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Sample records for causing severe neutropenia

  1. Genetics Home Reference: severe congenital neutropenia

    Science.gov (United States)

    ... Home Health Conditions severe congenital neutropenia severe congenital neutropenia Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Severe congenital neutropenia is a condition that causes affected individuals to ...

  2. Severe congenital neutropenia

    DEFF Research Database (Denmark)

    Borregaard, Niels

    2014-01-01

    In this issue of Blood, Tidwell et al1 demonstrate that mutations in the start codon (protein synthesis is initiated at the codon ATG) of neutrophil elastase (ELANE) result in the production of N-terminally truncated elastase, which mislocates to the nucleus and results in severe congenital neutr...... neutropenia (SCN)....

  3. Thalidomide-induced severe neutropenia during treatment of multiple myeloma.

    Science.gov (United States)

    Hattori, Yutaka; Kakimoto, Tsunayuki; Okamoto, Shinichiro; Sato, Norihide; Ikeda, Yasuo

    2004-04-01

    Recent reports have shown that thalidomide has antiangiogenic activity and is effective for the treatment of refractory multiple myeloma. Unlike other antineoplastic drugs, thalidomide is reported to rarely cause severe hematologic toxicity. In Keio University Hospital, 44 patients with refractory multiple myeloma, including 18 who had relapsed after hematopoietic stem cell transplantation, were treated with this drug as a single agent. Severe grade 3 or 4 neutropenia during thalidomide treatment was observed in 10 patients. This phenomenon was not noted in previous reports. Neutropenia usually occurred in the first or second week of treatment. Concomitant progression of thrombocytopenia occurred in 5 cases, and bone marrow hypoplasia without a significant increase in myeloma cell numbers was also observed in 5 cases. Neutropenia was not correlated with anti-tumor response or the plasma concentration of thalidomide but was more frequently observed in patients with a low neutrophil and platelet count, anemia, or a high plasma cell percentage in the bone marrow before thalidomide treatment. Thus, this drug should be used carefully for patients with pretreatment cytopenia or a high tumor burden in the bone marrow. PMID:15168599

  4. Double de novo mutations of ELA2 in cyclic and severe congenital neutropenia.

    Science.gov (United States)

    Salipante, Stephen J; Benson, Kathleen F; Luty, Joanna; Hadavi, Valeh; Kariminejad, Roxana; Kariminejad, Mohamad H; Rezaei, Nima; Horwitz, Marshall S

    2007-09-01

    Heterozygous mutations of ELA2, encoding the protease neutrophil elastase (NE), cause either autosomal dominant cyclic neutropenia or severe congenital neutropenia (SCN). Three hypotheses have been proposed for how allelic mutations produce these different disorders: 1) disruption of proteolytic activity; 2) mislocalization of the protein; or 3) destabilization of the protein resulting in induction of the unfolded protein response. As with other dominant diseases with reduced reproductive fitness, sporadic cases can result from new mutations not inherited from either parent. Here we report an exceptional genetic phenomenon in which both a cyclic neutropenia patient and an SCN patient each possess two new ELA2 mutations. Because of the rarity of the phenomenon, we investigated the origins of the mutations and found that both arise nonmosaically and in cis from the paternally-inherited allele. Moreover, these cases offer a unique opportunity to investigate molecular pathways distinguishing these two forms of hereditary neutropenia. We have characterized the mutants separately and in combination, with respect to their effects on proteolysis, subcellular trafficking, and induction of the unfolded protein response. Each pair of mutations acts more or less additively to produce equivalent net effects on reducing proteolytic activity and induction of the unfolded protein response, yet each has different and somewhat opposing effects on disturbing subcellular localization, thus offering support for a role for protein mistrafficking as a disease mechanism. PMID:17436313

  5. CLPB Mutations Cause 3-Methylglutaconic Aciduria, Progressive Brain Atrophy, Intellectual Disability, Congenital Neutropenia, Cataracts, Movement Disorder

    Science.gov (United States)

    Wortmann, Saskia B.; Ziętkiewicz, Szymon; Kousi, Maria; Szklarczyk, Radek; Haack, Tobias B.; Gersting, Søren W.; Muntau, Ania C.; Rakovic, Aleksandar; Renkema, G. Herma; Rodenburg, Richard J.; Strom, Tim M.; Meitinger, Thomas; Rubio-Gozalbo, M. Estela; Chrusciel, Elzbieta; Distelmaier, Felix; Golzio, Christelle; Jansen, Joop H.; van Karnebeek, Clara; Lillquist, Yolanda; Lücke, Thomas; Õunap, Katrin; Zordania, Riina; Yaplito-Lee, Joy; van Bokhoven, Hans; Spelbrink, Johannes N.; Vaz, Frédéric M.; Pras-Raves, Mia; Ploski, Rafal; Pronicka, Ewa; Klein, Christine; Willemsen, Michel A.A.P.; de Brouwer, Arjan P.M.; Prokisch, Holger; Katsanis, Nicholas; Wevers, Ron A.

    2015-01-01

    We studied a group of individuals with elevated urinary excretion of 3-methylglutaconic acid, neutropenia that can develop into leukemia, a neurological phenotype ranging from nonprogressive intellectual disability to a prenatal encephalopathy with progressive brain atrophy, movement disorder, cataracts, and early death. Exome sequencing of two unrelated individuals and subsequent Sanger sequencing of 16 individuals with an overlapping phenotype identified a total of 14 rare, predicted deleterious alleles in CLPB in 14 individuals from 9 unrelated families. CLPB encodes caseinolytic peptidase B homolog ClpB, a member of the AAA+ protein family. To evaluate the relevance of CLPB in the pathogenesis of this syndrome, we developed a zebrafish model and an in vitro assay to measure ATPase activity. Suppression of clpb in zebrafish embryos induced a central nervous system phenotype that was consistent with cerebellar and cerebral atrophy that could be rescued by wild-type, but not mutant, human CLPB mRNA. Consistent with these data, the loss-of-function effect of one of the identified variants (c.1222A>G [p.Arg408Gly]) was supported further by in vitro evidence with the mutant peptides abolishing ATPase function. Additionally, we show that CLPB interacts biochemically with ATP2A2, known to be involved in apoptotic processes in severe congenital neutropenia (SCN) 3 (Kostmann disease [caused by HAX1 mutations]). Taken together, mutations in CLPB define a syndrome with intellectual disability, congenital neutropenia, progressive brain atrophy, movement disorder, cataracts, and 3-methylglutaconic aciduria. PMID:25597510

  6. Severe congenital neutropenia with neurological impairment due to a homozygous VPS45 p.E238K mutation: A case report suggesting a genotype-phenotype correlation.

    Science.gov (United States)

    Meerschaut, Ilse; Bordon, Victoria; Dhooge, Catharina; Delbeke, Patricia; Vanlander, Arnaud V; Simon, Amos; Klein, Christoph; Kooy, R Frank; Somech, Raz; Callewaert, Bert

    2015-12-01

    VPS45 mutations cause severe congenital neutropenia (SCN). We report on a girl with SCN and neurological impairment harboring a homozygous p.E238K mutation in VPS45 (vacuolar sorting protein 45). She successfully underwent hematopoietic stem cell transplantation. Our findings delineate the phenotype and indicate a possible genotype-phenotype correlation for neurological involvement. PMID:26358756

  7. Genetics Home Reference: cyclic neutropenia

    Science.gov (United States)

    ... Understand Genetics Home Health Conditions cyclic neutropenia cyclic neutropenia Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Cyclic neutropenia is a disorder that causes frequent infections and ...

  8. Cardiac and Renal Malformations in a Patient with Sepsis and Severe Congenital Neutropenia

    Directory of Open Access Journals (Sweden)

    Aziz Eghbali

    2010-02-01

    Full Text Available Background:G6PC3 deficiency is a new neutropenic syndrome, which is characterized by severe persistent neutropenia, early onset infections and additional organ involvement, especially cardiac and urogenital malformations. Case Presentation:In this report, we present the clinical details of a recently known case of severe congenital neutropenia (SCN with G6PC3 mutation, who experienced the first episode of infections at birth. Repeated absolute neutrophil count of less than 500/?l was detected during work-up of sepsis in the first month of life. SCN was diagnosed and granulocyte colony-stimulating factor (GCSF administration initiated. Bone marrow examination revealed maturation arrest in myeloid series at promyelocyte-myelocyte stage. Diarrhea, bronchiolitis, and urinary tract infection were other infectious complications, while hydronephrosis, atrial septal defect, and patent ductus arteriosus were other manifestations.Conclusion:Prompt and accurate diagnosis of neutropenic patients and appropriate treatment can prevent further complications and improve the quality of life of the affected patients.

  9. Simultaneous occurrence of fetal and neonatal alloimmune thrombocytopenia and neonatal neutropenia due to maternal neutrophilic autoantibodies

    DEFF Research Database (Denmark)

    Taaning, Ellen; Jensen, Lise; Varming, Kim

    2012-01-01

    Foetal and neonatal alloimmune thrombocytopenia (FNAIT) and neonatal neutropenia caused by maternal autoantibodies against neutrophils are rare disorders. We describe a newborn with severe thrombocytopenia and intracerebral bleeding caused by maternal anti-HPA-3a alloantibodies and mild neutropenia...

  10. Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report

    OpenAIRE

    Rauf Mariam; Gleason Charise; Nooka Ajay K; Husman Abbie; Waller Edmund K

    2011-01-01

    Abstract Introduction The differential diagnosis of neutropenia includes medications, infections, autoimmune diseases, and deficiencies of Vitamin B12 and folate. The association of Vitamin B6 deficiency with severe neutropenia is a rare finding. Case presentation A 51-year-old Caucasian woman presented with fever and profound neutropenia (48 neutrophils/uL). Her clinical history included non-Hodgkin lymphoma, in remission following treatment with allogeneic bone marrow transplantation, quies...

  11. Relato de um caso de neutropenia congênita grave em um lactente jovem A case report of severe congenital neutropenia in a young infant

    Directory of Open Access Journals (Sweden)

    Lucas Fadel M. dos Santos

    2011-12-01

    Full Text Available OBJETIVO: Relatar um caso de neutropenia congênita grave e alertar os pediatras sobre tal diagnóstico em pacientes jovens, com infecções recorrentes. DESCRIÇÃO DO CASO: Lactente jovem com 45 dias de vida, com história de febre alta, letargia, recusa alimentar e hemogramas repetidos com leucopenia importante à custa de polimorfonucleares. A hipótese diagnóstica foi confirmada pelo aspirado de medula óssea, que mostrou hipoplasia de série granulocítica e completa ausência de neutrófilos maduros. Foi introduzida antibioticoterapia de largo espectro e estimulador da formação de colônias de granulócitos. O paciente evoluiu para óbito em decorrência de complicações infecciosas após 21 dias de internação. COMENTÁRIOS: Trata-se de um lactente jovem, portador de uma rara desordem congênita que leva à intensa neutropenia, deixando-o vulnerável a infecções graves e potencialmente fatais. À internação, o paciente apresentava sinais e sintomas sugestivos de sepse, sendo introduzido antibioticoterapia de amplo espectro, necessária por se tratar de lactente jovem, neutropênico e febril. A hipótese diagnóstica se baseou na história clínica e nos leucogramas alterados, sendo posteriormente confirmada pelo aspirado de medula óssea. Foi introduzido o estimulador da formação de colônias de granulócitos, que geralmente é efetivo, porém, nesse caso, não houve sucesso e o paciente evoluiu para óbito devido à grave infecção.OBJECTIVE: To report a case of severe congenital neutropenia and alert pediatricians about its diagnosis in young patients with recurrent infectious diseases. CASE DESCRIPTION: Young infant with 45 days of life, with a history of high fever, lethargy, poor feeding and repeated blood counts showing significant leucopenia due to a significant decrease of polymorphonuclear cells. The diagnosis was confirmed by bone marrow aspirate showing hypoplasia of the granulocytic series and complete absence of

  12. Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern.

    LENUS (Irish Health Repository)

    Morris, Patrick G

    2008-09-01

    Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed.

  13. Osteoporosis in children with severe congenital neutropenia: bone mineral density and treatment with bisphosphonates.

    Science.gov (United States)

    Borzutzky, Arturo; Reyes, María Loreto; Figueroa, Valeria; García, Cristián; Cavieres, Mirta

    2006-04-01

    A high incidence of decreased bone mineral density (BMD) has been described in patients with severe congenital neutropenia (SCN). The objectives of the study are to describe changes in BMD in children with SCN treated with granulocyte colony-stimulating factor and evaluate the response to treatment with bisphosphonates in those who had osteoporosis. A prospective open-label study was performed evaluating BMD and metabolism in 9 Chilean patients with SCN, administrating bisphosphonates in those with osteoporosis. Follow-up ranged between 7 months and 3.5 years. Six out of 9 patients had reduced BMD on initial assessment: 3 had osteoporosis (z score <-2) and 3 had osteopenia (z score <-1). Four children presented vertebral fractures. Two presented osteopenia on follow-up without clinical symptoms. Five patients were treated with bisphosphonates, increasing their BMD z score (mean increase 1.2, range 0.27 to 2.62). z Score of hydroxyproline/creatinine ratios, which was elevated in 4 patients with osteoporosis, decreased during treatment (mean decrease 2.18, range 1.56 to 2.53). Four patients remodeled and reexpanded fractured vertebrae during treatment. No side effects of bisphosphonates were seen on follow-up. Osteoporosis is an important comorbidity in SCN patients probably due to increased bone resorption. Bisphosphonates seem to be an effective treatment for osteoporosis in these patients. PMID:16679916

  14. Autoimmune Neutropenia as a Cause of Periodontal Disease in Preschool Children.

    Science.gov (United States)

    Hajishengallis, Evlambia; Rashewsky, Stephanie; Kulkarni, Cyelee; Stathopoulou, Panagiota

    2016-01-01

    In autoimmune neutropenia, autoantibodies attack neutrophils resulting in their destruction or alteration of their function. Since neutrophils have important immunologic functions, aberrations in their homeostasis lead to increased susceptibility to diseases, such as periodontitis. Periodontitis as a manifestation of neutropenia can affect adults and children. In this paper, we describe the treatment of periodontal disease in a 2-year-old female with autoimmune neutropenia. The importance of an interdisciplinary approach, frequent recalls, and meticulous mechanical therapy in stabilizing her periodontal condition, despite ongoing systemic infections is emphasized. PMID:26696110

  15. Adult siblings with homozygous G6PC3 mutations expand our understanding of the severe congenital neutropenia type 4 (SCN4 phenotype

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    Fernandez Bridget A

    2012-11-01

    Full Text Available Abstract Background Severe congenital neutropenia type 4 (SCN4 is an autosomal recessive disorder caused by mutations in the third subunit of the enzyme glucose-6-phosphatase (G6PC3. Its core features are congenital neutropenia and a prominent venous skin pattern, and affected individuals have variable birth defects. Oculocutaneous albinism type 4 (OCA4 is caused by autosomal recessive mutations in SLC45A2. Methods We report a sister and brother from Newfoundland, Canada with complex phenotypes. The sister was previously reported by Cullinane et al., 2011. We performed homozygosity mapping, next generation sequencing and conventional Sanger sequencing to identify mutations that cause the phenotype in this family. We have also summarized clinical data from 49 previously reported SCN4 cases with overlapping phenotypes and interpret the medical histories of these siblings in the context of the literature. Results The siblings’ phenotype is due in part to a homozygous mutation in G6PC3, [c.829C > T, p.Gln277X]. Their ages are 38 and 37 years respectively and they are the oldest SCN4 patients published to date. Both presented with congenital neutropenia and later developed Crohn disease. We suggest that the latter is a previously unrecognized SCN4 manifestation and that not all affected individuals have an intellectual disability. The sister also has a homozygous mutation in SLC45A2, which explains her severe oculocutaneous hypopigmentation. Her brother carried one SLC45A2 mutation and was diagnosed with “partial OCA” in childhood. Conclusions This family highlights that apparently novel syndromes can in fact be caused by two known autosomal recessive disorders.

  16. Neutropenia - infants

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007230.htm Neutropenia - infants To use the sharing features on this page, please enable JavaScript. Neutropenia is an abnormally low number of white blood ...

  17. [Severe inflammation during recovery from neutropenia: the immune reconstitution inflammatory syndrome following chemotherapy].

