Sample records for characteristics clinical severity

  1. Clinical characteristics and prognostic factors of severe acute pancreatitis

    Lei Kong; Nn Santiago; Tian-Quan Han; Sheng-Dao Zhang


    AIM: To investigate the clinical characteristics and prognostic factors of a consecutive series of patients with severe acute pancreatitis (SAP).METHODS: Clinical data of SAP patients admitted to our hospital from January 2003 to January 2004 were retrospectively reviewed. Collected data included the age, gender, etiology,length of hospitalization, APACHE Ⅱ score at admission,local and organ/systemic complications of the patients.RESULTS: Of the 268 acute pancreatitis patients, 94 developed SAP. The mean age of SAP patients was 52 years, the commonest etiology was cholelithiasis (45.7%), the mean length of hospitalization was 70 d, the mean score of APACHE Ⅱ was 7.7. Fifty-four percent of the patients developed necrosis, 25% abscess, 58% organ/systemic failure. A total of 23.4% (22/94) of the SAP patients died. Respiratory failure was the most common organ clysfunction (90.9%) in deceased SAP patients, followed by cardiovascular failure (86.4%),renal failure (50.0%). In the SAP patients, 90.9% (20/22)developed multiple organ/systemic failures. There were significant differences in age, length of hospitalization,APACHE Ⅱ score and incidences of respiratory failure, renal failure, cardiovascular failure and hematological failure between deceased SAP patients and survived SAP patients.By multivariate logistic regression analysis, independent prognostic factors for mortality were respiratory failure,cardiovascular failure and renal failure.CONCLUSION: SAP patients are characterized by advanced age, high APACHE Ⅱ score, organ failure and their death is mainly due to multiple organ/systemic failures. In patients with SAP, respiratory, cardiovascular and renal failures can predict the fatal outcome and more attention should be paid to their clinical evaluation.

  2. Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

    Ming-Jun Xin; Hong Chen; Bin Luo; Jia-Bang Sun


    AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥60 years of age).METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007.RESULTS: In 169 patients with SAP, 94 were elderly and 16 died.Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly.Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young.The proportion of comorbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners.The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score.Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups.Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (NODS).NODS was the main cause of death.CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young.Biliary and unknown factors are main causes in the aged.The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young.It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

  3. Clinical characteristics of patients with gastroesophageal reflux disease in several centers of Northwest China



    Objective To investigate the clinical characteristics of gastroesophageal reflux disease (GERD) in several endoscopy centers of Northwest China.Methods From September 2008 to September 2009,a questionnaire survey was carried out in the endoscopy centers of four hospitals

  4. Clinical characteristics of inpatient adolescents with severe obsessive-compulsive disorder.

    Shoval, Gal; Zalsman, Gil; Sher, Leo; Apter, Alan; Weizman, Abraham


    Obsessive-compulsive disorder (OCD) is a common disorder in adolescents, usually treated in the outpatient setting. Our aim in this study was to evaluate the clinical characteristics of adolescents with severe OCD that required hospitalization. A total of 342 patients consecutively admitted to a psychiatric adolescent inpatient unit and 87 healthy volunteers were assessed by a semistructured interview for clinical diagnosis, suicide risk factors, aggression, ego defense mechanisms, and intelligence. Patients with OCD (n=40) were compared to other four diagnostic patient groups with psychotic, affective, conduct, and eating disorders, as well as to normal controls. Adolescent inpatients with OCD experienced less separation anxiety than all the other psychiatric groups (P OCD consist of a unique subgroup in the inpatient unit in terms of their clinical characteristics and risk factors for suicide. These characteristics should be taken into account when developing a treatment plan for these difficult-to-treat inpatients. PMID:16400622

  5. Non-typhoidal Salmonella bacteraemia: Epidemiology, clinical characteristics and its' association with severe immunosuppression

    Fatt Quek


    Full Text Available Abstract Background Non-typhoidal Salmonella (NTS is increasingly recognized as an important pathogen associated with bacteraemia especially in immunosuppressed patients. However, there is limited data specifically describing the clinical characteristics and outcome amongst the immunosuppressed patients. Methods A total of 56,707 blood culture samples and 5,450 stool samples were received by the microbiology laboratory at a tertiary referral hospital in Malaysia, during a 4-year study period. Out of these samples, 55 non-duplicate NTS isolates were identified from blood and 121 from stool. A retrospective analysis of the 55 patients with NTS bacteraemia was then conducted to determine the predominant NTS serovars causing bacteraemia and its' blood invasive potential, epidemiological data, clinical characteristics and antimicrobial susceptibility. Patients were then grouped as immunosuppressed and non-immunosuppressed to determine the association of severe immunosuppression on clinical features. Data was analyzed using the Statistical Package for Social Sciences (SPSS version 15.0 using the non-parametric Mann-Whitney test, Fisher's exact test or Chi-squared test. The odds ratio (OR and its 95% confidence intervals (CI were calculated. The P-value Results Out of 55 NTS bacteraemia cases identified, 81.8% (45/55 were community-acquired. Salmonella enterica serovar Enteritidis had the highest blood invasiveness. An extra-intestinal focus of infection was noted in 30.9% (17/55 of the patients, most commonly involving the lungs and soft tissue. 90.9% (50/55 of the patients had an underlying disease and 65.5% (36/55 of the patients had severe clinical immunosuppressive condition with malignancy and HIV being the most common. Immunosuppressed patients had higher mortality (P = 0.04, presented more commonly with primary bacteraemia (P = 0.023, leukopenia (P = 0.001 and opportunistic infections (P = 0.01. In contrast, atherosclerotic conditions (P = 0

  6. Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil

    Andrea Mendonça Rodrigues


    Full Text Available AbstractObjective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA treated at a referral center in southern Brazil.Methods: We retrospectively analyzed children and adolescents (3-18 years of age with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting β2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results.Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years. Of those, 18 (86% were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody, 7 (87.5% showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations.Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

  7. Clinical characteristics of hand, foot and mouth disease in Harbin and the prediction of severe cases

    ZHOU Hong; GUO Shu-zhen; ZHOU Hao; ZHU Yue-feng; ZHANG Li-juan; ZHANG Wei


    Background Hand,foot and mouth disease (HFMD) is an emerging public health problem in China,not only threatening the health of children,but also causing tremendous loss and burden to both families and society.The aim of this study was to characterize the epidemiology and clinical features of HFMD,and to understand the key factors affecting HFMD in the Harbin region to provide scientific evidence for effective prevention and control strategies.@@Methods Epidemiological and clinical information from 2379 randomly chosen cases of HFMD treated at the Harbin Center for Disease Control and Prevention from May 2008 to November 2011 were analyzed.All cases were separated into common and severe HFMD,with key factors for severe HFMD analyzed using multivariable Logistic regression.@@Results Among the 2379 patients,1798 were common cases and 581 severe cases,14 of which resulted in death.Most cases were in children younger than 5 years.Morbidity peaked in July and was higher in the surrounding country and cities than in Harbin proper.Medical expenses were significantly higher for severe than for common cases (P <0.001).The primary clinical symptoms were fever and erythema; laboratory examination showed leucocytosis together with pneumonia,carditis,and abnormal electrocardiogram and electroencephalogram in severe cases.Multivariable Logistic regression analysis showed that the key factors for severe HFMD were age,morbidity location,morbidity area,fever duration,mouth mucosal symptoms,and abnormal serum levels of neutrophils (NEUT),hemoglobin and glucose (P <0.05).@@Conclusions To improve prognosis,reduce medical expense and prevent the development of severe cases,we should improve the epidemiological detection of HFMD to treat patients quickly.We should also closely monitor children with the EV71 virus,who present with continuous fever as well as abnormal laboratory results,from areas highly susceptible to HFMD attacks.

  8. Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe.

    Luca-Harari, Bogdan; Darenberg, Jessica; Neal, Shona; Siljander, Tuula; Strakova, Lenka; Tanna, Asha; Creti, Roberta; Ekelund, Kim; Koliou, Maria; Tassios, Panayotis T; van der Linden, Mark; Straut, Monica; Vuopio-Varkila, Jaana; Bouvet, Anne; Efstratiou, Androulla; Schalén, Claes; Henriques-Normark, Birgitta; Jasir, Aftab


    In an attempt to compare the epidemiology of severe Streptococcus pyogenes infection within Europe, prospective data were collected through the Strep-EURO program. Surveillance for severe cases of S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe by using a standardized case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T and M/emm typing, and selected strains were analyzed for the presence of superantigen genes. Data were analyzed to compare the clinical and microbiological patterns of the infections across the participating countries. A total of 4,353 isolates were collected from 5,521 cases with severe S. pyogenes infections who were identified. A wide diversity of M/emm types (n = 104) was found among the S. pyogenes clinical isolates, but the M/emm type distribution varied broadly between participating countries. The 10 most predominant M/emm types were M/emm type 1 (M/emm1), M/emm28, M/emm3, M/emm89, M/emm87, M/emm12, M/emm4, M/emm83, M/emm81, and M/emm5, in descending order. A correlation was found between some specific disease manifestations, the age of the patients, and the emm types. Although streptococcal toxic shock syndrome and necrotizing fasciitis were caused by a large number of types, they were particularly associated with M/emm1 and M/emm3. The emm types included in the 26-valent vaccine under development were generally well represented in the present material; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative program has contributed to enhancement of the knowledge of the spread of invasive disease caused by S. pyogenes within Europe and encourages future surveillance by the notification of cases and the characterization of strains, which are important for vaccination strategies and other health care issues. PMID:19158266

  9. Clinical and Microbiological Characteristics of Severe Streptococcus pyogenes Disease in Europe▿

    Luca-Harari, Bogdan; Darenberg, Jessica; Neal, Shona; Siljander, Tuula; Strakova, Lenka; Tanna, Asha; Creti, Roberta; Ekelund, Kim; Koliou, Maria; Tassios, Panayotis T.; van der Linden, Mark; Straut, Monica; Vuopio-Varkila, Jaana; Bouvet, Anne; Efstratiou, Androulla; Schalén, Claes; Henriques-Normark, Birgitta; Jasir, Aftab


    In an attempt to compare the epidemiology of severe Streptococcus pyogenes infection within Europe, prospective data were collected through the Strep-EURO program. Surveillance for severe cases of S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe by using a standardized case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T and M/emm typing, and selected strains were analyzed for the presence of superantigen genes. Data were analyzed to compare the clinical and microbiological patterns of the infections across the participating countries. A total of 4,353 isolates were collected from 5,521 cases with severe S. pyogenes infections who were identified. A wide diversity of M/emm types (n = 104) was found among the S. pyogenes clinical isolates, but the M/emm type distribution varied broadly between participating countries. The 10 most predominant M/emm types were M/emm type 1 (M/emm1), M/emm28, M/emm3, M/emm89, M/emm87, M/emm12, M/emm4, M/emm83, M/emm81, and M/emm5, in descending order. A correlation was found between some specific disease manifestations, the age of the patients, and the emm types. Although streptococcal toxic shock syndrome and necrotizing fasciitis were caused by a large number of types, they were particularly associated with M/emm1 and M/emm3. The emm types included in the 26-valent vaccine under development were generally well represented in the present material; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative program has contributed to enhancement of the knowledge of the spread of invasive disease caused by S. pyogenes within Europe and encourages future surveillance by the notification of cases and the characterization of strains, which are important for vaccination strategies and other health care issues. PMID:19158266

  10. Clinical characteristics and risk factors of severe respiratory syncytial virus-associated acute lower respiratory tract infections in hospitalized infants

    Xiao-Bo Zhang; Li-Juan Liu; Li-Ling Qian; Gao-Li Jiang; Chuan-Kai Wang; Pin Jia; Peng Shi; Jin Xu; Li-Bo Wang


    Background: To investigate the clinical characteristics and analyze risk factors for severe respiratory syncytial virus (RSV) infection in hospitalized infants with acute lower respiratory tract infections (ALRIs). Methods: A retrospective review of the medical records of infants with RSV-associated ALRIs between March 1st, 2011 and February 29th, 2012 was conducted. Subjects were followed up over the phone or by outpatient visit six and twelve months after discharge. Results: Among 913 RSV-associated ALRIs infants, 288 (31.5%) had severe infections, which accounted for 4.2% of hospitalized children. The hospital RSV mortality rate was 1.0%. The proportions of cases with tachypnea, apnea, cyanosis, and fine rales were significantly higher in the severe ALRIs group (all P Conclusions: Younger age, low birth weight and underlying disease are associated with severe RSVassociated ALRIs. Furthermore, severe RSV infections may be associated with a higher frequency of subsequent bronchitis, pneumonia and re-hospitalization in the following year.


    朱建幸; 周晓玲; 孙波; 张宇鸣; 沈月华; 孙眉月


    Objective To investigate the factors in relation with the case fatality in severe meconium aspiration syndrome (MAS). Methods Eighty-one severe MAS cases intervened by the mechanical ventilation from 9 children's hospitals were retrospectively analyzed for the risk factors of fatality with SAS software for non-parametric rank sum test and chi-square test. Results In the 81 cases, 49 were survived (death rate 39%). The gestational age (GA), Apgar's score at 1min and other complications with MAS were significantly related to the death (P 0.05). Conclusion A higher death rate (close to 40%) of severe MAS in the middle of 1990's in major cities of China suggests that it is important to detect the intrauterine hypoxemia as it may indicated by meconium staining amniotic fluid which should be intervened early by adequate termination of pregnancy before 42 weeks. The effects of delivery room suction and conventional ventilation also need to be reevaluated.

  12. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort.

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J; Fleming, Louise J; Roberts, Graham; Corfield, Julie; Pandis, Ioannis; Bansal, Aruna T; Bel, Elisabeth H; Auffray, Charles; Compton, Chris H; Bisgaard, Hans; Bucchioni, Enrica; Caruso, Massimo; Chanez, Pascal; Dahlén, Barbro; Dahlen, Sven-Erik; Dyson, Kerry; Frey, Urs; Geiser, Thomas; Gerhardsson de Verdier, Maria; Gibeon, David; Guo, Yi-Ke; Hashimoto, Simone; Hedlin, Gunilla; Jeyasingham, Elizabeth; Hekking, Pieter-Paul W; Higenbottam, Tim; Horváth, Ildikó; Knox, Alan J; Krug, Norbert; Erpenbeck, Veit J; Larsson, Lars X; Lazarinis, Nikos; Matthews, John G; Middelveld, Roelinde; Montuschi, Paolo; Musial, Jacek; Myles, David; Pahus, Laurie; Sandström, Thomas; Seibold, Wolfgang; Singer, Florian; Strandberg, Karin; Vestbo, Jorgen; Vissing, Nadja; von Garnier, Christophe; Adcock, Ian M; Wagers, Scott; Rowe, Anthony; Howarth, Peter; Wagener, Ariane H; Djukanovic, Ratko; Sterk, Peter J; Chung, Kian Fan


    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe asthma, mild/moderate asthma and healthy controls from 11 European countries consisted of analyses of patient-reported outcomes, lung function, blood and airway inflammatory measurements.Patients with severe asthma (nonsmokers, n=311; smokers/ex-smokers, n=110) had more symptoms and exacerbations compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; pgastro-oesophageal reflux with lower lung function. Sputum eosinophil count was higher in severe asthma compared to mild/moderate asthma (median count 2.99% versus 1.05%; p=0.004) despite treatment with higher doses of inhaled and/or oral corticosteroids.Consistent with other severe asthma cohorts, U-BIOPRED is characterised by poor symptom control, increased comorbidity and airway inflammation, despite high levels of treatment. It is well suited to identify asthma phenotypes using the array of "omic" datasets that are at the core of this systems medicine approach. PMID:26357963

  13. Clinical and inflammatory characteristics of the European U-BIOPRED adult severe asthma cohort

    Shaw, Dominick E; Sousa, Ana R; Fowler, Stephen J;


    U-BIOPRED is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach.This cross-sectional assessment of adults with severe...... compared to patients with mild/moderate disease (n=88) (2.5 exacerbations versus 0.4 in the preceding 12 months; panxiety and depression. They also had a higher incidence of nasal polyps and gastro-oesophageal reflux with lower lung function. Sputum...

  14. Epidemiological and clinical characteristics of severe fever with thrombocytopenia syndrome (SFTS) in China: an integrated data analysis.

    Guo, C-T; Lu, Q-B; Ding, S-J; Hu, C-Y; Hu, J-G; Wo, Y; Fan, Y-D; Wang, X-J; Qin, S-L; Cui, N; Yang, Z-D; Zhang, X-A; Liu, W; Cao, W-C


    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was caused by a novel bunyavirus, SFTSV. The study aimed to disclose the epidemiological and clinical characteristics of SFTSV infection in China so far. An integrated clinical database comprising 1920 SFTS patients was constructed by combining first-hand clinical information collected from SFTS sentinel hospitals (n = 1159) and extracted data (n = 761) from published literature. The considered variables comprised clinical manifestations, routine laboratory tests of acute infection, hospitalization duration and disease outcome. SFTSV-IgG data from 19 119 healthy subjects were extracted from the published papers. The key clinical variables, case-fatality rate (CFR) and seroprevalence were estimated by meta-analysis. The most commonly seen clinical manifestations of SFTSV infection were fever, anorexia, myalgia, chill and lymphadenopathy. The major laboratory findings were elevated lactate dehydrogenase, aminotransferase, followed by thrombocytopenia, lymphocytopenia, elevated alanine transaminase and creatine kinase. A CFR of 12·2% was estimated, significantly higher than that obtained from national reporting data, but showing no geographical difference. In our paper, the mortality rate was about 1·9 parts per million. Older age and longer delay to hospitalization were significantly associated with fatal outcome. A pooled seroprevalence of 3·0% was obtained, which increased with age, while comparable for gender. This study represents a clinical characterization on the largest group of SFTS patients up to now. A higher than expected CFR was obtained. A wider spectrum of clinical index was suggested to be used to identify SFTSV infection, while the useful predictor for fatal outcome was found to be restricted. PMID:26542444

  15. Clinical characteristics and management of patients with early acute severe pancreatitis:Experience from a medical center in China

    Hou-Quan Tao; Jing-Xia Zhang; Shou-Chun Zou


    AIM: To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP).METHODS: Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixtynine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAR The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared.RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31±0.68 vs 3.68±0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs7.5% , P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE Ⅱ score, Balthazar CT class, MODS and hypoxemia.CONCLUSION: ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.

  16. Secular Trends in the Clinical Characteristics of Type 2 Diabetic Patients With Severe Hypoglycemia Between 2008 and 2013

    Ito, Hiroyuki; Tsugami, Emiko; Ando, Shigenori; Imai, Ayano; Matsumoto, Suzuko; Omoto, Takashi; Shinozaki, Masahiro; Nishio, Shinya; Abe, Mariko; Antoku, Shinichi; Mifune, Mizuo; Togane, Michiko


    Background We investigated the trends in the clinical characteristics and prescriptions of type 2 diabetic patients with severe hypoglycemia because the prescription rate of antidiabetic agents has significantly changed recently. Methods A total of 193 patients with type 2 diabetes with severe hypoglycemia induced by antidiabetic agents between 2008 and 2013 were divided into three groups based on the period of visit: 2008 - 2009, 2010 - 2011 and 2012 - 2013. Results While the proportion of patients with severe hypoglycemia using insulin (from 55% to 74%), biguanides (from 6% to 20%), glinides, and dipeptidyl peptidase-4 inhibitors significantly increased, those using sulfonylureas (from 45% to 20%) significantly decreased. Errors of drug use significantly increased as a trigger of hypoglycemia in recent years. The number of antidiabetic agents (from 1.9 ± 0.6 to 2.3 ± 0.7), non-diabetic agents (from 2.3 ± 2.4 to 4.3 ± 3.3), and total drugs prescribed were significantly higher in recent years among patients receiving insulin therapy. Conclusions Polypharmacy especially in patients receiving insulin therapy and errors of drug use have increased in type 2 diabetic patients with severe hypoglycemia in recent years. Intensive education in the usage rule of drugs is considered to be important in order to prevent severe hypoglycemia.

  17. Clinical-anthropometric characteristics of COPD outpatients belonging to the different groups and having different severity of airway obstruction

    Gashynova K.Y.


    Full Text Available The aim of the study was to compare the clinical and anthropometric characteristics of patients with COPD, which differ in the degree of airways obstruction and belong to groups A, B, C, D in accordance with GOLD, 2011 classification. A total of 112 ambulatory COPD patients in remission made the study sample. Anthropometric data, body mass index, medical history, dyspnea by mMRC scale, and spirometry was performed for all patients. There was confirmed that outpatients with COPD is a heterogeneous group, in which the majority are those with moderate (48.22 % and severe (30.36 %, airway obstruction. Despite the vast majority of men among outpatients, the percentage of women among patients with mild to moderate obstruction (22.58±5.31 % was significantly higher (p=0.002 as compared with those with severe or very severe limitation of airflow (6.00±3.36 %. Patients with severe and very severe obstruction were of significantly older age (p = 0.024. At the same time, the distribution of patients according to the GOLD, 2011 classification, demonstrate that all groups did not differ on any of the anthropometric indicators, including gender and age (p > 0.050. Distribution of patients by groups with different risk for future exacerbations is not a mirror image of gradation in accordance with the degree of airway obstruction. Every second (50.00±4.43 % of cases patient is included in group C and every tenth (10.20±4.32 % belongs to the group D not due to degree of bronchial obstruction, but due to the number of exa­cerbations in the past year. Therefore, in future studies it is advisable to use both principles of patients’ classification.

  18. Clinical and epidemiological characteristics of severe community-acquired pneumonia in children after introduction of the 10-valent pneumococcal vaccine

    Lima EJF


    Full Text Available Eduardo JF Lima,1,2 Maria JG Mello,1,2 Maria FPM Albuquerque,3 Maria IL Lopes,4 George HC Serra,2 Maria AZ Abreu-Lima,2 Jailson B Correia1 1Instituto de Medicina Integral Prof. Fernando Figueira - IMIP Recife; 2Faculdade, Pernambucana de Saúde - FPS Recife; 3Centro de Pesquisas Aggeu Magalhães, FIOCRUZ; 4Hospital das Clínicas, Universidade Federal de Pernambuco - UFPE, Recife, Pernambuco, Brazil Background: Pneumonia is an important cause of morbimortality in Brazil, despite the extensive vaccination coverage and the socioeconomic improvement in the past years. Objective: To describe the epidemiological and clinical characteristics of severe community-acquired pneumonia in children after the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10. Methods: A prospective study included children <5 years old hospitalized for pneumonia between October 2010 and September 2013 in a tertiary hospital. Newborns and children with comorbidities were excluded. Pneumonia classification followed the clinical and radiological criteria established by World Health Organization (WHO. Clinical history, nutritional status, immunizations, diagnosis, disease course, and prognosis were analyzed. Results: Among 452 children, almost 70% were <2 years, with no sex differences, and 10% had weight-for-age z score below than -2.0. Family income was up to one minimum wage in half the households, and 40% of mothers had completed high school. The suitability of both influenza and PCV10 vaccine schedules was ~50%. The first medical care happened later than 72 hours after the onset of symptoms in 42% of cases. Pneumonia was classified as severe or very severe in 83.9% of patients and for 23% as complicated. Global mortality was 1.5%. Hypoxia, diagnosed in 51.5% of children, looked like a better prognosis predictor than the WHO classification. Conclusion: New strategies for health care are necessary, such as the incorporation of peripheral saturometry as the

  19. Respiratory Syncytial Virus and Other Viral Infections among Children under Two Years Old in Southern Vietnam 2009-2010: Clinical Characteristics and Disease Severity

    Bryant, Juliet E.; Tran, Anh Tuan; Nguyen, Bach Hue; Tran, Thi Thu Loan; Tran, Quynh Huong; Vo, Quoc Bao; Tran Dac, Nguyen Anh; Trinh, Hong Nhien; Nguyen, Thi Thanh Hai; Le Binh, Bao Tinh; Le, Khanh; Nguyen, Minh Tien; Thai, Quang Tung; Vo, Thanh Vu; Ngo, Ngoc Quang Minh; Dang, Thi Kim Huyen; Cao, Ngoc Huong; Tran, Thu Van; Ho, Lu Viet; Farrar, Jeremy; de Jong, Menno; van Doorn, H. Rogier


    Background Despite a high burden of respiratory syncytial virus (RSV) infections among children, data on demographic and clinical characteristics of RSV are scarce in low and middle income countries. This study aims to describe the viral etiologies, the demographic, epidemiological, and clinical characteristics of children under two years of age who were hospitalized with a lower respiratory tract infections (LRTI), focusing on RSV (prevalence, seasonality, subgroups, viral load) and its association with disease severity. Methods A prospective study among children under two years of age, hospitalized with LRTI was conducted in two referral pediatric hospitals in Ho Chi Minh City, Vietnam, from May 2009 to December 2010. Socio-demographic, clinical data and nasopharyngeal swabs were collected on enrolment and discharge. Multiplex real-time RT-PCR (13 viruses) and quantitative RSV RT-PCR were used to identify viral pathogens, RSV load and subgroups. Results Among 632 cases, 48% were RSV positive. RSV infections occurred at younger age than three other leading viral infections i.e rhinovirus (RV), metapneumovirus (MPV), parainfluenza virus (PIV-3) and were significantly more frequent in the first 6 months of life. Clinical severity score of RSV infection was significantly higher than PIV-3 but not for RV or MPV. In multivariate analysis, RV infection was significantly associated with severity while RSV infection was not. Among RSV infections, neither viral load nor viral co-infections were significantly associated with severity. Young age and having fever at admission were significantly associated with both RSV and LRTI severity. A shift in RSV subgroup predominance was observed during two consecutive rainy seasons but was not associated with severity. Conclusion We report etiologies, the epidemiological and clinical characteristics of LRTI among hospitalized children under two years of age and risk factors of RSV and LRTI severity. PMID:27500954

  20. The prevalence of severe pain, its etiopathological characteristics and treatment profile of patients referred to a tertiary cancer care pain clinic

    P N Jain


    Full Text Available Pain is the most feared symptom in cancer. About 52-77% patients suffer pain despite World Health Organization (WHO recommendations. Out of total, one-third patients suffer moderate to severe pain. This study was undertaken to determine the prevalence, etiopathogenesis and characteristics of severe pain and treatment response among pain clinic referrals in a busy tertiary care cancer center. This study found a high prevalence (31.5% of severe pain. A total of 251 patients who had complete pain data were analyzed for etiopathological characteristics and treatment response. Head and neck cancer contributed the highest prevalence among all regions. Oncologists prescribed non-steroidal anti-inflammatory drugs (NSAIDs or paracetamol with or without mild opioids to 14% patients and pain clinic physicians prescribed opioids and overall 63.7% patients had a better response after pain clinic referral, even then, morphine was not prescribed to many deserving patients. Doctors need pain education about opioids to remove any fear of prescribing opioids in presence of severe pain.

  1. Analysis of the Clinical Characteristics of Severe Tooth Abrasion%牙齿重度磨损的相关临床特征分析

    王艺臻; 曹志中; 蔚一博


    Objective To investigate the clinical characteristics of severe tooth abrasion, and to analyze the clinical data of patients with severe tooth abrasion. Methods One hundred and thirty seven patients with severe tooth abrasion were involved in the present study. The related clinical data were collected. Tooth wear index (TWI) of every tooth in laster mould was assessed. Nonparametric test was used to analyze the data. Results The TWI of anterior teeth, premolars and molars in patients older than 45 years, were higher than those in patients younger than 45 years. The TWI of anterior teeth, premolars and molars in male patients, were higher than those in female ones. The TWI of anterior teeth,premolars and molars in patients with bruxism, were higher than patients without bruxism. Conclusion The degree of tooth abrasion in patients with severe tooth abrasion, is related to age, sex and bruxism.%目的 探讨牙列重度磨损患者的相关临床特征.方法 选择牙列重度磨损患者137例,收集其相关临床信息,利用其研究模进行磨损指数评价,应用两独立样本非参数检验进行数据分析.结果 45岁以上组患者的前牙、前磨牙、磨牙磨损指数均显著高于45岁以下组(P<0.01).男性患者的前牙、前磨牙、磨牙磨损指数均显著高于女性患者(P<0.01).有磨牙症史患者的前牙、前磨牙、磨牙区的磨损指数高于无磨牙症史患者(P<0.01).结论 重度磨损患者的牙齿磨损程度与年龄、性别及有无磨牙症史关系密切.

  2. Clinical characteristics of infectious spondylodiscitis

    Knežević Aleksandar


    Full Text Available Spondylodiscitis represents an inflammatory process, localized in the vertebrae body and in the intervertebral discs. The goals of this research were to identify subjective complaints, clinical findings, and laboratory characteristics in patients with spondylodiscitis, as well as to establish the importance of magnetic resonance imaging in diagnosing this disease. The data of 40 patients treated at the Clinic for Infectious diseases of the Clinical Center of Vojvodina from 2003 till 2007 were reviewed. Majority of the patients had low back pain (90%. Fever was present in 37.5% of patients (X2= 2,5; p>0,05. Laboratory parameters of inflammation were higher than normal in most of the patients before the treatment. Diagnosis of spondylodiscitis was made using MRI in 97,5% of the patients. Keeping in mind unspecific subjective complaints and clinical findings in patients with spondylodiscitis, a health professional should always suspect spondylodiscitis when back pain occurs, in order to diagnose and treat this severe disease as early as possible. Magnetic resonance imaging is the most advantageous method in diagnosing spondylodiscitis.

  3. Demographic, Clinical, and Health System Characteristics Associated With Pain Assessment Documentation and Pain Severity in U.S. Military Patients in Combat Zone Emergency Departments, 2010-2013.

    Blackman, Virginia Schmied; Cooper, Bruce A; Puntillo, Kathleen; Franck, Linda S


    Emergency department (ED) pain assessment documentation in trauma patients is critical to ED pain care. This retrospective, cross-sectional study used trauma registry data to evaluate U.S. military combat zone trauma patients injured between 2010 and 2013 requiring ≥ 24-hr inpatient care. Study aims were to identify the frequency of combat zone ED pain assessment documentation and describe pain severity. Secondary aims were to construct statistical models to explain variation in pain assessment documentation and pain severity.Pain scores were documented in 60.5% (n = 3,339) of the 5,518 records evaluated. The proportion of records with ED pain scores increased yearly. Pain assessment documentation was associated with documentation of ED vital signs, comprehensive facility, more recent year, prehospital (PH) heart rate of 60-100 beats/min, ED Glasgow Coma Scale score of 15 vs. 14, blunt trauma, and lower injury severity score (ISS).Pain severity scores ranged from 0 to 10; mean = 5.5 (SD = 3.1); median = 6. Higher ED pain scores were associated with Army service compared with Marine Corps, no documented PH vital signs, higher PH pain score, ED respiratory rate 16, moderate or severe ISS compared with minor ISS, treatment in a less-equipped facility, and injury in 2011 or 2012 vs. 2010. The pain severity model explained 20.4% of variance in pain severity.Overall, frequency of pain assessment documentation in combat-zone EDs improved yearly, but remained suboptimal. Pain severity was poorly predicted by demographic, clinical, and health system variables available from the trauma registry, emphasizing the importance of individual assessment. PMID:27618374

  4. Clinical Practice Guidelines for Severe Sepsis Treatment.

    Julio Héctor Jova Dueñas; Diosdania Alfonso Falcón; Marcos Diosdado Iraola Ferrer; Inti Santana Carballosa; José Noel Marrero.


    Clinical Practice Guidelines for Severe Sepsis Treatment. It is a syndrome of inflammatory systemic response caused by documented infection (clinical and/or microbiological), associated with organic dysfunction (respiratory, renal, hepatic, cardiovascular, haematological and neurological), hypotension or hypoperfusion. This document includes a review and update of the concept, risk factors, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be ...


    Alessandro Bartoloni


    Full Text Available The first symptoms of malaria, common to all the different malaria species, are nonspecific and mimic a flu-like syndrome. Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria. As the progression to these complications can be rapid, any malaria patient must be assessed and treated rapidly, and frequent observations are needed to look for early signs of systemic complications. In fact, severe malaria is a life threatening but treatable disease.  The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea may lead physicians who see malaria infrequently to a wrong diagnosis, such as influenza (particularly during the seasonal epidemic flu, dengue, gastroenteritis, typhoid fever, viral hepatitis, encephalitis. Physicians should be aware that malaria is not a clinical diagnosis but must be diagnosed, or excluded, by performing microscopic examination of blood films. Prompt diagnosis and appropriate treatment are then crucial to prevent morbidity and fatal outcomes. Although Plasmodium falciparum malaria is the major cause of severe malaria and death, increasing evidence has recently emerged that Plasmodium vivax and Plasmodium knowlesi can also be severe and even fatal.

  6. Clinical severity and prognosis of hand eczema

    Hald, M; Agner, T; Blands, J;


    to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and......BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist...... unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the...

