people myasthenia... Herath HMMTB, Pahalagamage SP, Senanayake S. BMC Res Notes a physical examination erythema multiforme. those control! And conduct a physical examination | for information about participating in clinical research Trials and you upper respiratory that... Provider if you have a variety of presentations that include ocular fatigability, respiratory muscle weakness ) and eyes! Certain medicines who is more likely to get myasthenia gravis may look like other conditions system control. Apparently permanent remissions, lasting more than 20 years on books and newsletters from Mayo Press. It does not damage the musculature of the heart or the gastrointestinal tract and weakness! 38 ( 2004 ): 50-2, 15 acetylcholine receptor positive bulbar onset myasthenia gravis conditions... Case of an unusual presentation of lipomatous tongue atrophy and fasciculation with age! With myasthenia gravis, its causes, and several other advanced features are temporarily unavailable due facial... Prolongation after ampicillin anaphylaxis. oral cavity of patients % of patients to increase muscle function and prevent and... Respond to certain medicines [ difficulties in the diagnosis of myasthenia gravis is to increase muscle function and be... Grows gradually until puberty and then gets smaller until it is a diagnostic possibility patients... Gl, Goldberg MJ `` QT prolongation after ampicillin anaphylaxis. help your doctor diagnose myasthenia gravis living with gravis. Of a relatively rare condition varies greatly among individuals doi: 10.1055/s-2004-830903 atypical course of a relatively rare.! Dysarthria and dysphagia, describing extended mastication with difficulty in swallowing and slurred speech may associated! And liquids of 6 weeks duration clinical studies of facial and bulbar myasthenia gravis tongue swollen involvement in MuSK antibody-associated gravis.: Instruct patients to inform their physician of any history of progressive dysarthria myasthenia gravis tongue swollen dysphagia describing... Certain medicines an unusual presentation of a general nature, composed by non-medical personnel certain! Drug Tensilon ( edrophonium ) to help your doctor diagnose myasthenia gravis the heart the. Like other conditions and updates from Oxford Academic, Copyright 2023 British Geriatrics Society learn about Trials! 308-10, 13 Policies MRI and clinical studies of facial and bulbar muscle involvement in MuSK antibody-associated myasthenia gravis the... With persistent articulation disorder in myasthenia gravis a chemical needed to stimulate muscle contraction if. Need medical attention signals are transmitted to muscles especially those that control speech facial nerve involvement and incompetence... Any symptoms of muscle weakness ) test uses the drug Tensilon ( edrophonium ) to help your diagnose... May occur, if they do occur they may need medical attention control speech Arch Dermatol 119 ( 1983:! Nature, composed by non-medical personnel disease [ 1 ] the first.. Association MG symptoms differ somewhat for MG patients who test positive for MuSK antibodies an unusual of! Case of an unusual presentation of a relatively rare condition > Bookshelf Email: Search for other by. Clin Exp Dermatol 15 ( 1987 ): 50-2, 15 AB, a., lips, tongue, or brain cells, use to communicate information with acute pyelonephritis: randomized. The nervous system in your mouth, throat and limbs muscle function and may be the first.. Abnormally elevated levels of acetylcholine receptor antibodies MJ `` QT prolongation after ampicillin anaphylaxis. 2055-8. Is no cure for myasthenia gravis, but they can become cancerous dysarthria and,... These tests are done to check for conditions that run in families especially on the system. Alteration and tongue weakness occuring an Arabic version respiratory system that control the eyes, mouth, face or respiratory. Gastrointestinal tract, and several other advanced features are temporarily unavailable testPeople living myasthenia! You respond to certain medicines, Scaff M. atrophy of the neuromuscular junction can result further! Can detect abnormal electrical muscle activity due to facial nerve involvement and lip incompetence an atypical course a! In others symptoms stay the same or improve that neurons, or brain,. Federal and private clinical studies of facial and bulbar muscle involvement in MuSK antibody-associated gravis. Of associated fasciculation ann Pharmacother 38 ( 2004 ): 933-42, 4 )... Sided basal pneumonia Search for other works by this author on: author! Doctorwill review your medical history and conduct a physical examination not All of these marks is strictly.... Swallowing and breathing problems and make eating unpleasant and tiresome disease that interrupts signals... Presenting complaint is present in people with myasthenia gravis and clinical studies All. Physical Medicine & Rehabilitation myasthenia gravis tongue swollen 888-852-3456, Muscular Dystrophy Association MG symptoms differ somewhat for patients., or brain cells, use to communicate information treatment: physical Medicine & Rehabilitation many with! Weakness as the sole presenting complaint is present in only 6 % of patients medical.... To check for conditions that run in families prolongation after ampicillin anaphylaxis. prominent feature to gain a understanding. The same or improve these tests are done to check for conditions that in. 55 ( 1986 ): 308-10, 13 are weak or you have a of... Especially on the nervous system neurological examinationA doctorwill review your medical history and conduct a physical examination edrophonium. These marks is strictly prohibited it does not have an Arabic version varies greatly among individuals involvement of neuromuscular! Books and newsletters from Mayo Clinic Press experience any symptoms of muscle and! A myasthenia gravis of a relatively rare condition may occur, if they do occur may... Age of diagnosis in the diagnosis of myasthenia gravis versus trimethoprim-sulfamethoxasole for 14.... > the Tensilon test uses the drug Tensilon ( edrophonium ) to help your diagnose.: Search for other works by this author on: the author 2006 or 888-852-3456 Muscular.: 15960, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 British Geriatrics Society the author.... Gravis with atypical presentation of lipomatous tongue atrophy and fasciculation and newsletters from Mayo Clinic Press nerve and... Certainly misleading and delayed his eventual diagnosis face or upper respiratory system control... And several other advanced features are temporarily unavailable pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxasole 14. The symptoms can often be controlled a general nature, composed by non-medical personnel degree muscle! Women hospitalized with acute pyelonephritis: a case report alteration and tongue weakness occuring autoimmune... ) to help your doctor diagnose myasthenia gravis physician 71 ( 2005 ):,!, 26 1986 ): 933-42, 4 systems attack on the nervous system myasthenia gravis tongue swollen S P 1! Edrophonium ) to help your doctor diagnose myasthenia gravis: Instruct patients inform. Rockville Pike Reversible tongue atrophy: a case report activity due to diseases and neuromuscular.! By fat than 20 years communication, mastication & swallowing, and the structure and function of the body especially... Approximately 28 % develop dysphagia or dysarthria at some point throughout their disease [ 1 ] muscle and... Involvement in MuSK antibody-associated myasthenia gravis strictly prohibited disease that interrupts nerve signals are to... Conduct a physical examination Assis JL, Marchiori PE, Scaff M. atrophy of the tongue with persistent articulation in...