    Science.gov (United States)

    van Lier, Dirk P T; Janssen, Nico A F; Snoeren, Miranda M; Verweij, Paul E; Blijlevens, Nicole M A; van der Velden, Walter J F M

    2015-01-01

    Immune reconstitution inflammatory syndrome (IRIS) occurs when a patient is recovering from a transient immunodeficiency and results in an uncontrolled inflammatory response to infectious agents and tissue damage. Symptoms such as fever and radiological signs seem to paradoxically appear or worsen, unmasking a previously unrecognized infection. The patient's clinical condition may then deteriorate as a result of increasing tissue damage and this may even lead to death. IRIS was initially described in patients suffering from a HIV infection who experienced immune recovery following the initiation of antiretroviral therapy. Increasingly, however, the syndrome is being reported in patients who are recovering from an episode of neutropenia following chemotherapy, hypomethylating agent use or a stem cell transplantation for the treatment of a solid tumour or haematological cancers. We describe two cases of IRIS following an episode of neutropenia in patients with a haematological malignancy and elaborate on the pathogenesis, diagnosis and treatment of IRIS in cancer patients. PMID:26246060

  18. Treatment of severe neutropenia with high-dose pyridoxine in a patient with chronic graft versus host disease and squamous cell carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Rauf Mariam

    2011-08-01

    Full Text Available Abstract Introduction The differential diagnosis of neutropenia includes medications, infections, autoimmune diseases, and deficiencies of Vitamin B12 and folate. The association of Vitamin B6 deficiency with severe neutropenia is a rare finding. Case presentation A 51-year-old Caucasian woman presented with fever and profound neutropenia (48 neutrophils/uL. Her clinical history included non-Hodgkin lymphoma, in remission following treatment with allogeneic bone marrow transplantation, quiescent chronic graft-versus-host disease, and squamous cell carcinoma of the skin metastatic to cervical lymph nodes. Medications included atenolol, topical clobetasol, Ditropan (oxybutynin, prophylactic voriconazole, prophylactic valganciclovir, Soriatane (acitretin, and Carac (fluorouracil cream. The bone marrow was hypocellular without metastatic cancer or myelodysplasia. Neutropenia did not respond to stopping medications that have been associated with neutropenia (valganciclovir, voriconazole and Soriatane or treatment with antibiotics or granulocyte colony stimulating factor. Blood tests revealed absence of antineutrophil antibodies, normal folate and B12 levels, moderate zinc deficiency and severe Vitamin B6 deficiency. Replacement therapy with oral Vitamin B6 restored blood vitamin levels to the normal range and corrected the neutropenia. Her cervical adenopathy regressed clinically and became negative on scintography following Vitamin B6 therapy and normalization of the blood neutrophil count. Conclusion Severe pyridoxine deficiency can lead to neutropenia. Screening for Vitamin B6 deficiency, along with folate and Vitamin B12 levels, is recommended in patients with refractory neutropenia, especially those with possible malabsorption syndromes, or a history of chronic-graft-versus host disease. Severe neutropenia may facilitate progression of squamous cell carcinoma.

  19. CLPB Mutations Cause 3-Methylglutaconic Aciduria, Progressive Brain Atrophy, Intellectual Disability, Congenital Neutropenia, Cataracts, Movement Disorder

    OpenAIRE

    Wortmann, Saskia B.; Ziętkiewicz, Szymon; Kousi, Maria; Szklarczyk, Radek; Haack, Tobias B.; Gersting, Søren W.; Muntau, Ania C.; Rakovic, Aleksandar; Renkema, G. Herma; Rodenburg, Richard J.; Strom, Tim M.; Meitinger, Thomas; Rubio-Gozalbo, M. Estela; Chrusciel, Elzbieta; Distelmaier, Felix

    2015-01-01

    We studied a group of individuals with elevated urinary excretion of 3-methylglutaconic acid, neutropenia that can develop into leukemia, a neurological phenotype ranging from nonprogressive intellectual disability to a prenatal encephalopathy with progressive brain atrophy, movement disorder, cataracts, and early death. Exome sequencing of two unrelated individuals and subsequent Sanger sequencing of 16 individuals with an overlapping phenotype identified a total of 14 rare, predicted delete...

  20. Drug-induced immune neutropenia/agranulocytosis.

    Science.gov (United States)

    Curtis, Brian R

    2014-01-01

    Neutrophils are the most abundant white blood cell in blood and play a critical role in preventing infections as part of the innate immune system. Reduction in neutrophils below an absolute count of 500 cells/pL is termed severe neutropenia or agranulocytosis. Drug-induced immune neutropenia (DIIN) occurs when drug-dependent antibodies form against neutrophil membrane glycoproteins and cause neutrophil destruction. Affected patients have fever, chills, and infections; severe infections left untreated can result in death. Treatment with granulocyte colony-stimulating factor can hasten neutrophil recovery. Cumulative data show that severe neutropenia or agranulocytosis associated with exposure to nonchemotherapy drugs ranges from approximately 1.6 to 15.4 cases per million population per year. Drugs most often associated with neutropenia or agranulocytosis include dipyrone, diclofenac, ticlopidine, calcium dobesilate, spironolactone, antithyroid drugs (e.g., propylthiouracil), carbamazepine, sulfamethoxazole- trimethoprim, [3-lactam antibiotics, clozapine, levamisole, and vancomycin. Assays used for detection of neutrophil drug-dependent antibodies (DDAbs) include flow cytometry, monoclonal antibody immobilization of granulocyte antigens, enzyme-linked immunosorbent assay, immunoblotting, granulocyte agglutination, and granulocytotoxicity. However, testing for neutrophil DDAbs is rarely performed owing to its complexity and lack of availability. Mechanisms proposed for DIIN have not been rigorously studied, but those that have been studied include drug- or hapten-induced antibody formation and autoantibody production against drug metabolite or protein adducts covalently attached to neutrophil membrane proteins. This review will address acute, severe neutropenia caused by neutrophil-reactive antibodies induced by nonchemotherapy drugs-DIIN PMID:25247619

  1. ''Hair-on-end'' skull induced by long-term G-CSF treatment in severe congenital neutropenia

    Energy Technology Data Exchange (ETDEWEB)

    Albert, Michael H. [Dr. von Haunersches Kinderspital, Department of Haematology/Oncology, Munich (Germany); Notheis, Gundula; Wintergerst, Uwe [Dr. von Haunersches Kinderspital, Department of Infection/Immunity, Munich (Germany); Born, Christine [Klinikum Innenstadt, General Radiology, Munich (Germany); Schneider, Karl [Dr. von Haunersches Kinderspital, Department of Pediatric Radiology, Munich (Germany)

    2007-02-15

    ''Hair-on-end'' skull changes are typically seen in individuals suffering from thalassaemia. They are induced by widening of the diploic space due to marrow expansion that is a consequence of ineffective and excessive erythropoiesis. We present a child with severe congenital neutropenia who exhibited the typical hair-on-end sign on plain skull radiographs and MRI. In this patient the skull changes were very likely induced by the expansion of white blood cell precursors induced by long-term daily injections of recombinant human granulocyte colony stimulating factor (G-CSF) to treat his confounding disease. This case report is the first description of hair-on-end changes associated with the use of G-CSF. (orig.)

  2. IMPORTANCE OF SERUM PROCALCITONIN IN FEBRILE NEUTROPENIA

    Directory of Open Access Journals (Sweden)

    Mohd. Riyaz

    2014-07-01

    Full Text Available Febrile neutropenia is defined as a fever >101°F for 1 hour, with an absolute neutrophil count of ≤500 cells/microliter, or an ANC of ≤1000 cells/microliter with a projected nadir of ≤500 cells/microliter. In haematological malignancies it is the common complication and requires broad-spectrum antibacterial therapy. Clinical examination and cultures fail to detect a pathogen or an infectious focus in 25–50%, which are classified as pyrexia of unknown origin (PUO. Patient with pyrexia of unknown origin may receive long duration of antibiotic treatment as the cause is unclear of being infective or not. Febrile neutropenia is a common complication of many chemotherapeutic regimens for all types of cancers. Mortality and Morbidity is high particularly in elderly, immuno-compromised. Approximately 20- 40 % of patients with severe sepsis and 45-60% patients with septic shock die within 15-20 days. This study was done to know the sources of infection and to assess the diagnostic value of serum Procalcitonin and its relation with mortality in various stages of sepsis. Sepsis incidence was more in patient age more than 55yrs. the most common source of sepsis was respiratory tract infection. Serum PCT proved to be an indicator of sepsis in ill patients, with sensitivity of 91%. Presence of both persistent and profound neutropenia was associated with a much higher mortality. The occurrence of infection is directly proportional to the degree of neutropenia, at the onset of fever the PCT levels will not be helpful for the decision to start or stop the antibacterial therapy, and a PCT value higher than 0.5ng/ml in pyrexia of unknown origin might suggest a possibility of occult infection, i.e. with lacking microbiological and clinical documentation. A delayed PCT peak higher than0.5ng/ml contributes to the early diagnosis of fungal disease.

  3. Clinical and Laboratory Findings in Iranian Children with Cyclic Neutropenia

    OpenAIRE

    2004-01-01

    Cyclic neutropenia is a rare immunodeficiency syndrome, characterized by regular periodic oscillations in the circulating neutrophil count from normal to neutropenic levels through 3 weeks period, and lasting for 3-6 days. In order to determine the clinical features of cyclic neutropenia, this study was performed. Seven patients with cyclic neutropenia (3 males and 4 females), who experienced neutropenic periods every 3 weeks (5 with severe and 2 with moderate neutropenia), were investigated ...

  4. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia.

    Science.gov (United States)

    Freire, M P; de Oliveira Garcia, D; Garcia, C P; Campagnari Bueno, M F; Camargo, C H; Kono Magri, A S G; Francisco, G R; Reghini, R; Vieira, M F; Ibrahim, K Y; Rossi, F; Hajjar, L; Levin, A S; Hoff, P M; Pierrotti, L C; Abdala, E

    2016-04-01

    This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site. PMID:26711434

  5. An Unexpected Cause of Severe Hypokalemia

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    Fernando Caravaca-Fontan

    2015-01-01

    Full Text Available We describe an unusual case of severe hypokalemia with electrocardiographic changes, due to licorice consumption, in a 15-year-old female student with no previous medical history. Prompt replacement of potassium and cessation of licorice ingestion resulted in a favourable outcome. We also discuss the pathophysiology and diagnosis, emphasizing the importance of a detailed anamnesis to rule out an often forgotten cause of hypokalemia as the licorice poisoning.

  6. Deletion of GPIHBP1 causing severe chylomicronemia

    OpenAIRE

    Rios, Jonathan J.; Shastry, Savitha; Jasso, Juan; Hauser, Natalie; Garg, Abhimanyu; Bensadoun, André; Cohen, Jonathan C.; Hobbs, Helen H.

    2011-01-01

    Lipoprotein lipase (LPL) is a hydrolase that cleaves circulating triglycerides to release fatty acids to the surrounding tissues. The enzyme is synthesized in parenchymal cells and is transported to its site of action on the capillary endothelium by glycophosphatidylinositol (GPI)-anchored high-density lipoprotein-binding protein 1 (GPIHBP1). Inactivating mutations in LPL; in its cofactor, apolipoprotein (Apo) C2; or in GPIHBP1 cause severe hypertriglyceridemia. Here we describe an individual...

  7. Risk Factors Study for Lung Cancer Patients with Chemotherapy-induced Severe Neutropenia%化疗致肺癌患者严重粒细胞减少相关危险因素研究

    Institute of Scientific and Technical Information of China (English)

    樊迪; 尤海生; 胡萨萨; 王茂义; 封卫毅; 董亚琳

    2016-01-01

    Objective:To discuss the risk factors in lung cancer patients with chemotherapy-induced severe neutropenia to provide reference for clinical drug use. Methods:A retrospective analysis was performed for the patients with lung cancer,and the risk factors of severe neutropenia were statistically analyzed and found out. Results:The results of single factor experiments showed that the incidence of severe neutropenia was related with radiotherapy history,cycles of chemotherapy and the use time of granulocyte colony factor. Based on a binary logistic regression analysis,the history of radiotherapy and the use of granulocyte colony factor were the significant risk factors of severe neutropenia in the lung cancer patients. Conclusion:For the patients with radiotherapy history,it is better to choose chemotherapy drugs with lower toxicity,decrease drug dosage or preventively use granulocyte colony factor. The rational use of rhG-CSF can alleviate chemotherapy-induced severe neutropenia.%目的:探讨化疗致肺癌患者严重粒细胞减少的相关危险因素,为临床用药提供参考。方法:回顾性分析肺癌患者临床资料,统计分析找出与严重粒细胞减少有关的危险因素。结果:单因素分析显示严重粒细胞减少与放疗史、化疗周期和粒细胞集落因子使用时机具有相关性。Logistic 回归分析显示,放疗史、粒细胞集落因子使用时机是肺癌患者严重粒细胞减少的危险因素。结论:对于有放疗史的患者,可选用细胞毒性小的化疗方案,或降低药物剂量,或预防使用集落刺激因子;合理应用粒细胞集落刺激因子可减轻肺癌化疗引起的严重粒细胞减少。

  8. Deletion of GPIHBP1 causing severe chylomicronemia.

    Science.gov (United States)

    Rios, Jonathan J; Shastry, Savitha; Jasso, Juan; Hauser, Natalie; Garg, Abhimanyu; Bensadoun, André; Cohen, Jonathan C; Hobbs, Helen H

    2012-05-01

    Lipoprotein lipase (LPL) is a hydrolase that cleaves circulating triglycerides to release fatty acids to the surrounding tissues. The enzyme is synthesized in parenchymal cells and is transported to its site of action on the capillary endothelium by glycophosphatidylinositol (GPI)-anchored high-density lipoprotein-binding protein 1 (GPIHBP1). Inactivating mutations in LPL; in its cofactor, apolipoprotein (Apo) C2; or in GPIHBP1 cause severe hypertriglyceridemia. Here we describe an individual with complete deficiency of GPIHBP1. The proband was an Asian Indian boy who had severe chylomicronemia at 2 months of age. Array-based copy-number analysis of his genomic DNA revealed homozygosity for a 17.5-kb deletion that included GPIHBP1. A 44-year-old aunt with a history of hypertriglyceridemia and pancreatitis was also homozygous for the deletion. A bolus of intravenously administered heparin caused a rapid increase in circulating LPL and decreased plasma triglyceride levels in control individuals but not in two GPIHBP1-deficient patients. Thus, short-term treatment with heparin failed to attenuate the hypertriglyceridemia in patients with GPIHBP1 deficiency. The increasing resolution of copy number microarrays and their widespread adoption for routine cytogenetic analysis is likely to reveal a greater role for submicroscopic deletions in Mendelian conditions. We describe the first neonate with complete GPIHBP1 deficiency due to homozygosity for a deletion of GPIHBP1. PMID:22008945

  9. Congenital neutropenia: diagnosis, molecular bases and patient management

    Directory of Open Access Journals (Sweden)

    Chantelot Christine

    2011-05-01

    Full Text Available Abstract The term congenital neutropenia encompasses a family of neutropenic disorders, both permanent and intermittent, severe ( When neutropenia is detected, an attempt should be made to establish the etiology, distinguishing between acquired forms (the most frequent, including post viral neutropenia and auto immune neutropenia and congenital forms that may either be isolated or part of a complex genetic disease. Except for ethnic neutropenia, which is a frequent but mild congenital form, probably with polygenic inheritance, all other forms of congenital neutropenia are extremely rare and have monogenic inheritance, which may be X-linked or autosomal, recessive or dominant. About half the forms of congenital neutropenia with no extra-hematopoetic manifestations and normal adaptive immunity are due to neutrophil elastase (ELANE mutations. Some patients have severe permanent neutropenia and frequent infections early in life, while others have mild intermittent neutropenia. Congenital neutropenia may also be associated with a wide range of organ dysfunctions, as for example in Shwachman-Diamond syndrome (associated with pancreatic insufficiency and glycogen storage disease type Ib (associated with a glycogen storage syndrome. So far, the molecular bases of 12 neutropenic disorders have been identified. Treatment of severe chronic neutropenia should focus on prevention of infections. It includes antimicrobial prophylaxis, generally with trimethoprim-sulfamethoxazole, and also granulocyte-colony-stimulating factor (G-CSF. G-CSF has considerably improved these patients' outlook. It is usually well tolerated, but potential adverse effects include thrombocytopenia, glomerulonephritis, vasculitis and osteoporosis. Long-term treatment with G-CSF, especially at high doses, augments the spontaneous risk of leukemia in patients with congenital neutropenia.