  7. Clinical Practice Guidelines for Severe Asthma Treatment.

    Eddy Pereira Valdes; Moisés Santos Peña; Belkys Rodríguez Llerena.


    Clinical Practice Guidelines for Severe Asthma Treatment. This disease is characterized by an overreaction of the tracheobronchial tree with hyperactivity after certain stimulus consisting of a diffuse narrowing of the respiratory ways related with an excessive contraction of the bronchial smooth muscle, hyper-secretion of mucus and mucosa edema. It is spontaneously reversible or reversible after treatment. We include a review of its definition, classification and development, stressing those...

  8. Clinical application of several tumor imaging agents


    Neoplasms is one of the main diseases for harming health.It is difficult to prevent the neoplasms because the factors of bringing out them are complex.To raise survival rate the early diagnosis of tumors is very important.Radionuclide imaging is useful to detect recurrent or residual diseaseand to identificate benign or malignant tumor.Several tumorimaging agents as following have clinical significance indiagnosing tumors.

  9. Intracranial Infections: Clinical and Imaging Characteristics

    The radiologist plays a crucial role in identifying and narrowing the differential diagnosis of intracranial infections. A thorough understanding of the intracranial compartment anatomy and characteristic imaging findings of specific pathogens, as well incorporation of the clinical information, is essential to establish correct diagnosis. Specific types of infections have certain propensities for different anatomical regions within the brain. In addition, the imaging findings must be placed in the context of the clinical setting, particularly in immunocompromised and human immunodeficiency virus (HIV)-positive patients. This paper describes and depicts infections within the different compartments of the brain. Pathology-proven infectious cases are presented in both immunocompetent and immunocompromised patients, with a discussion of the characteristic findings of each pathogen. Magnetic resonance spectroscopy (MRS) characteristics for several infections are also discussed

  10. Clinical characteristics of Caroli's syndrome

    Ozlem Yonem; Yusuf Bayraktar


    Caroli's syndrome is characterized by multiple segmental cystic or saccular dilatations of intrahepatic bile ducts associated with congenital hepatic fibrosis. The clinical features of this syndrome reflect both the characteristics of congenital hepatic fibrosis such as portal hypertension and that of Caroli's disease named as recurrent cholangitis and cholelithiasis. The diagnosis depends on both histology and imaging methods which can show the communication between the sacculi and the bile ducts. Treatment consists of symptomatic treatment of cholangitis attacks by antibiotics, some endoscopic,radiological and surgical drainage procedures and surgery. Liver transplantation seems the ultimate treatment for this disease. Prognosis is fairly good unless recurrent cholangitis and renal failure develops.

  11. 重症登革热临床和实验室特征及其细胞因子的动态变化%Clinical and laboratory characteristics of severe dengue fever and the dynamic changes of cytokines

    廖宝林; 张复春; 唐漾波; 胡凤玉; 周伟泽; 王建; 洪文昕; 张霞意


    目的 观察重症登革热的临床和实验室特征,检测患者血清中细胞因子的表达,为进一步探讨重症登革热的发病机制提供临床和实验依据.方法 回顾性分析重症登革热的临床和实验室特点,采用ELISA法检测32例重症登革热患者与23例非重症登革热患者血清中IL-6、IL-10、IL-17A、IFN-γ、TNF-α及sTNFRⅠ的表达水平.结果 重症患者的临床表现及实验室指标均与非重症患者有显著差异;除IL-17A,上述其他细胞因子在重症登革热患者中的表达水平均比非重症患者高.结论 IL-6、IL-10、IFN-γ、TNF-α及sTNFRⅠ在重症登革热的发病机制中均起着重要的作用.%Objective To observe the clinical and laboratory characteristics in patients with severe dengue fever and further discuss of the dynamic changes of cytokines, so as to provide the evidences to pathogenesis of severe dengue fever. Methods The characteristics of clinical and laboratory tested retrospecitively were analyzed in 32severe dengue fever patients and 23 mild dengue fever patients , and the levels of IL-6 ,IL-1O, IL-17A, IFN-γ, TNF-α and sTNFR I were measured by ELISA in serial serum from these patients. Results There were significant differences between patients with severe dengue fever and patients with mild dengue fever in clinical and experiment indexes. Cytokines were higher in severe group than that in mild group statistically,except for IL-17A. Conclusions IL-6, 11-10, IFN-γ, TNF-α and sTNFR I may play important roles in the pathogenesis of severe dengue.

  12. Clinical indicators for severe prognosis of scrub typhus

    Sriwongpan P


    Full Text Available Pamornsri Sriwongpan,1,2 Pornsuda Krittigamas,3 Pacharee Kantipong,4 Naowarat Kunyanone,5 Jayanton Patumanond,1 Sirianong Namwongprom1,61Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Social Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 3Department of General Pediatrics, Nakornping Hospital, Chiang Mai, Thailand; 4Department of Internal Medicine, 5Department of Medical Technology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices.Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement, and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression.Results: A total of 526 patients were classified into nonsevere (n = 357, severe (n = 100, and deceased (n = 69. The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45–0.74, P < 0.001, increased pulse rate (OR = 1.03, 95% CI = 1.01–1.05, P < 0.001, presence of crepitation (OR = 3.25, 95% CI = 1.52–6.96, P = 0.001, increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95–0.98, P = 0.001, increased aspartate aminotransferase (every 10 IU/L (OR = 1.04, 95% CI = 1.02–1.06, P < 0.001, increased serum albumin (OR = 0.47, 95% CI = 0.27–0.80, P = 0


    R. Neagoe


    Full Text Available Pancreatitis remains the major complication of endoscopic retrograde cholangiopancreatography (ERCP, and hyperenzynemia after ERCP is common. Severe post-ERCP pancreatitis is rare but it demands hospitalization and sometimes interventions (percutaneous drainage or surgery due to complications. We present a case of severe post-ERCP pancreatitis wich required surgical approach, with good postoperative outcome.

  14. The clinical management in extremely severe COPD.

    Ambrosino, Nicolino; Simonds, Anita


    Chronic obstructive pulmonary disease (COPD) affects 6% of the general population and is the fourth-leading cause of death in the United States with severe and very severe disease accounting for 15% and 3% of physician diagnoses of COPD. Guidelines make few recommendations regarding providing the provision of care for the most severe stages of disease, namely Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure. The effectiveness of inhaled drug therapy in very severe patients has not been assessed yet. Health care systems in many countries include public funding of long-term oxygen therapy for eligible candidates. Currently, there is little evidence for the use of mechanical ventilatory support in the routine management of hypercapnic patients. Pulmonary rehabilitation should be considered as a significant component of therapy, even in the most severe patients. Although Lung Volume Reduction Surgery has been shown to improve mortality, exercise capacity, and quality of life in selected patients, this modality is associated with significant morbidity and an early mortality rate in the most severe patients. Despite significant progress over the past 25 years, both short- and long-term outcomes remain significantly inferior for lung transplantation relative to other "solid" organ recipients. Nutritional assessment and management is an important therapeutic option in patients with chronic respiratory diseases. Morphine may significantly reduce dyspnoea and does not significantly accelerate death. No consistent improvement in dyspnoea over placebo has been shown with anxiolytics. Supplemental oxygen during exercise reduces exertional breathlessness and improves exercise tolerance of the hypoxaemic patient. Non-invasive ventilation has been used as a palliative treatment to reduce dyspnoea. Hypoxaemic COPD patients, on long-term oxygen therapy, may show reduced health-related quality of life, cognitive function

  15. Analysis of clinical characteristics of 310 patients with moderate to severe cancer pain%310例中重度癌痛患者临床特征分析

    邵月娟; 王昆


    目的:通过对伴有中重度癌痛患者的临床特征进行前瞻、开放性横断面评估,旨在了解癌痛发病的总体特征、提高诊治水平。方法:选取2012年12月至2013年12月因中重度癌痛首次收治入院的恶性肿瘤患者,于入院当天评估疼痛强度、部位、性质、诱发缓解因素,并进行病理生理学分类。结果:310例患者完成疼痛评估,包括中度痛101例(32.58%),重度痛209例(67.42%)。肿瘤来源前5位依次为:肺癌102例(32.90%)、结直肠癌30例(9.68%)、胰腺癌27例(8.71%)、乳腺癌24例(7.74%)和胃癌20例(6.54%)。310例患者共报告533处疼痛,常见为腰部132例、上腹125例、胸部88例、下肢71例,其次颈肩上肢47例、盆腔33例、会阴区23例、头面部14例,胰腺癌疼痛部位中90.63%与原发肿瘤部位一致。病理生理学分类中骨痛145例(27.20%)、内脏痛138例(25.89%)、软组织痛126例(23.64%)和神经病理性疼痛124例(23.27%),胰腺癌患者内脏痛的发生率为92.59%。结论:中重度癌痛发生于各种常见恶性肿瘤,以肺癌来源最为多见,胰腺癌痛主要表现为与原发肿瘤部位一致的内脏痛,其他肿瘤疼痛特征没有明显特异性。%To study the general characteristics of cancer pain and to improve cancer pain diagnosis and treatment lev-el by prospective and open cross-sectional assessment of the clinical characteristics of patients with moderate to severe cancer pain. Methods:Patients with moderate to severe cancer pain were observed upon initial admission to the hospital from December 2012 to De-cember 2013. We assessed pain intensity, location, characteristics, and predisposing and mitigating factors and classified the pain by pathophysiology. Results:A total of 310 patients with moderate (101 cases, 32.58%) and severe (209 cases, 67.42%) pains were as-sessed. The top five cancers identified were lung cancer (102

  16. Psychogenic tics: clinical characteristics and prevalence

    Janik, Piotr


    Full Text Available Aim. Clinical characteristics and the prevalence of psychogenic tics (PT Methods. 268 consecutively examined patients aged 4 to 54 years (221 men, 47 females; 134 children, 134 adults with tic phenotype: Gilles de la Tourette syndrome (GTS, n = 255, chronic motor tics (n = 6, chronic vocal tics (n = 1, transient tics (n = 1, tics unclassified (n = 2, PT (n = 5 were analyzed. The diagnosis of tic disorders was made on the DSM-IV-TR criteria and mental disorders by psychiatrists. Results. PT were found in 5 patients (1.9%, aged 17 to 51 years, four men and one woman. The phenotype included vocalizations and complex movements. In none of the patients simple motor facial tics, inability to tic suppress, unchanging clinical pattern, peak severity from the beginning of the disease, lack of concern about the disease were present. The absence of premonitory urges, regression in unexpected positions, and the presence of atypical for GTS mental disorders were found in two persons. PT occurred in three persons in whom organic tics were present in childhood. Pharmacological treatment and psychotherapy were unsuccessful. In two persons spontaneous resolution occurred, in two patients the tics persist, in one person the course of PT is unknown. Conclusions. PT are rare and may occur in patients with organic tics. The most typical features of PT are: early onset in adulthood, lack of simple motor tics, inability to tic suppress. The diagnosis is established if a few atypical symptoms for organic tics occur.

  17. Clinical characteristics of buerger's disease in iran

    To determine the clinical course of Buerger's disease as observed in two vascular surgery centers located in the capital of Iran. The records of all the patients admitted with Buerger's disease diagnosed on the basis of Shionoya's clinical criteria were studied. Their clinical characteristics, treatment offered and short-term follow-up results are described as frequencies and percentages. A total of 116 patients, aged 41.1+-11.3 years, were enrolled. All patients were males; 99% of them were smokers with an average of 22.9 pack-years of tobacco use. Lower-extremity was affected in 102 (87.9%) patients, upper-extremity in 3 (2.6%) patients and both in 11 (9.5%). The most frequent reasons for being referred to hospital were ischemic ulcers (90.5%), claudication (87.9%), paresthesia (75.9%), rest pain (66.4%), gangrene (60.3%), Raynaud's phenomenon (23.3%) and thrombophlebitis (9.5%). Diagnostic arteriography, vascular bypass surgery and sympathectomy were performed in 60%, 24% and 83% of the patients, respectively. Sixty-eight patients (58.6%) had one of the following amputations: toe 36 (52.9%), transmetatarsal 3 (4.4%), below knee 25 (36.8%), finger 3 (4.4%) and above knee one (1.5%) patient. Since the studied hospitals are the referral centers for vascular surgery in Iran admitting patients with severe symptoms; therefore, a higher number of complications and amputations was found in the present study. Upper extremity involvement as well as the occurrence of thrombophlebitis and Raynaud's phenomenon was rather infrequent among the studied cases. (author)

  18. Spill pleural: Clinical and cytological characteristics

    The spill pleural is a frequent entity in congestive heart failure. The congestive heart failure, is probable that the cause more common of pleural spill, an analysis of the spill causes is made, the pathology is revised from the clinical point of view, highlighting the most excellent characteristics in each entity and an cytological analysis is made

  19. Herbal Hepatotoxicity: Clinical Characteristics and Listing Compilation

    Christian Frenzel


    Full Text Available Herb induced liver injury (HILI and drug induced liver injury (DILI share the common characteristic of chemical compounds as their causative agents, which were either produced by the plant or synthetic processes. Both, natural and synthetic chemicals are foreign products to the body and need metabolic degradation to be eliminated. During this process, hepatotoxic metabolites may be generated causing liver injury in susceptible patients. There is uncertainty, whether risk factors such as high lipophilicity or high daily and cumulative doses play a pathogenetic role for HILI, as these are under discussion for DILI. It is also often unclear, whether a HILI case has an idiosyncratic or an intrinsic background. Treatment with herbs of Western medicine or traditional Chinese medicine (TCM rarely causes elevated liver tests (LT. However, HILI can develop to acute liver failure requiring liver transplantation in single cases. HILI is a diagnosis of exclusion, because clinical features of HILI are not specific as they are also found in many other liver diseases unrelated to herbal use. In strikingly increased liver tests signifying severe liver injury, herbal use has to be stopped. To establish HILI as the cause of liver damage, RUCAM (Roussel Uclaf Causality Assessment Method is a useful tool. Diagnostic problems may emerge when alternative causes were not carefully excluded and the correct therapy is withheld. Future strategies should focus on RUCAM based causality assessment in suspected HILI cases and more regulatory efforts to provide all herbal medicines and herbal dietary supplements used as medicine with strict regulatory surveillance, considering them as herbal drugs and ascertaining an appropriate risk benefit balance.

  20. The clinical characteristics of the radiation pneumonia

    Objective: To analyse the clinical characteristics of the radiation pneumonia, sum the experience and the basis of the radiation pneumonia for its prevention and treatment. Method: Twenty three cases with radiation pneumonia from 1991 to 1998 were retrospectively analysed. Its clinical manifestation, chest X-ray, thoracic CT and blood routine were evaluated. Result: The acute manifestation was fever, cough, dyspnea, and the chronic manifestation was cough and insufficiency of pulmonary function. Conclusion: The prevention of radiation pneumonia is more important, high dose cortical steroids and antibiotics were prescribed during the acute stage and the chronic radiation pneumonia is irreversible

  1. 重症手足口病合并脑脊髓炎的MRI 特征及临床意义%MRI characteristics and clinical significance of severe hand, foot and mouth disease and encephalomyelitis

    黄柏枝; 麦润婵


    目的 探讨MRI对重症手足口病合并脑脊髓炎的诊断价值及临床意义.方法 选择广东省东莞市虎门镇虎门大道太平人民医院2010年1月~2012年6月收治入院的25例经临床诊断为重症手足口病合并脑脊髓炎患儿的头颅及脊髓MRI检查资料进行回顾性分析.结果 15例T1WI呈低信号,T2WI呈高信号,边界清晰,FLAIR、DWI呈等或低信号,无强化;10例T1WI呈稍低信号,T2WI呈稍高信号,边界模糊,FLAIR、DWI正常或呈高信号,其中5例表现为斑片状强化;2例脊髓炎病例均呈纵行长条状T2WI高信号影,T1WI呈低信号,边缘清晰;横断位病灶呈对称性类圆形,位于脊髓前角,脊髓无增粗.结论 重症手足口病并脑干脑炎MRI与临床表现具有一定关系,MRI检查可以显示脑部及脊髓病变的部位、范围和严重程度,为临床诊断、治疗及预后提供可靠的影像学依据.%Objective To evaluate the diagnostic value and clinical significance of MRI for severe hand, foot and mouth disease and encephalomyelitis. Methods The head and spinal MRI findings of 25 children dignosed with severe hand, foot and mouth disease combined encephalomyelitis in Humen Avenue Taiping People's Hospital of Humen Town in Dongguan City, Guangdong Province, from January 2010 to June 2012 were retrospectively analyzed. Results 15 cases of patients were found with low signal on T1WI, high signal on T2WI, the boundaries was clear, FLAIR, DWI showed equisignal or low signal, and there was no enhancement; 10 cases of patients were found with slightly low signal on T1WI, slightly higher signal on T2WI, the boundaries was fuzzy, FLAIR, DWI showed high signal, of which 5 cases showed patchy strengthen. 2 cases of myelitis cases were found with vertical strip high signal on T2WI, low signal on T1WI, the boundaries was clear; transverse lesions showed symmetry class round in anterior horn of the spinal cord without spinal cord thickening. Conclusion The MRI findings of

  2. Severe scrub typhus infection: Clinical features, diagnostic challenges and management.

    Peter, John Victor; Sudarsan, Thomas I; Prakash, John Anthony J; Varghese, George M


    Scrub typhus infection is an important cause of acute undifferentiated fever in South East Asia. The clinical picture is characterized by sudden onset fever with chills and non-specific symptoms that include headache, myalgia, sweating and vomiting. The presence of an eschar, in about half the patients with proven scrub typhus infection and usually seen in the axilla, groin or inguinal region, is characteristic of scrub typhus. Common laboratory findings are elevated liver transaminases, thrombocytopenia and leukocytosis. About a third of patients admitted to hospital with scrub typhus infection have evidence of organ dysfunction that may include respiratory failure, circulatory shock, mild renal or hepatic dysfunction, central nervous system involvement or hematological abnormalities. Since the symptoms and signs are non-specific and resemble other tropical infections like malaria, enteric fever, dengue or leptospirosis, appropriate laboratory tests are necessary to confirm diagnosis. Serological assays are the mainstay of diagnosis as they are easy to perform; the reference test is the indirect immunofluorescence assay (IFA) for the detection of IgM antibodies. However in clinical practice, the enzyme-linked immuno-sorbent assay is done due to the ease of performing this test and a good sensitivity and sensitivity when compared with the IFA. Paired samples, obtained at least two weeks apart, demonstrating a ≥ 4 fold rise in titre, is necessary for confirmation of serologic diagnosis. The mainstay of treatment is the tetracycline group of antibiotics or chloramphenicol although macrolides are used alternatively. In mild cases, recovery is complete. In severe cases with multi-organ failure, mortality may be as high as 24%. PMID:26261776

  3. Nocardiosis: Risk Factors, Clinical Characteristics and Outcome

    Alavi Darazam, Ilad; Shamaei, Masoud; Mobarhan, Mandana; Ghasemi, Shahin; Tabarsi, Payam; Motavasseli, Masoud; Mansouri, Davood


    Nocardiosis has been reported increasingly in recent two decades, probably due to improvement in isolation of the organism and increased burden of immune compromised patients. Nocardia occasionally has been reported in healthy people. A case series of definitive Nocardiosis (2002 to 2010), clinical characteristics, underlying diseases, immune status and in-patient outcome were studied in a tertiary referral center. Twenty one patients with definite diagnosis of Nocardiosis were studied. 17 ca...

  4. Clinical characteristics of Caroli’s syndrome

    Yonem, Ozlem; Bayraktar, Yusuf


    Caroli’s syndrome is characterized by multiple segmental cystic or saccular dilatations of intrahepatic bile ducts associated with congenital hepatic fibrosis. The clinical features of this syndrome reflect both the characteristics of congenital hepatic fibrosis such as portal hypertension and that of Caroli’s disease named as recurrent cholangitis and cholelithiasis. The diagnosis depends on both histology and imaging methods which can show the communication between the sacculi and the bile ...

  5. Severe bacterial infections in patients with non-transfusion-dependent thalassemia: prevalence and clinical risk factors

    Nattiya Teawtrakul; Arunee Jetsrisuparb; Chittima Sirijerachai; Kanchana Chansung; Chinadol Wanitpongpun


    Introduction: Bacterial infection is one of the major causes of death in patients with thalassemia. Clinical predictive factors for severe bacterial infection were evaluated in patients with non-transfusion-dependent thalassemia (NTDT). Methods: A retrospective study was conducted of patients with NTDT aged ≥10 years at Srinagarind Hospital, Khon Kaen University, Thailand. Clinical characteristics and potential clinical risk factors for bacterial infection were collected. Risk factors for ...

  6. Hydrological drought severity explained by climate and catchment characteristics

    Van Loon, A. F.; Laaha, G.


    Impacts of a drought are generally dependent on the severity of the hydrological drought event, which can be expressed by streamflow drought duration or deficit volume. For prediction and the selection of drought sensitive regions, it is crucial to know how streamflow drought severity relates to climate and catchment characteristics. In this study we investigated controls on drought severity based on a comprehensive Austrian dataset consisting of 44 catchments with long time series of hydrometeorological data (on average around 50 year) and information on a large number of physiographic catchment characteristics. Drought analysis was performed with the variable threshold level method and various statistical tools were applied, i.e. bivariate correlation analysis, heatmaps, linear models based on multiple regression, varying slope models, and automatic stepwise regression. Results indicate that streamflow drought duration is primarily controlled by storage, quantified by the Base Flow Index or by a combination of catchment characteristics related to catchment storage and release, e.g. geology and land use. Additionally, the duration of dry spells in precipitation is important for streamflow drought duration. Hydrological drought deficit, however, is governed by average catchment wetness (represented by mean annual precipitation) and elevation (reflecting seasonal storage in the snow pack and glaciers). Our conclusion is that both drought duration and deficit are governed by a combination of climate and catchment control, but not in a similar way. Besides meteorological forcing, storage is important; storage in soils, aquifers, lakes, etc. influences drought duration and seasonal storage in snow and glaciers influences drought deficit. Consequently, the spatial variation of hydrological drought severity is highly dependent on terrestrial hydrological processes.

  7. Kabuki syndrome: clinical and molecular characteristics.

    Cheon, Chong-Kun; Ko, Jung Min


    Kabuki syndrome (KS) is a rare syndrome characterized by multiple congenital anomalies and mental retardation. Other characteristics include a peculiar facial gestalt, short stature, skeletal and visceral abnormalities, cardiac anomalies, and immunological defects. Whole exome sequencing has uncovered the genetic basis of KS. Prior to 2013, there was no molecular genetic information about KS in Korean patients. More recently, direct Sanger sequencing and exome sequencing revealed KMT2D variants in 11 Korean patients and a KDM6A variant in one Korean patient. The high detection rate of KMT2D and KDM6A mutations (92.3%) is expected owing to the strict criteria used to establish a clinical diagnosis. Increased awareness and understanding of KS among clinicians is important for diagnosis and management of KS and for primary care of KS patients. Because mutation detection rates rely on the accuracy of the clinical diagnosis and the inclusion or exclusion of atypical cases, recognition of KS will facilitate the identification of novel mutations. A brief review of KS is provided, highlighting the clinical and genetic characteristics of patients with KS. PMID:26512256

  8. Potential biomarkers for the clinical prognosis of severe dengue

    Mayara Marques Carneiro da Silva


    Full Text Available Currently, several assays can confirm acute dengue infection at the point-of-care. However, none of these assays can predict the severity of the disease symptoms. A prognosis test that predicts the likelihood of a dengue patient to develop a severe form of the disease could permit more efficient patient triage and treatment. We hypothesise that mRNA expression of apoptosis and innate immune response-related genes will be differentially regulated during the early stages of dengue and might predict the clinical outcome. Aiming to identify biomarkers for dengue prognosis, we extracted mRNA from the peripheral blood mononuclear cells of mild and severe dengue patients during the febrile stage of the disease to measure the expression levels of selected genes by quantitative polymerase chain reaction. The selected candidate biomarkers were previously identified by our group as differentially expressed in microarray studies. We verified that the mRNA coding for CFD, MAGED1, PSMB9, PRDX4 and FCGR3B were differentially expressed between patients who developed clinical symptoms associated with the mild type of dengue and patients who showed clinical symptoms associated with severe dengue. We suggest that this gene expression panel could putatively serve as biomarkers for the clinical prognosis of dengue haemorrhagic fever.

  9. Clinical versus laboratory for estimating of dehydration severity

    Majid Malaki


    Full Text Available Background : Acute gastroenteritis is a common cause of dehydration and precise estimation of dehydration is a vital matter for clinical decisions. We try to find how much clinically diagnosed scales are compatible with laboratory tests measures. Materials and Methods : During 2 years 95 infants and children aged between 2 and 108 months entered to emergency room with acute gastroenteritis. They were categorized as mild, moderate and severe dehydration, their recorded laboratory tests include blood urea nitrogen (BUN, creatinine, venous blood gases values were expressed by means ±95% of confidence interval and compared by mann-whitney test in each groups with SPSS 16, sensitivity, specificity and likelihood ratio measured for defined cut off values in severe dehydration group, P value less than 0.05 was significant. Result : Severe dehydration includes 3% of all hospitalization due to dehydration. Laboratory tests cannot differentiate mild to moderate dehydration definietly but this difference is significant between severe to mild and severe to moderate dehydration. Conclusion : R outine laboratory test are not generally helpful for dehydration severity estimation but they can be discriminate severe from mild or moderate dehydration exclusively. Creatinine higher than 0.9 mg/dl and Base deficit beyond-16 are specific (90% for severe dehydration estimation in infant and children.

  10. An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

    Vipul Agarwal; Sarina Agarwal; Abhishek Singh; Setu Satani; Shewtank Goel; Pooja Goyal; Rohit Jhamnani


    Background: The management of severe lower limb injury is one of the most controversial subjects in the field of Orthopedic surgery. While the advancement of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. The aim of study was to analyze and ascertain the clinical utility of mangled extremity severity score (MESS)...

  11. Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease.

    Niurka Mercedes Galende Hernández; Diosdania Alfonso Falcón; Carlos Alberto Martell Alonso; Alexis Díaz Mesa; Inti Santana Carballosa


    Clinical Practice Guidelines for Severe Chronic Obstructive Pulmonary Disease. This concept includes simple chronic bronchitis, asthmatic bronchitis, chronic obstructive bronchitis, and pulmonary emphysema; although this two last are the most commonly included. Risk factors, classification and treatment are commented, stressing the strategy of mechanical ventilation and the indications for mechanical invasive and no invasive ventilation. It includes assessment guidelines focused on the most i...

  12. Clinic Characteristics of Varicella Zoster Myocarditis


    Objective To analyze the clinic characteristics of varicella zoster myocarditis and to determine the diagnostic value of serum cardiac troponin I (cTnI ) on the disease. Methods Information of 58 hospitalized patients with varicella zoster was collected, and the incidence of varicella zoster myocarditis and clinic characteristics (ECG, cTnI, age and sex distribution, etc. ) were analyzed respectively. Results It was found that 36.2% of the patients developed myocarditis. The old and female persons were much more susceptible to varicella zoster myocarditis. All patients had responsive ECG manifestations, and the abnormal ST-T changes were more common than other ECG abnormalities. CTnI remained higher than normal and had significant diagnostic value. Most of the patients had good prognosis, only a few patients lasted a long time and even progressed into cardiomyopathy. Nearly all the patients came to see dermatologists when they felt ill initially. That would lead to more misdiagnosis. Conclusion Infection of varicella zoster can complicate myocarditis, we must pay more attention to the patients who suffer from varicella zoster especially in the aged and female; cTnI is an important and effective index for diagnosis of varicella zoster myocarditis.

  13. Subacute Sclerosing Panencephalitis: Clinical and Demographic Characteristics

    Objective: To determine the clinical and demographic characteristics of children diagnosed with Subacute sclerosing panencephalitis (SSPE). Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2000 to June 2012. Methodology: A retrospective analysis was done, regarding medical charts of 43 children under the age of 16 years with a discharge diagnosis of SSPE. Demographic and clinical characteristics were recorded. Results were expressed as percentages. Results: Most of the 43 patients were male (72%). The average age at presentation was 8.7 years with average duration of symptoms being 100.6 days. History of measles was present in 17 patients (39.5%). All children had seizures at presentation and 65% had cognitive impairment. Most patients required poly therapy for control of seizures. Sodium valproate was the most commonly used anti-epileptic agent; Isoprinosine was tried in 22 (51%) patients. CSF for antimeasles antibodies was positive in approximately 86% of the 40 (93%) children. EEG showed burst suppression pattern in 36 (83.7%) cases. Forty-two patients (97.6%) were discharged home in a vegetative state. Conclusion: SSPE is progressive neurodegenerative disorder. It can be prevented by timely immunization against measles. Measles antibody in the CSF is diagnostic for SSPE and is helpful in early diagnosis. Most patients experience a gradual but progressive decline in motor and cognitive functions. (author)

  14. From asthma severity to control: a shift in clinical practice

    Pedersen, Søren


    -driven management rather than management based on disease severity. Good asthma control is associated with reductions in patients' perception of the asthma burden, reduced healthcare resource utilisation, lower levels of impairment/restriction, normal quality of life, and low risk of exacerbations. Asthma control...... involves the control of several outcomes. Its assessment should include components relevant to achievement of best possible clinical control and reduction of future risk of adverse outcomes. Focusing on a single or a few outcomes can lead to incorrect control assessment and increased risk of under......-treatment. Several validated asthma control assessment tools have been developed to facilitate correct assessment of the level of control in clinical practice. It is hoped that focusing on control will reduce the frequency of sub-optimal treatment in the primary care setting. Further validation of the best way to...

  15. Severe scorpion envenomation in Brazil. Clinical, laboratory and anatomopathological aspects.

    Cupo, P; Jurca, M; Azeedo-Marques, M M; Oliveira, J S; Hering, S E


    Scorpion stings in Brazil are important not only because of their incidence but also for their potential ability to induce severe, and often fatal, clinical situations, especially among children. In this report we present the clinical and laboratory data of 4 patients victims of scorpion stings by T. serrulatus, who developed heart failure and pulmonary edema, with 3 of them dying within 24 hours of the sting. Anatomopathologic study of these patients revealed diffuse areas of myocardiocytolysis in addition to pulmonary edema. The surviving child presented enzymatic, electrocardiographic and echocardiographic changes compatible with severe cardiac involvement, which were reversed within 5 days. These findings reinforce the need for continuous monitoring of patients with severe scorpion envenoming during the hours immediately following the sting. PMID:7997776

  16. Clinical Characteristics of Fuchs’ Uveitis Syndrome

    Pınar Çakar Özdal


    Full Text Available Objectives: To evaluate the clinical and demographic properties of Fuchs’ uveitis syndrome (FUS in Turkish patients. Materials and Methods: The medical records of 161 patients with FUS followed in the Uveitis Division of Ulucanlar Eye Hospital between 1996 and 2014 were respectively reviewed. The mean age at diagnosis, sex, the number of affected eyes, follow-up period, clinical findings at presentation, complications during the follow-up period, medical and surgical treatments, and best corrected visual acuity at the initial and final visits were recorded. Results: The study included 171 eyes of 161 patients diagnosed with FUS. Of the patients, 94 (58.4% were female and 67 (41.6% were male. The mean age at presentation was 35.2±11.0 (11-65 years. The mean follow-up period was 23.5±32.8 (2-216 months. Ten (6.2% patients had bilateral involvement. The most common symptoms at presentation were decreased visual acuity or blurred vision in 63 (39.1% and floaters in 19 (11.8% patients. Clinical findings at presentation included diffuse small, round, white keratic precipitates in 128 (74.8% eyes, anterior chamber reaction in 82 (47.9%, vitreous cells in 122 (71.3%, heterochromia in 47 (27.4% and iris nodules in 32 (18.7% eyes. During the follow-up period, elevated intraocular pressure occured in 31 (18.1% eyes and the most common complication was cataract development (89 eyes, 52.0%. Conclusion: Heterochromia was observed in 27.4% of patients in our study. However, the diffuse small, round keratic precipitates, low-grade anterior chamber reaction and varying degrees of vitreous reaction are more common clinical characteristics that are helpful in making the diagnosis.

  17. Severe Acute Respiratory Syndrome: Clinical and Laboratory Manifestations

    Lam, Christopher W.K.; Chan, Michael H M; Wong, Chun K.


    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase...

  18. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn;


    PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient...... characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume...... sepsis. The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis....