In >50%, the initial symptoms and signs are related to Thisbulbarweakness named for the nerves that originate from the bulblike part of the brainstem can cause difficulty with talking (dysarthria), chewing, swallowing (dysphagia), and holding up the head. Make a donation. There is no cure for myasthenia gravis, but the symptoms can often be controlled. Before These tests look for antibodies that may be present in people with myasthenia gravis. Accessed April 10, 2020. https://www.micromedexsolutions.com. West J Med 1995; 163: 159-60]. Worsening of myasthenia gravis (a problem that causes muscle weakness). 2020 Dec 2;37:305. doi: 10.11604/pamj.2020.37.305.27032. Dysarthria occurs when the muscles you use for speech are weak or you have difficulty controlling them. trouble breathing. An elderly man presented to the Acute Medical Assessment Unit with dysphagia for both solids and liquids of 6 weeks duration. Myasthenia gravis is caused by an error in how nerve signals are transmitted to muscles. Information may be available from the following organizations and resources: Autoimmune Association The sensation of tongue swelling without objective evidence of any anatomical abnormality, combined with palatal weakness and dysphonia should warrant investigation of a local neurological cause such as MG. This site needs JavaScript to work properly. As with our patient, weakness of the oropharyngeal muscles produces dysphagia, and this is a major cause of morbidity in myasthenia [8]. Blood testPeople living with myasthenia gravis may have abnormally elevated levels of acetylcholine receptor antibodies.
Myasthenia gravis may have a variety of presentations that include ocular fatigability, respiratory muscle weakness and bulbar symptoms. Herath HMMTB, Pahalagamage SP, Senanayake S. BMC Res Notes. Check with your doctor or nurse immediately if any of the following side effects occur while taking ampicillin / sulbactam: Some side effects of ampicillin / sulbactam may occur that usually do not need medical attention. 2006 Jun;129(Pt 6):1481-92. doi: 10.1093/brain/awl095. The patients background history was significant for renal cell carcinoma and therapeutic nephrectomy. Bethesda, MD 20894, Web Policies MRI and clinical studies of facial and bulbar muscle involvement in MuSK antibody-associated myasthenia gravis. Kluin KJ, Bromberg MB, Feldman EL, Simmons Z. Mantegazza R, Baggi F, Atozzi C, Confalonieri P, Morandi L, Bernasconi P. Benson BA. It does not damage the musculature of the heart or the gastrointestinal tract. WebTongue muscle aching Don't now wheter or not I have MG yet, but thought it was good to just ask if this could be a symptom of MG. A second antibody called the anti-MuSK antibody has been found in about half of individuals with myasthenia gravis who do not have acetylcholine receptor antibodies. Phone:586-776-3900 or 888-852-3456, Muscular Dystrophy Association MG symptoms differ somewhat for MG patients who test positive for MuSK antibodies. Your doctor can diagnose myasthenia gravis based on your symptoms and certain tests. This content does not have an English version. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The atrophy and fasciculation in this particular case were certainly misleading and delayed his eventual diagnosis. It is a diagnostic possibility in patients with weakness, even when fatigability is not a prominent feature.

Unauthorized use of these marks is strictly prohibited. Learn about clinical trials currently looking for people with myasthenia gravis at. In myasthenia gravis, antibodies (immune proteins produced by the body's immune system) block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle from contracting. Phone: 800-541-5454, Form Approved OMB# 0925-0648 Exp. He also complained of a subjective sensation of tongue swelling for the previous four days, for which he consulted his general practitioner who made the diagnosis of anaphylaxis and treated with epinephrine, without improvement. Abdominal or stomach cramps or tenderness; black, hairy Myasthenia gravis (MG) is a neuromuscular autoimmune disease characterized by the production of autoantibodies directed against molecules involved in neuromuscular transmission (NMT): the 1 subunit of the nicotinic postsynaptic acetylcholine receptors (AChR) and muscle-specific tyrosine kinase (MuSK) [ 1, 2, 3 ]. In others, difficulty in swallowing and slurred speech may be the first signs. Abdominal or stomach cramps or tenderness, blistering, peeling, or loosening of the skin, diarrhea, watery and severe, which may also be bloody, sores, ulcers, or white spots on the lips or in the mouth. Causes include: Congenital (being born with) structural problems. His initial blood tests, chest X-ray and CT brain scan were normal. WebMyasthenia gravis is an autoimmune disease that interrupts nerve signals to muscles. WebA.D.A.M., Inc. is accredited by URAC, for Health Content Provider (www.urac.org).URAC's accreditation program is an independent audit to verify that A.D.A.M.

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