  10. {sup 18}F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Vos, Fidel J.; Kullberg, Bart-Jan; Bleeker-Rovers, Chantal P. [Radboud University Nijmegen Medical Centre, Department of Internal Medicine, PO Box 9101, Nijmegen (Netherlands); Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Donnelly, J.P.; Blijlevens, Nicole M.A. [Radboud University Nijmegen Medical Centre, Department of Hematology, Nijmegen (Netherlands); Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Oyen, Wim J.G. [Radboud University Nijmegen Medical Centre, Department of Nuclear Medicine, Nijmegen (Netherlands); Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2012-01-15

    Between 30 and 50% of febrile neutropenic episodes are accounted for by infection. C-reactive protein (CRP) is a nonspecific parameter for infection and inflammation but might be employed as a trigger for diagnosis. The aim of the study was to evaluate whether {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT can be used to detect inflammatory foci in neutropenic patients with elevated CRP and whether it helps to direct treatment. Twenty-eight consecutive patients with neutropenia as a result of intensive chemotherapy for haematological malignancies or myeloablative therapy for haematopoietic stem cell transplantation were prospectively included. {sup 18}F-FDG PET/CT was added to the regular diagnostic workup once the CRP level rose above 50 mg/l. Pathological FDG uptake was found in 26 of 28 cases despite peripheral neutrophil counts less than 0.1 x 10{sup -9}/l in 26 patients: in the digestive tract in 18 cases, around the tract of the central venous catheter (CVC) in 9 and in the lungs in 7 cases. FDG uptake in the CVC tract was associated with coagulase-negative staphylococcal bacteraemia (p < 0.001) and deep venous thrombosis (p = 0.002). The number of patients having Streptococcus mitis bacteraemia appeared to be higher in patients with grade 3 oesophageal FDG uptake (p = 0.08). Pulmonary FDG uptake was associated with the presence of invasive fungal disease (p = 0.04). {sup 18}F-FDG PET/CT scanning during chemotherapy-induced febrile neutropenia and increased CRP is able to detect localized foci of infection and inflammation despite the absence of circulating neutrophils. Besides its potential role in detecting CVC-related infection during febrile neutropenia, the high negative predictive value of {sup 18}F-FDG PET/CT is important for avoiding unnecessary diagnostic tests and therapy. (orig.)

  11. Neutropenia in Patients with Primary Antibody Deficiency Disorders

    Directory of Open Access Journals (Sweden)

    "Nima Rezaei

    2004-06-01

    Neutropenia may occur in any of the primary immunodeficiency disorders. Persistent or severe infections always pose a supposition, which deserves further evaluation for detecting an underlying immune deficiency syndrome and neutropenia, since a delay in diagnosis may result in a serious organ damage or even death of the patient.

  12. The antimicrobial propeptide hCAP-18 plasma levels in neutropenia of various aetiologies

    DEFF Research Database (Denmark)

    Ye, Ying; Carlsson, Göran; Karlsson-Sjöberg, Jenny M T;

    2015-01-01

    The underlying cause of neutropenia may be difficult to determine due to similar clinical presentation in many neutropenic conditions. The neutrophil protein hCAP-18 (pro-LL-37) is a major component of neutrophil secondary granules and in this prospective study we assessed the use of hCAP-18 levels...... in blood plasma for differential diagnosis of neutropenic patients (n = 133) of various aetiologies. Plasma levels of hCAP-18 were determined using immunoblot and ELISA. Patients with severe congenital neutropenia (n = 23) presented with the lowest levels of plasma hCAP-18 and differential diagnostic...... diagnostic value in differential diagnosis of chronic neutropenia. Neutropenic patients with Shwachman-Diamond syndrome, Barth syndrome, Cohen syndrome, acute myeloid leukaemia and specific granule deficiency presented with reduced plasma hCAP-18 levels as well. The blood plasma level of hCAP-18 was thus low...

  13. Clozapine Rechallenge After Neutropenia or Leucopenia.

    Science.gov (United States)

    Prokopez, Cintia R; Armesto, Arnaldo R; Gil Aguer, María F; Balda, María V; Papale, Rosa M; Bignone, Inés M; Daray, Federico M

    2016-08-01

    To rechallenge with clozapine for a patient who previously has experienced neutropenia or leucopenia or during clozapine treatment is a difficult clinical decision. Herein, we analyzed the results of such a rechallenge in 19 patients. We analyzed all the reports, from the database of the pharmacovigilance department of the Argentine National Administration of Drugs, Foods, and Medical Devices, of patients who were rechallenged with clozapine after a leucopenia or a neutropenia. Nineteen cases of rechallenge after leucopenia or neutropenia were reported between 1996 and 2014. One third of the patients re-exposed to clozapine developed a new hematologic adverse reaction. The second blood dyscrasia was less severe in 83% of the cases and had a shorter median latency as compared with the first (8 weeks vs 182 weeks, P = 0.0045). There were no significant differences for demographic and clinical characteristics of patients who developed a second dyscrasia as compared with those who did not. The present study shows that almost 70% of the patients rechallenged with clozapine after a leucopenia or a neutropenia did not develop a new hematological adverse effect, whereas the remaining 30% had a faster but less serious neutropenia. PMID:27232877

  14. Severe Vitamin D Deficiency Causing Kyphoscoliosis.

    Science.gov (United States)

    Singhai, Abhishek; Banzal, Subodh

    2013-01-01

    Vitamin D deficiency is common among Indian population. Women are especially at risk for severe vitamin D deficiency. The risk is higher for those who are multiparous and postmenopausal. Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity and malabsorption are also important risk factors. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage and lower back) have also been misdiagnosed as musculoskeletal disorders, including fibromyalgia, polymyalgia rheumatica and ankylosing spondylitis. Here, we report two cases presented with kyphoscoliosis, diagnosed to have severe vitamin D deficiency. PMID:26664847

  15. Severe Vitamin D Deficiency Causing Kyphoscoliosis

    OpenAIRE

    Singhai, Abhishek; Banzal, Subodh

    2013-01-01

    Vitamin D deficiency is common among Indian population. Women are especially at risk for severe vitamin D deficiency. The risk is higher for those who are multiparous and postmenopausal. Poor exposure to sunlight, higher latitude, winter season, inadequate diet, older age, obesity and malabsorption are also important risk factors. Symptoms of hypovitaminosis D, including diffuse or migratory pain affecting several sites (especially the shoulder, pelvis, ribcage and lower back) have also been ...

  16. Deficiency of the ribosome biogenesis gene Sbds in hematopoietic stem and progenitor cells causes neutropenia in mice by attenuating lineage progression in myelocytes.

    Science.gov (United States)

    Zambetti, Noemi A; Bindels, Eric M J; Van Strien, Paulina M H; Valkhof, Marijke G; Adisty, Maria N; Hoogenboezem, Remco M; Sanders, Mathijs A; Rommens, Johanna M; Touw, Ivo P; Raaijmakers, Marc H G P

    2015-10-01

    Shwachman-Diamond syndrome is a congenital bone marrow failure disorder characterized by debilitating neutropenia. The disease is associated with loss-of-function mutations in the SBDS gene, implicated in ribosome biogenesis, but the cellular and molecular events driving cell specific phenotypes in ribosomopathies remain poorly defined. Here, we established what is to our knowledge the first mammalian model of neutropenia in Shwachman-Diamond syndrome through targeted downregulation of Sbds in hematopoietic stem and progenitor cells expressing the myeloid transcription factor CCAAT/enhancer binding protein α (Cebpa). Sbds deficiency in the myeloid lineage specifically affected myelocytes and their downstream progeny while, unexpectedly, it was well tolerated by rapidly cycling hematopoietic progenitor cells. Molecular insights provided by massive parallel sequencing supported cellular observations of impaired cell cycle exit and formation of secondary granules associated with the defect of myeloid lineage progression in myelocytes. Mechanistically, Sbds deficiency activated the p53 tumor suppressor pathway and induced apoptosis in these cells. Collectively, the data reveal a previously unanticipated, selective dependency of myelocytes and downstream progeny, but not rapidly cycling progenitors, on this ubiquitous ribosome biogenesis protein, thus providing a cellular basis for the understanding of myeloid lineage biased defects in Shwachman-Diamond syndrome. PMID:26185170

  17. Forgotten Kirschner Wire Causing Severe Hematuria

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2014-01-01

    Full Text Available Kirschner wire (K-wire is commonly used in the treatment of hip fracture and its migration into pelvis leading to bladder injury is a very rare complication. Nonremoval of these devices either because of lack of followup or because of prolonged requirement due to disease process is associated with this complication. We report a case of a patient who presented with acute onset severe hematuria with clot retention secondary to perforation of bladder by a migrated K-wire placed earlier, for the treatment of hip fracture. Initial imaging showed its presence in the soft tissues of the pelvis away from the major vascular structures. Patient was taken for emergency laparotomy and wire was removed after cystotomy. Postoperative period was uneventful and patient was discharged in satisfactory condition. K-wires are commonly used in the management of fracture bones and their migration has been reported in the literature although such migration in the intrapelvic region involving bladder is very rare. Early diagnosis and prompt removal of such foreign bodies are required to avert potentially fatal involvement of major structures.

  18. Elevated Fra-1 expression causes severe lipodystrophy.

    Science.gov (United States)

    Luther, Julia; Driessler, Frank; Megges, Matthias; Hess, Andreas; Herbort, Bettina; Mandic, Vice; Zaiss, Mario M; Reichardt, Anne; Zech, Christine; Tuckermann, Jan P; Calkhoven, Cornelis F; Wagner, Erwin F; Schett, Georg; David, Jean-Pierre

    2011-05-01

    A shift from osteoblastogenesis to adipogenesis is one of the underlying mechanisms of decreased bone mass and increased fat during aging. We now uncover a new role for the transcription factor Fra-1 in suppressing adipogenesis. Indeed, Fra1 (Fosl1) transgenic (Fra1tg) mice, which developed progressive osteosclerosis as a result of accelerated osteoblast differentiation, also developed a severe general lipodystrophy. The residual fat of these mice appeared immature and expressed lower levels of adipogenic markers, including the fatty acid transporter Cd36 and the CCAAT/enhancer binding protein Cebpa. Consequently accumulation of triglycerides and free fatty acids were detected in the serum of fasting Fra1tg mice. Fra-1 acts cell autonomously because the adipogenic differentiation of Fra1 transgenic primary osteoblasts was drastically reduced, and overexpression of Fra-1 in an adipogenic cell line blocked their differentiation into adipocytes. Strikingly, Cebpa was downregulated in the Fra-1-overexpressing cells and Fra-1 could bind to the Cebpa promoter and directly suppress its activity. Thus, our data add to the known common systemic control of fat and bone mass, a new cell-autonomous level of control of cell fate decision by which the osteogenic transcription factor Fra-1 opposes adipocyte differentiation by inhibiting C/EBPα. PMID:21486951

  19. Severe hyponatremia caused by nab-paclitaxel-induced syndrome of inappropriate antidiuretic hormone secretion

    Science.gov (United States)

    Neuzillet, Cindy; Babai, Samy; Kempf, Emmanuelle; Pujol, Géraldine; Rousseau, Benoît; Le-Louët, Hervé; Christophe Tournigand

    2016-01-01

    Abstract Incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing. Most patients have advanced disease at diagnosis and therapeutic options in this setting are limited. Gemcitabine plus nab-paclitaxel regimen was demonstrated to increase survival compared with gemcitabine monotherapy and is therefore indicated as first-line therapy in patients with metastatic PDAC and performance status Eastern Cooperative Oncology Group (ECOG) 0-2. The safety profile of gemcitabine and nab-paclitaxel combination includes neutropenia, fatigue, and neuropathy as most common adverse events of grade 3 or higher. No case of severe hyponatremia associated with the use of nab-paclitaxel for the treatment of PDAC has been reported to date. We report the case of a 72-year-old Caucasian man with a metastatic PDAC treated with gemcitabine and nab-paclitaxel regimen, who presented with a severe hyponatremia (grade 4) caused by a documented syndrome of inappropriate antidiuretic hormone secretion (SIADH). This SIADH was attributed to nab-paclitaxel after a rigorous imputability analysis, including a rechallenge procedure with dose reduction. After dose and schedule adjustment, nab-paclitaxel was pursued without recurrence of severe hyponatremia and with maintained efficacy. Hyponatremia is a rare but potentially severe complication of nab-paclitaxel therapy that medical oncologists and gastroenterologists should be aware of. Nab-paclitaxel-induced hyponatremia is manageable upon dose and schedule adaptation, and should not contraindicate careful nab-paclitaxel reintroduction. This is of particular interest for a disease in which the therapeutic options are limited. PMID:27368013

  20. REFRACTORY THROMBOCYTOPENIA AND NEUTROPENIA: A DIAGNOSTIC CHALLENGE

    Directory of Open Access Journals (Sweden)

    Emmanuel Gyan

    2015-02-01

    Full Text Available Background. The 2008 WHO classification identified refractory cytopenia with unilineage dysplasia (RCUD as a composite entity encompassing refractory anemia, refractory thrombocytopenia (RT, and refractory neutropenia (RN, characterized by 10% or more dysplastic cells in the bone marrow respective lineage. The diagnosis of RT and RN is complicated by several factors.  Diagnosing RT first requires exclusion of familial thrombocytopenia, chronic auto-immune thrombocytopenia, concomitant medications, viral infections, or hypersplenism. Diagnosis of RN should also be made after ruling out differential diagnoses such as ethnic or familial neutropenia, as well as acquired, drug-induced, infection-related or malignancy-related neutropenia. An accurate quantification of dysplasia should be performed in order to distinguish RT or RN from the provisional entity named idiopathic cytopenia of unknown significance (ICUS. Cytogenetic analysis, and possibly in the future somatic mutation analysis (of genes most frequently mutated in MDS, and flow cytometry analysis aberrant antigen expression on myeloid cells may help in this differential diagnosis. Importantly, we and others found that, while isolated neutropenia and thrombocytopenia are not rare in MDS, those patients can generally be classified (according to WHO 2008 classification as refractory cytopenia with multilineage dysplasia or refractory anemia with excess blasts, while RT and RN (according to WHO 2008 are quite rare.These results suggest in particular that identification of RT and RN as distinct entities could be reconsidered in future WHO classification updates.

  1. Effects of Traditional Chinese Medicine on Chemotherapy-Induced Myelosuppression and Febrile Neutropenia in Breast Cancer Patients

    Directory of Open Access Journals (Sweden)

    Huan Tian

    2015-01-01

    Full Text Available Title. Chemotherapy-induced myelosuppression lowers the quality of life in breast cancer patients and causes many complications. Traditional Chinese Medicine (TCM is a widely used complementary and alternative medicine therapies. Objective. To study whether TCM can reduce the incidence of chemotherapy-induced leukopenia, neutropenia, and febrile neutropenia (FN in breast cancer patients. Methods. The data were analyzed retrospectively between patients who received TCM treatment (group 1, n=453 and patients who did not receive TCM treatment (group 2, n=359. Significant risk factors associated with the occurrence of chemotherapy-induced leukopenia, neutropenia, and FN were identified using multivariate analysis. Propensity score-matched patients were analyzed to adjust for any baseline differences. Results. Group 1 patients had a significantly lower rate of chemotherapy-induced severe leukopenia, neutropenia, and FN, compared with group 2 (43% versus 71%, P<0.0001, 72% versus 78%, P=0.005, 6% versus 24%, P<0.0001, resp.. Multivariate analysis revealed that chemotherapy regimens containing anthracyclines combined with paclitaxel or docetaxel were the most significant predictor. Subgroup analysis indicated that TCM treatment showed benefit in relieving chemotherapy-induced leukopenia and FN in most chemotherapy regimens. Conclusions. TCM treatment could lower the risk of severe chemotherapy-induced leukopenia, neutropenia, and FN in breast cancer patients.

  2. Ipilimumab-Induced Neutropenia in Melanoma

    Science.gov (United States)

    Ban-Hoefen, Makiko; Burack, Richard; Sievert, Lynn; Sahasrabudhe, Deepak

    2016-01-01

    Ipilimumab is a human monoclonal IgG1 antibody against CTLA-4 that has been shown to prolong the overall survival of advanced melanoma. The most common adverse events associated with ipilimumab are immune-related. Severe hematological toxicity is rare. We report a case of severe neutropenia following ipilimumab therapy that fully resolved after the administration of prednisone, cyclosporine, and anti-thymocyte globulin therapies. PMID:27570779

  3. Ipilimumab-Induced Neutropenia in Melanoma.

    Science.gov (United States)

    Ban-Hoefen, Makiko; Burack, Richard; Sievert, Lynn; Sahasrabudhe, Deepak

    2016-01-01

    Ipilimumab is a human monoclonal IgG1 antibody against CTLA-4 that has been shown to prolong the overall survival of advanced melanoma. The most common adverse events associated with ipilimumab are immune-related. Severe hematological toxicity is rare. We report a case of severe neutropenia following ipilimumab therapy that fully resolved after the administration of prednisone, cyclosporine, and anti-thymocyte globulin therapies. PMID:27570779

  4. A Case of Neonatal Neutropenia Due to Anti-Fc Gamma Receptor IIIb Isoantibodies Treated with Recombinant Human Granulocyte Colony Stimulating Factor

    Directory of Open Access Journals (Sweden)

    Maja Tomicic

    2009-01-01

    Full Text Available Alloimmunization to granulocyte-specific antigens can occur during pregnancy. Maternal antibodies of IgG class can cross the placenta to result in alloimmune neonatal neutropenia. Antibodies to human neutrophil antigens anti-HNA-1a, HNA-1b, and HNA-2a have been most commonly reported to cause alloimmune neonatal neutropenia. Isoantibodies to Fc gamma RIIIb (CD16 if mother is a HNA-null phenotype are rarely involved in neonatal neutropenia. We report on a case of severe neutropenia (440 neutrophils/μL due to anti-Fc gamma RIIIb (CD16 isoimmunization. On day 14 severe omphalitis developed, which was treated for 7 days by an antibiotic (ceftriaxone in a dose of 80 mg/kg/d according to umbilical swab finding. Omphalitis persisted for 10 days in spite of antibiotic therapy and only resolved upon the introduction of rhG-CSF therapy. Therapy with rh-GCSF proved efficient and led to neutrophil count increase to 1970/μL and cure of omphalitis. However, therapeutic effect on granulocyte count was of transient nature, as granulocyte count fell to 760 n/μL on day 4 of therapy discontinuation. Neutropenia persisted for 2 months. The newborn was discharged from the hospital on day 26 with normal clinical status with clinical and laboratory control examinations at 2-week intervals. No additional infections were observed during the course of neutropenia.