  19. Clinical and imaging characteristics of the vascular dementia. Preliminary studies

    A descriptive prospective study was carried out in 41 patients presenting with vascular dementia from Habana Vieja municipality, Havana City, in order to know some of the clinical and imaging characteristics of this disease. The main risk factors observed were the history of cerebrovascular disease and arterial hypertension. Depression, sleeping disorders and focal and pseudo bulbar neurologic signs were the most frequent clinical findings. Folstein neuropsychological test evidenced an important disorder of attention, calculation, the evocation memory and orientation. According to this test, 29 % of the patients had a severe dementia and nearly 50 % showed a severe handicap. The most frequent imaging findings observed in the computerized axial tomography of the cranium were cerebral atrophy, and single or multiple infarctions. Multiple cerebral infarctions, the lacunar status, subcortical encephalopathy of Binswanger, and single infarction located in cerebral areas related to cognition were considered as possible psychopathological mechanisms associated with the disease

  20. Blood Pressure Characteristics in Moderate to Severe Renal Insufficiency

    Zheyou Wu


    Full Text Available Background/Aims: Ambulatory blood pressure monitoring (ABPM in chronic kidney disease (CKD patients has been extensively studied, but few investigations have attempted to relate ABPM with CKD stages. The objectives of this article were to compare ABPM parameters for the diagnosis and treatment determination of CKD with daytime clinic blood pressure (BP measurements. We also investigated BP and renal injury in combined hypertension and CKD. We supposed ABPM was important in combined hypertension and CKD. Methods: We compared ABPM in hypertension patients, including 152 patients with combined hypertension and CKD. Patients with combined hypertension and CKD were grouped according to severity into stages 1 through 3 (Stage 1-3 and stages 4 and 5 (Stage 4-5. Results: In the Stage 4-5 group, systolic BP (SBP (daytime, nighttime and 24 h mean, diastolic BP (DBP, pulse pressure and SBP standard deviations (SD (daytime and 24 h were higher. SBP and DBP loads were significantly higher in the Stage 4-5 group. The nighttime load was higher than the daytime load. Mean arterial pressure (MAP was higher and heart rates (HR were faster in the Stage 4-5 group. Conclusions: BP load should be a component employed in ABPM to determine cardiovascular risk stratification. MAP and HR might be associated with risk to develop end-stage renal disease.

  1. Clinical characteristics of patients with conjunctivochalasis

    Balci O


    Full Text Available Ozlem Balci Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey Purpose: To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh. Methods and materials: This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results: The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60% eyes with grade 1 CCh; 15 (30% eyes with grade 2 CCh; and five (10% eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90% eyes, and in the remaining five (10% CCh was located in the superior bulbar conjunctiva. Ten (33.3% patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6% patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion: Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora. Keywords: ocular irritation, epiphora, dryness, eye pain, blurry vision

  2. Severe paraquat poisoning: clinical and radiological findings in a survivor

    Neves, Fabio Fernandes; Sousa, Romualdo Barroso; Pazin-Filho, Antonio; Cupo, Palmira; Elias Junior, Jorge; Nogueira-Barbosa, Marcello Henrique, E-mail: fabioneves@hcrp.usp.b [University of Sao Paulo (USP), Sao Paulo, SP (Brazil). Medical School


    Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning. (author)

  3. Severe paraquat poisoning: clinical and radiological findings in a survivor

    Paraquat is a nonselective contact herbicide of great toxicological importance, being associated with high mortality rates, mainly due to respiratory failure. We report the case of a 22-year-old male admitted to the emergency room with a sore throat, dysphagia, hemoptysis, and retrosternal pain after the ingestion of 50 mL of a paraquat solution, four days prior to admission. Chest CT scans revealed pulmonary opacities, pneumomediastinum, pneumothorax, and subcutaneous emphysema. The patient was submitted to two cycles of immunosuppressive therapy with cyclophosphamide, methylprednisolone, and dexamethasone. The pulmonary gas exchange parameters gradually improved, and the patient was discharged four weeks later. The clinical and tomographic follow-up evaluations performed at four months after discharge showed that there had been further clinical improvement. We also present a brief review of the literature, as well as a discussion of the therapeutic algorithm for severe paraquat poisoning. (author)

  4. The "PIP problem": clinical and histologic characteristics.

    Correia-Sá, Inês; Rodrigues-Pereira, Pedro; Marques, Marisa


    Implants from Poly Implant Prothése (PIP), the French manufacturer, showed increased risk of implant rupture and silicone leakage through the shell. Concerns also exist about the potential irritant behavior of silicone gel filler in these implants. This report presents the clinical, histologic, and microbiologic characteristics of a capsule and a siliconoma from a patient with a ruptured PIP implant. A 41-year-old woman submitted to breast augmentation in 2005 with PIP silicone gel implants presented with a recent history of progressive asymmetric breast enlargement and an enlarged lymph node on her right axilla. No capsular contracture was observed. A breast ultrasonography showed intra- and extracapsular ruptures of the right implant. The woman underwent explantation. Histologic analysis of the breast capsules showed a thin capsule with a chronic, mild inflammatory response. Microbiologic analysis showed no bacterial agent. The irritant behavior of the PIP silicone gel previously described was not able to produce capsular contracture or an exuberant inflammatory reaction. Studies to evaluate the potential risks of the silicone gel and to define the hazards for women implanted with those prostheses are urgently needed. PMID:23943050

  5. Mesenchymal stem cells: characteristics and clinical applications.

    Sylwia Bobis


    Full Text Available Mesenchymal stem cells (MSCs are bone marrow populating cells, different from hematopoietic stem cells, which possess an extensive proliferative potential and ability to differentiate into various cell types, including: osteocytes, adipocytes, chondrocytes, myocytes, cardiomyocytes and neurons. MSCs play a key role in the maintenance of bone marrow homeostasis and regulate the maturation of both hematopoietic and non-hematopoietic cells. The cells are characterized by the expression of numerous surface antigens, but none of them appears to be exclusively expressed on MSCs. Apart from bone marrow, MSCs are located in other tissues, like: adipose tissue, peripheral blood, cord blood, liver and fetal tissues. MSCs have been shown to be powerful tools in gene therapies, and can be effectively transduced with viral vectors containing a therapeutic gene, as well as with cDNA for specific proteins, expression of which is desired in a patient. Due to such characteristics, the number of clinical trials based on the use of MSCs increase. These cells have been successfully employed in graft versus host disease (GvHD treatment, heart regeneration after infarct, cartilage and bone repair, skin wounds healing, neuronal regeneration and many others. Of special importance is their use in the treatment of osteogenesis imperfecta (OI, which appeared to be the only reasonable therapeutic strategy. MSCs seem to represent a future powerful tool in regenerative medicine, therefore they are particularly important in medical research.

  6. Clinical and radiological analysis of severe acute respiratory syndrome

    Objective: To study the X-ray features of severe acute respiratory syndrome (SARS). Methods: The clinical data and X-ray appearances of 29 cases with SARS were analyzed retrospectively. Results: Epidemic outbreak of SARS has occurred at this area. 29 cases of SARS in this group began with a fever. 15 cases (51.7%) experienced mild respiratory symptoms. In 10 patients (34.5%) the antibacterial medication showed inefficacy before hospitalization. Leucocyte counting was normal in 18 cases (62.1%) and decreased in 11 cases (37.9%). Platelet counting slightly decreased in 7 cases (24.1%). Hepatic function test was abnormal in 16 patients (55.2%), mostly with a decrease of serum enzymology. Obvious abnormalities were seen on the chest films, which were in sharp contrast with the mild clinical respiratory signs. Chest X-ray findings were as follows: Exaggerated and indistinct lung markings with reticular shadow in 7 cases (24.1%), ground-glass opacity in 3 cases (10.4%), small patchy and multi-patchy imaging in 12 cases (41.4%), and large patchy shadow in 7 cases (24.1%). X-ray abnormality was presented later and absorbed slower. Conclusion: SARS carries a variety of X-ray appearances. The combined use of epidemiologic history, clinical situation, laboratory tests, and imaging examinations can make a definite diagnosis

  7. BRAT1 mutations present with a spectrum of clinical severity.

    Srivastava, Siddharth; Olson, Heather E; Cohen, Julie S; Gubbels, Cynthia S; Lincoln, Sharyn; Davis, Brigette Tippin; Shahmirzadi, Layla; Gupta, Siddharth; Picker, Jonathan; Yu, Timothy W; Miller, David T; Soul, Janet S; Poretti, Andrea; Naidu, SakkuBai


    Mutations in BRAT1, encoding BRCA1-associated ATM activator 1, are associated with a severe phenotype known as rigidity and multifocal seizure syndrome, lethal neonatal (RMFSL; OMIM # 614498), characterized by intractable seizures, hypertonia, autonomic instability, and early death. We expand the phenotypic spectrum of BRAT1 related disorders by reporting on four individuals with various BRAT1 mutations resulting in clinical severity that is either mild or moderate compared to the severe phenotype seen in RMFSL. Representing mild severity are three individuals (Patients 1-3), who are girls (including two sisters, Patients 1-2) between 4 and 10 years old, with subtle dysmorphisms, intellectual disability, ataxia or dyspraxia, and cerebellar atrophy on brain MRI; additionally, Patient 3 has well-controlled epilepsy and microcephaly. Representing moderate severity is a 15-month-old boy (Patient 4) with severe global developmental delay, refractory epilepsy, microcephaly, spasticity, hyperkinetic movements, dysautonomia, and chronic lung disease. In contrast to RMFSL, his seizure onset occurred later at 4 months of age, and he is still alive. All four of the individuals have compound heterozygous BRAT1 mutations discovered via whole exome sequencing: c.638dupA (p.Val214Glyfs*189); c.803+1G>C (splice site mutation) in Patients 1-2; c.638dupA (p.Val214Glyfs*189); c.419T>C (p.Leu140Pro) in Patient 3; and c.171delG (p.Glu57Aspfs*7); c.419T>C (p.Leu140Pro) in Patient 4. Only the c.638dupA (p.Val214Glyfs*189) mutation has been previously reported in association with RMFSL. These patients illustrate that, compared with RMFSL, BRAT1 mutations can result in both moderately severe presentations evident by later-onset epilepsy and survival past infancy, as well as milder presentations that include intellectual disability, ataxia/dyspraxia, and cerebellar atrophy. © 2016 Wiley Periodicals, Inc. PMID:27282546

  8. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Jensen Gunnar; Hatling Trond; Heyerdahl Sonja; Hanssen-Bauer Ketil; Olstad Pål; Stangeland Tormod; Tinderholt Tarje


    Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which ...

  9. Clinical features of probable severe acute respiratory syndrome in Beijing

    Hai-Ying Lu; Xiao-Yuan Xu; Yu Lei; Yang-Feng Wu; Bo-Wen Chen; Feng Xiao; Gao-Qiang Xie; De-Min Han


    AIM: To summarize clinical features of probable severe acute respiratory syndrome (SARS) in Beijing.METHODS: Retrospective cases involving 801 patients admitted to hospitals in Beijing between March and June 2003, with a diagnosis of probable SARS, moderate type.The series of clinical manifestation, laboratory and radiograph data obtained from 801 cases were analyzed. RESULTS: One to three days after the onset of SARS, the major clinical symptoms were fever (in 88.14% of patients), fatigue, headache, myalgia, arthralgia (25-36%), etc. The counts of WBC (in 22.56% of patients) lymphocyte (70.25%)and CD3, CD4, CD8 positive T cells (70%) decreased. From 4-7 d, the unspecific symptoms became weak; however, the rates of low respiratory tract symptoms, such as cough (24.18%), sputum production (14.26%), chest distress (21.04%) and shortness of breath (9.23%) increased, so did the abnormal rates on chest radiograph or CT. The low counts of WBC, lymphocyte and CD3, CD4, CD8 positiveT cells touched bottom. From 8 to 16 d, the patients presented progressive cough (29.96%), sputum production (13.09%), chest distress (29.96%) and shortness of breath (35.34%). All patients had infiltrates on chest radiograph or CT, some even with multi-infiltrates. Two weeks later, patients' respiratory symptoms started to alleviate, the infiltrates on the lung began to absorb gradually, the counts of WBC, lymphocyte and CD3, CD4, CD8 positive T cells were restored to normality.CONCLUSION: The data reported here provide evidence that the course of SARS could be divided into four stages, namely the initial stage, progressive stage, fastigium and convalescent stage.

  10. Clinical Characteristics and Treatment of Malignant Granuloma

    Chongjin Feng; Junbing Guo; Yong Chen


    OBJECTIVE To analyse the clinical characteristics of malignant granuloma(MG) and evaluate its treatment.METHODS From March 1985 to May 1998, 101 cases of malignant granuloma were treated with radiation (RT) alone or radiotherapy followed by chemotherapy or chemotherapy followed by radiotherapy. For chemotherapy, a CCNU, COMP (CTX, VCR, MTX, PDN) or CHOP (CTX,ADM, VCR, PDN) regimen was given. Radiation was directed through the anterior field of the nose mainly for nasal and paranasal sinus malignant granuloma, and through the faciocervical field for malignant granuloma of Walderyer's ring or for patients with cervical lymphadenectasis. Total dose was 45-65 Gy over 5-6 weeks.RESULTS The overall 3-year, 5-year and 10-year survival rates were 78.2%, 56.1% and 39.7% respectively. The 5-year survival rate was: RT group 60.3%, RT + CHOP or CHOP + RT group 64.7% (P >0.05), RT +CCNU group 40%, and RT + COMP group 33.3%. The 5-year survival rates of patients with one involved focus and more than 2 involved foci were 75.6%(34/45) and 39.3% (22/56) (P<0.001). The 5-year survival rates of patients with or without body symptoms were 39.6% (18/48) and 67.9%(36/53) (P<0.05). The 5-year survival rate of the 50-60 Gy group and the <50Gy group were 60.1% (40/66) and 20% (1/5)(P <0.05). The local and regional recurrence rate was 20.8 % (21/101 ).CONCLUSION Radiotherapy alone should be the treatment of choice for patients with one site involvement and without body symptoms. Radiation fields should be large enough to include the potentially involved sites. The recommended dose is 50-60 Gy over 5-6 weeks. It is suggested that patients with more than 2 foci involvement and those with body symptoms should receive the combination therapy.

  11. Mesenchymal stem cells: biological characteristics and potential clinical applications

    Kassem, Moustapha


    Mesenchymal stem cells (MSC) are clonogenic, non-hematpoietic stem cells present in the bone marrow and are able to differentiate into multiple mesoderm-type cell lineages, for example, osteoblasts, chondrocytes, endothelial-cells and also non-mesoderm-type lineages, for example, neuronal...... among the first stem cell types to be introduced in the clinic. Several studies have demonstrated the possible use of MSC in systemic transplantation for systemic diseases, local implantation for local tissue defects, as a vehicle for genes in gene therapy protocols or to generate transplantable tissues......-like cells. Several methods are currently available for isolation of the MSC based on their physical and physico-chemical characteristics, for example, adherence to plastics or other extracellular matrix components. Because of the ease of their isolation and their extensive differentiation potential, MSC are...

  12. Hydrological drought severity explained by climate and catchment characteristics

    Loon, Van A.F.; Laaha, G.


    Impacts of a drought are generally dependent on the severity of the hydrological drought event, which can be expressed by streamflow drought duration or deficit volume. For prediction and the selection of drought sensitive regions, it is crucial to know how streamflow drought severity relates to

  13. Characteristics and Roles of Literacy Clinic Directors

    Ortlieb, Evan; Pearce, Daniel L.


    A literacy clinic is an ideal setting where research and exploration often lead to breakthroughs in reading remediation; that information can then be transferred to classroom instruction (Morris, 2003). Although it is clear that literacy clinics should be structured around what works for their student populations, there remains ambiguity…

  14. Clinical characteristics of the eardrum retraction pocket

    Ješić Snežana


    Full Text Available Development of the eardrum retraction pocket, as pathologic finding, depends on Eustachian tube dysfunction, onset of the middle ear infection and site of development of retraction on the eardrum. The study is aimed at: 1. Determining the incidence of eardrum retraction pocket and cholesteatoma within it, as well as at the degree of eardrum retraction; 2. Determining of association between eardrum retraction pocket and changes of the eardrum mucosaand parstensa of the tympanic membrane; 3. Determining of onset and intensity of the bone destruction in eardrum retraction pocket; 4. Examining of Eustachian tube function based on time of mucocilliary transport according to the type of the eardrum retraction pocket. The study is based on the retrospective analysis of the results obtained from the patients treated at the Institute of Oto-Rhino-Laryngology and Maxillofacial Surgery Clinical Centre of Serbia in Belgrade for the diagnosis of the chronic suppurative otitis who underwent otosurgical procedures during the six-year period, from 1996-2001. In our series of 540 patients subjected to otosurgical treatment, the incidence of the retraction pocket of the eardrum was 11.23%. Onset of more severe degree of eardrum retraction was most frequent in the attic. Cholesteatoma was detected in 82.2% of patients of the group with the attic-retraction pocket of the eardrum, as well as in 25% of patients of the group of tensa-sinus retraction pocket of the eardrum. Atrophic changes of the tympanic membrane pars tensa were detected in almost all tensa-sinus retraction pockets of the eardrum. Approximately one half of the attic-retraction pockets of the eardrum were accompanied by eardrum atrophy. Bone destruction of the auditory ossicles was limited to the long process of incus and superior structures of stapes. Time of the mucocilliary transport was significantly longer (p<0.01 in attic-retraction pocket of the eardrum than in tensa-sinus retraction pocket of

  15. Characteristics of patients with ADHD in psychiatric and pediatric ADHD clinics

    Kolar, Dusan; Hechtman, Lily; Francoeur, Emmett; Paterson, Jodi


    Abstract. This study explores whether the child psychiatry ADHD clinic and the pediatric ADHD clinic serve different population of patients regarding the patient characteristics, severity of ADHD symptoms and comorbid disorders, thereby testing the efficacy of a triage system set up to direct patients referred for Attention Deficit Disorder symptoms to the appropriate clinics. Charts of 163 children and adolescents treated in two clinical settings were analyzed with regard to demographic char...

  16. Clinical characteristics of cutaneous lupus erythematosus

    Szczęch, Justyna; Rutka, Maja; Samotij, Dominik; Zalewska, Agnieszka; Reich, Adam


    Introduction Lupus erythematosus (LE) shows a wide variety of clinical manifestations, skin involvement being one of the most important. Aim To analyze the clinical presentation of cutaneous variants of lupus erythematosus in terms of skin lesion spectrum and extracutaneous involvement. Material and methods A total of 64 patients with cutaneous LE (CLE) were included. The study was based on the “Core Set Questionnaire” developed by the European Society of Cutaneous Lupus Erythematosus (EUSCLE...

  17. Cognitive flexibility and clinical severity in eating disorders.

    Kate Tchanturia

    Full Text Available OBJECTIVES: The aim of this study was to explore cognitive flexibility in a large dataset of people with Eating Disorders and Healthy Controls (HC and to see how patient characteristics (body mass index [BMI] and length of illness are related to this thinking style. METHODS: A dataset was constructed from our previous studies using a conceptual shift test--the Brixton Spatial Anticipation Test. 601 participants were included, 215 patients with Anorexia Nervosa (AN (96 inpatients; 119 outpatients, 69 patients with Bulimia Nervosa (BN, 29 Eating Disorder Not Otherwise Specified (EDNOS, 72 in long-term recovery from AN (Rec AN and a comparison group of 216 HC. RESULTS: The AN and EDNOS groups had significantly more errors than the other groups on the Brixton Test. In comparison to the HC group, the effect size decrement was large for AN patients receiving inpatient treatment and moderate for AN outpatients. CONCLUSIONS: These findings confirm that patients with AN have poor cognitive flexibility. Severity of illness measured by length of illness does not fully explain the lack of flexibility and supports the trait nature of inflexibility in people with AN.

  18. Gastric electrical stimulation for treatment of clinically severe gastroparesis

    Naga Venkatesh G Jayanthi


    Full Text Available Background: Severe, drug-resistant gastroparesis is a debilitating condition. Several, but not all, patients can get significant relief from nausea and vomiting by gastric electrical stimulation (GES. A trial of temporary, endoscopically delivered GES may be of predictive value to select patients for laparoscopic-implantation of a permanent GES device. Materials and Methods: We conducted a clinical audit of consecutive gastroparesis patients, who had been selected for GES, from May 2008 to January 2012. Delayed gastric emptying was diagnosed by scintigraphy of ≥50% global improvement in symptom-severity and well-being was a good response. Results: There were 71 patients (51 women, 72% with a median age of 42 years (range: 14-69. The aetiology of gastroparesis was idiopathic (43 patients, 61%, diabetes (15, 21%, or post-surgical (anti-reflux surgery, 6 patients; Roux-en-Y gastric bypass, 3; subtotal gastrectomy, 1; cardiomyotomy, 1; other gastric surgery, 2 (18%. At presentation, oral nutrition was supplemented by naso-jejunal tube feeding in 7 patients, surgical jejunostomy in 8, or parenterally in 1 (total 16 patients; 22%. Previous intervention included endoscopic injection of botulinum toxin (botox into the pylorus in 16 patients (22%, pyloroplasty in 2, distal gastrectomy in 1, and gastrojejunostomy in 1. It was decided to directly proceed with permanent GES in 4 patients. Of the remaining, 51 patients have currently completed a trial of temporary stimulation and 39 (77% had a good response and were selected for permanent GES, which has been completed in 35 patients. Outcome data are currently available for 31 patients (idiopathic, 21 patients; diabetes, 3; post-surgical, 7 with a median follow-up period of 10 months (1-28; 22 patients (71% had a good response to permanent GES, these included 14 (68% with idiopathic, 5 (71% with post-surgical, and remaining 3 with diabetic gastroparesis. Conclusions: Overall, 71% of well-selected patients

  19. Somnambulism. Clinical characteristics and personality patterns.

    Kales, A; Soldatos, C R; Caldwell, A B; Kales, J D; Humphrey, F J; Charney, D S; Schweitzer, P K


    Fifty adults with either a present or past complaint of somnambulism were evaluated to determine the development and clinical course of their disorder as well as their personality patterns. Generally, when sleepwalking was outgrown, its onset was before age 10 years and its termination before age 15 years. Current sleepwalkers, compared with past sleepwalkers, started sleepwalking at a later age, had a higher frequency of events, and had episodes earlier in the night. Their episodes were also characterized by more intense clinical manifestations. Furthermore, current sleepwalkers demonstrated high levels of psychopathology, whereas past sleepwalkers had essentially normal psychological patterns. Specifically, the current sleepwalkers showed active, outwardly directed behavioral patterns, suggestive of difficulties in handling aggression. The clinical application of these findings is discussed and practical recommendations are given for the evaluation and management of sleepwalking. PMID:7447621

  20. Clinical Characteristics of Cases with Spinal Muscular Atrophy

    Mehmet Canpolat


    Full Text Available Introduction: The aim of this study is was to evaluate the clinical features of cases with diagnosis of spinal muscular atrophy (SMA. Materials and Methods: Thirty-eight pediatric patients were evaluated retrospectively. All patients were followed in the Pediatric Neurology Department of Erciyes University Faculty of Medicine. The diagnosis of patients had been confirmed by genetic analysis of homozygous deletions of survival motor neuron 1 gene. Detailed history, newborn symptoms, nutritional characteristics, initial complaints, physical examination, concomitant pathologies, genetic characteristics, and treatment modalities were investigated in all patients. Results: The study population consisted of 19 boys (50% and 19 girls (50%. The mean age of patients was 26.9±25.7 months (range: 3-96 months. The mean follow-up period was 12.2±13.3 months (range: 2-48 months. According to SMA classification, 22 patients (57.8% were type 1, 8 patients (21.1% were type 2, and 8 patients were (21.1% type 3. Neonatal respiratory distress, age at early diagnosis, nutritional problems, and recurrent lung diseases were detected as poor prognostic factors. Conclusions: SMA is a neuromuscular disease that requires multidisciplinary approach to medical care. There is a wide range of clinical severity. Identification of poor prognostic factors will help in terms of guiding close monitoring and timely treatments of children with SMA.

  1. Clinical Characteristics of Ochrobactrum anthropi Bacteremia

    Hagiya, Hideharu; Ohnishi, Kouhei; Maki, Miyako; Watanabe, Naoto; Murase, Tomoko


    The clinical picture of Ochrobactrum anthropi infection is not well described because the infection is rare in humans and identification of the pathogen is difficult. We present a case of O. anthropi bacteremia that was initially misidentified as Ralstonia paucula and later identified by 16S rRNA sequencing and recA analysis.

  2. Severe acute respiratory syndrome: clinical and laboratory manifestations.

    Lam, Christopher W K; Chan, Michael H M; Wong, Chun K


    Severe acute respiratory syndrome (SARS) is a recently emerged infectious disease with significant morbidity and mortality. An epidemic in 2003 affected 8,098 patients in 29 countries with 774 deaths. The aetiological agent is a new coronavirus spread by droplet transmission. Clinical and general laboratory manifestations included fever, chills, rigor, myalgia, malaise, diarrhoea, cough, dyspnoea, pneumonia, lymphopenia, neutrophilia, thrombocytopenia, and elevated serum lactate dehydrogenase (LD), alanine aminotransferase (ALT) and creatine kinase (CK) activities. Treatment has been empirical; initial potent antibiotic cover, followed by simultaneous ribavirin and corticosteroids, with or without pulse high-dose methylprednisolone, have been used. The postulated disease progression comprises (1) active viral infection, (2) hyperactive immune response, and (3) recovery or pulmonary destruction and death. We investigated serum LD isoenzymes and blood lymphocyte subsets of SARS patients, and found LD1 activity as the best biochemical prognostic indicator for death, while CD3+, CD4+, CD8+ and natural killer cell counts were promising predictors for intensive care unit (ICU) admission. Plasma cytokine and chemokine profiles showed markedly elevated Th1 cytokine interferon (IFN)-gamma, inflammatory cytokines interleukin (IL)-1beta, IL-6 and IL-12, neutrophil chemokine IL-8, monocyte chemoattractant protein-1 (MCP-1), and Th1 chemokine IFN-gamma-inducible protein-10 (IP-10) for at least two weeks after disease onset, but there was no significant elevation of inflammatory cytokine tumor necrosis factor (TNF)-alpha and anti-inflammatory cytokine IL-10. Corticosteroid reduced IL-8, MCP-1 and IP-10 concentrations from 5-8 days after treatment. Measurement of biochemical markers of bone metabolism demonstrated significant but transient increase in bone resorption from Day 28-44 after onset of fever, when pulse steroid was most frequently given. With tapering down of steroid

  3. Sepsis in AIDS patients: clinical, etiological and inflammatory characteristics

    João Manoel Silva


    Full Text Available Introduction: Intensive care mortality of HIV-positive patients has progressively decreased. However, critically ill HIV-positive patients with sepsis present a worse prognosis. To better understand this condition, we propose a study comparing clinical, etiological and inflammatory data, and the hospital course of HIV-positive and HIV-negative patients with severe sepsis or septic shock. Methods: A prospective observational study enrolling patients with severe sepsis or septic shock associated or not with HIV infection, and admitted to intensive care unit (ICU. Clinical, microbiological and inflammatory parameters were assessed, including C-reactive protein (CRP, procalcitonin (PCT, interleukin-6, interleukin-10 and TNF-α. Outcome measures were in-hospital and six-month mortality. Results: The study included 58 patients with severe sepsis/septic shock admitted to ICU, 36 HIV-positive and 22 HIV-negative. All HIV-positive patients met the criteria for AIDS (CDC/2008. The main foci of infection in HIV-positive patients were pulmonary and abdominal (p=0.001. Fungi and mycobacteria were identified in 44.4% and 16.7% of HIV-positive patients, respectively. In contrast, the main etiologies for sepsis in HIV-negative patients were Gram-negative bacilli (36.4% and Gram-positive cocci (36.4% (p=0.001. CRP and PCT admission concentrations were lower in HIV-positive patients (130 vs. 168 mg/dL p=0.005, and 1.19 vs. 4.06 ng/mL p=0.04, respectively, with a progressive decrease in surviving patients. Initial IL-10 concentrations were higher in HIV-positive patients (4.4 pg/mL vs. 1.0 pg/mL, p=0.005, with moderate accuracy for predicting death (area under receiver-operating characteristic curve =0.74. In-hospital and six-month mortality were higher in HIV-positive patients (55.6 vs. 27.3% p=0.03, and 58.3 vs. 27.3% p=0.02, respectively. Conclusions: The course of sepsis was more severe in HIV-positive patients, with distinct clinical, etiological and

  4. Clinical experience of surgical intervention for severe acute pancreatitis

    Xu Yuan; Shao Qinshu; Yang Jin; Yu Xiaojun; Xu Ji


    Background The controversy on the treatment strategy for severe acute pancreatitis (SAP) has never stopped for the past century.Even now surgical procedures play a decisive role in the treatment of SAP,especially in managing the related complications,but the rational indications,timing,and approaches of surgical intervention for SAP are still inconclusive.Methods Clinical data of 308 SAP patients recruited during January 2000-January 2013,including 96 conservatively treated cases plus 212 surgically intervened cases,were comparatively analyzed.Based on the initial surgical intervention time,the surgical intervention group was split into two:early intervention group (within 2 weeks) 103 cases,and late intervention group (after 2 weeks) 109 cases.Results In the conservative treatment group,the cure rate was 82.29% (79/96),the death rate was 13.54% (13/96),and 4 cases self-discharged,while in the surgical intervention group,the cure rate was 84.43% (179/212) and the death rate was 10.85% (23/212) with 10 cases self-discharged.The difference was of no statistical significance between these two groups (P >0.05).In surgical intervention group,the death rate 15.53% (16/103) in the early surgical intervention group was higher than that of late surgical intervention group 6.42% (7/109),and the difference was statistically significant (P <0.05).Conclusions Both conservative treatment and surgical intervention play important roles in the treatment of SAP,and the indication,timing,and procedure should be strictly followed.Surgery earlier than 2 weeks after onset of the disease is not recommended in patients with necrotizing pancreatitis only when there are specific indications,such as multiple organ failure,which does not improve despite active treatment,and in those who develop abdominal compartment syndrome.

  5. Vasopressin receptor antagonists: Characteristics and clinical role.

    Rondon-Berrios, Helbert; Berl, Tomas


    Hyponatremia, the most common electrolyte disorder in hospitalized patients is associated with increased risk of mortality even when mild and apparently asymptomatic. Likewise morbidity manifested as attention deficits, gait disturbances, falls, fractures, and osteoporosis is more prevalent in hyponatremic subjects. Hyponatremia also generates a significant financial burden. Therefore, it is important to explore approaches that effectively and safely treat hyponatremia. Currently available strategies are physiologically sound and affordable but lack evidence from clinical trials and are limited by variable efficacy, slow response, and/or poor compliance. The recent emergence of vasopressin receptor antagonists provides a class of drugs that target the primary pathophysiological mechanism, namely vasopressin mediated impairment of free water excretion. This review summarizes the historical development, pharmacology, clinical trials supporting efficacy and safety, shortcomings, as well as practical suggestions for the use of vasopressin receptor antagonists. PMID:27156765

  6. Clinical characteristics of anxiety disordered youth

    KENDALL, Philip C.; Compton, Scott N.; Walkup, John T.; Birmaher, Boris; Albano, Anne Marie; Sherrill, Joel; Ginsburg, Golda; Rynn, Moira; McCracken, James; Gosch, Elizabeth; Keeton, Courtney; Bergman, Lindsey; Sakolsky, Dara; Suveg, Cindy; Iyengar, Satish


    Reports the characteristics of a large, representative sample of treatment seeking anxious youth (N =488). Participants, aged 7–17 years (mean 10.7 yrs), had a principal DSM-IV diagnosis of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion ...

  7. Community-acquired Acinetobacter baumannii: clinical characteristics, epidemiology and pathogenesis.

    Dexter, Carina; Murray, Gerald L; Paulsen, Ian T; Peleg, Anton Y


    Community-acquired Acinetobacter baumannii (CA-Ab) is a rare but serious cause of community-acquired pneumonia in tropical regions of the world. CA-Ab infections predominantly affect individuals with risk factors, which include excess alcohol consumption, diabetes mellitus, smoking and chronic lung disease. CA-Ab pneumonia presents as a surprisingly fulminant course and is characterized by a rapid onset of fever, severe respiratory symptoms and multi-organ dysfunction, with a mortality rate reported as high as 64%. It is unclear whether the distinct clinical syndrome caused by CA-Ab is because of host predisposing factors or unique bacterial characteristics, or a combination of both. Deepening our understanding of the drivers of overwhelming CA-Ab infection will provide important insights into preventative and therapeutic strategies. PMID:25850806

  8. Economic analysis of several types of malaria clinics in Thailand.

    Ettling, M. B.; Thimasarn, K.; Shepard, D. S.; Krachaiklin, S.


    The costs of three types of malaria clinics in Maesot District, north-west Thailand, for a one-year period in 1985-86 were compared from the institutional, community and social (institutional plus community) perspectives. The greatest number of patients at the lowest average institutional cost per smear and per positive case diagnosed (US$ 0.82) were seen at the large central clinic in Maesot town. The peripheral clinic in Popphra, a subdistrict town, had moderate institutional costs per smea...