  5. Early-Onset Neutropenia Induced by Rituximab in a Patient with Lupus Nephritis and Hemolytic Anemia

    OpenAIRE

    Mariangelí Arroyo-Ávila; Fred-Jiménez, Ruth M.; Vilá, Luis M.

    2015-01-01

    Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE) including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 109/L) a...

  6. Effect of therapy on the neutropenia of hyperthyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Eakin, D.L.; Peake, R.L.; Weiss, G.B.

    1983-03-01

    Observations in a patient with recurrent hyperthyroidism, each time associated with neutropenia which resolved after therapy, prompted a chart review of other patients referred for radioactive iodine therapy. Of 99 untreated patients, 18 had neutrophil counts of less than 2,000/cu mm. After therapy with either thionamides or /sup 131/I, 41 of 53 (77%) evaluable patients had an increase in neutrophil count. Eleven of these evaluable patients had neutropenia before therapy; after therapy, all 11 had an increase in their neutrophil counts into the normal range, with a mean increase of 170%. In one patient, studies on the mechanism of neutropenia indicate that bone marrow production and reserve remain normal and that circulating neutrophils are normally marginated. A decreased neutrophil circulation time may be the cause of neutropenia associated with hyperthyroidism.

  7. 幼儿急疹引起粒细胞减少症的中西医结合治疗临床研究%Clinical study of children acute rash caused neutropenia in integrative medicine

    Institute of Scientific and Technical Information of China (English)

    彭丽琨

    2015-01-01

    Objective:To discuss the clinical study of children acute rash caused neutropenia in integrative medicine.Methods:120 patients with acute rash were selected.They were divided into the experimental group and the control group.Two groups were given Siji antiviral mixture,and the experimental group added oral leucogen on the basis of oral Siji antiviral mixture.Then we analyzed peripheral blood test for the children in the administration of third,7 and 14 days.Results:The control group and the experimental group were released after 7~14 days,and there was no significant difference.The average recovery time of the experimental group was earlier than that of the control group.Conclusion:The effect of the integrated traditional Chinese and western medicine therapy in the treatment of children acute rash caused by neutropenia was better,and recovered faster.%目的:探讨中西医结合治疗幼儿急疹引起粒细胞减少症的临床研究。方法:收治急疹患儿120例,分成对照组和试验组,两组均口服四季抗病毒合剂,试验组在口服四季抗病毒合剂的基础上,加口服利血生。在给药后3 d、7 d 和14 d 对患儿进行外周血象检测分析。结果:对照组和试验组的患儿均在发病后第7~14天恢复,无明显差异。试验组平均恢复时间较对照组短。结论:中西医结合治疗幼儿急疹引起粒细胞减少症恢复较快,效果较好。

  8. Clinical and Laboratory Findings in Iranian Children with Cyclic Neutropenia

    Directory of Open Access Journals (Sweden)

    Nima Rezaei

    2004-03-01

    Full Text Available Cyclic neutropenia is a rare immunodeficiency syndrome, characterized by regular periodic oscillations in the circulating neutrophil count from normal to neutropenic levels through 3 weeks period, and lasting for 3-6 days. In order to determine the clinical features of cyclic neutropenia, this study was performed. Seven patients with cyclic neutropenia (3 males and 4 females, who experienced neutropenic periods every 3 weeks (5 with severe and 2 with moderate neutropenia, were investigated in this study. They had been referred to Iranian Primary Immunodeficiency Registry during 23 years (1980-2003. The range of patients' ages was from 7 to 13 years (median 11 years. The median age at the onset of the disease was 12 months (1 month- 2 years and the median age of diagnosis was 2 (1.5-5 years, with a median diagnosis delay of 1 year (2 months- 5 years. Neutropenia was associated with leukopenia (3 patients, anemia (3 patients, and thrombocytopenia (1 patient. Patients were asymptomatic in healthy phase, but during the episode of neutropenia suffered from aphthous ulcers, abscesses and overwhelming infections. The most commonly occurred manifestations were: otitis media (6 cases, oral ulcers (5 cases, abscesses (4 cases, pneumonia (3 cases, diarrhea (3 cases, oral candidiasis (3 cases, cutaneous infections (2 cases, and periodontitis (2 cases. One of these patients subsequently died because of recurrent infections. Unusual, persistent or severe infections should be the initiating factors to search for an immune deficiency syndrome such as cyclic neutropenia, because a delay in diagnosis may result in chronic infection, irretrievable end-organ damage or even death of the patient.

  9. Nodular Adenomyosis of the Uterus Causing Severe Groin Pain

    OpenAIRE

    Tabrizi, Nasrin Moghadami; Dabirashrafi, Babak; Salehi, Parisa; Shams, Shahram; Dabirashrafi, Hormoz

    2006-01-01

    Objectives: To determine the cause of severe, disabling, groin pain. Methods: We describe in this case report 2 patients with severe groin pain. Two myoma-like masses were found on the uterus near the right round ligament. Both masses were excised via laparoscopy. Results: The pathology report of these 2 cases indicated adenomyosis. Both patients were asymptomatic after the procedure. Adenomyosis usually propagates in the myometrium, and the nodular shape of this pathology is rare. In patient...

  10. Severe upper airway obstruction caused by ulcerative laryngitis

    OpenAIRE

    Hatherill, M.; Reynolds, L; Waggie, Z; Argent, A

    2001-01-01

    AIMS—To present our experience of severe upper airway obstruction caused by ulcerative laryngitis in children.
METHODS—Retrospective case note review of 263 children with severe upper airway obstruction and a clinical diagnosis of croup admitted to a paediatric intensive care unit (PICU) over a five year period.
RESULTS—A total of 148 children (56%) underwent microlaryngoscopy (Storz 3.0 rigid telescope). Laryngeal ulceration with oedema was documented in 15 of these childre...

  11. Microbiology of destructive periodontal disease in adolescent patients with congenital neutropenia - A report of 3 cases

    NARCIS (Netherlands)

    van Winkelhoff, AJ; Schouten-van Meeteren, AYN; Baart, JA; Vandenbroucke-Grauls, CMJE

    2000-01-01

    Background, aims: Congenital neutropenia is one condition that may predispose for destructive periodontal disease at a young age. In this report, we describe the microbiology of 3 adolescent patients with congenital neutropenia two of whom suffered from severe periodontitis. Method: Microbiological

  12. CEREBRITIS AND NEUTROPENIA IN A CHILD WITH ANA NEGATIVE LUPUS

    Directory of Open Access Journals (Sweden)

    J. Akhoondian

    2009-04-01

    Full Text Available ObjectiveSystemic lupus erythematosus (SLE, an autoimmune systemic disease with unknown etiology, affects virtually every part of the body; involvement of the central nervous system (CNS is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE patients and is the least understood aspect of the disease. neutropenia is very uncommon in childhood lupus. True negative anti nuclear antibody (ANA tests in patients with lupus are now very rare. The patient reported here was a 12-year-old girl with ANA negative lupus cerebritis who presented with left hemiparesia after a generalized seizure, with neutropenia observed during its course.Key words:lupus cerebritis, neutropenia, ANA negative lupus, children

  13. CEREBRITIS AND NEUTROPENIA IN A CHILD WITH ANA NEGATIVE LUPUS

    Directory of Open Access Journals (Sweden)

    J. Akhoondian

    2009-01-01

    Full Text Available ObjectiveSystemic lupus erythematosus (SLE, an autoimmune systemic disease with unknown etiology, affects virtually every part of the body; involvement of the central nervous system (CNS is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE patients and is the least understood aspect of the disease. neutropenia is very uncommon in childhood lupus. True negative anti nuclear antibody (ANA tests in patients with lupus are now very rare. The patient reported here was a 12-year-old girl with ANA negative lupus cerebritis who presented with left hemiparesia after a generalized seizure, with neutropenia observed during its course.

  14. Technetium-99m DMSA preparation: Trivial issues causing severe problems

    International Nuclear Information System (INIS)

    Urinary tract infection (UTI) in children involving renal parenchyma, upper collecting system or bladder is one of the major causes for consideration in the diagnosis and management of paediatric nuclear medicine. Acute pyelonephritis is one of the prime causes of morbidity associated with urinary tract infection in children which can lead to progressive renal damage. Technetium-99m dimercaptosuccinic acid (DMSA) is used extensively for the assessment of UTI in paediatrics. The radiopharmaceutical preparation could be influenced by several factors, most of them are trivial, but invariably have severe impact on the quality of the scintiphotographs. This communication is mainly to highlight some of the issues related to 99mTc-DMSA preparation and the possible precautionary measures that need to be taken to obviate unwarranted problems. (author)

  15. [Severe atopic dermatitis caused by rare immunodeficiency in childhood].

    Science.gov (United States)

    Wolsk, Helene Mygind; Marquart, Hanne V; Laub, Bodil; Gniadecki, Robert; Nysom, Karsten; Ifversen, Marianne

    2015-12-14

    Two children are presented with autosomal recessive hyper IgE syndrome caused by a mutation in the dedicator of cytokinesis 8 gene (DOCK8). The manifestations are typically severe atopic dermatitis, food allergies, elevated serum IgE concentration, viral skin infections and risk of malignancies. DOCK8 deficiency was first reported in 2009, following the death of the oldest sibling. The youngest sibling was cured after allogenic stem cell transplantation. This case report illustrates the need of awareness of primary immunodeficiency in children with atypical manifestation of atopic dermatitis in combination with recurrent infections. PMID:26692033

  16. Fever and neutropenia in cancer patients : the diagnostic role of cytokines in risk assessment strategies

    NARCIS (Netherlands)

    Nijhuis, CSMO; Daenen, SMGJ; Vellenga, E; van der Graaf, WTA; Gietema, JA; Groen, HJM; Kamps, WA; de Bont, ESJM

    2002-01-01

    Cancer patients treated with chemotherapy are susceptible to bacterial infections. Therefore, all neutropenic cancer patients with fever receive standard therapy consisting of broad-spectrum antibiotics and hospitalization. However, febrile neutropenia in cancer patients is often due to other causes

  17. Role of biosimilars in neutropenia prevention in cancer patients

    Directory of Open Access Journals (Sweden)

    V. V. Ptushkin

    2014-01-01

    Full Text Available Decreasing the neutrophils count in peripheral blood after intensive chemotherapy (CT dramatically increases the risk of infectious complications.As a consequence, treatment costs significantly increased and patients quality of life reduced. Correction of neutropenia is possible with granulocyte colony stimulating factor (G-CSF – a human protein produced by recombinant technology and is able to support the survival and proliferation of hematopoietic stem cells. Pharmacoeconomic studies have shown that G-CSF reduces the frequency of hospitalization and antibiotics using, which can reduce the treatment cost. The use of G-CSF allows to reduce early and infection mortality after chemotherapy, providing background to prolonging life especially for the elderly (over 65 years and debilitated patients. The drug is included in all international recommendations. However, its use in Russia is limited due to high cost.Part of the policy aimed to reducing protein drugs cost and increase their availability is the creation of biosimilars protein drugs with proven effective. At the same time biosimilars as the original protein molecules are living cells products, causing serious difficulties in achieving their identity. To eliminate the risk of reducing the effectiveness or increase the toxicity, the European Union established regulations for the determination the bioproducts quality, a detailed description of the requirements for pre-clinical and clinical research, as well as the requirements for pharmacovigilance. Registered in the EEC countries G-CSF biosimilars have been first studied in healthy volunteers, and then in controlled clinical trials in comparison with the reference drug. High efficacy of one such G-CSF biosimilars (Zarsio® was shown in controlled clinical trials of 170 patients with breast cancer receiving intensive chemotherapy with Docetaxel and Doxorubicin. Total in the study only 6 % cases of febrile neutropenia (FN was

  18. Caracterización de pacientes pediátricos con neutropenia enviados a un hospital de referencia Characterization of neutropenic pediatric patients sent to a referral centre

    Directory of Open Access Journals (Sweden)

    Gustavo Adolfo Lazo-Páez

    2010-06-01

    ógica relativamente simple. Las infecciones documentadas en los casos analizados suelen ser causadas por los mismos gérmenes descritos en otras series. El conteo absoluto de neutrófilos al diagnóstico no incide sobre la frecuencia de infección recurrente, pero el tipo o curso clínico de la neutropenia sí lo hace.Aim: Neutropenia is a relatively common cause of patient referral to the Immunology and Pediatric Rheumatology Department of the National Children’s Hospital. The present study characterizes the cases of neutropenia referred to this department between November 1988 and June 2008. Methods: Eighty four patients between 0 and 12 years of age, were referred from November 6th, 1988 and June 1st, 2008. We performed a comprehensive descriptive analysis of the characteristics exhibited by these patients in terms of clinical course, pattern of infection, most common causative germs, complications and treatment applied. Results: Neutropenia resolved spontaneously in 52.2% of the patients, and they were classified as transient neutropenia, 21.7% of the cases developed cyclic neutropenia, 13% of were categorized as benign chronic neutropenia, 7.2% developed severe chronic symptomatic neutropenia, 2.9% had neutropenia associated with type 1B glycogenosis and 2.9% of the cases were not classifiable in any of the proposed categories. More than 50% of the cases were associated with an abnormal pattern of infection in terms of frequency, severity, multiplicity of systems involved, or the presence of opportunistic microorganisms. The upper respiratory tract was the most commonly affected system with infection. Prophylactic antibiotics were used in 39.1% of the cases and granulocyte colony stimulating factor was required in 11.6% at some stage of the course. The most frequently involved pathogens in infection were Pseudomonas aeruginosa, Staphylococcus sp and E. coli. Conclusion: The vast majority of neutropenic patients had a benign clinical course. The same germs described in other

  19. Neutropenia Associated with X-Linked Agammaglobulinemia

    Directory of Open Access Journals (Sweden)

    Aghamohammadi Asghar

    2009-03-01

    Full Text Available X-linked Agammaglobulinemia (XLA is a hereditary immunodeficiency, characterized by an early onset of recurrent bacterial infections, hypogammaglobulinemia and markedly reduced B lymphocytes number. In order to determine the association of neutropenia among Iranian patients with XLA, hospital records of 30 patients with confirmed XLA in Children Medical Center Hospital, were reviewed. Eight out of 30 XLA patients (26.7% developed neutropenia during the course of the disease. In two patients, episodes of neutropenia were identified before or at the time of diagnosis of XLA. Other six patients whom were not visited regularly and did not receive periodical immunoglobulin replacement therapy experienced neutropenia after diagnosis of XLA. Neutropenia in XLA is mainly associated with infection and is resolved with intravenous immunoglobulin replacement and antibiotics therapy.

  20. Re-challenge with Etanercept in patients with Etanercept-induced Neutropenia.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-08-05

    TNF blockers have rarely been associated with haematological complications; however, there are scattered case reports of marked neutropenia with their use and necessitating in their withdrawal. We would like to report a series of five patients who developed neutropenia with etanercept use; however, all these patients were re-challenged with etanercept with a mean follow up of 30 months. These patients developed neutropenia within 2 months of starting etanercept. Two patients were eventually taken off etanercept; one of them needed switching to a different form of TNF blockers, and the second patient is in clinical remission with low-dose corticosteroids. All our patients continued to have mild-moderate degree of neutropenia; however, they are being monitored very closely and they are enjoying complete disease remission. It was interesting to note that none of our patients had increased infections during the re-challenge phase, even though they had grade 2 to grade 4 neutropenia. We have re-challenged these patients without any clinical complications, revealing that patients with mild to moderate neutropenia can be safely exposed to TNF blockers as long as they are monitored with regular cell count checks. Although largely noted to be clinically insignificant in our patient series, the potential of drug-induced neutropenia in causing higher rate of infections do exist. Careful clinical and hematologic monitoring is the best way to recognize this adverse event.

  1. The antimicrobial propeptide hCAP-18 plasma levels in neutropenia of various aetiologies: a prospective study.

    Science.gov (United States)

    Ye, Ying; Carlsson, Göran; Karlsson-Sjöberg, Jenny M T; Borregaard, Niels; Modéer, Thomas U; Andersson, Mats L; Pütsep, Katrin L-A

    2015-01-01

    The underlying cause of neutropenia may be difficult to determine due to similar clinical presentation in many neutropenic conditions. The neutrophil protein hCAP-18 (pro-LL-37) is a major component of neutrophil secondary granules and in this prospective study we assessed the use of hCAP-18 levels in blood plasma for differential diagnosis of neutropenic patients (n = 133) of various aetiologies. Plasma levels of hCAP-18 were determined using immunoblot and ELISA. Patients with severe congenital neutropenia (n = 23) presented with the lowest levels of plasma hCAP-18 and differential diagnostic accuracy revealed high sensitivity (100%) and specificity (98.8%) for hCAP-18 ELISA. The correlation coefficient of the hCAP-18 ELISA versus immunoblotting was (R = 0.831) and that of the peptide LL-37 ELISA versus immunoblotting was (R = 0.405) (P syndrome, Barth syndrome, Cohen syndrome, acute myeloid leukaemia and specific granule deficiency presented with reduced plasma hCAP-18 levels as well. The blood plasma level of hCAP-18 was thus low in conditions in which the neutrophil antibacterial propeptide hCAP-18 is deficient, i.e. severe congenital neutropenia and neutrophil-specific granule deficiency, and in conditions in which bone marrow myelopoiesis is negatively affected. PMID:26119962

  2. CEREBRITIS AND NEUTROPENIA IN A CHILD WITH ANA NEGATIVE LUPUS

    OpenAIRE

    J. Akhoondian; Z. Rezaii yazdi; F Behmanesh; Talebi, S.

    2009-01-01

    ObjectiveSystemic lupus erythematosus (SLE), an autoimmune systemic disease with unknown etiology, affects virtually every part of the body; involvement of the central nervous system (CNS) is one of the major causes of morbidity and mortality in systemic lupus erythematosus (SLE) patients and is the least understood aspect of the disease. neutropenia is very uncommon in childhood lupus. True negative anti nuclear antibody (ANA) tests in patients with lupus are now very rare. The patient repor...

  3. Mefenamic acid-induced neutropenia and renal failure in elderly females with hypothyroidism.

    OpenAIRE

    Handa, S I; FREESTONE, S.

    1990-01-01

    We report mefenamic acid-induced non-oliguric renal failure and severe neutropenia occurring simultaneously in two elderly females. The neutropenia was due to maturation arrest of the myeloid series in one patient. Both patients were also hypothyroid, but it is not clear whether this was a predisposing factor to the development of these adverse reactions. However, it would seem prudent not to use mefenamic acid in hypothyroid patients until the hypothyroidism has been corrected.

  4. Frequency of neutropenia among Turkish and Syrian pediatric thalassemia patients under deferiprone monotherapy.

    Science.gov (United States)

    Belen, Burcu Fatma; Polat, Meltem; Özsevik, Sevinç Nursev; Soylu, Esma

    2016-02-01

    Weekly monitoring of absolute neutrophil count (ANC) under deferiprone therapy in thalassemia patients is recommended to avoid agranulocytosis adverse event. Actually, this recommendation may not be applicable in clinical setting. Our study aimed to establish incidence of neutropenia under deferiprone (DFP) monotherapy when it was monitored bimonthly due to socioeconomic conditions effecting local and refugee thalassemic patients including Syrian origin (SYR; n = 26) and Turkish origin (TR; n = 26) groups. Patients on DFP were followed up for 12 months. Fifteen neutropenic episodes were seen in 5 patients. All 5 patients (4 from SYR group and 1 from TR group) had splenomegaly and hypersplenism, and neutropenia ceased in 4 patients after splenectomy despite continuation of deferiprone. In the TR group, the frequency of patients who have neutropenia (absolute neutrophil count [ANC] studies. Other causes of neutropenia in DFP-treated patients should also be kept in mind. PMID:26918459

  5. ABCB1基因多态性与乳腺癌患者化疗所致严重中性粒细胞减少症的相关性研究%Association between ABCB1 Gene Polymorphisms and Chemotherapy-induced Severe Neutropenia in Pa-tients with Breast Cancer

    Institute of Scientific and Technical Information of China (English)

    付正传; 钱芳; 杨旭环; 宫素红; 程曙光; 刘思海

    2016-01-01

    OBJECTIVE:To discuss the association between ABCB1 gene polymorphisms and adriamycin and cyclophospha-mide(AC)combined with chemotherapy-induced severe neutropenia in patients with breast cancer. METHODS:218 breast cancer patients receiving AC combined with chemotherapy were selected from our hospital during 2012-2015;PCR-RFLP was used to de-tect polymorphisms of ABCB1 2677G>T/A and 3435C>T. The associated between different age,BMI,clinical stages genotypes, etc and AC combined with chemotherapy-induced severe neutropenia were investigated,and risk factors of neutropenia were ana-lyzed by multivariate logistic regression. RESULTS:Among 218 breast cancer patients,170 patients suffered from severe neutrope-nia,accounting for 78.0%. Among ABCB1 2677G>T/A polymorphisms,distribution frequency of GT or GA genotype,TT,TA or AA genotype,GG genotype in severe neutropenia were 80.6%,86.2% and 60.0%,with statistical significance (PT polymorphisms,distribution frequency of TT,CT and CC genotype in severe neutropenia were 86.4%, 78.4% and 72.7%,there was no statistical significance(P>0.05). AST and ABCB1 2677G>T/A polymorphisms were correlated with severe neutropenia (PT/A polymorphism was a strong predictor of neutropenia [OR=3.875, 95%CI(1.555,9.922),P=0.008]. CONCLUSIONS:ABCB1 2677>T/A polymorphisms may be aggravate AC combined with che-motherapy-induced neutropenia in patients with breast cancer.%目的:探讨乳腺癌患者三磷酸腺苷结合盒转运子B亚家族成员1(ABCB1)基因多态性与多柔比星和环磷酰胺(AC)联合化疗所致严重中性粒细胞减少症的相关性。方法:选择我院2012-2015年接受AC联合化疗的乳腺癌患者218例,采用聚合酶链-限制性片段长度多态性分析法进行ABCB12677G>T/A、3435C>T基因多态性检测,考察患者不同年龄、体质量指数、临床分期、基因型等各因素与AC联合化疗所致严重中性粒细胞减少症的相关性,并采用多元逻辑回归分析

  6. Lipegfilgrastim in the management of chemotherapy-induced neutropenia of cancer patients

    Directory of Open Access Journals (Sweden)

    Guariglia R

    2016-01-01

    Full Text Available Roberto Guariglia,1 Maria Carmen Martorelli,1 Rosa Lerose,2 Donatella Telesca,2 Maria Rita Milella,2 Pellegrino Musto3 1Unit of Hematology and Stem Cell Transplantation, 2Pharmacy Service, 3Scientific Direction, IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture, Potenza, Italy Abstract: Neutropenia and febrile neutropenia (FN are frequent and potentially fatal toxicities of myelosuppressive anticancer treatments. The introduction of granulocyte colony-stimulating factors (G-CSFs in clinical practice has remarkably reduced the duration and severity of neutropenia, as well as the incidence of FN, thus allowing the administration of chemotherapeutic agents at the optimal dose and time with lower risk. The current scenario of G-CSFs in Europe includes filgrastim, lenograstim, some G-CSF biosimilars, and pegfilgrastim. Recently, a novel long-acting G-CSF, lipegfilgrastim, became available. Lipegfilgrastim is a glycopegylated G-CSF, alternative to pegfilgrastim, and has shown in randomized trials, to be equivalent to pegfilgrastim in reducing the incidence of severe neutropenia and FN in patients with breast cancer receiving chemotherapy, with a similar safety profile. Furthermore, lipegfilgrastim was more effective than the placebo in reducing the incidence of severe neutropenia, its duration, and time to absolute neutrophil count recovery, in patients with non-small cell lung cancer receiving myelosuppressive therapy. Although the number of studies currently published is still limited, lipegfilgrastim seems to be a promising drug in the management of chemotherapy-induced neutropenia. Keywords: neutropenia, febrile neutropenia, granulocyte colony-stimulating factors, G-CSF, pegfilgrastim, lipegfilgrastim

  7. Severe lymphedema caused by repeated self-injury.

    Science.gov (United States)

    Mihara, M; Hara, H; Murai, N; Todokoro, T; Iida, T; Narushima, M; Koshima, I

    2011-12-01

    Lymphedema is divided into primary and secondary forms. Primary lymphedema often develops in young people and may be caused by lymphvascular aplasia, hypoplasia, and hyperplasia. The most frequent cause of secondary lymphedema after lymphatic filariasis is regional lymph node dissection for treatment of a malignant tumor, and this complication occurs most frequently in middle aged or older patients. Here, we describe a relatively young patient (27 years old) in whom collecting lymph vessels in the upper limb were disrupted by repeated self-injury, with resultant lymphedema. There have been very few reports on lymphedema caused by self-induced trauma. This case report illustrates that secondary lymphedema should also be considered and evaluated appropriately when diagnosed in a relatively young patient without a history of cancer or infection. PMID:22458120

  8. Severe hypotension and hypothermia caused by acute ethanol toxicity

    OpenAIRE

    Wilson, E; W. S. Waring

    2007-01-01

    This article reports the time course and clinical features of acute ethanol poisoning in an elderly man who had previously abstained from alcohol. Several hours after ingestion, severe hypotension and hypothermia developed, and the consciousness level was reduced. Supportive measures were sufficient to allow the patient's blood pressure and temperature to recover by 24 h post ingestion. The clinical manifestations of ethanol toxicity are often confounded by coexistent drug ingestion and varia...

  9. A cause of severe thigh injury: Battery explosion

    Directory of Open Access Journals (Sweden)

    Tahsin Görgülü

    2016-02-01

    Discussion: Battery explosion causing lower extremity tissue defect is a type of injury that is rarely seen in the literature. Regardless of battery size and energy level, they should be considered as potential explosive material and protector masks, clothing should be worn during contact with this type of material.

  10. Severe anemia causing cerebral venous sinus thrombosis in an infant

    OpenAIRE

    Sushil Beri; Arif Khan; Nahin Hussain; Jayaprakash Gosalakkal

    2012-01-01

    Iron deficiency anemia is a common pediatric problem affecting up to 25% children worldwide. It has been linked with cerebral venous sinus thrombosis in the literature. We describe a 9-month-old child who had severe iron deficiency anemia and developed acute venous sinus thrombosis associated with minor infection. Treatment with anticoagulation was partially successful with persistent thrombosis after 3 months. We reviewed the current literature highlighting the association of anemia as a ris...

  11. Gelsolin amyloid angiopathy causes severe disruption of the arterial wall.

    Science.gov (United States)

    Koskelainen, Susanna; Pihlamaa, Tiia; Suominen, Sinikka; Zhao, Fang; Salo, Tuula; Risteli, Juha; Baumann, Marc; Kalimo, Hannu; Kiuru-Enari, Sari

    2016-08-01

    Hereditary gelsolin amyloidosis (HGA) is a dominantly inherited systemic disease reported worldwide. HGA is characterized by ophthalmological, neurological, and dermatological manifestations. AGel amyloid accumulates at basal lamina of epithelial and muscle cells, thus amyloid angiopathy is encountered in nearly every organ. HGA patients have cardiovascular, hemorrhagic, and potentially vascularly induced neurological problems. To clarify pathomechanisms of AGel angiopathy, we performed histological, immunohistochemical, and electron microscopic analyses on facial temporal artery branches from 8 HGA patients and 13 control subjects. We demonstrate major pathological changes in arteries: disruption of the tunica media, disorganization of vascular smooth muscle cells, and accumulation of AGel fibrils in arterial walls, where they associate with the lamina elastica interna, which becomes fragmented and diminished. We also provide evidence of abnormal accumulation and localization of collagen types I and III and an increase of collagen type I degradation product in the tunica media. Vascular smooth muscle cells appear to be morphologically and semi-quantitatively normal, only their basal lamina is often thickened. In conclusion, angiopathy in HGA results in severe disruption of arterial walls, characterized by prominent AGel deposition, collagen derangement and severe elastolysis, and it may be responsible for several, particularly hemorrhagic, disease manifestations in HGA. PMID:27198069

  12. Radiation-induced oesophagitis in lung cancer patients. Is susceptibility for neutropenia a risk factor?

    Energy Technology Data Exchange (ETDEWEB)

    Ruysscher, D. de [MAASTRO Clinic, Maastricht (Netherlands). Dept. of Radiation Oncology; Meerbeeck, J. van [Ghent Univ. Hospital (Belgium). Dept. of Respiratory Medicine; Vandecasteele, K. [Ghent Univ. Hospital (BE). Dept. of Radiation Oncology] (and others)

    2012-07-15

    Background: Radiation-induced oesophagitis is a major side effect of concurrent chemotherapy and radiotherapy. A strong association between neutropenia and oesophagitis was previously shown, but external validation and further elucidation of the possible mechanisms are lacking. Methods and patients: A total of 119 patients were included at two institutions. The concurrent group comprised 34 SCLC patients treated with concurrent carboplatin and etoposide, and concurrent chest irradiation, and 36 NSCLC patients with concurrent cisplatin and etoposide, and concurrent radiotherapy, while the sequential group comprised 49 NSCLC patients received sequential cisplatin and gemcitabine, and radiotherapy. Results: Severe neutropenia was very frequent during concurrent chemoradiation (grade: 4 41.4%) and during induction chemotherapy in sequentially treated patients (grade 4: 30.6%), but not during radiotherapy (only 4% grade 1). In the concurrent group, the odds ratios of grade 3 oesophagitis vs. neutropenia were the following: grade 2 vs. grade 0/1: 5.60 (95% CI 1.55-20.26), p = 0.009; grade 3 vs. grade 0/1: 10.40 (95% CI 3.19-33.95); p = 0.0001; grade 4 vs. grade 0/1: 12.60 (95% CI 4.36-36.43); p < 0.00001. There was no correlation between the occurrence of neutropenia during induction chemotherapy and acute oesophagitis during or after radiotherapy alone. In the univariate analysis, total radiation dose (p < 0.001), overall treatment time of radiotherapy (p < 0.001), mean oesophageal dose (p = 0.038) and neutropenia (p < 0.001) were significantly associated with the development of oesophagitis. In a multivariate analysis, only neutropenia remained significant (p = 0.023). Conclusion: We confirm that neutropenia is independently correlated with oesophagitis in concurrent chemoradiation, but that the susceptibility for chemotherapy-induced neutropenia is not associated with radiation-induced oesophagitis. Further studies focusing on the underlying mechanisms are thus

  13. Severe anemia causing cerebral venous sinus thrombosis in an infant

    Directory of Open Access Journals (Sweden)

    Sushil Beri

    2012-01-01

    Full Text Available Iron deficiency anemia is a common pediatric problem affecting up to 25% children worldwide. It has been linked with cerebral venous sinus thrombosis in the literature. We describe a 9-month-old child who had severe iron deficiency anemia and developed acute venous sinus thrombosis associated with minor infection. Treatment with anticoagulation was partially successful with persistent thrombosis after 3 months. We reviewed the current literature highlighting the association of anemia as a risk factor for development of stroke in children.

  14. Secondary Infections in Febrile Neutropenia in Hematological Malignancies: More Than Another Febrile Neutropenic Episode

    Directory of Open Access Journals (Sweden)

    Aslıhan Demirel

    2015-09-01

    Full Text Available Objective: Febrile neutropenic episodes (FNEs are among the major causes of mortality in patients with hematological malignancies. Secondary infections develop either during the empirical antibiotic therapy or 1 week after cessation of therapy for a FNE. The aim of this study was to investigate the risk factors associated with secondary infections in febrile neutropenic patients. Materials and Methods: We retrospectively analyzed 750 FNEs in 473 patients between January 2000 and December 2006. Results: Secondary infections were diagnosed in 152 (20% of 750 FNEs. The median time to develop secondary infection was 10 days (range: 2-34 days. The duration of neutropenia over 10 days significantly increased the risk of secondary infections (p0.05. While fever of unknown origin (p=0.005 and catheter-related bacteremia (p<0.001 were less frequently observed in secondary infections, the frequency of microbiologically (p=0.003 and clinically (p<0.001 documented infections, fungal pneumonias (p<0.001, infections related to gram-positive bacteria (p=0.04 and fungi (p<0.001, and 30-day mortality rate (p<0.001 were significantly higher in cases of secondary infections (p<0.001. Conclusion: Secondary infections should be regarded as life-threatening complications of febrile neutropenia. Secondary infections represent a more severe and mortal complication and cannot be regarded just as another FNE.