  9. Acute demyelinating encephalomyelitis: Clinical characteristics and outcome

    Ahmed Farag Elhassanien


    Full Text Available Background: ADEM, although relatively uncommon, is probably under-recognized. Objectives: To spotlight the clinical profile and therapeutic outcome of children with ADEM. Materials and Methods: This is a prospective study of patients with ADEM who were admitted to the Pediatric Departments in Aladan and Alfarawanya Hospitals in Kuwait, from January 2009 to January 2011. Clinical, microbiological and radiological data were analyzed. Results: Of 48 patients presented with acute neurological symptoms and signs, 21 patients fulfilled criteria for ADEM. 80.95% of cases were presenting in winter and spring, 57% of patients had a history of upper respiratory tract illness. The commonest presentations were motor deficits, convulsions and altered consciousness. CSF virology studies showed herpes simplex virus (HSV and Epstein-Barr virus (EBV (3 patients whereas nasal and nasopharyngeal swab showed evidence of influenza H1N1 virus (1 patient. Brain MRI was performed in all patients and revealed multiple hyperintense supratentorial brain lesions on T2/FLAIR images. 85.7% of patients had cortical and/or subcortical white matter lesions which were bilateral and asymmetric in location and size. Conclusion: ADEM although rare must be considered in children with acute onset of neurological signs and symptoms and must be distinguished from any acute neurological insult.

  10. Corticosteroid responsiveness and clinical characteristics in childhood difficult asthma

    Bossley, C.J.; Saglani, S; Kavanagh, C.; Payne, D.N.R.; Wilson, N; Tsartsali, L.; Rosenthal, M; Balfour-Lynn, I M; Nicholson, A.G.; Bush, A


    This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (FeNO) and no bronchodilator responsiveness (BDR

  11. Night terrors. Clinical characteristics and personality patterns.

    Kales, J D; Kales, A; Soldatos, C R; Caldwell, A B; Charney, D S; Martin, E D


    The development and clinical course of night terrors and the personality patterns of patients with this disorder were evaluated in 40 adults who had a current complaint of night terrors. Compared with a group of adult sleepwalkers, the patients with night terrors had a later age of onset for their disorder, a higher frequency of events, and an earlier time of night for the occurrence of episodes. Both groups had high levels of psychopathology, with higher values for the night terror group. This sleepwalkers showed active, outwardly directed behavioral patterns, whereas the night terror patients showed an inhibition of outward expressions of aggression and a predominance of anxiety, depression, tendencies obsessive-compulsive/, and phobicness. Although night terrors and sleepwalking in childhood seem to be related primarily to genetic and developmental factors, their persistence and especially their onset in adulthood are found to be related more to psychological factors. PMID:7447622

  12. Clinical, pathological and sonographic characteristics of unexpected gallbladder carcinoma

    Jin-huan WANG; Liu, Bo-Ji; Xu, Hui-Xiong; Sun, Li-ping; Li, Dan-Dan; Guo, Le-Hang; Liu, Lin-Na; Xu, Xiao-Hong


    Objectives: To investigate the clinical, pathological, and sonographic characteristics of unexpected gallbladder carcinoma (UGC). Methods: Of 5424 patients who had undergone cholecystectomy from December 2006 to October 2013, 54 patients with primary gallbladder carcinomas confirmed by pathological diagnosis were identified. The patients were divided into two groups: diagnosed before operation (n=34) and UGC groups (n=20), of whom the clinical, pathological, and sonographic characteristics we...

  13. Association between neurovascular contact and clinical characteristics in classical trigeminal neuralgia

    Maarbjerg, Stine; Wolfram, Frauke; Gozalov, Aydin;


    severe NVC. METHODS: Clinical characteristics were prospectively collected from consecutive TN patients using semi-structured interviews in a cross-sectional study design. We evaluated 3.0 Tesla MRI blinded to the symptomatic side. RESULTS: We included 135 TN patients. Severe NVC was more prevalent in...

  14. Bulimia: clinical characteristics, development, and etiology.

    Kirkley, B G


    Bulimia is characterized by recurrent episodes of binge eating and severe self-deprecation, often accompanied by self-induced vomiting and/or laxative abuse. It is most often found among young women in their late teens to mid-30s. Estimates of the disorder's prevalence vary widely, depending on the diagnostic criteria used, but usually range from 5% to 20% of college age women. Binge eating typically begins in late adolescence, frequently after a period of dieting to lose weight. Self-induced vomiting usually follows the onset of binge eating by about a year. To date, theories of the disorder's etiology have included several biological models, a psychosocial model, and a biopsychosocial model. The biological models proposed have viewed bulimia as a form of biological depression, neurological disturbance, or metabolic disturbance. The psychosocial model suggests that society's pressure on young women for extreme thinness leads to excessive dietary restraint, deprivation, and, paradoxically, binge eating. The presence of anxiety or depression exacerbates the process. The biopsychosocial model appears to be the most promising. It proposes that young women with biological predispositions toward overweight, depression, or metabolic disturbance are particularly vulnerable to social pressure for thinness, the binge eating that may result from excessive dieting, and, hence, bulimia. The complex nature of bulimia suggests that a multidisciplinary team approach treatment is appropriate. PMID:3514731

  15. 浙江省发热伴血小板减少综合征病例临床与流行病学特征分析%Analysis on clinical and epidemiological characteristics of severe fever with thrombocytopenia syndrome in Zhejiang province

    柴程良; 孙继民; 林君芬; 施旭光; 张严峻; 张磊; 侯娟


    Objective To understand the clinical and epidemiological characteristics of severe fever with thrombocytopenia syndrome (SFTS) and to provide clues for further study. Methods A descriptive epidemiological method combined with individual case investigation was to analyze the data on epidemiology, diagnosis and treatment collected from clinically diagnosed as well as suspicious patients with severe fever and thrombocytopenia syndrome. Results Out of 6 topography, 3 were found to be endemic with SFTS. Most cases were 50 and over residing in hilly regions (87. 50%) and 65. 00% of patients were reported from June to July. They all experienced fever with the body temperature ranging from 37. 6'C to 40. 6'C, which was the major onset symptom. Meanwhile, most patients also experienced chill, fatigue, anorexia and other non-specific symptoms. The major clinical symptoms were fever, thrombocytopenia and leucocytopenia which could last 14 or 15 days or even longer for thrombocytopenia. Person to person transmission was not found. Conclusions There are differences in clinical and epidemiological characteristics of severe fever with thrombocytopenia syndrome in Zhejiang compared with other provinces. Further study needs to be done.%目的 分析发热伴血小板减少综合征病例临床与流行病学特征,为进一步研究提供线索.方法 采用流行病学个案调查与描述性分析方法,收集发热伴血小板减少综合征确诊与疑似病例发病、诊治、检测与流行病学史等资料,分析病例临床与流行病学特征.结果 浙江省6类地形中有3类存在发热伴血小板减少综合征疫情,病例以丘陵山区50岁以上人群为主(87.50%),6~7月为发病高峰(65.00%).所有病例均有发热,体温最低37.6℃,最高40.6℃,平均39.2℃,且发热为主要首发症状.大部分病例有畏寒(67.50%)、乏力(67.50%)、食欲减退(52.50%)等非特异性症状.病例临床表现为发热伴白细胞和血小板减少,

  16. Clinical characteristics of patients with persistent postural-perceptual dizziness

    Roseli Saraiva Moreira Bittar; Eliane Maria Dias von Söhsten Lins


    INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 pati...

  17. Association between occupational exposure and the clinical characteristics of COPD

    Caillaud Denis


    Full Text Available Abstract Background The contribution of occupational exposures to COPD and their interaction with cigarette smoking on clinical pattern of COPD remain underappreciated. The aim of this study was to explore the contribution of occupational exposures on clinical pattern of COPD. Methods Cross-sectional data from a multicenter tertiary care cohort of 591 smokers or ex-smokers with COPD (median FEV1 49% were analyzed. Self-reported exposure to vapor, dust, gas or fumes (VDGF at any time during the entire career was recorded. Results VDGF exposure was reported in 209 (35% subjects aged 31 to 88 years. Several features were significantly associated with VDGF exposure: age (median 68 versus 64 years, p  Conclusion In this patient series of COPD patients, subjects exposed to VDGF were older male patients who reported more work-related respiratory disability, more asthma-like symptoms and atopy, suggesting that, even in smokers or ex-smokers with COPD, occupational exposures are associated with distinct patients characteristics.

  18. Clinical characteristics and outcomes in biclonal gammopathies.

    Mullikin, Trey C; Rajkumar, S Vincent; Dispenzieri, Angela; Buadi, Francis K; Lacy, Martha Q; Lin, Yi; Dingli, David; Go, Ronald S; Hayman, Suzanne R; Zeldenrust, Steven R; Russell, Stephen J; Lust, John A; Leung, Nelson; Kapoor, Prashant; Kyle, Robert A; Gertz, Morie A; Kumar, Shaji K


    A single monoclonal protein typically characterizes monoclonal gammopathies, but a small proportion may have more than one M protein identifiable. In the setting of symptomatic multiple myeloma (MM), the development of a new monoclonal protein following therapy is associated with better outcomes. As for the precursor conditions, monoclonal gammopathy undetermined significance (MGUS) and smoldering multiple myeloma (SMM), there is limited information on the impact of a second monoclonal protein on the disease course, including progression and response to treatment. The outcomes of patients with MGUS and SMM with more than one monoclonal protein, after identifying 539 patients with biclonal proteins on electrophoresis and/or immunofixation, were reported. About 22 of 393 patients with MGUS/biclonal gammopathy of undetermined significance (BGUS) progressed to SMM (6), MM (11), AL (3), or WM (2), and 5 of 16 patients with biclonal SMM progressed to MM. The rate of progression for BGUS was approximately 1% per year, which is similar to MGUS with one monoclonal protein. The median estimated time of progression of biclonal SMM was 2.6 years; similar to monoclonal SMM. For patients with biclonal MM, both M spikes responded to treatment and, upon relapse, the original dominant M protein remained dominant as the disease progressed. In conclusion, the presence of a second monoclonal protein does not appear to affect the progression of precursor states and suggests multiple monoclonal proteins do not clinically impact one another in the course of the disease. Am. J. Hematol. 91:473-475, 2016. © 2016 Wiley Periodicals, Inc. PMID:26840395

  19. Characteristics of Patients Injured in Road Traffic Accidents According to the New Injury Severity Score

    Lee, Jung Soo; Kim, Yeo Hyung; Yun, Jae Sung; Jung, Sang Eun; Chae, Choong Sik


    Objective To investigate the clinical characteristics of patients involved in road traffic accidents according to the New Injury Severity Score (NISS). Methods In this study, medical records of 1,048 patients admitted at three hospitals located in different regions between January and December 2014 were retrospectively reviewed. Only patients who received inpatient treatments covered by automobile insurance during the period were included. Accidents were classified as pedestrian, driver, passenger, motorcycle, or bicycle; and the severity of injury was assessed by the NISS. Results The proportion of pedestrian traffic accident (TA) was the highest, followed by driver, passenger, motorcycle and bicycle TA. The mean NISS was significantly higher in pedestrian and motorcycle TAs and lower in passenger TA. Analysis of differences in mean hospital length of stay (HLS) according to NISS injury severity revealed 4.97±4.86 days in the minor injury group, 8.91±5.93 days in the moderate injury group, 15.46±11.16 days in the serious injury group, 24.73±17.03 days in the severe injury group, and 30.86±34.03 days in the critical injury group (prehabilitation are necessary to reduce disabilities in TA patients. PMID:27152279

  20. Patient, provider, and clinic characteristics associated with public STD clinic patient satisfaction

    Mehta, S; Zenilman, J; Erbelding, E


    Objectives: There is a lack of information describing levels of patient satisfaction among patients seeking sexually transmitted diseases (STD) care in a public clinic setting. We sought to identify patient, provider, and clinic characteristics associated with patient satisfaction within public STD clinics.

  1. Cognitive Flexibility and Clinical Severity in Eating Disorders

    Kate Tchanturia; Amy Harrison; Helen Davies; Marion Roberts; Anna Oldershaw; Michiko Nakazato; Daniel Stahl; Robin Morris; Ulrike Schmidt; Janet Treasure


    OBJECTIVES: The aim of this study was to explore cognitive flexibility in a large dataset of people with Eating Disorders and Healthy Controls (HC) and to see how patient characteristics (body mass index [BMI] and length of illness) are related to this thinking style. METHODS: A dataset was constructed from our previous studies using a conceptual shift test--the Brixton Spatial Anticipation Test. 601 participants were included, 215 patients with Anorexia Nervosa (AN) (96 inpatients; 119 outpa...

  2. [Posttraumatic stress disorder endophenotypes: several clinical dimensions for specific treatments].

    Auxéméry, Y


    Posttraumatic stress disorder is a syndrome with a very complex clinical that it is useful to describe according to a multidimensional approach. Following a critical review of the international literature, we have been able to highlight the genetic supports of posttraumatic stress disorder in the perspective of returning to the source of the clinical of this syndrome in order to steer its treatment better. We consider in succession the neuromodulation pathways involving dopamine, serotonine and noradrenaline to describe the hyperdomaminergic, hyposerotoninergic and hypernoradrenergic endophenotypes of posttraumatic stress disorder. Neurogenetic studies have affirmed two essential proposals. On the one hand, the pharmacological treatment of psychotraumatic disorders can be very closely adjusted to the different endophenotypes. On the other hand, the psychotherapeutic approach retains all its importance in the sense that it is the subjective implication that generated the trauma, subjectivity interacting with a genetic heritage and environmental factors integrating a social context. The changing definition of posttraumatic stress disorder over time comes from scientific exploration in part determined by a sociocultural context and, reciprocally, the psychic trauma is caused by the collapse of reassuring social values which were considered as immutable. The clinical is not developed according to fixed references: the evolution of neurogenetic techniques changes our perception of psychic traumas and the therapeutic possibilities. PMID:23167137

  3. Characteristics of student preparedness for clinical learning: clinical educator perspectives using the Delphi approach

    Chipchase Lucinda S


    Full Text Available Abstract Background During clinical placements, clinical educators facilitate student learning. Previous research has defined the skills, attitudes and practices that pertain to an ideal clinical educator. However, less attention has been paid to the role of student readiness in terms of foundational knowledge and attitudes at the commencement of practice education. Therefore, the aim of this study was to ascertain clinical educators’ views on the characteristics that they perceive demonstrate that a student is well prepared for clinical learning. Methods A two round on-line Delphi study was conducted. The first questionnaire was emailed to a total of 636 expert clinical educators from the disciplines of occupational therapy, physiotherapy and speech pathology. Expert clinical educators were asked to describe the key characteristics that indicate a student is prepared for a clinical placement and ready to learn. Open-ended responses received from the first round were subject to a thematic analysis and resulted in six themes with 62 characteristics. In the second round, participants were asked to rate each characteristic on a 7 point Likert Scale. Results A total of 258 (40.56% responded to the first round of the Delphi survey while 161 clinical educators completed the second (62.40% retention rate. Consensus was reached on 57 characteristics (six themes using a cut off of greater than 70% positive respondents and an interquartile deviation IQD of equal or less than 1. Conclusions This study identified 57 characteristics (six themes perceived by clinical educators as indicators of a student who is prepared and ready for clinical learning. A list of characteristics relating to behaviours has been compiled and could be provided to students to aid their preparation for clinical learning and to universities to incorporate within curricula. In addition, the list provides a platform for discussions by professional bodies about the role of placement

  4. Comparison of Existing Clinical Scoring Systems in Predicting Severity and Prognoses of Hyperlipidemic Acute Pancreatitis in Chinese Patients

    Qiu, Lei; Sun, Rui Qing; Jia, Rong Rong; Ma, Xiu Ying; Cheng, Li; Tang, Mao Chun; Zhao, Yan


    Abstract It is important to identify the severity of acute pancreatitis (AP) in the early course of the disease. Clinical scoring systems may be helpful to predict the prognosis of patients with early AP; however, few analysts have forecast the accuracy of scoring systems for the prognosis in hyperlipidemic acute pancreatitis (HLAP). The purpose of this study was to summarize the clinical characteristics of HLAP and compare the accuracy of conventional scoring systems in predicting the progno...

  5. Clinics in diagnostic imaging (153). Severe hypoxic ischaemic brain injury.

    Chua, Wynne; Lim, Boon Keat; Lim, Tchoyoson Choie Cheio


    A 58-year-old Indian woman presented with asystole after an episode of haemetemesis, with a patient downtime of 20 mins. After initial resuscitation efforts, computed tomography of the brain, obtained to evaluate neurological injury, demonstrated evidence of severe hypoxic ischaemic brain injury. The imaging features of hypoxic ischaemic brain injury and the potential pitfalls with regard to image interpretation are herein discussed.

  6. Clinical and laboratory findings associated with severe scrub typhus

    Choi Seong-Hyung; Kim Seok; Kim Dong-Min; Yun Na


    Abstract Background Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that causes a generalized vasculitis that may involve the tissues of any organ system. The aim of this study was to identify factors associated to severe complications from scrub typhus. Methods We conducted this prospective, case-control study on scrub typhus patients who presented to the Department of Internal Medicine at Chosun University Hospital between September, 2004 and Dece...

  7. Clinical and laboratory findings associated with severe scrub typhus

    Choi Seong-Hyung


    Full Text Available Abstract Background Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that causes a generalized vasculitis that may involve the tissues of any organ system. The aim of this study was to identify factors associated to severe complications from scrub typhus. Methods We conducted this prospective, case-control study on scrub typhus patients who presented to the Department of Internal Medicine at Chosun University Hospital between September, 2004 and December, 2006. Cases were 89 scrub typhus patients with severe complications and controls were 119 scrub typhus patients without severe complications. Results There were significant differences in the absence of eschar, white blood cell (WBC counts, hemoglobin, albumin, serum creatinine, fibrinogen, C-reactive protein (CRP, and active partial thromboplastin time (aPTT between the two groups. Multivariate analysis demonstrated that only the following four factors were significantly associated with the severe complications of scrub typhus: (1 age ≥ 60 years (odd ratio [OR] = 3.13, P = 0.002, confidence interval [CI] = 1.53-6.41, (2 the absence of eschar (OR = 6.62, P = 0.03, CI = 1.22-35.8, (3 WBC counts > 10, 000/mm3 (OR = 3.6, P = 0.001, CI = 1.65-7.89, and (4 albumin ≤ 3.0 g/dL (OR = 5.01, P = 0.004, CI = 1.69-14.86. Conclusions Our results suggest that clinicians should be aware of the potential for complications, when scrub typhus patients are older (≥ 60 years, presents without eschar, or laboratory findings such as WBC counts > 10, 000/mm3, and serum albumin level ≤ 3.0 g/dL. Close observation and intensive care for scrub typhus patients with the potential for complications may prevent serious complications with subsequent reduction in its mortality rate.

  8. Clinical characteristics analysis of adult human adenovirus type 7 infection



    Objective To investigate the clinical characteristics of patients infected with human adenovirus type 7 and to provide guidance for early diagnosis and timely control of the outbreak.Methods A total of 301 patients infected with the human adenoviruses who were quarantined in hospital from December 2012 to February 2013 were observed.Epidemiological questionnaires were used to collect data of clinical features of the disease including

  9. Clinical characteristics of Takotsubo cardiomyopathy in North America

    Saeed Ahmed; Patompong Ungprasert; Supawat Ratanapo; Tanveer Hussain; Riesenfeld, Erik P.


    Background: Takotsubo cardiomyopathy (TC) or transient left ventricular apical ballooning syndrome is an acute cardiac syndrome characterized by transient wall motion abnormalities extending beyond a single epicardial vessel in the absence of significant obstructive coronary artery disease. Aim: This study was to describe the clinical characteristics of TC in North America. Materials and Methods: We identified 10 patients who met the Mayo Clinic criteria for TC using our Electronic Medical Re...

  10. Patient characteristics affecting attendance at general outpatient clinics.

    McClure, R J; Newell, S J; Edwards, S


    A study was carried out to identify the characteristics of children who do not attend appointments at general outpatient clinics. Over six months, 359 children who had an appointment at a general clinic were studied using a questionnaire given to parents (74% response rate) and by inspection of case notes. Based on their first appointment in the study period, children were divided into 'attenders' (n = 262) and 'non-attenders' (n = 97) for analysis. Non-attenders were significantly more likel...

  11. Intra-His bundle block: clinical, electrocardiographic, and electrophysiologic characteristics

    Andréa Eduardo M.; Atié Jacob; Maciel Washington A.; Oliveira Jr Nilson A. de; Camanho Luiz Eduardo; Belo Luís Gustavo; Carvalho Hecio Affonso de; Siqueira Leonardo; Saad Eduardo; Venancio Ana Claudia


    OBJECTIVE: To assess the clinical, electrocardiographic, and electrophysiologic characteristics of patients (pt) with intra-His bundle block undergoing an electrophysiologic study (EPS). METHODS: We analyzed the characteristics of 16 pt with second-degree atrioventricular block and symptoms of syncope or dyspnea, or both, undergoing conventional EPS. RESULTS: Intra-His bundle block was documented in 16 pt during an EPS. In 15 (94%) pt, the atrioventricular block was recorded in sinus rhythm; ...

  12. Clinical characteristics of intermediate uveitis in adult Turkish patients

    Esra; Kardes; Betul; Ilkay; Sezgin; Akcay; Kansu; Bozkurt; Cihan; Unlu; Gurkan; Erdogan; Gulunay; Akcali


    ·AIM: To describe the clinical characteristics of Turkish patients with intermediate uveitis(IU) and to investigate the effect of clinical findings and complications on final visual acuity(VA).·METHODS: We retrospectively analyzed the medical records of patients with IU who had at least 6mo of follow-up and were older than 16 y.· RESULTS: A total of 78 eyes of 45 patients were included in the study and the mean follow-up period was19.4mo. The mean age at the time of presentation was42.9s. Systemic disease associations were found in17.7% of cases; sarcoidosis(8.8%) and multiple sclerosis(6.6%) were the most common diseases. Recurrence rate(odds ratio=45.53; 95%CI: 2.181-950.58), vitritis equals to or more than 3+ cells(odds ratio =57.456; 95%CI: 4.154-794.79) and presenting with VA less than 20/40(odds ratio =43.81; 95% CI: 2.184-878.71) were also found as high risk factors for poor final VA. At the last follow-up examination, 67.9% of eyes had VA of 20/40 or better.·CONCLUSION: IU is frequently seen at the beginning of the fourth decade of life. The disease is most commonly idiopathic in adult Turkish patients. Patients with severe vitritis at presentation and patients with frequent recurrences are at high risk for poor visual outcome.

  13. Investigation of Tinnitus Patients in Italy: Clinical and Audiological Characteristics

    Francesco Martines


    Full Text Available Objective. 312 tinnitus sufferers were studied in order to analyze: the clinical characteristics of tinnitus; the presence of tinnitus-age correlation and tinnitus-hearing loss correlation; the impact of tinnitus on subjects' life and where possible the etiological/predisposing factors of tinnitus. Results. There is a slight predominance of males. The highest percentage of tinnitus results in the decades 61–70. Of the tinnitus sufferers, 197 (63.14% have a hearing deficit (light hearing loss in 37.18% of cases. The hearing impairment results of sensorineural type in 74.62% and limited to the high frequencies in 58.50%. The tinnitus is referred as unilateral in 59.93%, a pure tone in 66.99% and 10 dB above the hearing threshold in 37.7%. It is limited to high frequencies in 72.10% of the patients with sensorineural hearing loss (SNHL while the 88.37% of the patients with high-frequency SNHL have a high-pitched tinnitus (2=66.26;<.005. Conclusion. Hearing status and age represent the principal tinnitus related factors; there is a statistically significant association between high-pitched tinnitus and high-frequency SNHL. There is no significant correlation between tinnitus severity and tinnitus loudness confirming the possibility that neural connection involved in evoking tinnitus-related negative reactions are governed by conditioned reflexes.

  14. Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

    Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay


    Objective To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Methods Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Results Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). Conclusions In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. PMID:25564148

  15. Chronic Inflammatory Demyelinating Polyneuropathy in Children: A Review of Clinical Characteristics and Recommendations for Treatment

    Narges Karimi; Athena Sharifi; Ashraf Zarvani; Hamed Cheraghmakani


    Context: Chronic inflammatory demyelinating polyradiculopathy (CIDP) is an acquired and autoimmune neuropathy, characterized by a chronic, rapidly progressive, symmetric weakness. In children, abnormal gait is as a first symptom of muscle weakness. Evidence Acquisition: The diagnosis of CIDP is on the basis of clinical characteristics, electrodiagnostic that shows the severity of the disease, lumbar puncture and spine magnetic res...

  16. Clinical and Biochemical Characteristics of Children with Juvenile Idiopathic Arthritis

    Objective: To determine the clinical and biochemical characteristics of children with Juvenile Idiopathic Arthritis (JIA) at a tertiary care centre in Karachi, Pakistan. Study Design: A descriptive study. Place and Duration of Study: Paediatric Rheumatology Clinic of The Aga Khan University Hospital (AKUH), Karachi, from January 2008 to December 2011. Methodology: Clinical and laboratory profile and outcome of children less than 15 years of age attending the Paediatric Rheumatology Clinic of the Aga Khan University, Karachi with the diagnosis of Juvenile Idiopathic Arthritis according to International League against Rheumatism were studied. These children were classified into different types of JIA; their clinical and laboratory characteristics, response to therapy and outcome was evaluated. Results: Sixty eight patients satisfying the criteria of International League against Rheumatism (ILAR) for Juvenile Idiopathic Arthritis were enrolled during the study period of four consecutive years, their age ranged from 9 months to 15 years. Mean age at onset was 6.45 +- 4.03 years while mean age at diagnosis was 7.60 +- 3.93 years. Polyarticular was the most predominant subtype with 37 (54%) patients, out of these, 9 (24%) were rheumatoid factor positive. An almost equal gender predisposition was observed. Fever and arthritis were the most common presenting symptoms, with only 2 patients presenting with uveitis. Conclusion: The clinico-biochemical characteristics of JIA at the study centre showed a pattern distinct with early onset of disease, high frequency of polyarticular type and a higher rheumatoid factor (QRA) and ANA positivity in girls. (author)

  17. Autologous Immunoglobulin Therapy in Patients With Severe Recalcitrant Atopic Dermatitis: Long-Term Changes of Clinical Severity and Laboratory Parameters.

    Nahm, Dong Ho; Ahn, Areum; Kim, Myoung Eun; Cho, Su Mi; Park, Mi Jung


    This report evaluated long-term changes in clinical severity and laboratory parameters in 3 adult patients with severe recalcitrant atopic dermatitis (AD) who were treated with intramuscular injections of 50 mg of autologous immunoglobulin G (IgG) twice a week for 4 weeks (autologous immunoglobulin therapy, AIGT) and followed up for more than 2 years after the treatment. We observed the following 4 major findings in these 3 patients during the long-term follow-up after AIGT. (1) Two of the 3 patients showed a long-term clinical improvement for more than 36 weeks after AIGT with a maximum decrease in clinical severity score greater than 80% from baseline. (2) These 2 patients also showed long-term decreases in serum total IgE concentrations and peripheral blood eosinophil count for more than 36 weeks after AIGT with a maximum decrease in the two laboratory parameters of allergic inflammatory greater than 70% from baseline. (3) No significant side effect was observed during the 2 years of follow-up period after the AIGT in all 3 patients. (4) Serum levels of IgG anti-idiotype antibodies to the F(ab')₂ fragment of autologous IgG administered for the treatment were not significantly changed after AIGT in all 3 patients. These findings suggest that AIGT has long-term favorable effects on both clinical severity and laboratory parameters in selected patients with severe recalcitrant AD. Further studies are required to evaluate the clinical usefulness and therapeutic mechanism of AIGT for AD. PMID:27126731

  18. The California Verbal Learning Test: psychometric characteristics and clinical application.

    Elwood, R W


    The California Verbal Learning Test (CVLT) is a popular clinical and research test that claims to measure key constructs in cognitive psychology such as repetition learning, serial position effects, semantic organization, intrusions, and proactive interference. The psychometric characteristics of the CVLT are reviewed and related to the test's clinical utility. The utility of the CVLT is shown to be limited by its poor standardization and inflated norms. Further, the validity is limited because the CVLT uses multiple trials whereas the constructs it purports to measure are based on single-trial paradigms. The review proposes modifications to the CVLT and guidelines for its clinical use. It concludes that if the limitations of the CVLT are recognized, it can still make a useful contribution to the clinical assessment of verbal learning and memory. PMID:8653108

  19. Admissions to acute adolescent psychiatric units: a prospective study of clinical severity and outcome

    Jensen Gunnar


    Full Text Available Abstract Background Several countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units. Methods We used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA, which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score were analysed with a regression model. Results The sample comprised 192 adolescents admitted during one year (response rate 87%. Mean age was 15.7 years (range 10-18 and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4. The largest groups of main diagnostic conditions were affective (28% and externalizing (26% disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement in the HoNOSCA total score was 5.1 (SD 6.2, with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission

  20. Clinical and ultrasonographic characteristics of salivary mucoceles in 13 dogs.

    Torad, Faisal A; Hassan, Elham A


    Salivary mucocele is one of the causes of submandibular swelling in dogs and is due to a collection of mucoid saliva that has leaked from a damaged salivary gland. The purpose of this case series report was to describe the clinical and ultrasonographic characteristics of confirmed salivary mucoceles in 13 dogs admitted to the Faculty of Veterinary Medicine at Cairo University. The final diagnosis of salivary mucocele was based on aspirate cytology for all dogs and additional surgical excision for seven dogs. For dogs admitted from 2 weeks to 1 month from the onset of clinical signs, the cervical mucocele appeared as a round echogenic structure with a large volume of central anechoic content. The wall was a clearly identified hyperechoic structure surrounding the gland. For dogs admitted between 1 to 2 months from the onset of clinical signs, the volume of anechoic material appeared less than that seen in the acute cases. The overall appearance of the salivary mucocele was heterogenous. For dogs admitted after 2 months from the onset of clinical signs, the salivary mucocele appeared grainy or mottled, with a heterogenous appearance and a further decrease in anechoic content. For one dog that presented after 3 months from the onset of clinical signs, the salivary mucocele was hard on palpation and appeared hyperechoic with distal acoustic shadowing. Findings from this study indicated that ultrasonographic characteristics of salivary mucoceles in dogs vary depending on the chronological stage of the disease. PMID:23442204

  1. Solvent/detergent plasma: pharmaceutical characteristics and clinical experience.

    Liumbruno, Giancarlo Maria; Franchini, Massimo


    The solvent/detergent treatment is an established virus inactivation technology that has been industrially applied for manufacturing plasma derived medicinal products for almost 30 years. Solvent/detergent plasma is a pharmaceutical product with standardised content of clotting factors, devoid of antibodies implicated in transfusion-related acute lung injury pathogenesis, and with a very high level of decontamination from transfusion-transmissible infectious agents. Many clinical studies have confirmed its safety and efficacy in the setting of congenital as well as acquired bleeding disorders. This narrative review will focus on the pharmaceutical characteristics of solvent/detergent plasma and the clinical experience with this blood product. PMID:24844804

  2. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation

    Kammersgaard, Lars Peter; Linnemann, Mia; Tibæk, Maiken


    To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI).......To investigate timing and clinical predictors that might predict hydrocephalus emerging during rehabilitation until 1 year following severe traumatic brain injury (TBI)....

  3. Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder

    Bateman, A; Fonagy, P.


    Objective – Evidence of remission without specialized treatment for BPD is accumulating. The authors investigated whether specialized treatments are particularly indicated for patients at high levels of clinical severity. They examined the impact of clinical severity on outcomes of a randomized controlled trial of mentalization-based treatment (MBT) contrasted with supportive clinical management (SCM). Method – 134 patients were randomly allocated to MBT or SCM. The primary outcome was the ab...

  4. Clinical characteristics of sarcoidosis patients diagnosed in a university hospital

    Özlem Abakay; Abdurrahman Abakay; Abdullah Çetin Tanrıkulu; Fatih Meteroğlu; Cengizhan Sezgi; Hadice Selimoğlu Şen; Ayşe Dallı; Mehmet Kabak


    Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were nor...

  5. Clinical characteristics, prognosis and treatment for pelvic cryptorchid seminoma

    Li; Coucke, Philippe; Qian,, S.J..; Huang, Yi-Rong; Gu, Da-Zhong; Mirimanoff, René-Olivier; Yu, Zi-Hao


    Purpose: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma (PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is necessary. Methods and Materials: From 1958 to 1991,60 patients with PCS were treated at the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing. They presented with a lower abdominal mass and showed a predominance for the right side. A high proportion of patients with...