  15. Severe head injury caused by motorcycle traffic accident

    Institute of Scientific and Technical Information of China (English)

    李钢

    1999-01-01

    Objective To explore the characteristic and treatment of the severe head injury due to motorcycle accident.Methods Review and analysis of 27 motorcycle traffic trauma cases who were admitted to our hospital from Oct.1995 to Sep.1997.Results Young men were the main composition of these patients.Multiple injuries associated with brain ste or diffuse axonal injury were common,which were the main factors influencing the consciousness and prognosis of the patients.The wound was usually severely contaminated.Evacuation of hematomas,decompression by depleting skull flap,hypotheymia and artificial hibernation were conducted in this series.Among them,14 cases were cured ,3 cases were seriously disabled,10 cases died.Conclusions Motorcycle's weight is light so it easily loses its balance.The riders and the passengers are exposed and lack protection.Driving against traffic regulations is frquently seen.All these are the reasons why the motorcycle traffic accidents often take place. When the traffic accident happens,the patients' head generally is thrown a long distance and dashed against the barrier or the ground.The psture nd mechanism of injury were complicated and varied.The decelerated injury and rolling injury occurred frequently and they were the main reasons for brain stem or diffuse axonal injury.The patients who have surgical indication should be operated upon as soon as possible.Hibernation and low temoerature therapy are conducive to the protection of the brain function at the early stage of postinjury or postoperation.A careful epluchage is essential to reduce infection of the open injury.

  16. Early-onset neutropenia induced by rituximab in a patient with lupus nephritis and hemolytic anemia.

    Science.gov (United States)

    Arroyo-Ávila, Mariangelí; Fred-Jiménez, Ruth M; Vilá, Luis M

    2015-01-01

    Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE) including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 10(9)/L) after the second weekly rituximab infusion (375 mg/m(2) weekly × 4) given for nephritis and hemolytic anemia. She also had early-onset thrombocytopenia after rituximab therapy. Both hematological disorders resolved 12 days after the fourth and final dose. This case, together with few others, suggests that early-onset neutropenia may occur during rituximab therapy. Even though rituximab-induced neutropenia seems to be transient, it may predispose SLE patients to severe complications such as infections. PMID:25767732

  17. Early-Onset Neutropenia Induced by Rituximab in a Patient with Lupus Nephritis and Hemolytic Anemia

    Directory of Open Access Journals (Sweden)

    Mariangelí Arroyo-Ávila

    2015-01-01

    Full Text Available Rituximab is an anti-CD20 monoclonal antibody that has been used to treat several complications of systemic lupus erythematosus (SLE including nephritis, cerebritis, and hematological disorders. Neutropenia is among the adverse events associated with rituximab; this usually occurs several weeks after therapy. However, early-onset neutropenia has been reported only in a few cases. Herein, we describe a 36-year-old Hispanic SLE woman who developed severe early-onset neutropenia (0.3 × 109/L after the second weekly rituximab infusion (375 mg/m2 weekly × 4 given for nephritis and hemolytic anemia. She also had early-onset thrombocytopenia after rituximab therapy. Both hematological disorders resolved 12 days after the fourth and final dose. This case, together with few others, suggests that early-onset neutropenia may occur during rituximab therapy. Even though rituximab-induced neutropenia seems to be transient, it may predispose SLE patients to severe complications such as infections.

  18. Severe hyponatremia caused by nab-paclitaxel-induced syndrome of inappropriate antidiuretic hormone secretion: A case report in a patient with metastatic pancreatic adenocarcinoma.

    Science.gov (United States)

    Neuzillet, Cindy; Babai, Samy; Kempf, Emmanuelle; Pujol, Géraldine; Rousseau, Benoît; Le-Louët, Hervé; Christophe Tournigand

    2016-06-01

    Incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing. Most patients have advanced disease at diagnosis and therapeutic options in this setting are limited. Gemcitabine plus nab-paclitaxel regimen was demonstrated to increase survival compared with gemcitabine monotherapy and is therefore indicated as first-line therapy in patients with metastatic PDAC and performance status Eastern Cooperative Oncology Group (ECOG) 0-2. The safety profile of gemcitabine and nab-paclitaxel combination includes neutropenia, fatigue, and neuropathy as most common adverse events of grade 3 or higher. No case of severe hyponatremia associated with the use of nab-paclitaxel for the treatment of PDAC has been reported to date.We report the case of a 72-year-old Caucasian man with a metastatic PDAC treated with gemcitabine and nab-paclitaxel regimen, who presented with a severe hyponatremia (grade 4) caused by a documented syndrome of inappropriate antidiuretic hormone secretion (SIADH). This SIADH was attributed to nab-paclitaxel after a rigorous imputability analysis, including a rechallenge procedure with dose reduction. After dose and schedule adjustment, nab-paclitaxel was pursued without recurrence of severe hyponatremia and with maintained efficacy.Hyponatremia is a rare but potentially severe complication of nab-paclitaxel therapy that medical oncologists and gastroenterologists should be aware of. Nab-paclitaxel-induced hyponatremia is manageable upon dose and schedule adaptation, and should not contraindicate careful nab-paclitaxel reintroduction. This is of particular interest for a disease in which the therapeutic options are limited. PMID:27368013

  19. Technical evaluation of methods for identifying chemotherapy-induced febrile neutropenia in healthcare claims databases

    Directory of Open Access Journals (Sweden)

    Weycker Derek

    2013-02-01

    Full Text Available Abstract Background Healthcare claims databases have been used in several studies to characterize the risk and burden of chemotherapy-induced febrile neutropenia (FN and effectiveness of colony-stimulating factors against FN. The accuracy of methods previously used to identify FN in such databases has not been formally evaluated. Methods Data comprised linked electronic medical records from Geisinger Health System and healthcare claims data from Geisinger Health Plan. Subjects were classified into subgroups based on whether or not they were hospitalized for FN per the presumptive “gold standard” (ANC 9/L, and body temperature ≥38.3°C or receipt of antibiotics and claims-based definition (diagnosis codes for neutropenia, fever, and/or infection. Accuracy was evaluated principally based on positive predictive value (PPV and sensitivity. Results Among 357 study subjects, 82 (23% met the gold standard for hospitalized FN. For the claims-based definition including diagnosis codes for neutropenia plus fever in any position (n=28, PPV was 100% and sensitivity was 34% (95% CI: 24–45. For the definition including neutropenia in the primary position (n=54, PPV was 87% (78–95 and sensitivity was 57% (46–68. For the definition including neutropenia in any position (n=71, PPV was 77% (68–87 and sensitivity was 67% (56–77. Conclusions Patients hospitalized for chemotherapy-induced FN can be identified in healthcare claims databases--with an acceptable level of mis-classification--using diagnosis codes for neutropenia, or neutropenia plus fever.

  20. Ticagrelor as an alternative in clopidogrel-associated neutropenia.

    Science.gov (United States)

    Shah, Rahman; Keough, Leigh Anne; Belalcazar-Portacio, Astrid; Ramanathan, Kodangudi B

    2015-01-01

    Aspirin in combination with platelet P2Y12 receptor blocker has become the mainstay antiplatelet treatment strategy for the prevention of stent thrombosis. Ticlopidine was the first widely used P2Y12 receptor blockers, but clopidogrel has mostly replaced the use of ticlopidine due to its more favorable adverse event profile on bone marrow. However, when clopidogrel induced bone marrow toxicity occurs, little is known about the efficacy and safety of alternative treatments, and thus, in these cases, medical decisions may be very difficult. We report a case of clopidogrel-induced severe neutropenia in a patient treated with coronary stent and safety of alternative treatment with ticagrelor. PMID:24433137

  1. Bone Marrow Suppression and Hemophagocytic Histiocytes Are Common Findings in Korean Severe Fever with Thrombocytopenia Syndrome Patients.

    Science.gov (United States)

    Shin, Sang Yong; Cho, Oh Hyun; Bae, In Gyu

    2016-09-01

    The causes of cytopenia in patients with severe fever with thrombocytopenia syndrome (SFTS) are not fully understood until now. We reviewed the bone marrow (BM) findings of patients with SFTS to unravel the cause of the cytopenia. Three Korean SFTS were enrolled in this study. Thrombocytopenia, neutropenia, and anemia were detected in all three patients. Severe hypocellular marrow (overall cellularity Korean SFTS. PMID:27401664

  2. The Value of C-Reactive Protein and Procalcitonin in Febrile Neutropenia

    Directory of Open Access Journals (Sweden)

    Solmaz Çelebi

    2009-06-01

    Full Text Available Aim: Febrile neutropenia is the major cause of mortality and morbidity in cancer patients. For this reason, early diagnosis of severe infections and appropriate antimicrobial therapy are very important. The aim of this study was to investigate the difference between C-reactive protein (CRP and procalcitonin in determining the sepsis and its severity. Materials and Method: A total of 30 children (35 episodes with febrile neutropenia who were hospitalized in the Uludag University, Pediatric Hematology and Oncology Unit were included in this prospective study. The blood samples for CRP and procalcitonin were collected daily between 0 to 5th days. Serum CRP and procalcitonin levels were compared with culture positivity, prolonged fever, mucositis and absolute granulosit count (AGC. Results: A total of 16 patients (56% diagnosed with acute leukemia and, 14 patients (46% having solid tumours were evaluated. In sequential analysis of febrile episodes, both the median of procalcitonin and the CRP concentrations showed the same tendency and there was no significant correlation between them (r=0.2, p>0.05. There was no significant association between CRP and procalcitonin among those having positive culture and mucositis. However, CRP values at the 3rd, 4th and 5th days were significantly higher in the patients with AGC100/mm3. Similarly, CRP values were significantly higher at the 1st, 2nd, 3rd and 4th days among the patients having prolonged fever. Conclusion: Our study suggests that there is no difference between CRP and procalcitonin in determining sepsis and its severity. Although procalcitonin is a valuable acute phase reactant in non-neutropenic patients, larger prospective investigations are needed to show the prognostic value of procalcitonin in neutropenic patients. (Journal of Current Pediatrics 2009; 7: 7-12

  3. Chronic neutropenia. A new canine model induced by human granulocyte colony-stimulating factor.

    OpenAIRE

    Hammond, W. P.; Csiba, E; Canin, A; Hockman, H; Souza, L M; Layton, J E; Dale, D C

    1991-01-01

    Normal dogs were treated with recombinant human granulocyte colony-stimulating factor (rhG-CSF) at 10 micrograms/kg/day for 30 d, which caused an initial neutrophilia, followed by a prolonged period of chronic neutropenia. A control dog treated with recombinant canine G-CSF (rcG-CSF) showed persistent neutrophilia over 3 mo. Serum from dogs during neutropenia contained an antibody to rhG-CSF, which neutralized the stimulatory effects of both rhG-CSF and rcG-CSF on dog marrow neutrophilic prog...

  4. Neutropenia crónica e infección por el virus de la inmunodeficiencia humana Chronic neutropenia and human immunodeficiency virus infection

    Directory of Open Access Journals (Sweden)

    Ronald A Noguera-Valverde

    2008-09-01

    associated with acute human immunodeficiency virus infection. As antiretroviral therapy establishes and viral activity diminishes, hematological disturbances improve. However, some antiretroviral drugs, e.g., zidovudine, exhibits medullary toxicity and it can worsen the hematological findings in these patients, forcing subsequent changes on therapeutic schemes. Cytotoxics used in associated neoplasms have known antimedullary activity. Some antimicrobial agents like trimethoprimsulfamethoxazole, used prophylactically, also exhibit medullary toxicity, because of this, they should be used with caution or should be avoided. Finally, other mechanisms which can cause neutropenia are enlisted: formation of anti- neutrophiles antibodies, primary damage of granulocyte progenitor, imbalance of neutrophil production, antibodies against gp120 viral envelope glycoprotein, or vitamins deficiencies. The approach of the neutropenic febrile patient in whom severe bacterial infection is suspected, includes the use of granulocyte-colonies stimulating factors in order to increase the absolute neutrophil count and to achieve a better clinical outcome.

  5. Risk assessment in fever and neutropenia in children with cancer : What did we learn?

    NARCIS (Netherlands)

    Poele, Esther M. te; Tissing, Wim J. E.; Kamps, Willem A.; de Bont, Eveline S. J. M.

    2009-01-01

    Children with cancer treated with chemotherapy are susceptible to bacterial infections and serious infectious complications. However, fever and neutropenia can also result from other causes, for which no antibiotic treatment is needed. In the past decades attempts have been made to stratify the hete

  6. CLPB Variants Associated with Autosomal-Recessive Mitochondrial Disorder with Cataract, Neutropenia, Epilepsy, and Methylglutaconic Aciduria

    DEFF Research Database (Denmark)

    Saunders, Carol; Smith, Laurie; Wibrand, Flemming;

    2015-01-01

    type IV 3-MGA-uria characterized by cataracts, severe psychomotor regression during febrile episodes, epilepsy, neutropenia with frequent infections, and death in early childhood. Four of the individuals were of Greenlandic descent, and one was North American, of Northern European and Asian descent...

  7. Critical appraisal of biosimilar filgrastim (Nivestim™ for febrile and chemotherapy-induced neutropenia

    Directory of Open Access Journals (Sweden)

    Waller CF

    2012-08-01

    Full Text Available Cornelius F WallerFreiburg University Medical Center, Department of Hematology/Oncology, Freiburg, GermanyAbstract: Recombinant granulocyte colony-stimulating factor (filgrastim stimulates the proliferation and differentiation of hematopoietic stem and progenitor cells committed to neutrophil and granulocyte lineages. Filgrastim has been used as an adjunct to chemotherapy for ameliorating neutropenia, one of the major side effects of chemotherapy in cancer patients. Its use has led to reduction of infections and hospital admissions for patients with cancer undergoing chemotherapy. In addition, filgrastim has multiple other indications in hematology and oncology. Following the European Union patent expiry of Neupogen® (filgrastim; Amgen Inc in 2006, a biosimilar filgrastim has been developed (Nivestim™; Hospira. In accordance with the requirements of the European Medicines Agency, Nivestim has been studied in a development program that included preclinical studies, two Phase I clinical trials, and one Phase III clinical study. Preclinical studies showed pharmacodynamic as well as pharmacokinetic bioequivalence with the original product, Neupogen. Two randomized, single-center, Phase I trials compared both the pharmacokinetic, pharmacodynamic, and safety profiles of Nivestim and Neupogen in healthy volunteers. In both studies, 90% confidence intervals for the primary endpoints were within the predefined range (0.80–1.25 necessary to demonstrate bioequivalence. Nivestim was well tolerated, with no additional safety concerns over Neupogen. Bioequivalence was demonstrated in a randomized, double-blind multicenter Phase III trial of 279 patients with breast cancer receiving myelosuppressive chemotherapy. The mean duration of severe neutropenia in cycle 1, the primary endpoint, was similar between Nivestim (1.6 days, n = 165 and Neupogen (1.3 days, n = 85, meeting predefined criteria for bioequivalence. Secondary endpoints supporting

  8. Severe hypoglycaemia requiring the assistance of emergency medical services - frequency, causes and symptoms

    Czech Academy of Sciences Publication Activity Database

    Krnačová, V.; Kuběna, Aleš Antonín; Macek, K.; Bezděk, M.; Šmahelová, A.; Vlček, J.

    2012-01-01

    Roč. 156, č. 3 (2012), s. 271-277. ISSN 1213-8118 Grant ostatní: GA UK(CZ) SVV-2010-261-004 Keywords : regression trees * causes * symptoms * incidence * emergency medical service * severe hypoglycaemia Subject RIV: EI - Biotechnology ; Bionics Impact factor: 0.990, year: 2012 http://library.utia.cas.cz/separaty/2013/E/kubena-severe hypoglycaemia requiring the assistance of emergency medical services - frequency causes and symptoms.pdf

  9. A Rare Cause of Retinal Artery Occlusion in Severe Hypernatremic Dehydration in Newborns.

    Science.gov (United States)

    Ozer, Pinar Altiaylik; Kabatas, Emrah Utku; Kurtul, Bengi Ece; Dilli, Dilek; Zenciroglu, Aysegul; Okumus, Nurullah

    2016-05-01

    Neonatal hypernatremia is an important electrolyte disorder that may have serious complications. It may be a rare and underdiagnosed cause of venous and arterial thrombosis, leading to severe brain damage by cerebral edema and intracranial hemorrhage. Here, the authors present a case of bilateral central retinal artery occlusion in a newborn with severe hypernatremic dehydration who is found to be normal in terms of other causes of retinal arterial thromboembolization. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:482-485.]. PMID:27183555

  10. Streptoccocus pyogenes: a forgotten cause of severe community-acquired pneumonia.

    Science.gov (United States)

    Birch, C; Gowardman, J

    2000-02-01

    We report a case of severe community-acquired pneumonia caused by Streptococcus pyogenes (Lancefield Group A streptoccocus) that was complicated by a streptococcal toxic shock syndrome. Although this micro-organism is an uncommon cause of community-acquired pneumonia, previously well individuals may be infected and the clinical course may be fulminant. A household contact was the likely point of infection. Invasive group A streptococcal disease continues to remain an important cause of morbidity and mortality in the community and therefore will continue to be encountered by intensive care physicians. Treatment of Group A streptococcal infection remains penicillin; however, clindamycin should be added in severe infection. PMID:10701045

  11. New developments in the treatment of chemotherapy-induced neutropenia: focus on balugrastim.

    Science.gov (United States)

    Ghidini, Michele; Hahne, Jens Claus; Trevisani, Francesco; Panni, Stefano; Ratti, Margherita; Toppo, Laura; Tomasello, Gianluca

    2016-01-01

    Neutropenia and febrile neutropenia are two major complications of chemotherapy. Dose reductions, delays in treatment administration, and the use of granulocyte colony-stimulating factors are equally recommended options to preserve absolute neutrophil count in case of chemotherapy regimens bringing a risk of febrile neutropenia of 20% or higher. Recombinant granulocyte colony-stimulating factors, such as filgrastim and lenograstim, have a short elimination half-life (t1/2) and need to be used daily, while others, like pegfilgrastim and lipegfilgrastim, are characterized by a long t1/2 requiring only a single administration per cycle. Balugrastim is a novel long-acting recombinant granulocyte colony-stimulating factor obtained by means of a genetic fusion between recombinant human serum albumin and granulocyte colony-stimulating factor. Albumin binding increases the molecular weight and determines a high plasmatic stability leading to a t1/2 of ~19 days. Balugrastim's efficacy, safety, and tolerability have been assessed in four different clinical trials involving breast cancer patients treated with doxorubicin and docetaxel. Pegfilgrastim was chosen as a comparator. Balugrastim was noninferior to pegfilgrastim with regard to the reduction of mean duration of severe neutropenia during cycle 1. Moreover, both treatments were comparable in terms of efficacy and safety profile. Balugrastim was well tolerated, with the only related adverse event being mild to moderate bone pain. The aim of this review is to summarize the currently available literature data on balugrastim. PMID:27445479

  12. Rationalizing the approach to children with fever in neutropenia

    NARCIS (Netherlands)

    Ammann, Roland A.; Tissing, Wim J. E.; Phillips, Bob

    2012-01-01

    Purpose of review Fever in neutropenia is the most frequent potentially life-threatening complication of chemotherapy in children and adolescents with cancer. This review summarizes recent studies that refine our knowledge of how to manage pediatric fever in neutropenia, and their implications for c

  13. Psoas Abscess Caused by Non-Typhoid Salmonella in a Patient with Severe Aplastic Anemia

    OpenAIRE

    Kuo, Chin-Chi; Ku, Shih-Chi; Wang, Jann-Tay; Tsai, Ching-Wei; Wu, Vin-Cent; Chou, Wen-Chien

    2010-01-01

    The clinical spectrum of infections caused by non-typhoid Salmonella spp. includes gastroenteritis, enteric fever, bacteremia, and extraintestinal localized complications, especially in immunocompromised hosts. Here we report a patient with severe aplastic anemia developing left iliopsoas abscess caused by non-typhoid Salmonella (NTS), which was successfully treated by prolonged antibiotic treatment and repeated debridement. Our data indicate that aplastic anemia is a risk factor for infectio...

  14. Causes of severe visual impairment and blindness in children in the Republic of Suriname

    OpenAIRE

    Heijthuijsen, Astrid Anna Maria; Beunders, Victoria Apollonia Annemarie; Jiawan, Dinesh; de Mesquita-Voigt, Anne-Marie Bueno; Pawiroredjo, Jerrel; Mourits, Maarten; Tanck, Michael; Verhoeff, Joost; Saeed, Peerooz

    2013-01-01

    Aims To determine the causes of severe visual impairment and blindness (SVI/BL) in children in Suriname (Dutch Guyana) and to identify preventable and treatable causes. Methods 4643 children under 16 years of age were recruited from two locations: 33 children attending the only school for the blind were examined and 4610 medical records were analysed at an eye clinic. Data have been collected using the WHO Prevention of Blindness Programme eye examination record for children. Results 65 child...

  15. Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis

    Directory of Open Access Journals (Sweden)

    Rima eMoghnieh

    2015-02-01

    Full Text Available Bacteremia remains a major cause of life-threatening complications in patients receiving anticancer chemotherapy. The spectrum and susceptibility profiles of causative microorganisms differ with time and place. Data from Lebanon are scarce. We aim at evaluating the epidemiology of bacteremia in cancer patients in a university hospital in Lebanon, emphasizing antibiotic resistance and risk factors of multi-drug resistant organism (MDRO-associated bacteremia.This is a retrospective study of 75 episodes of bacteremia occurring in febrile neutropenic patients admitted to the hematology-oncology unit at Makassed General Hospital, Lebanon, from October 2009-January 2012.It corresponds to epidemiological data on bacteremia episodes in febrile neutropenic cancer patients including antimicrobial resistance and identification of risk factors associated with third generation cephalosporin resistance (3GCR and MDRO-associated bacteremia. Out of 75 bacteremias, 42.7% were gram-positive (GP, and 57.3% were gram-negative (GN. GP bacteremias were mostly due to methicillin-resistant coagulase negative staphylococci (28% of total bacteremias and 66% of GP bacteremias. Among the GN bacteremias, Escherichia coli (22.7% of total, 39.5% of GN organisms and Klebsiellapneumoniae(13.3% of total, 23.3% of GN organisms were the most important causative agents. GN bacteremia due to 3GC sensitive (3GCS bacteria represented 28% of total bacteremias, while 29% were due to 3GCR bacteria and 9% were due to carbapenem-resistant organisms. There was a significant correlation between bacteremia with MDRO and subsequent intubation, sepsis and mortality. Among potential risk factors, only broad spectrum antibiotic intake >4 days before bacteremia was found to be statistically significant for acquisition of 3GCR bacteria. Using carbapenems or piperacillin/ tazobactam>4 days before bacteremia was significantly associated with the emergence of MDRO (p value<0.05.

  16. Acute liver injury with severe coagulopathy in marasmus caused by a somatic delusional disorder.

    Science.gov (United States)

    Stein, Lance L; Jesudian, Arun B

    2011-01-01

    Marasmus is a severe form of protein-calorie malnutrition characterized by the depletion of fat stores, muscle wasting, and the lack of edema. In developed countries, marasmus is often the result of anorexia nervosa. Abnormal transaminases with liver synthetic dysfunction have rarely been reported with anorexia nervosa. To our knowledge, we report the first detailed case of acute liver injury with severe coagulopathy (INR > 1.5) in a patient with marasmus due to self-induced calorie restriction caused by a somatic delusional disorder. This case highlights the severity of liver injury that may occur with significant weight loss from self-induced calorie restriction and the rapid normalization of this injury with treatment. It is important for clinicians to be aware of patterns of acute liver injury in patients with severe protein-calorie malnutrition, regardless of the underlying cause. PMID:25954537

  17. Rhabdomyolysis due to Severe Hypernatremia Caused by Dehydration, in a Child with Gastroenteritis: a Case Report

    Directory of Open Access Journals (Sweden)

    Mitra Basiratnia

    2016-06-01

    Full Text Available Background Rhabdomyolysis is considered a rare medical condition in pediatric population. Case Report We report our experience on a one year old girl referred to Shiraz Nemazee Hospital, Southern Iran with rhabdomyolysis due to severe hypernatremia, secondary to gastroenteritis. Discussion Rhabdomyolysis should be taken in to consideration in hypernatremic states, as it may lead to severe consequences. Treatment of underlying cause and proper management of hypernatremia could be helpful while handling this complicated situation.

  18. Rhabdomyolysis due to Severe Hypernatremia Caused by Dehydration, in a Child with Gastroenteritis: a Case Report

    OpenAIRE

    Mitra Basiratnia; Yasna Pouralborz; Forough Saki

    2016-01-01

    Background Rhabdomyolysis is considered a rare medical condition in pediatric population. Case Report We report our experience on a one year old girl referred to Shiraz Nemazee Hospital, Southern Iran with rhabdomyolysis due to severe hypernatremia, secondary to gastroenteritis. Discussion Rhabdomyolysis should be taken in to consideration in hypernatremic states, as it may lead to severe consequences. Treatment of underlying cause and proper management of hypernatremia could be helpful while...

  19. SEVERE MALARIA CAUSED BY PLASMODIUM VIVAX IN PREGNANCY MASQUERADING AS HELLP SYNDROME

    Directory of Open Access Journals (Sweden)

    Monika

    2014-01-01

    Full Text Available The following is a case report of a woman who presented to the hospital with severe anemia with features of HELLP syndrome and initial slide for P .vivax negative but on constan t observation and monitoring turned out to be a case of severe malaria caused by vivax species of malaria. Primigravida with 35week5day pregnancy was admitted with complaints of severe anemia and history of fever 14 days back. Init i ally 3 pint blood was transfused i/v/o severe anemia . Investigations revealed Hb - 3gm% and platelet count 30 , 000 , LFT deranged , Hemolysis in peripheral smear , smear negative for malarial parasite. HELLP syndrome was in mind and this required termination but on repeat investigations and smear vivax was positive . Her platelet count kept deteriorating despite t ransfusions till antimalarial regimen was not started. Once smear positive the fastest antimalarial artesunate regimen with clindamycin was started and after 48 hrs. her counts improved. Overall 14 pints of platelets were transfused and patient delivered u neventfully with mild PPH at platelet count of 30 , 000. Severe malaria is usually caused by p falciparum but recently reports of severe malaria caused by vivax is increasing and HELLP syndrome is an important differential diagnosis which needs to be exclud ed as management is entirely different.

  20. SEVERE MALARIA CAUSED BY PLASMODIUM VIVAX IN PREGNANCY MASQUERADING AS HELLP SYNDROME

    OpenAIRE

    Monika; Premila; Geetika; Pranjal

    2014-01-01

    The following is a case report of a woman who presented to the hospital with severe anemia with features of HELLP syndrome and initial slide for P .vivax negative but on constan t observation and monitoring turned out to be a case of severe malaria caused by vivax species of malaria. Primigravida with 35week5day pregnancy was admitted with complaints of severe anemia and history of fever 14 days back. Init i ally 3 pint blood was transfused i/v/o s...

  1. Risk assessment on severe hazards to China caused by West Nile virus

    Institute of Scientific and Technical Information of China (English)

    CHEN Jiming; SUN Yingxue; WANG Zhiliang; SHEN Chaojian; XIE Zhonglun; WANG Ximing

    2004-01-01

    Recent West Nile virus epidemics in USA draw worldwide concerns. Here the basic biological and epidemiologicai features of the virus are analyzed along with the special immunity of humans and animals, the immigration of birds and the natural environments in China. The risk of severe hazards to China caused by West Nile virus is assessed not high thereafter.

  2. Severe hemolysis caused by graft-derived anti-B production after lung transplantation

    DEFF Research Database (Denmark)

    Taaning, E; Morling, N; Mortensen, S A;

    1996-01-01

    Anti-B antibody causing sever hemolytic anemia and renal failure was found in the serum of a blood group B patient who had received a bilateral lung transplant from a blood group O donor. Although the donor origin of the antibody was not confirmed, it is likely that the anti-B antibody was produced...

  3. Causes of severe visual impairment and blindness in children in the Republic of Suriname

    Science.gov (United States)

    Heijthuijsen, Astrid Anna Maria; Beunders, Victoria Apollonia Annemarie; Jiawan, Dinesh; de Mesquita-Voigt, Anne-Marie Bueno; Pawiroredjo, Jerrel; Mourits, Maarten; Tanck, Michael; Verhoeff, Joost; Saeed, Peerooz

    2013-01-01

    Aims To determine the causes of severe visual impairment and blindness (SVI/BL) in children in Suriname (Dutch Guyana) and to identify preventable and treatable causes. Methods 4643 children under 16 years of age were recruited from two locations: 33 children attending the only school for the blind were examined and 4610 medical records were analysed at an eye clinic. Data have been collected using the WHO Prevention of Blindness Programme eye examination record for children. Results 65 children were identified with SVI/BL, 58.5% were blind and 41.5% were severely visually impaired (SVI). The major anatomical site of SVI/BL was the retina in 33.8%, lens in 15.4% and normal appearing globe in 15.4%. The major underlying aetiology of SVI/BL was undetermined in 56.9% (mainly cataract and abnormality since birth) and perinatal factors 21.5% (mainly retinopathy of prematurity (ROP)). Avoidable causes of SVI/BL accounted for 40% of cases; 7.7% were preventable and 32.3% were treatable with cataracts and ROP the most common causes (15.4% and 12.3%, respectively). Conclusions More than a third of the SVI/BL causes are potentially avoidable, with childhood cataract and ROP the leading causes. Corneal scarring from vitamin A deficiency does not seem to be a continuing issue in Suriname. PMID:23603759

  4. Anti-E Alloimmunization: A Rare Cause of Severe Fetal Hemolytic Disease Resulting in Pregnancy Loss

    Directory of Open Access Journals (Sweden)

    An-Shine Chao

    2009-01-01

    Full Text Available We report a case of severe intrauterine hemolysis caused by sole anti-E alloimmunization. A 36-year-old multipara woman presented with hydrops fetalis at 27 weeks of gestation. She had a history of previous neonatal death. In this pregnancy, she was found to have very high titer of anti-E antibody. Ultrasonography detected marked skin edema, cardiomegaly, hepatosplenomegaly, pleural effusion, ascites, placentomegaly, and polyhydramnios. The Doppler peak systolic velocity in the middle cerebral artery was 0.8 m/s, indicating severe fetal anemia. Multiple intrauterine transfusions for the anemic fetus were administered. However, persistent severe fetal anemia and placentomegaly caused poor neonatal death and mirror syndrome in the mother. Uncommon red blood cell alloimmunization has to be watched for early in any population, especially in a woman with a history of unexplained perinatal loss.

  5. Medical visits for chemotherapy and chemotherapy-induced neutropenia: a survey of the impact on patient time and activities

    Directory of Open Access Journals (Sweden)

    Moore Kelley

    2004-05-01

    Full Text Available Abstract Background Patients with cancer must make frequent visits to the clinic not only for chemotherapy but also for the management of treatment-related adverse effects. Neutropenia, the most common dose-limiting toxicity of myelosuppressive chemotherapy, has substantial clinical and economic consequences. Colony-stimulating factors such as filgrastim and pegfilgrastim can reduce the incidence of neutropenia, but the clinic visits for these treatments can disrupt patients' routines and activities. Methods We surveyed patients to assess how clinic visits for treatment with chemotherapy and the management of neutropenia affect their time and activities. Results The mean amounts of time affected by these visits ranged from approximately 109 hours (hospitalization for neutropenia and 8 hours (physician and chemotherapy to less than 3 hours (laboratory and treatment with filgrastim or pegfilgrastim. The visits for filgrastim or pegfilgrastim were comparable in length, but treatment with filgrastim requires several visits per chemotherapy cycle and treatment with pegfilgrastim requires only 1 visit. Conclusions This study provides useful information for future modelling of additional factors such as disease status and chemotherapy schedule and provides information that should be considered in managing chemotherapy-induced neutropenia.

  6. Traumatic retropharyngeal emphysema as a cause for severe respiratory distress in a newborn

    International Nuclear Information System (INIS)

    Traumatic injury to the pharynx or esophagus in a newborn from intubation or tube suctioning may have various presentations. Difficulty passing a gastric tube or feeding problems may erroneously suggest the diagnosis of esophageal atresia. Associated respiratory distress may be caused by pneumothorax or pleural effusion if the pleural space is entered. We report the case of a full-term newborn presenting with severe respiratory distress caused by a large retropharyngeal air collection resulting from hypopharyngeal perforation from prior intubation and suctioning. Chest abnormality, sufficient to account for the degree of respiratory distress, was not demonstrated. (orig.)