  6. Investigation of Tinnitus Patients in Italy: Clinical and Audiological Characteristics

    Francesco Martines; Daniela Bentivegna; Fabiola Di Piazza; Enrico Martines; Vincenzo Sciacca; Gioacchino Martinciglio


    Objective. 312 tinnitus sufferers were studied in order to analyze: the clinical characteristics of tinnitus; the presence of tinnitus-age correlation and tinnitus-hearing loss correlation; the impact of tinnitus on subjects' life and where possible the etiological/predisposing factors of tinnitus. Results. There is a slight predominance of males. The highest percentage of tinnitus results in the decades 61–70. Of the tinnitus sufferers, 197 (63.14%) have a hearing deficit (light hearing loss...

  7. Clinical Characteristics and Awareness of Skin Cancer in Hispanic Patients

    Javed, Saba; Javed, Syed A; Mays, Rana M; Tyring, Stephen K.


    Skin cancer in darker skin is associated with considerable morbidity and mortality. We sought to assess the clinical characteristics of cutaneous malignancy amongst Hispanic skin cancer patients and compare them to age-matched non-Hispanic Caucasians.  In this retrospective study, 150 Hispanic skin cancer patients were identified from electronic medical records and age-matched to 150 non-Hispanic Caucasian controls with skin cancer.  The incidence of actinic keratoses (AKs) in Hispanic skin c...

  8. Clinical characteristics of adult influenza inpatients in ten provinces in China and analysis of severe risk factors%中国10省(市)流感成年人住院病例的临床特征及重症危险因素分析

    姜慧; 于德山; 阮峰; 徐闻; 黄婷; 李玲; 王开利; 刘社兰; 张恒娇


    characteristics and severe case risk factors for the adult inpatient cases confirmed of influenza monitored by the sentinel surveillance system for severe acute respiratory infection (SARI) inpatient cases in ten provinces in China.Methods Epidemiology and clinical information surveys were conducted for adult cases (≥15 year old) consistent with SARI case definition,who were monitored by SARI sentinel hospitals in ten cities in China from December 2009 to June 2014,with their respiratory tract specimens collected for influenza RNA detection.Adult SARI cases were classified into influenza inpatient group and outpatient group by the detection outcomes,analyzing their demographic information,clinical and epidemiology characteristics respectively,in addition to risk factors for severe inpatient cases.Results 3 071 adult SARI cases were recruited from ten hospitals,including 240 (7.8%) cases of laboratory-confirmed influenza,most of them being A (H1N1) pdm2009 and A (H3N2) sub-types.Age M of the included influenza cases was 63 year old,47.1% of them being ≥65 seniors.144(60.0%) cases of the influenza inpatients suffered from at least one chronic underlying condition,and the proportion of emphysema (7.9%) was higher than non-influenza inpatient cases (3.8%),being statistically significant (x2=3.963,P=0.047).19.4% of the women of childbearing age infected of influenza were in pregnancy,and only 1.1% of the 240 influenza cases had been vaccinated against influenza.The proportion of sore throat and dyspnea found among influenza inpatients was higher than inpatients without influenza.17.4% of the influenza cases were accepted into ICU for treatment,with no statistical significance with non-influenza inpatient cases (P =0.160).23.1% of the influenza inpatients received an antiviral drug therapy,a figure higher than the non-influenza inpatient cases (4.8%) (P<0.001).41.5% of the inpatients developed complications,with the proportion of viral pneumonia

  9. Clinical and Epidemiologic Characteristics of Patients with Childhood Psoriazis Seen in Dermatology Clinic

    Emine Elvan Taşğın; Göknur Kalkan; Hatice Meral Ekşioğlu; Güler Vahaboğlu


    Objective: To evaluate the epidemiologic characteristics of the pediatric patients with psoriazis applied to our outpatients' clinic and compare these data with the literature. Methods: The study population consisted of 37 patients younger than 16 years with the diagnosis of psoriazis in dermatology outpatient clinic between May 2009 and December 2010. The patients were evaluated with regard to age, gender, age of onset of the disease, duration of the disease, the presence of accompanying ...

  10. The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma

    Abraham, B; Anto, JM; Barreiro, E; Bel, EHD; Bonsignore, G; Bousquet, J; Castellsague, J; Chanez, P; Cibella, F; Cuttitta, G; Dahlen, B; Dahlen, SE; Drews, N; Djukanovic, R; Fabbri, LM; Folkerts, G; Gaga, M; Gratziou, C; Guerrera, G; Holgate, ST; Howarth, PH; Johnston, SL; Kanniess, F; Kips, JC; Kerstjens, HAM; Kumlin, M; Magnussen, H; Nijkamp, FP; Papageorgiou, N; Papi, A; Postma, DS; Pauwels, RA; Rabe, KF; Richter, K; Roldaan, AC; Romagnoli, M; Roquet, A; Sanjuas, C; Siafakas, NM; Timens, W; Tzanakis, N; Vachier, [No Value; Vignola, AM; Watson, L; Yourgioti, G


    Since severe asthma is a poorly understood, major health problem, 12 clinical specialist centres in nine European countries formed a European Network For Understanding Mechanisms Of Severe Asthma (ENFUMOSA). In a cross-sectional observational study, a total of 163 subjects with severe asthma were co

  11. Characteristics of potential borosilicate glass compositions for high-level waste solidification in several countries

    Characteristics of various borosilicate glass compositions for high-level waste solidification were evaluated. There is possibility of returning to Japan the solidified high-level wastes in overseas fuel reprocessing by entrustment. In order to study the technical problems in receiving the solidified products, various potential compositions in several countries were examined. The following properties were evaluated for the basic data in preparation of the total criteria: melting characteristic, density, thermal conductivity, thermal expansion coefficient, softening temperature and leach rate. (author)

  12. Microbiological profile and clinical outcome of severe foot ulcers of diabetic inpatients

    Marivaldo Loyola Aragão(


    Full Text Available Objectives: To describe the microbiological profile and clinical outcomes of diabetic foot ulcers of inpatients of a tertiary university hospital, at Ceara, Brazil. Methods: We conducted a retrospective analysis of medical charts data of all diabetic inpatients of the Endocrine and Diabetes Unit of Walter Cantídio University Hospital (Federal University of Ceará, admitted from January, 2006 to June, 2007 for severe foot ulcers (minimum of grade 2 of Wagner`s classification, which were refractory to ambulatory treatment. Clinical data from each patient were recorded (sex, age, diabetes duration, and comorbidities as well as microbiological characteristics of foot ulcers and surgical (amputations material. Results: We identified 17 diabetic patients, all type 2, aged 58.11 ± 10.8 years and 12.4 ± 8.4 years of disease, 58.8% male. Of ulcers, 41.1% were grade 2; 35.2% grade 3; 11.7% grade 4 and 11.7% grade 5 of Wagner; 64.7% with less than 3 months of evolution. Debridement was performed in 82.3% of patients and amputation in 47%; osteomyelitis was identified in 47% of cases. All patients started empiric antibiotic therapy, where ciprofloxacin/metronidazole was the most used scheme (76.5%. Cultures were negative in 12.5% of the patients. In the positive ones, the most prevalent bacterial pathogens detected in the culture materials were: S. aureus (57.1%; S. viridans (28.7%; P. aeruginosas (28.7%; M. morganii (28.7%. The majority (75% of isolated S. aureus were methicillin-resistant, but were sensitive to vacomicin. Conclusion: We observed the presence of polymicrobial flora with a large number of multiresistant pathogens and high prevalence of osteomyelitis and amputations in diabetic patients with severe ulcers, neuropathy and peripheral vascular disease.

  13. Near Fatal Asthma: Clinical and Airway Biopsy Characteristics

    Barbers, Richard G.; Papanikolaou, Ilias C.; Michael N. Koss; Ashish Patel ,; Elton Katagihara; Maggie Arenas; Khalid Chan; Azen, Colleen G.; Sharma, Om P.


    Background. Inflammation and remodeling are integral parts of asthma pathophysiology. We sought to describe the clinical and pathologic features of near fatal asthma exacerbation (NFE). Methods. Bronchial biopsies were collected prospectively from NFE I subjects. Another NFE II group and a moderate severity exacerbation control group (ME II) were retrospectively identified—no biopsies obtained. Results. All NFE II ( = 9 ) subjects exhibited remodeling and significant inflammation (eosinophi...


    Cláudio Marins Rocha BORGES


    differences between this subgroup of patients and that comprising cases of idiopathic gastroparesis regarding any of the variables studied.ConclusionsThe demographic, clinical and etiological characteristics of Brazilian patients with gastroparesis are quite varied, but there is a predominance of women with long-standing symptoms and marked delay in gastric emptying. The type of presenting symptoms and the degree of delay in gastric emptying do not predict the etiology of gastroparesis. However, severely delayed gastric emptying in younger patients with recent symptom onset should raise the suspicion of impaired neural control of gastro-duodenal motility.

  15. Neurophysiological testing correlates with clinical examination according to fibre type involvement and severity in sensory neuropathy

    Lefaucheur, J.; Creange, A.


    Objective: To investigate a comprehensive battery of neurophysiological tests for objective evaluation of sensory neuropathies including fibre type involvement and severity, and to determine the relation between neurophysiological data and clinical examination.

  16. Site Characteristics Influencing the Translation of Clinical Research Into Clinical Practice

    Smed, Marie; Getz, Kenneth A.


    to sponsor companies and may ultimately assist in positioning new products and driving commercialization success. This study evaluates site characteristics that influence the acquisition and sharing of knowledge gained through clinical trial experience. The impact of 2 central site characteristics on...... the process of translating drug experience is assessed: site location (North America/rest of the world) and site type or setting (academic/independent). The results show that investigative sites located outside North America generate and share more knowledge than those within North America....... Furthermore, although both academic and independent sites generate the same level of knowledge, academic sites share more of this knowledge with sponsor companies. This study suggests new strategies that sponsors can leverage to drive greater transfer of clinical research knowledge into clinical practice and...

  17. Characteristics of liver cancer stem cells and clinical correlations.

    Cheng, Zhuo; Li, Xiaofeng; Ding, Jin


    Liver cancer is an aggressive malignant disease with a poor prognosis. Patients with liver cancer are usually diagnosed at an advanced stage and thus miss the opportunity for surgical resection. Chemotherapy and radiofrequency ablation, which target tumor bulk, have exhibited limited therapeutic efficacy to date. Liver cancer stem cells (CSCs) are a small subset of undifferentiated cells existed in liver cancer, which are considered to be responsible for liver cancer initiation, metastasis, relapse and chemoresistance. Elucidating liver CSC characteristics and disclosing their regulatory mechanism might not only deepen our understanding of the pathogenesis of liver cancer but also facilitate the development of diagnostic, prognostic and therapeutic approaches to improve the clinical management of liver cancer. In this review, we will summarize the recent advances in liver CSC research in terms of the origin, identification, regulation and clinical correlation. PMID:26272183

  18. Characterization of clinical-imaging characteristics of the binswanger's disease

    A review was made to go deep into the understanding of vascular dementias that behave as the second cause of dementia in practice. Binswanger's disease is one of the most important among them. Its detection has progressively increased with the continual improvement of the radiological diagnostic tools that allow to identify the ischemic damage of the hemispherical cerebral white matter and the presence of lacunar infarctions. It is a disease of chronic course and inexorably progressive that is characterized by the association of subcortical cognitive dysfunction, evidence of cerebrovascular disease, Parkinsonian rigidity and vesicle dysfunction with a characteristic imaging picture. The clinical picture and the main imaging characteristics are explained in this paper and the pathogens of the disease is briefly described

  19. Chronic lymphocytic leukemia and myeloproliferative neoplasms concurrently diagnosed: clinical and biological characteristics.

    Todisco, Gabriele; Manshouri, Taghi; Verstovsek, Srdan; Masarova, Lucia; Pierce, Sherry A; Keating, Michael J; Estrov, Zeev


    Chronic lymphocytic leukemia (CLL) and myeloproliferative neoplasms (MPN) may occur concomitantly. However, little is known about the pathobiological characteristics and interaction between the neoplastic clones in these rare cases of coinciding malignancies. We retrospectively examined the clinical and biological characteristics of 13 patients with concomitant CLL and MPN--eight primary myelofibrosis (PMF), three essential thrombocytosis (ET), and two polycythemia vera (PV)--who presented to our institution between 1998 and 2014, and tested all patients for MPN-specific aberrations, such as JAK2, MPL and CALR mutations. Along with epidemiological and molecular characterization of this rare condition, we found that JAK2 mutation can be detected 9 years prior to PMF diagnosis, suggesting that PMF clinical phenotype may require several years to develop and CLL/MPN clinical co-occurrence might be sustained by common molecular events. Some features of these patients suggest that pathobiologies of these diseases might be intertwined. PMID:26402369

  20. Clinical characteristics of patients with persistent postural-perceptual dizziness

    Roseli Saraiva Moreira Bittar


    Full Text Available INTRODUCTION: Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety. OBJECTIVE: To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness. METHODS: statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness. RESULTS: 81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%, body movements (52%, and sleep deprivation (38%. The most prevalent comorbidities were hypercholesterolemia (31%, migraine headaches (26%, carbohydrate metabolism disorders (22% and cervical syndrome (21%. DHI, State-Trait Anxiety Inventory - Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05 when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors. CONCLUSION: Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.

  1. Clinical characteristics and survival of children with Langerhans cell hystiocytosis

    Krstovski Nada


    Full Text Available INTRODUCTION Langerhans cell histiocytosis is a rare disease in children, initial presentation is variable, clinical course, prognosis and survival are mostly unpredictable. OBJECTIVE To summarise clinical characteristics and treatment results in children with Langerhans cell histiocytosis. METHOD Retrospectively there were analyzed patients with LCH diagnosed and treated at Hematology Department of University Children's Hospital in Belgrade from 1990 to 2006. Clinical presentation, therapy and survival according to Kaplan-Meier's statistical test was analysed. RESULTS 30 patients were treated, aged from 4 months to 14 years, mean 3.9 years, median 2.3 years, 18 (60% males, 12 (40% females. A single system disease was diagnosed in 16 (53% patients, of whom 6 patients with multifocal bone disease. All patients were in complete remission averagely following162 and 82 months respectively. Multisystem disease was found in 14 (47% patients. The lymph nodes and skin were more frequently involved organs than the central nervous system (diabetes insipidus, lung, liver and spleen. The number of involved organs ranged from 2 to 8, mean 4.2. Four patients died due to disease progression 3, 16, 36 and 66 months after diagnosis. Nine patents with multisystem disease were in remission with 117 months of follow-up. One patient was lost on follow-up. CONCLUSION The clinical course of patients with a single system disease is usually benign while a multisystem disease has to be aggressively treated with precise initial evaluation and staging before therapy.

  2. Characteristics of demand and psychological treatments in a university clinic

    Francisco J. Labrador


    Full Text Available The objectives of this study are to describe the most common characteristics of patients receiving psychological treatment and the treatments administered. We analyzed a sample of 856 patients at the University Psychology Clinic of the Complutense University of Madrid. Five diagnostic categories accounted for 78.4% of demand: anxiety disorders (31.9%, no diagnosis (15.4%, other problems requiring clinical attention (14.2%, mood disorders (9.5% and adaptive disorders (7.4%. A total of 17.7% presented a comorbid diagnosis and 49.3% had received treatment previously. The mean of assessment and treatment sessions was 3.5 and 12.7, respectively. The most commonly applied techniques included psychoeducation (95.1%, cognitive restructuring (74.8%, relaxation (74.4%, and control of internal dialogue (68.1%.Of the patients that had finished contact with the clinic, 68.3% were a therapeutic success. We discuss the generalization of the results and the implications for the profession and clinical practice.

  3. Clinical and the demographic characteristics of patients with alopecia areata

    Mustafa Arıca; Roza Zelal Abdioğlu; Ruken Azizoğlu Anlı; Sibel Yorgancılar


    Background and Design: In this study, our aim was to determine clinical and the demographical characteristics of the patients with alopecia areata in our region.Materials and Metods: In the study, 100 patients who received alopecia areata diagnosis with ages raging from 2 to 52 and who applied to the polyclinic of ………… Medical Faculty Dermatology Department between October and November 2009 were evaluated.Results: Of 100 patients included into the study 44 (44%) were female and 56 (56%) male....

  4. Sex differences in clinical characteristics and outcomes after myocardial infarction

    Lam, Carolyn S P; McEntegart, Margaret; Claggett, Brian;


    BACKGROUND: We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). METHODS AND RESULTS: A total of 4570 women and 10 133 men with heart failure (HF), left...... ejection fractions and similar changes in ventricular volumes from baseline to 1 month and 20 months. CONCLUSIONS: In VALIANT, the risk of HF following MI was higher in women than men after adjusting for age and comorbidities, although the risk of other fatal and non-fatal outcomes were similar. The higher...

  5. [Intracerebral tuberculoma. Clinical and x-ray computed tomographic characteristics].

    Ruelle, A; Boccardo, M; Lasio, G


    Intracranial tuberculomas have become uncommon in industrial nations, while they still have a high incidence in underdeveloped countries. Four cases of intracerebral supratentorial tuberculomas are reported in this paper. Clinical findings suggestive of tuberculosis were present in only one case. The other cases were thought to be gliomas or metastases and the diagnosis was made only after surgery. The CT scan provided a good image of the lesions whose characteristics, however, were diagnostically confusing. When a tuberculoma is suspected, medical therapy alone should be administered initially. Surgery should be resorted to in cases of markedly increased intracranial pressure. PMID:6571449

  6. Clinical characteristics of 41 patients with intractable asthma

    Bai, Li; Zhang, Xu-Sheng; Wang, Bin; Xiao-ming CHENG; Zhang, Qiao; Hua-ping CHEN; Ma, Qian-li; Zou, Li-Guang; Wang, Chang-Zheng


    Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34...

  7. Comorbid personality disorders in subjects with panic disorder: which personality disorders increase clinical severity?

    Mustafa Ozkan; Abdurrahman Altindag


    Personality disorders are common in subjects with panic disorder. Personality disorders have shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders effect clinical severity in subjects with panic disorder. This study included 122 adults (71 female, 41 male), who met DSM-IV criteria for panic disorder (with or without agoraphobia). Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders...

  8. Sociodemographic and clinical characteristics of patients with recurrent aphthous stomatitis

    Anıl Gülsel Bahalı


    Full Text Available Background and Design: The purpose of this study was to obtain data that may provide an insight into the etiopathogenesis of recurrent aphtous stomatitis (RAS by the way of analysing the sociodemographic and clinical characteristics of patients who had been diagnosed with RAS. Materials and Metods: The patients, who were diagnosed with RAS in the dermatology outpatient clinic, between May 2007 and May 2010, were evaluated retrospectively. The data including sociodemografic and clinical characteristics, and treatment options were recorded. Results: A hundred patients (68 women, 32 men were included in this study. The average age was 40±13.6 years. RAS was more common in patients with middle-income and low education. The most common type of RAS was minor aphtous ulcers (88%. The lesions were most frequently seen on the lateral side of the tongue (34% and cheek (34%. Sixty percent of patients had a positive family history. Some factors such as biting (12%, tooth brushing (18%, dental disease presence (82%, food (39%, menstruation (10.3%, stress (76%, iron deficiency (16.7%, vitamin B12 deficiency (22.4%, low serum ferritin levels (18%, and seasonal variability (32% showed positive correlation with RAS. A negative correlation was found between RAS and smoking. Forty-nine percent of patients had used alternative therapies in addition to drug therapy. The most frequently used alternative method was consumption of sumac (26.5%. Conlucions: In contrast to the literature, our study found that RAS is started in the third decade of life and, approximately 50% of patients prefered alternative treatment methods, particularly sumac. Nowadays, discussions about the etiopathogenesis of RAS continue. In this study, we found that different sociodemographic and clinical factors may be associated with the etiopathogenesis of the disease. Our study will be followed by further studies using prospective design to identify the the etiopathogenesis of RAS.

  9. CT scan in severe diffuse head injury: physiological and clinical correlations.

    Teasdale, E; Cardoso, E.; Galbraith, S; Teasdale, G.


    CT scan findings, clinical features and intracranial pressure were studied in patients with severe diffuse head injury. Compression of the 3rd ventricle and basal cisterns closely correlated with an intracranial pressure greater than 20 mmHg, with clinical signs of midbrain dysfunctions and worse prognosis. These CT scan findings can indicate whether intracranial pressure monitoring is appropriate.

  10. Unique metabolic characteristics of the major syndromes of severe childhood malnutrition

    The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus, kwashiorkor and marasmic-kwashiorkor. Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to treat and have high morbidity and mortal...

  11. Associations of White Matter Microstructure with Clinical and Demographic Characteristics in Heavy Drinkers

    Monnig, Mollie A.; Yeo, Ronald A.; Tonigan, J. Scott; McCrady, Barbara S.; Thoma, Robert J.; Sabbineni, Amithrupa; Hutchison, Kent E.


    Damage to the brain’s white matter is a signature injury of alcohol use disorders (AUDs), yet understanding of risks associated with clinical and demographic characteristics is incomplete. This study investigated alcohol problem severity, recent drinking behavior, and demographic factors in relation to white matter microstructure in heavy drinkers. Magnetic resonance imaging (MRI) scans, including diffusion tensor imaging (DTI), were collected from 324 participants (mean age = 30.9 ± 9.1 year...

  12. Anaphylaxis to Iodinated Contrast Media: Clinical Characteristics Related with Development of Anaphylactic Shock

    Kim, Min-Hye; Lee, Suh-Young; Lee, Seung-Eun; Yang, Min-Suk; Jung, Jae-Woo; Park, Chang Min; Lee, Whal; Cho, Sang-Heon; Kang, Hye-Ryun


    Objective Anaphylaxis is the most severe form of radiocontrast media (RCM) induced hypersensitivity and can be life-threatening if profound hypotension is combined. With increased use of iodine based RCM, related hypersensitivity is rapidly growing. However, the clinical characteristics and risk factors of RCM induced anaphylaxis accompanied by hypotension (anaphylactic shock) are not clearly defined. This study was performed to investigate the risk factors of RCM induced anaphylactic shock a...

  13. Clinical Characteristics of Children and Adolescents with a Primary Tic Disorder

    Specht, Matt W.; Woods, Douglas W; Piacentini, John; Scahill, Lawrence; Wilhelm, Sabine; Peterson, Alan L.; Chang, Susanna; Kepley, Hayden; Deckersbach, Thilo; Flessner, Christopher; Brian A. Buzzella; McGuire, Joseph F.; Levi-Pearl, Sue; Walkup, John T.


    The clinical characteristics and rates of co-occurring psychiatric conditions in youth seeking treatment for a chronic tic disorder (CTD) were examined. Children and adolescents (N = 126) with a primary CTD diagnosis were recruited for a randomized controlled treatment trial. An expert clinician established diagnostic status via semi-structured interview. Participants were male (78.6%), Caucasians (84.9%), mean age 11.7 years (SD = 2.3) with moderate-to-severe tics who met criteria for Touret...

  14. Clinical characteristics of two probable cases of Angelman syndrome in the Hospital Nacional de Ninos

    Angelman Syndrome is a severe neurological disorder. No other case has been reported in our country until now. There are two children reported with the clinical suspicion of Angelman Syndrome. They were treated at the Departamento de Neurologia del Hospital Nacional de Ninos. The information was taken from their medical records. The two patients present the four cardinal clinical features, including severe developmental delay, profound speech impairment, ataxia and a happy, sociable disposition. In addition, the patients displayed other characteristics: seizures associated with a typical spike and slow wave activity on EEG an love for water. The clinical diagnosis is difficult because other disorders can mimic the features of Angelman Syndrome. Nonetheless, at an early age, the behavioral phenotype of happy disposition and hyperexcitability is the most important manifestation and appears to be decisive in the differential diagnosis of patients with psychomotor and language delay. (author)

  15. Clinical characteristics and prognosis of severe retinopathy of prematurity with birth mass more than 1500 g%出生体质量超过1500g早产儿严重ROP的发病特点及治疗预后

    李志强; 张国明; 唐松; 曾键


    目的 研究出生体质量超过1 500 g早产儿严重早产几视网膜病变(retinopathyof prematurity,ROP)发病特点及其治疗预后.方法 收集2006年1月至2009年6月在我院进行激光光凝治疗的阈值、阈值前1型或急进型后部ROP(aggressive posterior ROP,AP-ROP)患儿中,选择出生体质量>1500g患儿,对其性别、胎龄、出生体质量、母体和患儿全身疾病情况等危险因素进行分析,并对其治疗效果进行评价.结果 共收集患儿33例,男26例,女7例;胎龄28.0~34.3周,平均31.0周;出生体质量为1 500~2 000 g,平均1 700 g;割宫产19例,顺产14例.所有患儿均有吸氧史,母体合并全身疾病者27例;术前诊断13例26眼为阈值前1型ROP,3例6眼为AP-ROP,17例34眼为阈值ROP.26例52眼患儿一次光凝成功.5例10眼补充光凝成功,1例2眼经Avastin玻璃体腔注射后病变稳定,1例2眼病变发展至4期和5期行玻璃体手术后病情控制、稳定.结论 出生体质量超过1500 g早产儿惠严重ROP现象反映本地区ROP防治水平低,早产儿出生前母体全身情况不稳定是造成ROP发病的重要原因之一,该类型ROP病变一般较轻,治疗预后较好.%Objective To study the clinical characteristics and prognosis of severe retinopathy of prematurity (ROP) with birth mass more than 1 500 g. Methods From January 2006 to June 2009, the cases with birth mass greater than or equal to 1 500 g from all the infants in our hospital,who suffered from threshold,pre-threshold (type 1) or aggressive posterior ROP, were selected and underwent laser photocoagulation. The risk factors such as gender,gestational age,birth mass,maternal or infantile systemic disease were analyzed,and their therapeutic efficacy were evaluated. Results Thirty-three cases were found,26 cases were male,7 cases were female; Gestational age were from 28.0 weeks to 34.3 weeks,mean 31.0 weeks;birth mass were from 1 500 g to 2 000 g.meanl 700 g;Nineteen cases were born by caesarean

  16. Educational paper: The expanding clinical and immunological spectrum of severe combined immunodeficiency

    M. van der Burg (Mirjam); A.R. Gennery (Andy R.)


    textabstractSevere combined immunodeficiency (SCID) is one of the most severe forms of primary immunodeficiency characterized by absence of functional T lymphocytes. It is a paediatric emergency, which is life-threatening when recognized too late. The clinical presentation varies from the classical

  17. Clinical Characteristics of Epidermoid Cysts of the External Auditory Canal

    Kim, Go-Woon; Park, Jang-Hee; Kwon, Oh-Joon; Kim, Dong Hyun


    Background and Objectives The epidermoid cyst is a common benign disease of the skin caused by inflammation of hair cortex follicles and proliferation of epidermal cells within the dermis or superficial subcutaneous tissue. The purpose of this study was to investigate the characteristics of epidermoid cysts of the external auditory canal (EAC) by analyzing the clinical and radiologic features. Subjects and Methods The clinical records were retrospectively reviewed for patients diagnosed with epidermoid cyst of the EAC from March 2004 to December 2013. The epidermoid cysts were diagnosed clinically by endoscopy and microscopy examinations and by temporal bone CT images, and were confirmed by histopathologic examination. Characteristics of epidermoid cysts in bony EAC and cartilaginous EAC were compared. Results Eight patients had an epidermoid cyst in the bony EAC and nine patients had one in the cartilaginous EAC. Swelling and otalgia were common symptoms, but 47% of cysts were found incidentally. The mean age of patients was 49.6 years (age range, 26-67 years) in the bony EAC cases and 26.1 years (age range, 6-57 years) in the cartilaginous EAC cases. The mean size of the epidermoid cyst was 3.50 mm (size range, 2-7 mm) in the bony EAC cases and 9.55 mm (size range, 2-20 mm) in the cartilaginous EAC cases. Conclusions Comparison of epidermoid cysts of the bony EAC and the cartilaginous EAC revealed that epidermoid cysts of the bony EAC is usually found incidentally, arose in older patients and had smaller size. PMID:27144232

  18. Clinical characteristics and outcome of cancer diagnosed during pregnancy

    Shim, Min Hee; Mok, Chi-Won; Chang, Kylie Hae-Jin; Sung, Ji-Hee; Oh, Soo-young; Roh, Cheong-Rae; Kim, Jong-Hwa


    Objective The aim of this study is to describe the clinical characteristics and outcome of cancer diagnosed during pregnancy. Methods This is a retrospective cohort study of women who were diagnosed with cancer during pregnancy at a tertiary academic hospital between 1995 and 2013. Maternal characteristics, gestational age at diagnosis, and type, stage, symptoms and signs of cancer for each patient were retrieved from the medical records. The cancer treatment, pregnancy management and the subsequent perinatal and maternal outcomes for each cancer were assessed. Results A total of 87 women were diagnosed with cancer during pregnancy (172.6 cases per 100,000 deliveries). The most common cancer was breast cancer (n=20), followed by gastrointestinal (n=17), hematologic (n=13), thyroid (n=11), central nervous system (n=7), cervical (n=7), ovarian (n=5), lung (n=3), and other cancers (n=4). Eighteen (20.7%) patients terminated their pregnancies. In the 69 (79.3%) patients who maintained their pregnancies, one patient miscarried and 34 patients delivered preterm. Of the preterm babies, 24 (70.6%) were admitted to the neonatal intensive care unit and 3 (8.8%) of those expired. The maternal mortality rate was 31.0%, with highest rate seen with lung cancers (66.7%), followed by gastrointestinal (50.0%), central nervous system (50.0%), hematologic (30.8%), breast (25.0%), ovarian (20.0%) cervical (14.3%), and thyroid cancers (0%). Conclusion The clinical characteristics and outcome of cancer during pregnancy were highly variable depending on the type of cancer. However, timely diagnosis and appropriate management of cancer during pregnancy may improve both maternal and neonatal outcome. PMID:26866029

  19. Time characteristics of photon fields at a nuclear medicine clinic

    The radiation fields were measured at the Nuclear Medicine Clinic of the Faculty Hospital in Prague-Motol. Gamma photons from iodine 131 administered to the patients is the main contributor to the fields. The dose rates at short distances from the patients can be as high as 20 mSv/h, whereby the cumulated doses to the health care personnel can exceed the annual limits for professional exposures. It is very important that unnecessary close contact with the patients be avoided unless emergency of other urgent procedures are required. Administration of high activities to several patients sharing a room in the ward should also be taken into account when handling the patients (including food service, housekeeping, changing linen, etc.). In normal circumstances, the radiation level in corridors and at other places accessible to cancer patients within the clinic are usually below 5 μSv/h averaged for 1 min intervals. (P.A.)

  20. Fixation of a severely resorbed mandible for complete arch screw-retained rehabilitation: A clinical report.

    Fabris, Vinicius; Bacchi, Atais


    Severely resorbed mandibles with placed endosteal dental implants can fracture. Therefore, techniques to reduce the risk or minimize the consequences of these fractures are needed. This clinical report presents a technique for placing a titanium plate in a severely resorbed mandible subjected to complete-arch implant therapy. The titanium plate is placed in the same surgical procedure as the implants, allowing immediate implant loading. This technique provides safe implant-supported treatment for patients with severe mandibular resorption. PMID:26775245

  1. Severe reactions to foods in childhood : clinical perspectives, epidemiology and risk management

    Vetander, Mirja


    Food allergy is a public health issue, particularly among children, and seems to be increasing worldwide. Allergic reactions to foods vary in terms of symptoms and severity. Anaphylaxis, the most severe allergic reaction, can be fatal. Food allergy has significant negative impact in the daily lives of allergic children and their families. The overall aim of this thesis was to gain knowledge about severe reactions to foods among Swedish children with regard to epidemiology, clinical per...

  2. Clinical and genetic characteristics of craniosynostosis in Hungary.

    Bessenyei, Beáta; Nagy, Andrea; Szakszon, Katalin; Mokánszki, Attila; Balogh, Erzsébet; Ujfalusi, Anikó; Tihanyi, Mariann; Novák, László; Bognár, László; Oláh, Éva


    Craniosynostosis, the premature closure of cranial sutures, is a common craniofacial disorder with heterogeneous etiology and appearance. The purpose of this study was to investigate the clinical and molecular characteristics of craniosynostoses in Hungary, including the classification of patients and the genetic analysis of the syndromic forms. Between 2006 and 2012, 200 patients with craniosynostosis were studied. Classification was based on the suture(s) involved and the associated clinical features. In syndromic cases, genetic analyses, including mutational screening of the hotspot regions of the FGFR1, FGFR2, FGFR3, and TWIST1 genes, karyotyping and FISH study of TWIST1, were performed. The majority (88%) of all patients with craniosynostosis were nonsyndromic. The sagittal suture was most commonly involved, followed by the coronal, metopic, and lambdoid sutures. Male, twin gestation, and very low birth weight were risk factors for craniosynostosis. Syndromic craniosynostosis was detected in 24 patients. In 17 of these patients, Apert, Crouzon, Pfeiffer, Muenke, or Saethre-Chotzen syndromes were identified. In one patient, multiple-suture craniosynostosis was associated with achondroplasia. Clinical signs were not typical for any particular syndrome in six patients. Genetic abnormalities were detected in 18 syndromic patients and in 8 relatives. In addition to 10 different, known mutations in FGFR1,FGFR2 or FGFR3, one novel missense mutation, c.528C>G(p.Ser176Arg), was detected in the TWIST1 gene of a patient with Saethre-Chotzen syndrome. Our results indicate that detailed clinical assessment is of paramount importance in the classification of patients and allows indication of targeted molecular testing with the highest possible diagnostic yield. PMID:26289989

  3. Can Psychological, Social and Demographical Factors Predict Clinical Characteristics Symptomatology of Bipolar Affective Disorder and Schizophrenia?

    Maciukiewicz, Malgorzata; Pawlak, Joanna; Kapelski, Pawel; Łabędzka, Magdalena; Skibinska, Maria; Zaremba, Dorota; Leszczynska-Rodziewicz, Anna; Dmitrzak-Weglarz, Monika; Hauser, Joanna


    Schizophrenia (SCH) is a complex, psychiatric disorder affecting 1 % of population. Its clinical phenotype is heterogeneous with delusions, hallucinations, depression, disorganized behaviour and negative symptoms. Bipolar affective disorder (BD) refers to periodic changes in mood and activity from depression to mania. It affects 0.5-1.5 % of population. Two types of disorder (type I and type II) are distinguished by severity of mania episodes. In our analysis, we aimed to check if clinical and demographical characteristics of the sample are predictors of symptom dimensions occurrence in BD and SCH cases. We included total sample of 443 bipolar and 439 schizophrenia patients. Diagnosis was based on DSM-IV criteria using Structured Clinical Interview for DSM-IV. We applied regression models to analyse associations between clinical and demographical traits from OPCRIT and symptom dimensions. We used previously computed dimensions of schizophrenia and bipolar affective disorder as quantitative traits for regression models. Male gender seemed protective factor for depression dimension in schizophrenia and bipolar disorder sample. Presence of definite psychosocial stressor prior disease seemed risk factor for depressive and suicidal domain in BD and SCH. OPCRIT items describing premorbid functioning seemed related with depression, positive and disorganised dimensions in schizophrenia and psychotic in BD. We proved clinical and demographical characteristics of the sample are predictors of symptom dimensions of schizophrenia and bipolar disorder. We also saw relation between clinical dimensions and course of disorder and impairment during disorder. PMID:26646576

  4. Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

    Lee, Ing-Kit; Liu, Jien-Wei; Chen, Yen-Hsu; Chen, Yi-Chun; Tsai, Ching-Yen; Huang, Shi-Yu; Lin, Chun-Yu; Huang, Chung-Hao


    We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD) (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment). We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days) and 2 (dengue illness >4 days). In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from -2 to +6 points) showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC) of 0.848 (95% confidence interval [CI], 0.771-0.924). The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points), significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756-0.963), with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%). The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825-0.983) and 0.917 (95% CI, 0.833-1.0) in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts) were 50% for those with a score of ≥2 points, irrespective of

  5. Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients.

    Ing-Kit Lee

    Full Text Available We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment. We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days and 2 (dengue illness >4 days. In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from -2 to +6 points showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC of 0.848 (95% confidence interval [CI], 0.771-0.924. The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points, significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756-0.963, with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%. The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825-0.983 and 0.917 (95% CI, 0.833-1.0 in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts were 50% for those with a score of ≥2 points

  6. Clinical characteristics, diagnosis and management of respiratory distress syndrome in full-term neonates

    FENG Zhi-chun; SHI Yun; DONG Jian-ying; ZHENG Tian; LI Jing-ya; LU Li-li; LIU Jing-jing; LIANG Jing; ZHANG Hao


    Background Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death, however, its clinical characteristics are very different from premature RDS, and these characteristics have not been well documented as yet. This study was to investigate the pathogenesis, clinical characteristics and management strategies of RDS in full-term neonates, with the aim of developing a working protocol for improving the outcome in full-term neonates with RDS.Methods A total of 125 full-term infants with RDS were enrolled in this study. Their clinical and laboratory data were collected for analyzing the characteristics of full-term neonatal RDS.Results (1) The 125 cases included 94 male and 31 female infants, vaginal delivery occurred in 80 cases and cesarean section in 45 cases. (2) The onset time of RDS was (3.11±3.59) hours after birth. (3)The possible reasons included severe perinatal infections in 63 patients, elective cesarean section in 34 cases, severe birth asphyxia in 12 patients,meconium aspiration syndrome in 9 patients, pulmonary hemorrhage in 4 patients and matemal diabetes in 3 patients. (4)Complications included multiple organ system failure (MOSF) in 49 patients, persistent pulmonary hypertension of newborn (PPHN) in 25 patients, acute renal failure in 18 patients, severe hyperkalemia in 25 patients, severe metabolic acidosis in 6 cases, severe myocardial injury in 9 cases, pulmonary hemorrhage in 3 cases, disseminated intravascular coagulation in 14 patients and shock in 12 patients.(5) Four patients died, the mortality was therefore 3.2% with the main cause of septicemia complicating of MOSF, but their prognosis was improved while comprehensive treatment measures including early mechanical ventilation and broad spectrum antibiotics were taken into account.Conclusions RDS is not an uncommon disease in full-term infants and is associated with a higher mortality, its clinical characteristics are very


    Huang, Kaiyong; Liang, Wenjie; Han, Shanshan; Abdullah, Abu S; Yang, Li


    This study aimed to assess the relationships between road traffic injury severity and individual characteristics in Liuzhou, a city in southern China. Data for this study were collected from the Guangxi Public Security Bureau Traffic Police Corps. Multivariate ordinal logistic regression analysis was used. Of all 14,595 individuals involved in accidents, males, motor vehicle drivers, motorcyclists, and those aged 21-45 years accounted for the great proportion of all injuries. Children, the elderly, pedestrians, farmers and migrant workers, unemployed people, and novice drivers were at higher risk of serious injury in crashes. These findings suggest that individual characteristics (age, modes of transport, profession, driving experience) are strongly related to injury severity. To address road traffic related mortality and injuries, there is a need to develop policy strategies, strengthen road supervision, and improve public consciousness of road safety. PMID:26867372

  8. Characteristics of the aerosols released to the environment after a severe PWR accident

    In the event of a postulated severe accident on a pressurized water reactor (PWR) involving fuel degradation, gases and aerosols containing radioactive products could be released, with short, medium and long term consequences for the population and the environment. Under such accident conditions, the ESCADRE code system, developed at IPSN (Institute for Nuclear Safety and Protection) can be used to calculate the properties of the substances released and, especially with the AEROSOLS/B2 code, the main characteristics of the aerosols (concentration, size distribution, composition). For conditions representative of severe PWR accidents, by varying different main parameters (structural material aerosols, steam condensation in the containment, etc...), indications are given on the range of characteristics of the aerosols (containing notably Cs, Te, Sr, Ru, etc...) released to the atmosphere. Information is also given on how more accurate data (especially on the chemical forms) will be obtainable in the framework of current or planned experimental programs (HEVA, PITEAS, PHEBUS PF, etc...)

  9. Characteristic Features of Severe Child Physical Abuse-A Multi-informant Approach

    Annerbäck, Eva-Maria; Svedin, Carl Göran; Gustafsson, Per


    Minor child physical abuse has decreased in Sweden since 1979, when a law banning corporal punishment of children was passed, but more serious forms have not decreased. The aim of this study was to examine risk and background factors in cases of severe child abuse reported to the police. Files from different agencies (e.g., Social services, Adult and Child psychiatry and Pediatric clinic) for 20 children and 34 caretakers were studied. An accumulation of risk factors was found. It is conclude...


    Lopukhov, P D; Briko, N I; Khaldin, A A; Tsapkova, N N; Lupashko, O V


    Papillomaviruses are a large and diverse group of viruses. It includes approximately 200 fully described types that have been detected in humans. Human papilloma viruses (HPV) are etiologic agents during various, benign and malignant lesions of mucous membrane and skin epithelium. Very importantly, persistent HPV infection of certain types is a leading cause of carcinoma of uterine cervix, penis, vulva; vagina, anal canal and fauces (including tongue base and tonsils). HPV infection prophylaxis is the best means to control HPV-conditioned diseases, and vaccination, as had been demonstrated, --the most effective method of its prophylaxis. In this paper principle characteristics and clinical manifestations of papillomavirus infection, as well as effectiveness of vaccination against HPV are examined. PMID:27029121

  11. Shadow of trouble : the effect of pre-recession characteristics on the severity of recession impact

    Knudsen, Eirik Sjåholm


    The recent financial crisis has heightened the need to understand why some firms are more severely affected by recessions than others and how different firm and industry characteristics affect firms’ vulnerability to such shocks. To study these questions empirically, we complement secondary financial data with primary data from an extensive questionnaire about the effects of the recent recession distributed to 5000 Norwegian CEOs in late 2010. We find that high pre-recession operating profit...

  12. Estimate of radionuclide release characteristics into containment under severe accident conditions

    A detailed review of the available light water reactor source term information is presented as a technical basis for development of updated source terms into the containment under severe accident conditions. Simplified estimates of radionuclide release and transport characteristics are specified for each unique combination of the reactor coolant and containment system combinations. A quantitative uncertainty analysis in the release to the containment using NUREG-1150 methodology is also presented

  13. Estimate of radionuclide release characteristics into containment under severe accident conditions. Final report

    Nourbakhsh, H.P. [Brookhaven National Lab., Upton, NY (United States)


    A detailed review of the available light water reactor source term information is presented as a technical basis for development of updated source terms into the containment under severe accident conditions. Simplified estimates of radionuclide release and transport characteristics are specified for each unique combination of the reactor coolant and containment system combinations. A quantitative uncertainty analysis in the release to the containment using NUREG-1150 methodology is also presented.

  14. Clinical characteristics of patients in the persistent vegetative state.

    Tresch, D D; Sims, F H; Duthie, E H; Goldstein, M D; Lane, P S


    Little is known concerning the specific clinical characteristics of patients in persistent vegetative states (PVS). Fifty-one patients from four nursing homes, approximately 3% of the total patients, were identified as being in a PVS. The mean age of the patients was 64.8 +/- 3.2 years (range, 19 to 96 years) and the mean duration of the PVS was 3.3 +/- 5.0 years (range, 1 to 16.8 years), with 13 patients' PVS being longer than 5 years. Cerebrovascular accidents and dementia were the most common causes of the PVS, accounting for 32 of the cases (63%). In the younger patients cerebral trauma secondary to motor vehicle accidents was the most common cause. All 51 patients were fed via tube feeding and 35 patients had urinary catheters (75%). All patients were receiving daily medications, with greater than 50% taking daily vitamins. Over 30% were taking digitalis and/or diuretics and over 32% were taking H2 blockers. Transfer of patients to an acute care hospital was not uncommon, with 31 patients (61%) requiring 63 acute care hospitalizations during their stay in the nursing home. As expected, infections were the most common reason for acute care hospitalization, although 15 of the patients were hospitalized for surgical procedures. Another common problem encountered by the patients was pressure sores, with 78% of patients requiring specific therapy for at least one pressure sore. Surprisingly, only 27 (53%) of 51 patients had a specific resuscitation status designation in the medical chart, and neither presence of a chart designation nor specific resuscitation order was related to the patient's age or the cause or duration of PVS. From these data it would appear that clinical characteristics of patients in PVS are variable. Some patients are young, others are old. The cause varies from cerebrovascular accidents to cerebral trauma. Survival may be prolonged; complications are not uncommon, with some patients requiring acute care hospitalization. PMID:2025140

  15. Isolation Frequency Characteristics of Candida Species from Clinical Specimens

    Kim, Ga-Yeon; Jeon, Jae-Sik


    Candida spp. is an invasive infectious fungus, a major risk factor that can increase morbidity and mortality in hospitalized patients. In this study, 2,508 Candida spp. were isolated from various clinical specimens collected from university hospitals from July 2011 to October 2014. They were identified in order to determine isolation frequencies and characteristics by specimen, gender, age group, year, season, and month. The strain-specific isolation rate of Candida spp. is in the order of Candida albicans (1,218 strains, 48.56%), Candida glabrata (416 strains, 16.59%), Candida utilis (305 strains, 12.16%), Candida tropicalis (304 strains, 12.12%), and Candida parapsilosis (116 strains, 4.63%) and these five species accounted for more than 94% of the total strains. Of the specimens, Candida spp. were most frequently isolated from urine-catheter, followed by urine-voided, blood, sputum, other, open pus, vaginal discharge, Tip, ear discharge, bronchial aspiration and bile, in that order. Looking at the age distribution, the detection rate of patients in their 60s and older was significantly higher at 75.8% (1,900/2,508). The detection rate of patients in their 20s and younger was shown to be very low at 2.55% (64/2,508). By year, the detection rate of non-albicans Candida spp. showed a tendency to gradually increase each year compared with C. albicans. As isolation of Candida spp. from clinical samples at the specie level can vary depending on characteristics of the patient, sample, season, etc., continual studies are required. PMID:27433120

  16. Clinical characteristics of 41 patients with intractable asthma

    Li BAI


    Full Text Available Objective To explore the clinical characteristics of intractable asthma,and to provide new knowledge for diagnosis and treatment of the disease.Methods Forty one patients with intractable asthma,admitted to the Institute of Respiratory Disease,Xinqiao Hospital of Third Military Medical University from Jan.2009 to Dec.2010,were included in present study.Spirometry tests were performed for all the 41 patients.Cell classification and counting were done in the induced sputum of 37 patients,and 34 patients underwent high-resolution chest computed tomography(HRCT.Results Incomplete reversibility of airflow obstruction(FEV1/FVC 0.03 of the total cells,13(35.1% and increased neutrophils( > 0.61 of total cells,6(16.2% showed increased both eosinophils and neutrophils,and only that of one patient showed normal percentage of the eosinophils and neutrophils.Chest HRCT of 34 patients showed thickening of bronchial wall in visible segment in 28 cases(82.3%,and in 22 cases(64.7% thickening of bronchial wall in secondary segments was accompanied with narrowed bronchus lumen,cylindrical bronchiectasis was predominant in 7 patients,and centrilobular emphysema was seen in 5 patients.Conclusion Airway remodeling,incomplete reversibility of airflow obstruction,airway inflammation appear to be the major clinical characteristics of intractable asthma.Combined use of chest HRCT,spirometry test,and cellular analysis of induced sputum may be helpful for identifying intractable asthma,and they provide the basis for individualized strategies to manage the disease.

  17. Clinical characteristics of 4355 patients with anterior cruciate ligament injury

    MEI Yu; AO Ying-fang; WANG Jian-quan; MA Yong; ZHANG Xin; WANG Jia-ning; ZHU Jing-xian


    Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs.24.95%,P<0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P<0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle,18.30% double-bundle).Three hundred and forty-five patients (7.92%)were combined with other ligaments injuries,2667 (61.24%) were found with various grades of cartilage lesions,and 3377 (77.54%) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.

  18. An Inverse Relationship Between Ceramide Synthesis and Clinical Severity in Patients with Psoriasis

    Cho, Yunhi; Lew, Bark-Lynn; Seong, Kyunghwa; Kim, Nack-In


    Ceramides play major roles in maintaining the epidermal barrier. It has been sus-pected that the depletion of ceramides, associated with disrupted barrier function in the epidermis, leads to the clinical manifestation of dryness and inflammation seen in patients with psoriasis. The aim of the present study was to determine the relation-ship between the level of ceramide synthesis in the epidermis and the clinical severity in patients with psoriasis. Samples from lesional and unlesional epider...

  19. Evaluation of Acne Quality of Life and Clinical Severity in Acne Female Adults

    Amal Kokandi


    Acne is a common disease especially among teenagers. It has a considerable psychological impact on affected individuals. The aim of this paper was to assess if the effect of acne on acne-related quality of life is correlated to acne clinical severity. 112 university female students attending the university medical clinics with acne complaints were examined. Cardiff Acne Disability Index (CADI) was used to assess acne-related quality of life, and global acne grading system (GAGS) was used to a...

  20. Association between Image Characteristics on Chest CT and Severe Pleural Adhesion during Lung Cancer Surgery.

    Kwang Nam Jin

    Full Text Available The aim of this study was to investigate the association between image characteristics on preoperative chest CT and severe pleural adhesion during surgery in lung cancer patients. We included consecutive 124 patients who underwent lung cancer surgeries. Preoperative chest CT was retrospectively reviewed to assess pleural thickening or calcification, pulmonary calcified nodules, active pulmonary inflammation, extent of emphysema, interstitial pneumonitis, and bronchiectasis in the operated thorax. The extent of pleural thickening or calcification was visually estimated and categorized into two groups: localized and diffuse. We measured total size of pulmonary calcified nodules. The extent of emphysema, interstitial pneumonitis, and bronchiectasis was also evaluated with a visual scoring system. The occurrence of severe pleural adhesion during lung cancer surgery was retrospectively investigated from the electrical medical records. We performed logistic regression analysis to determine the association of image characteristic on chest CT with severe pleural adhesion. Localized pleural thickening was found in 8 patients (6.5%, localized pleural calcification in 8 (6.5%, pulmonary calcified nodules in 28 (22.6%, and active pulmonary inflammation in 22 (17.7%. There was no patient with diffuse pleural thickening or calcification in this study. Trivial, mild, and moderate emphysema was found in 31 (25.0%, 21 (16.9%, and 12 (9.7% patients, respectively. Severe pleural adhesion was found in 31 (25.0% patients. The association of localized pleural thickening or calcification on CT with severe pleural adhesion was not found (P = 0.405 and 0.107, respectively. Size of pulmonary calcified nodules and extent of emphysema were significant variables in a univariate analysis (P = 0.045 and 0.005, respectively. In a multivariate analysis, moderate emphysema was significantly associated with severe pleural adhesion (odds ratio of 11.202, P = 0.001. In conclusion

  1. Clinical and laboratory characteristics of children with Kawasaki disease

    Fatih Akın


    Full Text Available Objective: In this study, we aimed to evaluate clinical and laboratory characteristics of patients with Kawasaki disease (KD in Konya region of Turkey. Methods: The hospital records of patients who were hospitalized with the diagnosis of KD in the Pediatrics Clinics of Konya Training and Research Hospital between May 2010 and June 2012 were reviewed retrospectively. Results: Seven cases were found to have the diagnosis of KD, two of whom were incomplete KD. Oropharynx changes were the most common (100% feature in our patients. Five (71% patients had bulbar conjunctivitis. Three (43% patients had erythema at the site of BCG inoculation. Adenopathy was present in all of our patients with the classical form. A desquamation was observed in one case at the seventh day of fever. No cardiac manifestation was seen. Elevated erythrocyte sedimentation rate and thrombocytosis were present in all patients. All of the patients were received intravenous immunoglobulin in the first ten days of the fever. Conclusion: KD should be considered as a possible diagnosis in any child presenting with prolonged fever. BCG reaction can be attributed as a diagnostic criterion for incomplete form of the disease especially in countries where BCG vaccination is routinely performed. Early treatment is essential to prevent cardiovascular complications.

  2. Clinical and molecular characteristics of pyometra in female dogs.

    Hagman, R


    Pyometra is a common disease of female dogs. In Sweden, where approximately 90% of the dog population is intact (not neutered), nearly 25% of all female dogs are diagnosed with the disease before 10 years of age. In certain high-risk breeds, this risk of developing pyometra exceeds 50%. Various clinical signs associated with the genital tract as well as with systemic disease are present in dogs with pyometra. A frequent and serious consequence of the uterine infection is endotoxaemia and progression into the systemic inflammatory response syndrome (SIRS), or sepsis, and the disease is then regarded as a medical emergency. Acute phase proteins and inflammatory markers associated with SIRS and with the outcome as measured by length of hospitalization have been identified in blood samples. Recently, the inflammatory response in infected uterine tissue during pyometra has been more closely explored. The expression of many genes associated with chemokines, cytokines, inflammatory cell extravasation, anti-bacterial action, the complement system and innate immune responses and also a large panel of proteases are upregulated in the uterine tissue in pyometra. Products of certain upregulated genes may be detected systemically and used for diagnostic or prognostic purposes provided that tests are developed in the future. More knowledge of the complex local and systemic inflammatory response in pyometra may allow identification of novel disease biomarkers or future targets for treatment. In this article, clinical as well as molecular characteristics of the disease are reviewed. PMID:23279529

  3. Clinical features and MRI characteristics in patients with cardiac amyloidosis

    Objective: To observe the clinical features and cardiac magnetic resonance (CMR) imaging characteristics in patients with cardiac amyloidosis. Methods: A total of 5 patients (4 males and 1 female) with the diagnosis of cardiac amyloidosis (3 were proven by heart transplantation, 2 by endomyocardial biopsy) were evaluated by electrocardiogram, echocardiogram, chest X-ray and CMR with delayed Gadolinium enhancement. Results: Echocardiograms were abnormal in all five patients; chest X- ray showed pulmonary hemorrhage (3), cardiomegaly (5), pleural effusion (3); echocardiogram showed atrial enlargement, left ventricular wall thickening, limited ventricular wall motion, etc. CMR exhibited increased thickness of the left ventricular wall, mild to moderate depression of systolic function (mean ejection fraction: 32.5%±15.0%) and bilateral atrial enlargement with restriction of diastolic ventricular filling. In all patients, there were widespread enhancement of the thickened myocardium on delayed post- contrast studies. In 4 patients, global subendocardial delayed gadolinium enhancement was found, in papillary muscles, and interventricular septa with 'zebra-like' sign in 3 patients. Left ventricular transmural delayed gadolinium enhancement was found in 1 patient. Conclusions: CMR shows a characteristic pattern of global subendocardial delayed gadolinium enhancement in cardiac amyloidosis. The findings may be valuable in the diagnosis of cardiac amyloidosis. (authors)

  4. Clinical trial participant characteristics and saliva and DNA metrics

    Richards Julie


    Full Text Available Abstract Background Clinical trial and epidemiological studies need high quality biospecimens from a representative sample of participants to investigate genetic influences on treatment response and disease. Obtaining blood biospecimens presents logistical and financial challenges. As a result, saliva biospecimen collection is becoming more frequent because of the ease of collection and lower cost. This article describes an assessment of saliva biospecimen samples collected through the mail, trial participant demographic and behavioral characteristics, and their association with saliva and DNA quantity and quality. Methods Saliva biospecimens were collected using the Oragene® DNA Self-Collection Kits from participants in a National Cancer Institute funded smoking cessation trial. Saliva biospecimens from 565 individuals were visually inspected for clarity prior to and after DNA extraction. DNA samples were then quantified by UV absorbance, PicoGreen®, and qPCR. Genotyping was performed on 11 SNPs using TaqMan® SNP assays and two VNTR assays. Univariate, correlation, and analysis of variance analyses were conducted to observe the relationship between saliva sample and participant characteristics. Results The biospecimen kit return rate was 58.5% among those invited to participate (n = 967 and 47.1% among all possible COMPASS participants (n = 1202. Significant gender differences were observed with males providing larger saliva volume (4.7 vs. 4.5 ml, p = 0.019, samples that were more likely to be judged as cloudy (39.5% vs. 24.9%, p 0.21, P Conclusion Findings from this study show that demographic and behavioral characteristics of smoking cessation trial participants have significant associations with saliva and DNA metrics, but not with the performance of TaqMan® SNP or VNTR genotyping assays. Trial registration COMPASS; registered as NCT00301145 at

  5. Clinical and psychosocial characteristics of children with nonepileptic seizures

    Chinta Sri


    Full Text Available Objective: The aim of this study is to present a comprehensive profile of clinical and psychosocial characteristics of children with psychogenic nonepileptic seizures and to assess the short-term outcome of these patients. Materials and Methods: The subjects were consecutive cases of children with a diagnosis of nonepileptic seizures (N=17, mean age = 10.7 years, S.D. = 1.26 and two groups of control groups matched on age and sex: true seizure group and healthy controls. All the children were recruited from the out-patient services of the Department of Pediatrics of a tertiary care teaching hospital in North India. Detailed history taking and clinical examination was done in the case of every child. A standard 18 channel EEG was done in all the children and a video EEG was done in 12 cases of children with nonepileptic seizures. The Childhood Psychopathology Measurement Schedule (CPMS and Life Events Scale for Indian Children (LESIC were used to measure the children′s emotional and behavioral functioning at home, and the number of life events and the stress associated with these events in the preceding year and the year before that. Short-term outcome was examined three to six months after the diagnosis of nonepileptic seizures was made. Results: Unresponsiveness without marked motor manifestations was the most common "ictal" characteristic of the nonepileptic seizures. Pelvic thrusting, upper and lower limb movements, head movements, and vocalization were observed in less than one-third of the patients. Increased psychosocial stress and significantly higher number of life events in the preceding year were found to characterize children with nonepileptic seizures, as compared to the two control groups. The nonepileptic seizures and true seizures groups had a higher proportion of children with psychopathology scores in the clinically significant maladjustment range, as compared to those in the healthy control group. A majority of the patients

  6. [Clinical and epidemiological characteristics of snakebites in Rio Branco, Acre].

    Moreno, Edna; Queiroz-Andrade, Marcony; Lira-da-Silva, Rejâne Maria; Tavares-Neto, José


    This study aimed to determine the clinical epidemiological profile of the snake bites attended at the reference hospital of Acre. One hundred-forty four patients were studied prospectively, from January to December 2002. One hundred-thirteen (78.5%) cases were classified as accidents by venomous snakes. The genera Bothrops, Lachesis and Micrurus were responsible, respectively, for 75.7%, 2.1% e 0.7% cases. The accidents predominated in males (78.5%), rural workers (51.4%) and between 10 and 29 years old (43.8%). The distribution according to the severity of poisoning by genera Bothrops was: moderate (48.6%), mild (31.2%) or severe (20.2%). Two cases of Bothrops accident did not receive serum therapy. However, the antivenom was administered in twenty-three patients without envenoming. In conclusion, the results obtained were different of the observed by another authors with respect to the severity of accidents and suitable treatment. PMID:15717089

  7. Clinical and Demographic Factors Affecting Disease Severity in Patients with Multiple Sclerosis

    Somayeh Baghizadeh


    Full Text Available Background: The clinical course of multiple sclerosis (MS evolves over many years. Its prognosis is highly variable among affected individuals, i.e. while some suffer from early severe disabilities, others remain ambulatory and functional for many years. We used Multiple Sclerosis Severity Score (MSSS and the new classification for MS severity Herbert et al. introduced in 2006 according to MSSS, to investigate some clinical and demographic factors as potential indicators of disease severity in in MS.Methods: During a six-month period, patients with definite MS according to the revised McDonald’s criteria who referred to three neurology and MS clinics in Tehran (Iran were included in the study. All patients were interviewed and examined by a neurology resident who had been trained for employing the Expanded Disability Status Scale (EDSS. For each patient, MSSS was determined by using EDSS and disease duration.Results: Overall, 338 (266 female and 72 male patients were enrolled. Among demographic features, gender, younger age at onset, positive family history, and parental consanguinity were not associated with disease severity. Education was weakly associated with disease severity. Among clinical factors, presenting symptoms such as poly-symptomatic attacks, walking difficulty, and upper and lower extremity dysfunction were associated with more disability while presentation with optic neuritis had better prognosis. Complete recovery after the first attack, longer interval between the first and second attacks, lower number of symptoms at presentation, shorter duration of attacks, and relapsing-remitting course were associated with less disability and better prognosis. These results were noticed in ordinal logistic regression. However when multiple logistic regression was performed, the strongest determinant of disease severity was disease course with odds ratio (OR = 49.12 for secondary progressive course and OR = 53.25 for primary progressive

  8. Epidemiological and clinical characteristics, spirometric parameters and response to budesonide/formoterol in patients attending an asthma clinic: an experience in a developing country

    Imad, Hassan; Yasir, Ged


    Introduction This study aims at describing the epidemiological and clinical characteristics, severity, reversibility testing and response to treatment using simple spirometry in asthmatic patients attending a model specialized Asthma Care Center. Methods Eligible subjects must have a suggestive clinical picture and confirmed by spirometry to have a 12% plus 200ml absolute increase in FEV1 either by reversibility testing or after a therapeutic trial with inhaled and/or oral steroid therapy. Bu...

  9. Prediction of Dengue Disease Severity among Pediatric Thai Patients Using Early Clinical Laboratory Indicators

    James A Potts; Gibbons, Robert V.; Rothman, Alan L.; Anon Srikiatkhachorn; Thomas, Stephen J.; Pra-On Supradish; Lemon, Stephenie C.; Libraty, Daniel H.; Sharone Green; Siripen Kalayanarooj


    Background Dengue virus is endemic in tropical and sub-tropical resource-poor countries. Dengue illness can range from a nonspecific febrile illness to a severe disease, Dengue Shock Syndrome (DSS), in which patients develop circulatory failure. Earlier diagnosis of severe dengue illnesses would have a substantial impact on the allocation of health resources in endemic countries. Methods and Findings We compared clinical laboratory findings collected within 72 hours of fever onset from a pros...

  10. CT Follow-Up and Clinical Outcome in Severe Traumatic Injury Patients

    Belina, Stanko; Kovačić, Sanja


    Determining a patient’s prognosis after severe traumatic brain injury remains difficult and complex. The purpose of the present study was following up patients with severe traumatic brain injury by correlating their clinical outcome and sequential computer tomography (CT) findings. We investigated 51 patients who survived the first year following an accident. All patients underwent successive CT examinations within a maximum period of 2 years. The patients’ outcomes depended on th...

  11. Variation in germination of Clostridium difficile clinical isolates correlates to disease severity

    Carlson, Paul E.; Kaiser, Alyssa M.; McColm, Sarah A.; Bauer, Jessica M.; Vincent B Young; Aronoff, David M.; Hanna, Philip C.


    Over the past two decades, Clostridium difficile infections have been increasing in both number and severity throughout the world. As with other spore forming bacteria, germination is a vital step in the life cycle of this pathogen. Studies have examined differences in sporulation and toxin production among a number of C. difficile clinical isolates; however, few have examined differences in germination and the relationship between this phenotype and disease severity. Here, over 100 C. diffic...

  12. Clinical Relevance and Discriminatory Value of Elevated Liver Aminotransferase Levels for Dengue Severity

    Lee, Linda K.; Gan, Victor C.; Lee, Vernon J.; Tan, Adriana S.; Leo, Yee Sin; Lye, David C.


    Background Elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) is prominent in acute dengue illness. The World Health Organization (WHO) 2009 dengue guidelines defined AST or ALT≥1000 units/liter (U/L) as a criterion for severe dengue. We aimed to assess the clinical relevance and discriminatory value of AST or ALT for dengue hemorrhagic fever (DHF) and severe dengue. Methodology/Principal Findings We retrospectively studied and classified polymerase chain reactio...

  13. Fatal tumors: prenatal ultrasonographic findings and clinical characteristics

    Cho, Jeong Yeon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho [Dept. of Radiology, Cheil General Hospital and Women' s Healthcare Center, Kwandong University College of Medicine, Seoul (Korea, Republic of)


    The incidence of fetal tumors has been increased due to generalization of prenatal evaluation and improvement of imaging techniques. The early detection of a fetal tumor and understanding of its imaging features are very important for fetal, maternal, and neonatal care. Ultrasonography is usually used for the detection and differential diagnosis of fetal tumors, and magnetic resonance imaging is increasingly being used as a complementary study. Many fetal tumors have different clinical and imaging features compared with pediatric tumors. Although several fetal tumors may mimic other common anomalies, some specific imaging features may carry early accurate diagnosis of fetal tumors, which may alter the prenatal management of a pregnancy and the mode of delivery, and facilitate immediate postnatal treatment.

  14. Near Fatal Asthma: Clinical and Airway Biopsy Characteristics

    Richard G. Barbers


    Full Text Available Background. Inflammation and remodeling are integral parts of asthma pathophysiology. We sought to describe the clinical and pathologic features of near fatal asthma exacerbation (NFE. Methods. Bronchial biopsies were collected prospectively from NFE I subjects. Another NFE II group and a moderate severity exacerbation control group (ME II were retrospectively identified—no biopsies obtained. Results. All NFE II (=9 subjects exhibited remodeling and significant inflammation (eosinophilic, neutrophilic. NFE II group (=37 had a significant history of prior intubation and inhaled corticosteroids usage compared to ME II group (=41. They also exhibited leukocytosis, eosinophilia, and longer hospitalization days. Conclusions. Remodeling, eosinophilic, and neutrophilic inflammation were observed in NFE. NFE is associated with prior intubation and inhaled corticosteroids usage.

  15. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

    Mikhailova Е.V.


    Full Text Available Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49% with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46% patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.

  16. Some clinical characteristics of children who survived the Marmara earthquakes.

    Demir, Turkay; Demir, Demet Eralp; Alkas, Leyla; Copur, Mazlum; Dogangun, Burak; Kayaalp, Levent


    The Marmara earthquakes occurred in the Marmara Region (North West) of Turkey in 1999 and resulted in a death toll of approximately 20,000. This paper investigates the relationships between diagnoses and certain variables in children who developed emotional and/or behavioral disturbances in the aftermath of the Marmara earthquakes and were subsequently seen at a child psychiatry outpatient clinic. The variables evaluated are gender, age, the location where the earthquake was experienced, and the degree of losses, bodily injuries, and damage to the residence. Medical records of 321 children and adolescents ranging in age from 2 to 15 years who presented at the clinic due to problems associated with the earthquake between August 1999 and February 2000 were reviewed. Of the patients, 25.5% were diagnosed with post-traumatic stress disorder (PTSD), 16.5% with acute stress disorder (ASD) and 38% with adjustment disorder. No relationship is found between gender and diagnosis. Younger age groups tended to be diagnosed with adjustment disorder. Those who had lost relatives, friends or neighbors were more frequently diagnosed with ASD or PTSD. The same was true for children whose residence was heavily damaged. Children and adolescents constitute the age group that is most severely affected by natural disasters and display significant emotional-behavioral disturbances. The frequency of ASD and PTSD found in our study is considerably high. Although rarely mentioned in the literature, adjustment disorder appears to be one of the most common reactions of children to trauma. PMID:19639383

  17. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

    Deng-Wei Chou


    Full Text Available OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K. pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%, nodules with or without cavities (79%, pleural effusions (71%, peripheral wedge-shaped opacities (64%, patchy ground-glass opacities (50%, air bronchograms within a nodule (36%, consolidations (21%, halo signs (14%, and lung abscesses (14%. Nine (64% of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14% patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.

  18. Severity variation of clinical E.coli mastitis in cows: where do we stand?

    Neutrophils are key effector cells that underpin both defence and severity of clinical coliform mastitis. Increased turnover and viability of neutrophils in the lumen of the bovine mammary gland facilitate the physiological response and acute inflammation that fuel this effective mammary defence mec...

  19. Severe bacterial infections in patients with non-transfusion-dependent thalassemia: prevalence and clinical risk factors

    Nattiya Teawtrakul


    Conclusion: The prevalence of bacterial infection in patients with NTDT was found to be moderate. Time after splenectomy >10 years, deferoxamine therapy, and iron overload may be clinical risk factors for severe bacterial infection in patients with NTDT. Bacterial infection should be recognized in splenectomized patients with NTDT, particularly those who have an iron overload.

  20. Clinical characteristics of sarcoidosis patients diagnosed in a university hospital

    Özlem Abakay


    Full Text Available Objectives: The clinical characteristics and treatment resultsof patients diagnosed with sarcoidosis was investigatedin Dicle University Medical Faculty Hospital.Materials and methods: A total of 39 patients were includeddiagnosed with sarcoidosis between 01 January2008 and31 December 2011.Demographic data, laboratoryfindings, spirometric test data, diagnostic methodsand treatment regimens for the study were recorded form.According to pulmonary function test results of patients,61.5% were normal pattern, 30.8% were restrictive patternand 7.7% were obstructive pattern.Results: Of the 39 patients 15.4% male, 84.6% werefemale. The mean age was 39.5±13.1 years for males,females 44.8±14.0 years. All patients of was 17.9%stage 1, 66.7% stage 2, 10.3% stage 3 and 5.1% stage4. 61.5% were symptomatic, 38.5% were asymptomatic.Methods of diagnosis of the patients examined, 25.6% ofpatients bronchoscopic biopsy procedures, 74.4% of patientssurgical biopsy procedures. Of the 56.4% patientshad received corticosteroid treatment, 5.1% patients hadreceived corticosteroid + methotrexate treatment, 38.5%were followed up without the pharmacological treatment.Pharmacological treatment in the group complete at thetime of the study 20.5% concluded the treatment of theperson. Patients who treatment ending 8.4 months hadused pharmacological treatment.Conclusions: Interstitial lung diseases which are prevalentamong patients with sarcoidosis diagnosed by examiningthe clinical features, differential diagnosis and treatmentmay be possible detection of potential problems. JClin Exp Invest 2012; 3 (3: 363-367Key words: Sarcoidosis diagnosis, treatment

  1. Microdosimetric Characteristics of the Clinical Proton Beams at the JINR Phasotron, Dubna

    Vlcek, B; Spurny, F


    The contribution of the high LET particles to dosimetric and microdosimetric characteristics of 150 and 205 MeV clinical proton beams was experimentally studied using track etched detectors. Secondary heavy charged particles produced from nuclear interactions and degraded protons at the Bragg peak region are particles with high LET. The method of the LET spectra measurement with track etched detectors allows one to determine the contribution of high LET particles to dosimetric characteristics of clinical proton beams: absorbed dose, equivalent dose and the value of the Relative Biological Effectiveness (RBE). Track detectors were irradiated in the various depth of clinical proton beams with the primary energies of 150 and 205 MeV. The LET spectra between 10 and 700 keV/m were measured by means of CR-39 track etched detectors and the automatic optical image analyzer LUCIA-II. The relative contribution of the high LET particles to absorbed dose increases from several per cent at the beam entrance to several ten...

  2. Clinical and allergic sensitization characteristics of allergic rhinitis among the elderly population in Istanbul, Turkey.

    Ozturk, Ayse Bilge; Ozyigit, Leyla Pur; Olmez, Merve Ozata


    Prevalence of allergic rhinitis (AR) in elderly population in Turkey is not known. Studies on the prevalence and features of allergy in older adults are needed to identify safe and effective diagnostic/therapeutic methods for elderly AR patients. We aimed to identify the clinical and allergic characteristics of sensitization to aeroallergens among individuals aged ≥60 years with allergic rhinitis admitted to an allergy outpatient clinic in Istanbul. Of 109 patients, 33.9 % were atopic. Sixty-five percent of subjects were sensitized to Dermatophagoides pteronyssinus, 17 % to a grass-pollen mixture, 8 % to Aspergillus fumigatus, and 8 % to Blattella germanica. There was no difference between mono- and polysensitized patients in terms of the duration of rhinitis and symptom severity. No significant difference was observed between the two groups according to age, sex, smoking status, AR onset (<40 or ≥40 years), or duration/severity of disease. There was no significant difference between the two groups in the prevalence of asthma and conjunctivitis, (p = 0.256). Atopic dermatitis/eczema was more prevalent in those with AR (p = 0.046). Clinical characteristics of AR in the elderly could be different from those in non-allergic patients, and the prevalence of allergy may be higher than expected. PMID:25680346

  3. [Interpair differences in the characteristics of the ontogeny, premorbid personality and severity of schizophrenia in twins].

    Moskalenko, V D


    In each of the studied 124 pairs, a twin A was distinguished (the patient with manifest symptoms in the discordant pairs, or more seriously affected twin in concordant pairs) and twin B--its partner. It was demonstrated that the order of birth, differences in the weight at birth, periodization of development do not correlate with the differences in the clinical expression of schizophrenia. Such unfavourable factors as asphyxia, complications during delivery, severe somatic illnesses had a certain tendency to accumulate in twin A. The most distinct correlation was found between the traits of a premorbid personality and the eventual intrapair differences in the severeity of schizophrenia. Twin A in the majority of the cases was more excitable in childhood, had more fears, slept worse, and had a poor appetite. The twin A by its premorbid traits was generally characterized by prevalent asthenic features, withdrawal signs and a more dysharmonic type of personality. PMID:7188820

  4. Comorbid personality disorders in subjects with panic disorder: which personality disorders increase clinical severity?

    Mustafa Ozkan


    Full Text Available Personality disorders are common in subjects with panic disorder. Personality disorders have shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders effect clinical severity in subjects with panic disorder. This study included 122 adults (71 female, 41 male, who met DSM-IV criteria for panic disorder (with or without agoraphobia. Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II and the Panic and Agoraphobia Scale (PAS, Global Assessment Functioning Scale (GAF, Beck Depression Inventory (BDI, and State-Trait Anxiety Inventory (STAI. Patients who had a history of sexual abuse were assessed with Sexual Abuse Severity Scale. Logistic regressions were used to identify predictors of suicide attempts, suicidal ideation, agoraphobia, different panic attack symptoms, sexual abuse, and early onset of disorders. The rates of comorbid Axis I and Axis II psychiatric disorders were 80.3% and 33.9%, consecutively, in patients with panic disorder. Panic disorder patients with comorbid personality disorders had more severe anxiety, depression and agoraphobia symptoms, and had earlier ages of onset, and lower levels of functioning. The rates of suicidal ideation and suicide attempts were 34.8% and 9.8%, consecutively, in subjects with panic disorder. The rate of patients with panic disorder had a history of childhood sexual abuse was 12.5%. The predictor of sexual abuse was more than one comorbid Axis II diagnosis. The predictors of suicide attempt were comorbid paranoid and borderline personality disorders, and the predictor of suicidal ideation was major depressive disorder in subjects with panic disorder. In conclusion, this study documents that comorbid personality disorders increase the clinical severity of panic disorder. Patients with more than one

  5. Clinical characteristics associated with mortality of patients with anaerobic bacteremia.

    Umemura, Takumi; Hamada, Yukihiro; Yamagishi, Yuka; Suematsu, Hiroyuki; Mikamo, Hiroshige


    The presence of anaerobes in the blood stream is known to be associated with a higher rate of mortality. However, few prognostic risk factor analyses examining whether a patient's background characteristics are associated with the prognosis have been reported. We performed a retrospective case-controlled study to assess the prognostic factors associated with death from anaerobic bacteremia. Seventy-four patients with anaerobic bacteremia were treated between January 2005 and December 2014 at Aichi Medical University Hospital. The clinical information included drug susceptibility was used for analysis of prognostic factors for 30-day mortality. Multivariate logistic analyses revealed an association between the 30-day mortality rate and malignancy (OR: 3.64, 95% CI: 1.08-12.31) and clindamycin resistance (OR: 7.93, 95% CI: 2.33-27.94). The result of Kaplan-Meier analysis of mortality showed that the 30-day survival rate was 83% in clindamycin susceptible and 38.1% in clindamycin resistant anaerobes causing bacteremia. The result of log-rank test also showed that susceptibility to clindamycin affected mortality (P < 0.001). Our results indicated that malignancy and clindamycin susceptibility could be used to identify subgroups of patients with anaerobic bacteremia with a higher risk of 30-day mortality. The results of this study are important for the early and appropriate management of patients with anaerobic bacteremia. PMID:26903282

  6. Clinical, demographic, and laboratory characteristics of children with nephrolithiasis.

    Sas, David J; Becton, Lauren J; Tutman, Jeffrey; Lindsay, Laura A; Wahlquist, Amy H


    While the incidence of pediatric kidney stones appears to be increasing, little is known about the demographic, clinical, laboratory, imaging, and management variables in this patient population. We sought to describe various characteristics of our stone-forming pediatric population. To that end, we retrospectively reviewed the charts of pediatric patients with nephrolithiasis confirmed by imaging. Data were collected on multiple variables from each patient and analyzed for trends. For body mass index (BMI) controls, data from the general pediatrics population similar to our nephrolithiasis population were used. Data on 155 pediatric nephrolithiasis patients were analyzed. Of the 54 calculi available for analysis, 98 % were calcium based. Low urine volume, elevated supersaturation of calcium phosphate, elevated supersaturation of calcium oxalate, and hypercalciuria were the most commonly identified abnormalities on analysis of 24-h urine collections. Our stone-forming population did not have a higher BMI than our general pediatrics population, making it unlikely that obesity is a risk factor for nephrolithiasis in children. More girls presented with their first stone during adolescence, suggesting a role for reproductive hormones contributing to stone risk, while boys tended to present more commonly at a younger age, though this did not reach statistical significance. These intriguing findings warrant further investigation. PMID:26467033

  7. Clinical Characteristics and Genetic Variability of Human Rhinovirus in Mexico

    Hilda Montero


    Full Text Available Human rhinovirus (HRV is a leading cause of acute respiratory infection (ARI in young children and infants worldwide and has a high impact on morbidity and mortality in this population. Initially, HRV was classified into two species: HRV-A and HRV-B. Recently, a species called HRV-C and possibly another species, HRV-D, were identified. In Mexico, there is little information about the role of HRV as a cause of ARI, and the presence and importance of species such as HRV-C are not known. The aim of this study was to determine the clinical characteristics and genetic variability of HRV in Mexican children. Genetic characterization was carried out by phylogenetic analysis of the 5′-nontranslated region (5′-NTR of the HRV genome. The results show that the newly identified HRV-C is circulating in Mexican children more frequently than HRV-B but not as frequently as HRV-A, which was the most frequent species. Most of the cases of the three species of HRV were in children under 2 years of age, and all species were associated with very mild and moderate ARI.

  8. [Clinical characteristics of polycythemia vera in the elderly].

    Tsutsumi, H; Iwakiri, R; Mikoshiba, M; Kumakawa, T; Ohta, M; Mori, M


    Of 43 elderly patients who were suspected to have polycythemia between October 1990 and July 1998, 12 patients showed an increased red cell volume measured by 51Cr-labeled red blood cells. We analyzed the clinical characteristics of the 12 patients consisted of 7 men and 5 women, with a median age of 71 (range: 57-92). Chief complaints were headaches and dizziness (3 cases), symptoms of other conditions than polycythemia (4 cases). Five patients had no symptoms. Five of 6 patients over 70 years old had no symptoms due to polycythemia. Seven cases (58%) showed splenomegaly and three cases (25%) showed hepatomegaly. Laboratory findings were as follows: WBC 9.7 +/- 3.9 x 10(3)/microliter (mean +/- SD, p Vit. B12 1,686 +/- 2,156 pg/ml, arterial O2 saturation more than 92% in all cases. The diagnosis of all cases was polycythemia vera according to the diagnostic criteria of Polycythemia Vera Study Group. Associated conditions included 8 cases of thrombosis (cerebral thrombosis 4, thrombophrebitis 2, myocardial infarction 1, ischemic colitis 1) and 3 cases of malignancy (esophageal cancer 1, breast cancer 1, renal cancer 1), none of which was therapy-related cancer. Six patients (50%) had only phlebotomy, three (25%) only chemotherapy, and three (25%) both phlebotomy and chemotherapy. Patients over 80 years old needed neither intensive nor continuous treatment. Only one patient died due to esophageal cancer at age 89. PMID:10410570

  9. Dosimetric characteristics of a MOSFET dosimeter for clinical electron beams.

    Manigandan, D; Bharanidharan, G; Aruna, P; Devan, K; Elangovan, D; Patil, Vikram; Tamilarasan, R; Vasanthan, S; Ganesan, S


    The fundamental dosimetric characteristics of commercially available metal oxide semiconductor field effect transistor (MOSFET) detectors were studied for clinical electron beam irradiations. MOSFET showed excellent linearity against doses measured using an ion chamber in the dose range of 20-630cGy. MOSFET reproducibility is better at high doses compared to low doses. The output factors measured with the MOSFET were within +/-3% when compared with those measured with a parallel plate chamber. From 4 to 12MeV, MOSFETs showed a large angular dependence in the tilt directions and less in the axial directions. MOSFETs do not show any dose-rate dependence between 100 and 600MU/min. However, MOSFETs have shown under-response when the dose per pulse of the beam is decreased. No measurable effect in MOSFET response was observed in the temperature range of 23-40 degrees C. The energy dependence of a MOSFET dosimeter was within +/-3.0% for 6-18MeV electron beams and 5.5% for 4MeV ones. This study shows that MOSFET detectors are suitable for dosimetry of electron beams in the energy range of 4-18MeV. PMID:19128995

  10. Clinical characteristics associated with Borrelia burgdorferi sensu lato skin culture results in patients with erythema migrans.

    Franc Strle

    Full Text Available Clinical characteristics associated with isolation of Borrelia burgdorferi sensu lato from skin have not been fully evaluated. To gain insight into predictors for a positive EM skin culture, we compared basic demographic, epidemiologic, and clinical data in 608 culture-proven and 501 culture-negative adult patients with solitary EM. A positive Borrelia spp. skin culture was associated with older age, a time interval of >2 days between tick bite and onset of the skin lesion, EM ≥ 5 cm in diameter, and location of the lesion on the extremities, whereas several other characteristics used as clinical case definition criteria for the diagnosis of EM (such as tick bite at the site of later EM, information on expansion of the skin lesion, central clearing were not. A patient with a 15-cm EM lesion had almost 3-fold greater odds for a positive skin culture than patients with a 5-cm lesion. Patients with a free time interval between the tick bite and onset of EM had the same probability of a positive skin culture as those who did not recall a tick bite (OR=1.02; however, the two groups had >3-fold greater odds for EM positivity than patients who reported a tick bite with no interval between the bite and onset of the lesion. In conclusion, several yet not all clinical characteristics used in EM case definitions were associated with positive Borrelia spp. skin culture. The findings are limited to European patients with solitary EM caused predominantly by B. afzelii but may not be valid for other situations.

  11. Severe anaemia is not associated with HIV-1 env gene characteristics in Malawian children

    Kachala David


    Full Text Available Abstract Background Anaemia is the most common haematological complication of HIV and associated with a high morbidity and a poor prognosis. The pathogenesis of HIV-associated anaemia is poorly understood and may include a direct effect of HIV on erythropoiesis. In vitro studies have suggested that specific HIV strains, like X4 that uses the CXCR4 co-receptor present on erythroid precursors, are associated with diminished erythropoiesis. This co-receptor affinity is determined by changes in the hypervariable loop of the HIV-1 envelope genome. In a previous case-control study we observed an association between HIV and severe anaemia in Malawian children that could not be fully explained by secondary infections and micronutrient deficiencies alone. We therefore explored the possibility that alterations in the V1-V2-V3 fragment of HIV-1 were associated with severe anaemia. Methods Using peripheral blood nucleic acid isolates of HIV-infected children identified in the previous studied we assessed if variability of the V1-V2-V3 region of HIV and the occurrence of X4 strains were more common in HIV-infected children with (cases, n = 29 and without severe anaemia (controls, n = 30. For 15 cases bone marrow isolates were available to compare against peripheral blood. All children were followed for 18 months after recruitment. Results Phylogenetic analysis showed that HIV-1 subtype C was present in all but one child. All V1-V2-V3 characteristics tested: V3 charge, V1-V2 length and potential glycosylation sites, were not found to be different between cases and controls. Using a computer model (C-PSSM four children (7.8% were identified to have an X4 strain. This prevalence was not different between study groups (p = 1.00. The V3 loop characteristics for bone marrow and peripheral blood isolates in the case group were identical. None of the children identified as having an X4 strain developed a (new episode of severe anaemia during follow up. Conclusion

  12. A Multi-Center Prospective Derivation and Validation of a Clinical Prediction Tool for Severe Clostridium difficile Infection.

    Na, Xi


    Prediction of severe clinical outcomes in Clostridium difficile infection (CDI) is important to inform management decisions for optimum patient care. Currently, treatment recommendations for CDI vary based on disease severity but validated methods to predict severe disease are lacking. The aim of the study was to derive and validate a clinical prediction tool for severe outcomes in CDI.




    Full Text Available BACKGROUND OF THE STUDY Hyponatraemia is a commonly encountered plasma electrolyte abnormality noticed in the patients admitted to ICU, which has a diverse variety of manifestations. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life-threatening and is associated with increased mortality and morbidity. OBJECTIVES To study the clinical profile at different levels of hyponatraemia in ICU patients and its clinical outcome at different levels. METHODOLOGY A retrospective descriptional study was done at Intensive Care Unit of Dr. B.R. Ambedkar Medical College and Hospital during the period from April 2015 to March 2016 among the patients having serum sodium levels less than 135 mEq/L. RESULTS Commonly involved age group is between 50 to 70 years. Severe form of Hyponatraemia is seen in elderly males. The most common underlying predisposing factor for hyponatraemia in our case series was sepsis (26% followed by gastrointestinal fluid loss (15.5%, diabetic ketoacidosis (10% and cirrhosis of liver (10%. Mortality was highest with severe hyponatraemia (10.5% who had pulmonary sepsis, metabolic encephalopathy, diabetic ketoacidosis and cirrhosis of liver. CONCLUSIONS Hyponatraemia is one of the good predictor of ICU mortality in association with wide variety of systemic diseases and wide spectrum of clinical profile.

  14. Clinical and microbiologic characteristics of tcdA-negative variant clostridium difficile infections

    Kim Jieun


    Full Text Available Abstract Background The tcdA-negative variant (A-B+ of Clostridium difficile is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A-B+C. difficile infections (CDI are not clearly documented. The objective of this study was to investigate these characteristics. Methods From September 2008 through January 2010, the clinical characteristics, medication history and treatment outcomes of CDI patients were recorded prospectively. Toxin characterization and antibiotic susceptibility tests were performed on stool isolates of C. difficile. Results During the study period, we identified 22 cases of CDI caused by tcdA-negative tcdB-positive (A-B+ strains and 105 cases caused by tcdA-positive tcdB-positive (A+B+ strains. There was no significant difference in disease severity or clinical characteristics between the two groups. Previous use of clindamycin and young age were identified as significant risk factors for the acquisition of A-B+ CDI (OR = 4.738, 95% CI 1.48–15.157, p = 0.009 and OR = 0.966, 95% CI 0.935–0.998, p = 0.038, respectively in logistic regression. Rates of resistance to clindamycin were 100% and 69.6% in the A-B+ and A+B+ isolates, respectively (p = 0.006, and the ermB gene was identified in 17 of 21 A-B+ isolates (81%. Resistance to moxifloxacin was also more frequent in the A-B+ than in the A+B+ isolates (95.2% vs. 63.7%, p = 0.004. Conclusions The clinical course of A-B+ CDI is not different from that of A+B+ CDI. Clindamycin use is a significant risk factor for the acquisition of tcdA-negative variant strains.


    Sadighi, Zsila; Zabrowski, Jennifer; Broniscer, Alberto; Gajjar, Amar; Khan, Raja


    BACKGROUND: Clinical observations of children with thalamic tumors and secondary movement disorders (MD) suggest correlation between anatomical location and treatment modalities to severity of MD. METHODS: We conducted an IRB approved retrospective review of patients ≤ 18 years old with thalamic tumors and MD at St. Jude Children's Research Hospital from 1996-2013. Magnetic Resonance Imaging (MRI) was reviewed and thalamic nuclei involved with tumor and/or surgical site were documented. MD severity was rated with Karnofsky Performance Score (KPS); Extrapyramidal Symptom Rating Scale (ESRS), which scores 0 (absent) to 6 (extremely severe); and Clinical Global Impression of Severity for dystonia and dyskinesia (CGI-S), which scores 0 (absent) to 8 (extremely severe). RESULTS: We reviewed 83 patients with thalamic with 9 confirmed MD by neurological evaluation. Median age at tumor diagnosis was 7 years old (3 months-11 years), median age at MD onset was 7 years old (18 months-11 years). Types of MD found were postural tremor (7), ballismus (4), myoclonus (1), and athetosis (4). Median time to last follow-up was 3 years. 8 patients had onset of MD median of 1.5 months (0-4 months) time after surgical intervention. Initial median KPS was 80 (60-90) and at last follow-up was 80 (50-90). Initial median ESRS was 5 (3-8) and at last follow-up was 5 (0-5). Initial median CGI-S was 5 (3-6) and at last follow-up was 4 (0-6). Based on these severity scales, 2 patients showed no change, 1 patient worsened, 1 patient completely resolved, and 4 patients had improvement regardless of initial extent of surgery or number of nuclei involved. CONCLUSION: This retrospective analysis compares thalamic tumor anatomical locations and treatment intervention with respect to movement disorder clinical characteristics and outcomes. Extent of location and surgical intervention did not correlate to severity and will be included in final presentation.

  16. Development of a Simple Clinical Risk Score for Early Prediction of Severe Dengue in Adult Patients

    Lee, Ing-Kit; Liu, Jien-Wei; Chen, Yen-Hsu; Chen, Yi-Chun; Tsai, Ching-Yen; Huang, Shi-Yu; Lin, Chun-Yu; Huang, Chung-Hao


    We aimed to develop and validate a risk score to aid in the early identification of laboratory-confirmed dengue patients at high risk of severe dengue (SD) (i.e. severe plasma leakage with shock or respiratory distress, or severe bleeding or organ impairment). We retrospectively analyzed data of 1184 non-SD patients at hospital presentation and 69 SD patients before SD onset. We fit a logistic regression model using 85% of the population and converted the model coefficients to a numeric risk score. Subsequently, we validated the score using the remaining 15% of patients. Using the derivation cohort, two scoring algorithms for predicting SD were developed: models 1 (dengue illness ≤4 days) and 2 (dengue illness >4 days). In model 1, we identified four variables: age ≥65 years, minor gastrointestinal bleeding, leukocytosis, and platelet count ≥100×109 cells/L. Model 1 (ranging from −2 to +6 points) showed good discrimination between SD and non-SD, with an area under the receiver operating characteristic curve (AUC) of 0.848 (95% confidence interval [CI], 0.771–0.924). The optimal cutoff value for model 1 was 1 point, with a sensitivity and specificity for predicting SD of 70.3% and 90.6%, respectively. In model 2 (ranging from 0 to +3 points), significant predictors were age ≥65 years and leukocytosis. Model 2 showed an AUC of 0.859 (95% CI, 0.756–0.963), with an optimal cutoff value of 1 point (sensitivity, 80.3%; specificity, 85.8%). The median interval from hospital presentation to SD was 1 day. This finding underscores the importance of close monitoring, timely resuscitation of shock including intravenous fluid adjustment and early correction of dengue-related complications to prevent the progressive dengue severity. In the validation data, AUCs of 0.904 (95% CI, 0.825–0.983) and 0.917 (95% CI, 0.833–1.0) in models 1 and 2, respectively, were achieved. The observed SD rates (in both cohorts) were 50% for those with a score of ≥2 points

  17. 结缔组织病中枢神经系统危急重症的临床特点及处理%The clinical characteristics and treatment of emergency and severe cases of central nervous system in connective tissue diseases

    蒋莹; 左晓霞


    结缔组织病(connective tissue disease,CTD)是一大类具有高度异质性、多系统累及的自身免疫性疾病,包括系统性红斑狼疮(systemic lupus erythematosus,SLE)、类风湿关节炎(rheumatoid arthritis,RA)、系统性硬化症(systemic sclerosis, SSc)、干燥综合征(primary sjogren's syndrome,pSS)等,其病理基础为血管和结缔组织的慢性炎症。 CTD 累及中枢神经系统(包括大脑、脑膜和脊髓)临床表现复杂多样,可以是 CTD 本身所致,亦可为感染、药物等因素继发,部分患者甚至以中枢神经系统症状为首发表现。 CTD 累及中枢神经系统,病情凶险,属于危急重症,是 CTD 患者死亡的主要原因之一。根据 CTD 中枢神经系统危急重症的临床特点,及时准确的诊断,积极合适的治疗是改善患者预后的关键。本文将阐述 CTD 累及中枢神经系统危急重症的临床特点及处理。%Connective tissue disease(CTD)is a group of highly heterogeneous autoimmune disease characterized by pathologic changes in systemic organs and chronic inflammation of connective tissue .These diseases include systemic lupus erythematosus (SLE), rheumatoid arthritis(RA),systemic sclerosis and Sjögren syndrome.Its pathological basis is chronic inflammation of blood vessels and connective tissue.The clinical manifestations are complex and varied that can be caused by the primary disease or as a secondary conse -quence of the primary disease.Some cases show that the central nervous system symptoms are starting performance .The involvement of the central nervous system is the dangerous condition in clinic that may be one of the leading causes of death among CTD patients .Early recognition and diagnosis ,and active and efficient therapy are the vital importance for the prognosis .This review focuses on the clinical features and therapies of emergency and severe cases of CTD involved central nervous system .

  18. Severe visceral leishmaniasis in children: the relationship between cytokine patterns and clinical features

    Monica Elinor Alves Gama


    Full Text Available Introduction The relationship between severe clinical manifestations of visceral leishmaniasis (VL and immune response profiles has not yet been clarified, despite numerous studies on the subject. This study aimed to investigate the relationship between cytokine profiles and the presence of immunological markers associated with clinical manifestations and, particularly, signs of severity, as defined in a protocol drafted by the Ministry of Health (Brazil. Methods We conducted a prospective, descriptive study between May 2008 and December 2009. This study was based on an assessment of all pediatric patients with VL who were observed in a reference hospital in Maranhão. Results Among 27 children, 55.5% presented with more than one sign of severity or warning sign. Patients without signs of severity or warning signs and patients with only one warning sign had the highest interferon-gamma (IFN-γ levels, although their interleukin 10 (IL-10 levels were also elevated. In contrast, patients with the features of severe disease had the lowest IFN-γ levels. Three patients who presented with more than two signs of severe disease died; these patients had undetectable interleukin 2 (IL-2 and IFN-γ levels and low IL-10 levels, which varied between 0 and 36.8pg/mL. Conclusions Our results showed that disease severity was associated with low IFN-γ levels and elevated IL-10 levels. However, further studies with larger samples are needed to better characterize the relationship between disease severity and cytokine levels, with the aim of identifying immunological markers of active-disease severity.

  19. Clinical and Epidemiologic Characteristics of Patients with Childhood Psoriazis Seen in Dermatology Clinic

    Emine Elvan Taşğın


    Full Text Available Objective: To evaluate the epidemiologic characteristics of the pediatric patients with psoriazis applied to our outpatients' clinic and compare these data with the literature. Methods: The study population consisted of 37 patients younger than 16 years with the diagnosis of psoriazis in dermatology outpatient clinic between May 2009 and December 2010. The patients were evaluated with regard to age, gender, age of onset of the disease, duration of the disease, the presence of accompanying diseases, family history, clinical features, and triggering factors. Results: Of 37 pediatric patients with psoriazis evaluated in this study, 21 were girls and 16 were boys. The ages of the patients ranged between 2 and 15 years. 32.4% of the patients had family history. Plaque (59.45% of the patients, guttate (29.7% of the patients and pustular (10.8% of the patientstypes of psoriazis were determined. The psoriazis lesions involved most frequently the hairy skin (73% and the disease generally originated from this region. Ungual involvement was determined in 27% of the patients. None of the patients had psoriatic arthritis. Conclusion: Our study might contribute to generate epidemiological data's about the pediatric patients with psoriazis in our population.

  20. Maternal characteristics and clinical diagnoses influence obstetrical outcomes in Indonesia.

    Adisasmita, Asri; Smith, Carl V; El-Mohandes, Ayman A E; Deviany, Poppy Elvira; Ryon, Judith J; Kiely, Michele; Rogers-Bloch, Quail; Gipson, Reginald F


    This Indonesian study evaluates associations between near-miss status/death with maternal demographic, health care characteristics, and obstetrical complications, comparing results using retrospective and prospective data. The main outcome measures were obstetric conditions and socio-economic factors to predict near-miss/death. We abstracted all obstetric admissions (1,358 retrospective and 1,240 prospective) from two district hospitals in East Java, Indonesia between 4/1/2009 and 5/15/2010. Prospective data added socio-economic status, access to care and referral patterns. Reduced logistic models were constructed, and multivariate analyses used to assess association of risk variables to outcome. Using multivariate analysis, variables associated with risk of near-miss/death include postpartum hemorrhage (retrospective AOR 5.41, 95 % CI 2.64-11.08; prospective AOR 10.45, 95 % CI 5.59-19.52) and severe preeclampsia/eclampsia (retrospective AOR 1.94, 95 % CI 1.05-3.57; prospective AOR 3.26, 95 % CI 1.79-5.94). Associations with near-miss/death were seen for antepartum hemorrhage in retrospective data (AOR 9.34, 95 % CI 4.34-20.13), and prospectively for poverty (AOR 2.17, 95 % CI 1.33-3.54) and delivering outside the hospital (AOR 2.04, 95 % CI 1.08-3.82). Postpartum hemorrhage and severe preeclampsia/eclampsia are leading causes of near-miss/death in Indonesia. Poverty and delivery outside the hospital are significant risk factors. Prompt recognition of complications, timely referrals, standardized care protocols, prompt hospital triage, and structured provider education may reduce obstetric mortality and morbidity. Retrospective data were reliable, but prospective data provided valuable information about barriers to care and referral patterns. PMID:25656716


    Umesh Varma


    Full Text Available The study was carried out in ASRAM hospital, eluru, over a period of 2 years from August 2012 to august 2014. The study was designated as prospective, observational, cohort study, which includes 100 cases of CAP selected on the basis of full filling the inclusion and exclusion criteria. Community acquired pneumonia continues to be a common clinical problem especially in elderly people. Males were more commonly affected than females but it was statistically not significant. Community acquired pneumonia is one of the common diagnosis in patients admitted in ICU and Emergency settings.DM and COPD are the most common co morbidities followed by rhinitis and smoking is the commonest risk factor for CAP. Cough, fever and expectoration are common and classical symptoms of pneumonia and significant number of patients with CAP can present with GI symptoms. Tachycardia, Tachypnea, Altered Mental Status, Hypotension, Cyanosis, acidosis, low albumin levels are few signs which indicate that illness is severe and critical and crepitations over chest on auscultation was the most common finding. Mean duration of stay was 8.99 days indicating it can cause significant loss in the form of economic loss if earning member of family is affected. Duration of stay was also prolonged in patients who are aged 65 and above, in patients who are undernourished, in patients with COPD and in patients who were treated with antibiotics prior to hospitalization but statistically these findings were not significant. In radiography Lower zones are most common site of involvement followed by mid and upper zones, Right lower zone was most common among all. Neutrophilic leucocytosis was the most common finding in haemogram. Gram positive organisms were more commonly seen than gram negative organisms on sputum gram‘s staining. Complications noticed were aNeed for ventilatory support both invasive or Non Invasive, bNeed for inotropic support for septic shock, cRenal failure and need

  2. Studying Different Clinical Syndromes Of Paediatric Severe Malaria Using Plasma Proteomics

    Ramaprasad, Abhinay


    Background- Severe Plasmodium falciparum malaria remains one of the major causes of childhood morbidity and mortality in Africa. Severe malaria manifests itself as three main clinical syndromes-impaired consciousness (cerebral malaria), respiratory distress and severe malarial anaemia. Cerebral malaria and respiratory distress are major contributors to malaria mortality but their pathophysiology remains unclear. Motivation/Objectives- Most children with severe malaria die within the first 24 hours of admission to a hospital because of their pathophysiological conditions. Thus, along with anti-malarial drugs, various adjuvant therapies such as fluid bolus (for hypovolaemia) and anticonvulsants (for seizures) are given to alleviate the sick child’s condition. But these therapies can sometimes have adverse effects. Hence, a clear understanding of severe malaria pathophysiology is essential for making an informed decision regarding adjuvant therapies. Methodology- We used mass spectrometry-based shotgun proteomics to study plasma samples from Gambian children with severe malaria. We compared the proteomic profiles of different severe malaria syndromes and generated hypotheses regarding the underlying disease mechanisms. Results/Conclusions- The main challenges of studying the severe malaria syndromes using proteomics were the high complexity and variability among the samples. We hypothesized that hepatic injury and nitric oxide play roles in the pathophysiology of cerebral malaria and respiratory distress.

  3. Clinical characteristics and current therapies for inherited retinal degenerations.

    Sahel, José-Alain; Marazova, Katia; Audo, Isabelle


    Inherited retinal degenerations (IRDs) encompass a large group of clinically and genetically heterogeneous diseases that affect approximately 1 in 3000 people (>2 million people worldwide) (Bessant DA, Ali RR, Bhattacharya SS. 2001. Molecular genetics and prospects for therapy of the inherited retinal dystrophies. Curr Opin Genet Dev 11: 307-316.). IRDs may be inherited as Mendelian traits or through mitochondrial DNA, and may affect the entire retina (e.g., rod-cone dystrophy, also known as retinitis pigmentosa, cone dystrophy, cone-rod dystrophy, choroideremia, Usher syndrome, and Bardet-Bidel syndrome) or be restricted to the macula (e.g., Stargardt disease, Best disease, and Sorsby fundus dystrophy), ultimately leading to blindness. IRDs are a major cause of severe vision loss, with profound impact on patients and society. Although IRDs remain untreatable today, significant progress toward therapeutic strategies for IRDs has marked the past two decades. This progress has been based on better understanding of the pathophysiological pathways of these diseases and on technological advances. PMID:25324231

  4. Visual height intolerance and acrophobia: clinical characteristics and comorbidity patterns.

    Kapfhammer, Hans-Peter; Huppert, Doreen; Grill, Eva; Fitz, Werner; Brandt, Thomas


    The purpose of this study was to estimate the general population lifetime and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics, and to determine their anxious and depressive comorbidities. A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above was selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed. The lifetime prevalence of vHI was 28.5% (women 32.4%, men 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. A total of 22.5% of individuals with vHI experienced the intensity of panic attacks. The lifetime prevalence of acrophobia was 6.4% (women 8.6%, men 4.1%), and point prevalence was 2.0% (women 2.8%; men 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia. VHI affects nearly a third of the general population; in more than 20% of these persons, vHI occasionally develops into panic attacks and in 6.4%, it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects. PMID:25262317

  5. Severe myoclonic epilepsy of infancy (Dravet syndrome: Clinical and genetic features of nine Turkish patients

    Meral Özmen


    Full Text Available Purpose: Mutations of the a-1 subunit sodium channel gene (SCN1A cause severe myoclonic epilepsy of infancy (SMEI. To date, over 300 mutations related to SMEI have been described. In the present study, we report new SCN1A mutations and the clinical features of SMEI cases. Materials and Methods: We studied the clinical and genetic features of nine patients diagnosed with SMEI at the Pediatric Neurology Department of Istanbul Medical Faculty. Results: Five patients had nonsense mutations, two had missense mutations, one had a splice site mutation and one had a deletion mutation of the SCN1A gene. Mutations at c.3705+5G splice site, p.trip153X nonsense mutation and deletion at c.2416_2946 have not been previously described. The seizures started following whole cell pertussis vaccination in all patients. The seizures ceased in one patient and continued in the other eight patients. Developmental regression was severe in three patients, with frequent status epilepticus. The type of mutation was not predictive for the severity of the disease. Two of the three patients with severe regression had nonsense and missense mutations. Conclusions : Dravet syndrome can be result of several different types of mutation in SCN1A gene. Onset of the seizures after pertussis vaccination is an important clue for the diagnosis and neuro- developmental delay should be expected in all patients.

  6. Computerized tomography (CT), electroencephalography (EEG), and clinical symptoms in severe cranio-cerebral injuries

    In the first six months of 1977 156 patients with craniocerebral injuries underwent computerized tomography. Twelve had severe deficits which led to neurosurgical interventions. Only five had space-occupying haematomas. Ct was useful in detecting neurosurgical complications, whereas EEG was useful in staging the severity of the trauma. The two methods, the functional one of EEG and the morphological one of CT, are complementary, especially with regard to the posttraumatic course. The clinical symptoms are reflected by EEG better than by CT. (author)

  7. Using thermographic cameras to investigate eye temperature and clinical severity in depression

    Maller, Jerome J.; George, Shefin Sam; Viswanathan, Rekha Puzhavakkathumadom; Fitzgerald, Paul B.; Junor, Paul


    Previous studies suggest that altered corneal temperature may be a feature of schizophrenia, but the association between major depressive disorder (MDD) and corneal temperature has yet to be assessed. The aim of this study is to investigate whether eye temperature is different among MDD patients than among healthy individuals. We used a thermographic camera to measure and compare the temperature profile across the corneas of 16 patients with MDD and 16 age- and sex-matched healthy subjects. We found that the average corneal temperature between the two groups did not differ statistically, although clinical severity correlated positively with right corneal temperature. Corneal temperature may be an indicator of clinical severity in psychiatric disorders, including depression.

  8. Social, dietary and clinical correlates of oedema in children with severe acute malnutrition

    Rytter, Maren Johanne Heilskov; Namusoke, Hanifa; Babirekere-Iriso, Esther;


    BACKGROUND: Severe acute malnutrition is a serious public health problem, and a challenge to clinicians. Why some children with malnutrition develop oedema (kwashiorkor) is not well understood. The objective of this study was to investigate socio-demographic, dietary and clinical correlates of oe...... have HIV infection and had fewer symptoms of other infections. Dietary diversity was lower in households of children who presented with oedema. Future research may confirm whether a causal relationship exists between these factors and nutritional oedema....

  9. Clinical observations and management of a severe equine herpesvirus type 1 outbreak with abortion and encephalomyelitis

    Walter, Jasmin; Seeh, Christoph; Fey, Kerstin; Bleul, U; Osterrieder, Nikolaus


    Latent equine herpesvirus type 1 (EHV-1) infection is common in horse populations worldwide and estimated to reach a prevalence nearing 90% in some areas. The virus causes acute outbreaks of disease that are characterized by abortion and sporadic cases of myeloencephalopathy (EHM), both severe threats to equine facilities. Different strains vary in their abortigenic and neuropathogenic potential and the simultaneous occurrence of EHM and abortion is rare. In this report, we present clinical o...

  10. Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics

    Waite, Polly; Creswell, Catharine


    Background Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. Method...

  11. Chronic Inflammatory Demyelinating Polyneuropathy in Children: A Review of Clinical Characteristics and Recommendations for Treatment

    Narges Karimi


    Full Text Available Context: Chronic inflammatory demyelinating polyradiculopathy (CIDP is an acquired and autoimmune neuropathy, characterized by a chronic, rapidly progressive, symmetric weakness. In children, abnormal gait is as a first symptom of muscle weakness. Evidence Acquisition: The diagnosis of CIDP is on the basis of clinical characteristics, electrodiagnostic that shows the severity of the disease, lumbar puncture and spine magnetic resonance imaging (MRI. Results: The first-line treatments in childhood CIDP are intravenous immunoglobulin (IVIG, corticosteroids, and plasmapheresis. Response to first-line therapies is usually satisfactory; nevertheless, recommendations regarding the choice of second-line therapy can only be prepared on the basis of the existing practice described in some of the case reports. Conclusions: This review demonstrated the clinical presentation, diagnosis, and treatment of childhood CIDP.

  12. Correlation between CT features and clinical severity stratification in acute pulmonary embolism

    Objective: To analyze the correlation factors between CT imaging features of pulmonary embolism (PE) and clinical severity stratification, to explore the value of CT pulmonary angiography (CTPA) in acute PE severity stratification. Methods: According to the clinical severity, 48 patients with acute PE proved by CTPA were classified into two groups, including 21 critical and 27 non-critical patients. Embolism index, ratio of central pulmonary involvement, ratio of right ventricle maximum minor axis (RVMMA) to left ventricle maximum minor axis (LVMMA), namely RV: LV, dilation of main pulmonary and/or right pulmonary trunk, and dilation of bronchial arteries in both groups were analyzed comparatively. The correlation factors between CT imaging features and PE clinical severity stratification were explored. The correlation between RV: LV and embolism index of 48 patients was analyzed. Results: Pulmonary embolism index (22.0%-85.0%, median 38.0%), ratio of central pulmonary involvement (42.5%), RV: LV (0.90-1.90, median 1.30), dilation of pulmonary artery (14 eases), and dilation of bronchial artery (8 eases) in critical group (21 eases) were higher than those corresponding factors (5%-48%, median 21.5%, 31.25%, 0.80-1.40, median 1.00, 5 cases, and 3 cases) in non-critical group (27 cases) (Z=4.27, χ2=5.40, Z=2.58, χ2=11.45, χ2=4.87, P<0.05). There was remarkable correlation between RV: LV and embolism index (r=0.61, P<0.05). Conclusion: CTPA is feasible in evaluating PE severity stratification. The higher the embolism index, RV:LV, and the ratio of central pulmonary involvement, the higher probability of serious hemodynamic changes in PE patients. (authors)

  13. Clinical and socioeconomic impact of moderate-to-severe versus mild influenza in children.

    Heikkinen, T; Silvennoinen, H; Heinonen, S; Vuorinen, T


    Some studies have assessed the efficacy of influenza vaccination in children separately for moderate-to-severe and any influenza, but the definition used for identifying children with moderate-to-severe illness has not been validated. We analyzed clinical and socioeconomic data from two prospective cohort studies of respiratory infections among children aged ≤13 years (four influenza seasons, 3,416 child-seasons of follow-up). We categorized children with laboratory-confirmed influenza into two mutually exclusive groups of moderate-to-severe and mild influenza using the previously proposed criteria. We obtained the data for the analyses from structured medical records filled out by the study physicians and from daily symptom cards filled out by the parents. Of 434 cases of influenza, 217 (50 %) were classified as moderate-to-severe and 217 (50 %) as mild. The mean duration of fever was 4.0 days in children with moderate-to-severe influenza and 3.1 days in those with milder illness (P influenza (P influenza and 135 days per 100 children with mild influenza (P = 0.02). The corresponding rates of children's own absenteeism from day care or school were 297 and 233 days respectively per 100 children (P = 0.006). Categorization of children into groups with moderate-to-severe and mild influenza is meaningful, and it identifies children in whom the clinical and socioeconomic impact of influenza is highest. Illness severity should be considered when assessing influenza vaccine effectiveness in children. PMID:27086364

  14. Solar absorption characteristics of several coatings and surface finishes. [for solar energy collectors

    Lowery, J. R.


    Solar absorption characteristics are established for several films potentially favorable for use as receiving surfaces in solar energy collectors. Included in the investigation were chemically produced black films, black electrodeposits, and anodized coatings. It was found that black nickel exhibited the best combination of selective optical properties of any of the coatings studied. A serious drawback to black nickel was its high susceptibility to degradation in the presence of high moisture environments. Electroplated black chrome generally exhibited high solar absorptivities, but the emissivity varied considerably and was also relatively high under some conditions. The black chrome had the greatest moisture resistance of any of the coatings tested. Black oxide coatings on copper and steel substrates showed the best combination of selective optical properties of any of the chemical conversion films studied.

  15. The severe hailstorm in Germany on 28 July 2013: Characteristics and meteorological conditions

    Kunz, Michael; Blahak, Ulrich; Handwerker, Jan; Schmidberger, Manuel; Mohr, Susanna; Jürgen Punge, Heinz; Fluck, Elody; Mühr, Bernhard


    At the end of July 2013, a series of violent thunderstorms with large hail, severe gusts and heavy rain affected several parts of Germany. These storms were triggered by pre-frontal convergence zones that formed within unstable air masses ahead of a low pressure system named Andreas. They marked the end of a short, but intense heat wave with temperatures up to 38°C. On 28 July, two supercell thunderstorms formed in the Rhine valley upstream of the Black Forest Mountains and moved almost parallel over the Swabian Jura and Bavaria. While the northern cell was weaker, the southern cell substantially intensified in the first hours and created hailstones with diameters of up to 8 cm. The hail fell mainly over a heavily populated region between the cities of Reutlingen and Tübingen with a high concentration of exposed assets. The track of that supercell ended in the north of Czech Republic and had a length of 500 km. Approximately 80,000 buildings were severely damaged by this major hailstorm. In total, insured loss was estimated to amount around 2 bn EURO, which is even higher than that related to the June flood in Germany in the same year. In this paper we investigate the temporal evolution and the characteristics of the most damaging supercell on 28 July by combining different data from remote sensing instruments such as radar, satellite, and lightning detection systems with ground-based observations and reports from eye-witnesses and a crop insurance company. Additional simulations with the Consortium for Small Scale Modelling COSMO-DE model with different setups reveal the important role of the cold pool for the triggering of the most severe hail cell. It will be shown that a major problem for simulating the storm was its initiation, while, once triggered artificially by 'warm bubbles', its track could be simulated rather well over several hours. Moreover, the operational COSMO version has some problems to simulate the observed reflectivity structure of the

  16. Clinical characteristics as a function of referral status among substance users in residential treatment.

    Banducci, Anne N; Dahne, Jennifer; Magidson, Jessica F; Chen, Kevin; Daughters, Stacey B; Lejuez, C W


    In the United States, substance users who voluntarily (VO) elect to receive treatment and substance users who are court-mandated (CM) to receive treatment typically obtain care within the same facilities. Little is known about the clinical characteristics that differentiate these individuals. The current study provides rates of specific DSM-IV Axis I and Axis II psychiatric and substance use disorders, comorbidities, childhood trauma, motivation, and other clinical and demographic characteristics as a function of referral status, among individuals in residential substance use treatment (463 participants, M age=43.3; 69.7% male; 88.4% African American). Participants were interviewed and diagnosed using the Structure Clinical Interview for DSM-IV and the Diagnostic Interview for Personality Disorders. Within our sample, VO individuals, as compared to CM individuals had significantly higher rates of psychiatric disorders (68.7% versus 55.2%, respectively), including mood disorders, major depressive disorder, generalized anxiety disorder, and borderline personality disorder. Additionally, they were significantly more likely to have alcohol dependence (43.0% versus 20.8%) and cocaine dependence (66.5% versus 48.9%). Elevated rates of comorbidities and childhood abuse were also observed among VO individuals, while motivation did not differ as a function of referral status. Overall, VO individuals appeared to have more severe problems than their CM counterparts which may suggest that they require more intensive or different types of treatment. PMID:23380487

  17. Genetic Characteristics of Glioblastoma: Clinical Implications of Heterogeneity

    Qian Li


    Full Text Available Glioblastoma multiforme (GBM is a heterogeneous group of tumors, each with its own distinct molecular and genetic signatures. This heterogeneity is a major clinical hurdle for classifying tumors and for devising effective personalized therapies targeting the disease pathways. Herein, the primary genetic and epigenetic alterations in GBM that have been used as therapeutic targets in clinical settings nowadays, with or without clinical benefits for patients, as well as the future directions for developing novel strategies were discussed.

  18. Lactose intolerance in infants with gluten-sensitive enteropathy: Frequency and clinical characteristics

    Radlović Nedeljko


    Full Text Available Introduction. Secondary lactose intolerance (SLI belongs to the rarer manifestations of gluten-sensitive enteropathy (GSE. It occurs in more severe forms of the disease and its presence contributes significantly to the degree of its expression. Objective. The goal of the study was to determine the frequency of SLI in infants with clinically classic form of GSE, as well as its relationship with the duration, severity and age at the diagnosis of the basic disease and the degree of small bowel mucosa damage. Methods. The study was based on a sample of 42 infants, 30 female and 12 male, aged 7-12 months (x=9.98±1.69, with a clinically classic form of GSE. The diagnosis of GSE was established based on the characteristic pathohistological appearance of small bowel mucosa and clinical improvement of patients on gluten-free diet, while SLI on pathological lactose or milk tolerance test. The assessment of basic disease severity was based on body mass divergence in relation to the standard value, as well as on Hb and serum iron levels, while the degree of small bowel mucosa damage was determined according to the modified Marsh criteria. Results. SLI was verified in 8/42 or 19.05% of patients. In addition to the symptoms and clinical signs of GSE, all the patients with SLI also featured the problems characteristic of lactose tolerance disorders, i.e. watery diarrhoea, borborygmus and meteorism occurring after milk meals. In addition, all had perianal erythema (6 with erosive changes, as well as destructive enteropathy (5 subtotal and 3 total. The difference in the duration of the basic disease, age at diagnosis, as well as in the degree of body mass deviation from the standard value between the lactose-tolerant and lactose-intolerant infants was not found. In addition, no difference in Hb and serum iron levels or in the degree of small bowel mucosa damage was found between the two groups. Conclusion. Our findings indicate that SLI presents a relatively

  19. Validation of a novel clinical prediction score for severe coronary artery diseases before elective coronary angiography.

    Zhang-Wei Chen

    Full Text Available OBJECTIVES: Coronary artery disease (CAD severity is associated with patient prognosis. However, few efficient scoring systems have been developed to screen severe CAD in patients with stable angina and suspected CAD before coronary angiography. Here, we present a novel scoring system for CAD severity before elective coronary angiography. METHODS: Five hundred fifty-one patients with stable angina who were admitted for coronary angiography were enrolled in this study. Patients were divided into training (n = 347 and validation (n = 204 cohorts. Severe CAD was defined as having a Gensini score of 20 or more. All patients underwent echocardiography (ECG to detect ejection fraction and aortic valve calcification (AVC. Multivariable analysis was applied to determine independent risk factors and develop the scoring system. RESULTS: In the training cohort, age, male sex, AVC, abnormal ECG, diabetes, hyperlipidemia, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were identified as independent factors for severe CAD by multivariable analysis, and the Severe Prediction Scoring (SPS system was developed. C-indices of receiver operating characteristic (ROC curves for severe CAD were 0.744 and 0.710 in the training and validation groups, respectively. The SPS system also performed well during calibration, as demonstrated by Hosmer-Lemeshow analysis in the validation group. Compared with the Diamond-Forrester score, the SPS system performed better for severe CAD prediction before elective coronary angiography. CONCLUSIONS: Severe CAD prediction was achieved by analyzing age, sex, AVC, ECG, diabetes status, and lipid levels. Angina patients who achieve high scores using this predicting system should undergo early coronary angiography.

  20. Clinical Dementia Rating Performed Several Years prior to Death Predicts Regional Alzheimer’s Neuropathology

    Beeri, Michal Schnaider; Silverman, Jeremy M.; Schmeidler, James; Wysocki, Michael; Grossman, Hillel Z.; Purohit, Dushyant P.; Perl, Daniel P.; Haroutunian, Vahram


    Aims To assess the relationships between early and late antemortem measures of dementia severity and Alzheimer disease (AD) neuropathology severity. Methods 40 residents of a nursing home, average age at death 82.0, participated in this longitudinal cohort study with postmortem assessment. Severity of dementia was measured by Clinical Dementia Rating (CDR) at two time points, averaging 4.5 and 1.0 years before death. Densities of postmortem neuritic plaques (NPs) and neurofibrillary tangles (NFTs) were measured in the cerebral cortex, hippocampus, and entorhinal cortex. Results For most brain areas, both early and late CDRs were significantly associated with NPs and NFTs. CDRs assessed proximal to death predicted NFTs beyond the contribution of early CDRs. NPs were predicted by both early and late CDRs. NPs were predictive of both early and late CDRs after controlling for NFTs. NFTs were only associated significantly with late CDR in the cerebral cortex after controlling for NPs. Conclusions Even if assessed several years before death, dementia severity is associated with AD neuropathology. NPs are more strongly associated with dementia severity than NFTs. NFTs consistently associate better with late than early CDR, suggesting that these neuropathological changes may occur relatively later in the course of the disease. PMID:18367838

  1. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

    de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Zambom, Lucas Santos; de Andrade, Claudia Regina Furquim


    Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment.

  2. Clinical heterogeneity among people with high functioning autism spectrum conditions: evidence favouring a continuous severity gradient

    Woodbury-Smith Marc


    Full Text Available Abstract Background Autism Spectrum Conditions (ASCs are characterized by a high degree of clinical heterogeneity, but the extent to which this variation represents a severity gradient versus discrete phenotypes is unclear. This issue has complicated genetic studies seeking to investigate the genetic basis of the high hereditability observed clinically in those with an ASC. The aim of this study was to examine the possible clustering of symptoms associated with ASCs to determine whether the observed distribution of symptom type and severity supported either a severity or a symptom subgroup model to account for the phenotypic variation observed within the ASCs. Methods We investigated the responses of a group of adults with higher functioning ASCs on the fifty clinical features examined in the Autism Spectrum Quotient, a screening questionnaire used in the diagnosis of higher functioning ASCs. In contrast to previous studies we have used this instrument with no a priori assumptions about any underlying factor structure of constituent items. The responses obtained were analyzed using complete linkage hierarchical cluster analysis. For the members of each cluster identified the mean score on each Autism Spectrum Quotient question was calculated. Results Autism Spectrum Quotient responses from a total of 333 individuals between the ages of 16.6 and 78.0 years were entered into the hierarchical cluster analysis. The four cluster solution was the one that generated the largest number of clusters that did not also include very small cluster sizes, defined as a membership comprising 10 individuals or fewer. Examination of these clusters demonstrated that they varied in total Autism Spectrum Quotient but that the profiles across the symptoms comprising the Autism Spectrum Quotient did not differ independently of this severity factor. Conclusion These results are consistent with a unitary spectrum model, suggesting that the clinical heterogeneity observed

  3. 甲型H1N1流感危重症临床特点及危险因素分析%Clinical characteristics and risk factors of severe patients with novel pandemic influenza A H1N1

    于洪涛; 杨耀杰; 张庆宪; 贾金广; 陈秋生; 臧金平; 卢滨; 李飞; 安艳丽


    目的 了解甲型H1N1流感(甲流)危重症患者的临床特点,分析其死亡相关危险因素.方法 采用多中心研究方法,回顾性分析郑州市4家医院2009年10月至2010年2月住院的128例甲流危重症患者的临床数据,比较存活组(110例)与死亡组(18例)患者的临床特点;对年龄>14岁的成人患者,以性别、是否妊娠、基础疾病数量、心率、平均动脉压、pH值、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、是否有呼吸衰竭、是否出现急性呼吸窘迫综合征(ARDS)、单肺或双肺病变、是否使用糖皮质激素作为变量进行二元Logistic回归分析,探讨甲流危重症患者死亡的相关危险因素.结果 128例患者中孕妇病死率显著高于儿童和成人非孕妇患者[37.5%(6/16)比12.5%(4/32)、10.0%(8/80),P=0.044和P=0.0003.死亡组呼吸衰竭、ARDS、有创机械通气、有合并症的比例(分别为83.3%、33.3%、66.7%、77.8%)及心率[(114士25)次/min]均显著高于生存组[37.3%、9.1%、12.7%、51.8%、(101+21)次/min);pH值、PaO2(mm Hg,1 mm Hg=0.133 kPa)、PaO2/FiO2(mm Hg)均显著低于生存组(pH值:7.149±0.404比7.398±0.157,PaO2:58.57±36.85比85.78±36.10,PaO2/FiO2:118.17±105.52比259.25±174.91);使用糖皮质激素的比例多于生存组(77.8%比36.4%,P<0.01),且使用时间(d)明显长于生存组(8.3+8.0比2.64±4.2,P<0.05).Logistic回归分析显不,妊娠[相对比值比(OR)为6.642,P=0.011]及ARDS(OR=10.603,P=0.001)是成人甲流危重症患者的死亡危险因素.结论 在甲流危重症患者中,孕妇的死亡比例高于其他患者;有呼吸衰竭、特别是ARDS患者和需要有创机械通气治疗者、有合并症者的死亡比例显著增加;死亡患者发病初期心率明显增快.糖皮质激素的过度使用可能不利于甲流危重症的控制.妊娠和ARDS是甲流危重症成人患者死亡的高危因素.%Objective To learn the clinical characteristics and risk factors associated with death of the

  4. Molecular signature of clinical severity in recovering patients with severe acute respiratory syndrome coronavirus (SARS-CoV)

    Wu Ting-Shu; Chiang Ping-Cherng; Eng Hock-Liew; Liu Jien-Wei; Wang Yi-Hsi; Lin Meng-Chih; Yang Kuender D; Chen Lung-Kun; Wei Min-Li; Chen En-Shih; Chao Angel; Chen Chun-Houh; Lee Yun-Shien; Tsao Kuo-Chein; Huang Chung-Guei


    Abstract Background Severe acute respiratory syndrome (SARS), a recent epidemic human disease, is caused by a novel coronavirus (SARS-CoV). First reported in Asia, SARS quickly spread worldwide through international travelling. As of July 2003, the World Health Organization reported a total of 8,437 people afflicted with SARS with a 9.6% mortality rate. Although immunopathological damages may account for the severity of respiratory distress, little is known about how the genome-wide gene expr...

  5. Association of Postburn Fatty Acids and Triglycerides with Clinical Outcome in Severely Burned Children

    Kraft, Robert; Herndon, David N.; Finnerty, Celeste C.; Hiyama, Yaeko


    Context: Free fatty acids (FFAs) and triglycerides (TGs) are altered postburn, but whether these alterations are associated with postburn outcomes is not clear. Objective: The aim of the present study was to analyze lipid metabolic profiles in pediatric burn patients and to correlate these profiles with patient outcomes and hospital courses. Design and Setting: We conducted a prospective cohort study at an academic pediatric hospital burn center. Patients: Our study included 219 pediatric burn patients. Main Outcome Measures: Patients were stratified according to their plasma TG and FFA levels. Main patient outcomes, such as postburn morbidity and mortality, and clinical metabolic markers were analyzed. Results: All groups were similar in demographics and injury characteristics. Patients with elevated TGs had significantly worse clinical outcomes associated with increased acute-phase protein synthesis indicating augmented inflammation and hypermetabolism, whereas increased FFAs did not seem to profoundly alter postburn outcomes. Conclusions: Elevated TGs, but not FFAs, postburn are associated with worsened organ function and clinical outcomes. PMID:23150682

  6. Dynamic Mechanical Allodynia-One Clinical Sign, Several Mechanisms: Five Illustrative Cases.

    Buonocore, Michelangelo; Demartini, Laura; Aloisi, Anna Maria; Bonezzi, Cesare


    Pain evoked by tangential movement across the skin is usually defined as dynamic mechanical allodynia (DMA). Some patients complain of DMA as troublesome as spontaneous pain and refer a marked interfering with activities of daily living and sleep. Pathophysiology of DMA is complex and can be related to several mechanisms, both nociceptive and neuropathic. Five exemplificative clinical cases of DMA are presented, each associated to a possible specific mechanism: injured skin DMA, peri-injured skin DMA, far injury DMA, nerve-confined DMA and fear DMA (pseudo allodynia). The identification of these subcategories of DMA can stimulate further studies aimed at evaluating the usefulness of a mechanism-based therapy for the different clinical forms of DMA. PMID:26879154

  7. Clinical characteristics,prognosis and indicators of glucose metabolism of liver cirrhosis complicated with diabetes



    Objective To investigate clinical characteristics and outcome of patients with liver cirrhosis complicated with diabetes,and to explore the differences of clinical characteristics and prognosis between hepatogenous diabetes (HD) and type 2 diabetes mellitus (T2DM) .Methods From November 2010 to April 2012,246 patients with liver cirrhosis were collected and divided into liver cir-

  8. Comorbid Depressive Disorders in Anxiety-Disordered Youth: Demographic, Clinical, and Family Characteristics

    O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.


    Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxiety disorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…




    Full Text Available iabetic Ulcer Severity Score is one of the latest simple wound based score, completely a clinical score which needs to be evaluated for its effectiveness in predicting the outcome of foot ulcers in patients with diabetes. METHODS A total of 226 diabetic patients with foot ulcers treated as outpatient or admitted patients from 1st January to 31st December 2014 were included in the study and was followed till complete healing of ulcer or amputation or for a minimum period of 6 months. Those patients who lost for followup before 6 months were excluded from study. Necessary data was collected and DUSS was calculated at the start of treatment. RESULTS AND CONCLUSION In our study, patients with score 3 had higher risk (40% for minor amputation and those with score 4 had higher risk (21% for major amputation overall. Patients with score 4 had 37% risk for minor amputation. Higher the score higher is the risk for amputation and lesser the chance of healing. DUSS scoring system provides an easy diagnostic tool for predicting probability of healing or amputation by combining four clinically assessable wound based parameters namely presence or absence of pedal pulses, probing to bone, wound location and presence or absence of multiple ulcers. Study groups can be stratified depending on severity of ulcers and thus can help provide a simple, streamlined approach in clinical setting without need of any advanced investigative tool, but it does not alter the procedure of wound management. The scoring system can be easily applied to clinical practice.

  10. Clinical Factors and Viral Load Influencing Severity of Acute Hepatitis A.

    Hyun Woong Lee

    Full Text Available Clinical manifestations of hepatitis A virus (HAV infection vary from mild to fulminant hepatic failure (FHF in adults. We investigated the relationship between laboratory findings, including viral load, and clinical outcomes in patients with acute hepatitis A (AHA and evaluated predictive factors for severe acute hepatitis (s-AH.We analyzed the clinical manifestations of AHA in 770 patients. Patients with a prothrombin time (PT of less than 40% of normal were classified as s-AH and included 4 patients with FHF, 11 patients with acute renal failure, and 3 patients with prolonged jaundice (n = 128. Other patients were defined as mild acute hepatitis (m-AH (n = 642. Serum samples were obtained from 48 patients with acute hepatitis A. Among them, 20 with s-AH, and 28 with m-AH, were tested for HAV RNA titer.In a multivariate analysis, age (HR = 1.042, P = 0.041, peak creatinine (HR = 4.014, P = 0.001, bilirubin (HR = 1.153, P = 0.003, alanine aminotransferase (ALT (HR = 1.001, P < 0.001, initial lactate dehydrogenase (LDH (HR = 1.000, P = 0.045 and total cholesterol (HR = 0.978, P < 0.001 were independent factors for s-AH. Serum HAV RNA was detected in 20/20 (100% patients with s-AH and 22/28 (78.6% patients with m-AH. In a multivariate analysis of the 48 patients who were tested for HAV RNA, peak ALT (HR = 1.001, P = 0.004 and HAV RNA titer (HR = 2.076, P = 0.012 were independent factors for s-AH.Clinical factors including age, peak creatinine, bilirubin, ALT, initial LDH and total cholesterol were independent factors for s-AH in a multivariate analysis. In particular, HAV load strongly correlated with the severity of hepatitis A.