  7. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients

    International Nuclear Information System (INIS)

    Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [18 F]FDG PET/CT has the potential to identify inflammatory and infectious foci, but its potential role as an investigation for persistent FNP has not previously been explored. The aim of this study was to prospectively evaluate the clinical utility of FDG PET/CT in patients with cancer and severe neutropenia and five or more days of persistent fever despite antibiotic therapy. Adult patients with a diagnosis of an underlying malignancy and persistent FNP (temperature ≥38 C and neutrophil count <500 cells/μl for 5 days) underwent FDG PET/CT as an adjunct to conventional evaluation and management. The study group comprised 20 patients with FNP who fulfilled the eligibility criteria and underwent FDG PET/CT in addition to conventional evaluation. The median neutrophil count on the day of the FDG PET/CT scan was 30 cells/μl (range 0-730 cells/μl). Conventional evaluation identified 14 distinct sites of infection, 13 (93 %) of which were also identified by FDG PET/CT, including all deep tissue infections. FDG PET/CT identified 9 additional likely infection sites, 8 of which were subsequently confirmed as ''true positives'' by further investigations. FDG PET/CT was deemed to be of 'high' clinical impact in 15 of the 20 patients (75 %). This study supports the utility of FDG PET/CT scanning in severely neutropenic patients with five or more days of fever. Further evaluation of the contribution of FDG PET/CT in the management of FNP across a range of underlying malignancies is required. (orig.)

  8. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Guy, Stephen D.; Tramontana, Adrian R. [Western Health, Department of Infectious Diseases, Private Bag, Footscray, Victoria (Australia); University of Melbourne, Parkville, Victoria (Australia); Worth, Leon J.; Thursky, Karin A.; Slavin, Monica A. [University of Melbourne, Parkville, Victoria (Australia); Peter MacCallum Cancer Centre, Department of Infectious Diseases, Melbourne, Victoria (Australia); Lau, Eddie; Hicks, Rodney J. [University of Melbourne, Parkville, Victoria (Australia); Peter MacCallum Cancer Centre, Centre for Cancer Imaging, Melbourne, Victoria (Australia); Seymour, John F. [University of Melbourne, Parkville, Victoria (Australia); Peter MacCallum Cancer Centre, Department of Haematology, Melbourne, Victoria (Australia)

    2012-08-15

    Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [{sup 18} F]FDG PET/CT has the potential to identify inflammatory and infectious foci, but its potential role as an investigation for persistent FNP has not previously been explored. The aim of this study was to prospectively evaluate the clinical utility of FDG PET/CT in patients with cancer and severe neutropenia and five or more days of persistent fever despite antibiotic therapy. Adult patients with a diagnosis of an underlying malignancy and persistent FNP (temperature {>=}38 C and neutrophil count <500 cells/{mu}l for 5 days) underwent FDG PET/CT as an adjunct to conventional evaluation and management. The study group comprised 20 patients with FNP who fulfilled the eligibility criteria and underwent FDG PET/CT in addition to conventional evaluation. The median neutrophil count on the day of the FDG PET/CT scan was 30 cells/{mu}l (range 0-730 cells/{mu}l). Conventional evaluation identified 14 distinct sites of infection, 13 (93 %) of which were also identified by FDG PET/CT, including all deep tissue infections. FDG PET/CT identified 9 additional likely infection sites, 8 of which were subsequently confirmed as ''true positives'' by further investigations. FDG PET/CT was deemed to be of 'high' clinical impact in 15 of the 20 patients (75 %). This study supports the utility of FDG PET/CT scanning in severely neutropenic patients with five or more days of fever. Further evaluation of the contribution of FDG PET/CT in the management of FNP across a range of underlying malignancies is required. (orig.)

  9. Immune mediated neutropenia and thrombocytopenia in 3 giant schnauzers.

    Science.gov (United States)

    Vargo, Cheryl L; Taylor, Susan M; Haines, Deborah M

    2007-11-01

    Neutropenia, thrombocytopenia, and splenomegaly were recognized in 3 adult female giant schnauzers. Antineutrophil antibodies were demonstrated in 2 dogs. Following splenectomy, administration of prednisone and azathioprine resulted in normalization of neutrophil and platelet numbers in all dogs. PMID:18050797

  10. Causes and anatomical site of blindness and severe visual loss in Isfahan, Islamic Republic of Iran.

    Science.gov (United States)

    Dehghan, A; Kianersi, F; Moazam, E; Ghanbari, H

    2010-02-01

    This study in 2005 evaluated the causes and major anatomical site of blindness and severe visual loss at a school for blind children in Isfahan province, Islamic Republic of Iran. All 211 students were examined according to the modified WHO/PBL eye examination record: 70.4% were blind, 24.3% had severe visual loss and 5.3% were visually impaired. The major causes of abnormality were hereditary factors (42.7%), prenatal/neonatal (18.5%) and unknown etiology (35.5%). The main sites of abnormality were the retina (62.6%), whole globe (17.5%), lens (7.1%) and optic nerve (7.1%). A high proportion of parents were in a consanguineous marriage (49.2%). The pattern of blindness in Isfahan encompasses characteristics of both developed and developing countries. PMID:20799580

  11. Root Causes and Impacts of Severe Accidents at Large Nuclear Power Plants

    OpenAIRE

    Högberg, Lars

    2013-01-01

    The root causes and impacts of three severe accidents at large civilian nuclear power plants are reviewed: the Three Mile Island accident in 1979, the Chernobyl accident in 1986, and the Fukushima Daiichi accident in 2011. Impacts include health effects, evacuation of contaminated areas as well as cost estimates and impacts on energy policies and nuclear safety work in various countries. It is concluded that essential objectives for reactor safety work must be: (1) to prevent accidents from d...

  12. Comparing the Pain Severity Caused by Muscular Injection of Tramadole in Z and Bulb Methods

    OpenAIRE

    SH Najafi Doulatabad; Z Mohebi Nobandegani; J Malekzadeh

    2008-01-01

    ABSTRACT: Introduction & Objective: Pain, rather than any other problems, would persuade people to pursue remedy and treatment. Muscular injections are among pain producing factors. This technique of prescription can be followed by some complications from which pain is the most prevalent one. This study was performed to compare the pain severity caused by muscular injection of Tramadole in Z and Bulb methods. Materials & Methods: This is a clinical trial study in which 90 women who re...

  13. Duodenal diverticulum associated with annular pancreas: a rare cause of severe cholangitis.

    Science.gov (United States)

    Ben Ameur, H; Boujelbene, S; Affes, N; Ghorbel, A; Beyrouti, M I

    2011-06-01

    Duodenal diverticulum is a common occurrence but most are asymptomatic. However, in some cases, they can cause mechanical biliary compression. We report the case of a duodenal diverticulum in a 64-year-old woman revealed by severe cholangitis with septic shock and a liver abscess. Associated annular pancreas was found. We discuss the various investigations to diagnose these two entities as well as the therapeutic strategy in this unique combination of disease. PMID:21715238

  14. Anti-E Alloimmunization: A Rare Cause of Severe Fetal Hemolytic Disease Resulting in Pregnancy Loss

    OpenAIRE

    Reyin Lien; Yao-Lung Chang; Szu Ying Ho; Angel Chao; An-Shine Chao

    2010-01-01

    We report a case of severe intrauterine hemolysis caused by sole anti-E alloimmunization. A 36-year-old multipara woman presented with hydrops fetalis at 27 weeks of gestation. She had a history of previous neonatal death. In this pregnancy, she was found to have very high titer of anti-E antibody. Ultrasonography detected marked skin edema, cardiomegaly, hepatosplenomegaly, pleural effusion, ascites, placentomegaly, and polyhydramnios. The Doppler peak systolic velocity in the middle cerebra...

  15. Primary immune-mediated neutropenia in a cat

    OpenAIRE

    Waugh, Carly E.; Scott, Katherine D.; Bryan, Laura K.

    2014-01-01

    An 18-month-old male castrated indoor Himalayan cat was presented for recurrent fever, lethargy, and uveitis. Persistent neutropenia was identified and tests for infectious disease and bone marrow cytology were performed. Primary immune-mediated neutropenia was diagnosed and successfully treated. At the time of writing this report, 24 mo after the initial diagnosis. the patient was clinically normal and not receiving therapy.

  16. Characterisation of the Cullin-3 mutation that causes a severe form of familial hypertension and hyperkalaemia.

    Science.gov (United States)

    Schumacher, Frances-Rose; Siew, Keith; Zhang, Jinwei; Johnson, Clare; Wood, Nicola; Cleary, Sarah E; Al Maskari, Raya S; Ferryman, James T; Hardege, Iris; Yasmin; Figg, Nichola L; Enchev, Radoslav; Knebel, Axel; O'Shaughnessy, Kevin M; Kurz, Thimo

    2015-10-01

    Deletion of exon 9 from Cullin-3 (CUL3, residues 403-459: CUL3(Δ403-459)) causes pseudohypoaldosteronism type IIE (PHA2E), a severe form of familial hyperkalaemia and hypertension (FHHt). CUL3 binds the RING protein RBX1 and various substrate adaptors to form Cullin-RING-ubiquitin-ligase complexes. Bound to KLHL3, CUL3-RBX1 ubiquitylates WNK kinases, promoting their ubiquitin-mediated proteasomal degradation. Since WNK kinases activate Na/Cl co-transporters to promote salt retention, CUL3 regulates blood pressure. Mutations in both KLHL3 and WNK kinases cause PHA2 by disrupting Cullin-RING-ligase formation. We report here that the PHA2E mutant, CUL3(Δ403-459), is severely compromised in its ability to ubiquitylate WNKs, possibly due to altered structural flexibility. Instead, CUL3(Δ403-459) auto-ubiquitylates and loses interaction with two important Cullin regulators: the COP9-signalosome and CAND1. A novel knock-in mouse model of CUL3(WT) (/Δ403-459) closely recapitulates the human PHA2E phenotype. These mice also show changes in the arterial pulse waveform, suggesting a vascular contribution to their hypertension not reported in previous FHHt models. These findings may explain the severity of the FHHt phenotype caused by CUL3 mutations compared to those reported in KLHL3 or WNK kinases. PMID:26286618

  17. Clopidogrel-Induced Neutropenia after Coronary Stenting: Is Cilostazol a Good Alternative?

    Directory of Open Access Journals (Sweden)

    Massimo Montalto

    2011-01-01

    Full Text Available Dual antiplatelet therapy with aspirin plus thienopyridines has become the standard treatment of patients undergoing coronary stenting. Clopidogrel has mostly replaced the use of ticlopidine due to its more favourable adverse event profile. However, also the use of clopidogrel is not without side effects. Clopidogrel major adverse events are represented by marrow suppression, manifesting with aplastic anaemia, thrombocytopenia and neutropenia. When clopidogrel toxicity occurs, there are few and unsubstantiated alternative treatments and thus, in these cases, medical decisions may be very difficult. We report a case of clopidogrel-induced bone marrow toxicity manifesting with severe neutropenia in a patient treated with multiple coronary stents and provide suggestions for an alternative treatment.

  18. Sepsis Caused by Achromobacter Xylosoxidans in a Child with Cystic Fibrosis and Severe Lung Disease

    Science.gov (United States)

    Stobbelaar, Kim; Van Hoorenbeeck, Kim; Lequesne, Monique; De Dooy, Jozef; Ho, Erwin; Vlieghe, Erika; Ieven, Margaretha; Verhulst, Stijn

    2016-01-01

    Patient: Female, 10 Final Diagnosis: Sepsis Symptoms: Fever • hypotension • not tollerating enteral feeds • respiratory deterioration Medication: — Clinical Procedure: IV antibiotics • lungtransplantion Specialty: Pediatrics and Neonatology Objective: Unusual clinical course Background: Achromobacter xylosoxidans is an aerobic, motile, Gram-negative, opportunistic pathogen that can be responsible for various severe nosocomial and community-acquired infections. It has been found in immunocompromised patients and patients with several other underlying conditions, but the clinical role of this microorganism in cystic fibrosis is unclear. Case Report: We describe a case of septic shock caused by A. xylosoxidans in a 10-year-old child with cystic fibrosis and severe lung disease. Conclusions: As the prevalence of A. xylosoxidans in cystic fibrosis patients is rising and patient-to-patient transmission is highly probable, further studies are warranted to determine its role and to document the appropriate treatment strategy for eradication and long-term treatment of this organism. PMID:27498677

  19. Depletion of WRN protein causes RACK1 to activate several protein kinase C isoforms

    DEFF Research Database (Denmark)

    Massip, L; Garand, C; Labbé, A;

    2010-01-01

    show that a knock down of the WRN protein in normal human fibroblasts induces phosphorylation and activation of several protein kinase C (PKC) enzymes. Using a tandem affinity purification strategy, we found that WRN physically and functionally interacts with receptor for activated C-kinase 1 (RACK1...... contrast, different DNA-damaging treatments known to activate PKCs did not induce RACK1/PKCs association in cells. Overall, our results indicate that a depletion of the WRN protein in normal fibroblasts causes the activation of several PKCs through translocation and association of RACK1 with such kinases.......Werner's syndrome (WS) is a rare autosomal disease characterized by the premature onset of several age-associated pathologies. The protein defective in patients with WS (WRN) is a helicase/exonuclease involved in DNA repair, replication, transcription and telomere maintenance. In this study, we...

  20. Sepsis Caused by Achromobacter Xylosoxidans in a Child with Cystic Fibrosis and Severe Lung Disease.

    Science.gov (United States)

    Stobbelaar, Kim; Van Hoorenbeeck, Kim; Lequesne, Monique; De Dooy, Jozef; Ho, Erwin; Vlieghe, Erika; Ieven, Margaretha; Verhulst, Stijn

    2016-01-01

    BACKGROUND Achromobacter xylosoxidans is an aerobic, motile, Gram-negative, opportunistic pathogen that can be responsible for various severe nosocomial and community-acquired infections. It has been found in immunocompromised patients and patients with several other underlying conditions, but the clinical role of this microorganism in cystic fibrosis is unclear. CASE REPORT We describe a case of septic shock caused by A. xylosoxidans in a 10-year-old child with cystic fibrosis and severe lung disease. CONCLUSIONS As the prevalence of A. xylosoxidans in cystic fibrosis patients is rising and patient-to-patient transmission is highly probable, further studies are warranted to determine its role and to document the appropriate treatment strategy for eradication and long-term treatment of this organism. PMID:27498677

  1. A retrspective study of rescuing severe open craniocerebral injuries caused by traffic accidents

    Institute of Scientific and Technical Information of China (English)

    陈长才; 宁可; 等

    1999-01-01

    Objective:To investigate the rescuing principles of severe open craniocerebral injuries caused by traffic accidents.Methods:A retrospective study was performed for 36 patients admitted to our hospital from January 1986 to December 1995,who suffered from severe open craniocerebral injuries in traffic accidents.Results:These 36 cases occupied 52.10% of all the severe open craniocerebral injuries during the same period.The clinical features included confusion of consciousness, extensive cerebral contusion and laceration,severe contamination of the wound,high incidence of intracranial hematoma and multiple system injuries.Nineteen patients.(63.34%)ecovered normal neurological function,7 were (23.33%)mild disabled,4(13.33%)severe disabled,2(5.56%) vegetative survival,and 4(11.11%)dead.Conclusions:The main principles of salvage should emphasize the importance of emergent prehospital rescue,and be transfered to a specialized hospital as soon as possible.Postoperative complications included severe brain edema,intracerebral infection,and pneumonia,Debriding thoroughly at early stage and treating complications effectively would lower the rate of mortality and disability.

  2. The molecular basis of variable phenotypic severity among common missense mutations causing Rett syndrome.

    Science.gov (United States)

    Brown, Kyla; Selfridge, Jim; Lagger, Sabine; Connelly, John; De Sousa, Dina; Kerr, Alastair; Webb, Shaun; Guy, Jacky; Merusi, Cara; Koerner, Martha V; Bird, Adrian

    2016-02-01

    Rett syndrome is caused by mutations in the X-linked MECP2 gene, which encodes a chromosomal protein that binds to methylated DNA. Mouse models mirror the human disorder and therefore allow investigation of phenotypes at a molecular level. We describe an Mecp2 allelic series representing the three most common missense Rett syndrome (RTT) mutations, including first reports of Mecp2[R133C] and Mecp2[T158M] knock-in mice, in addition to Mecp2[R306C] mutant mice. Together these three alleles comprise ∼25% of all RTT mutations in humans, but they vary significantly in average severity. This spectrum is mimicked in the mouse models; R133C being least severe, T158M most severe and R306C of intermediate severity. Both R133C and T158M mutations cause compound phenotypes at the molecular level, combining compromised DNA binding with reduced stability, the destabilizing effect of T158M being more severe. Our findings contradict the hypothesis that the R133C mutation exclusively abolishes binding to hydroxymethylated DNA, as interactions with DNA containing methyl-CG, methyl-CA and hydroxymethyl-CA are all reduced in vivo. We find that MeCP2[T158M] is significantly less stable than MeCP2[R133C], which may account for the divergent clinical impact of the mutations. Overall, this allelic series recapitulates human RTT severity, reveals compound molecular aetiologies and provides a valuable resource in the search for personalized therapeutic interventions. PMID:26647311

  3. Two Cases of Severe Combined Immunodeficiency Caused By Adenosine Deaminase Deficiency

    Directory of Open Access Journals (Sweden)

    Turkan Patiroglu

    2014-08-01

    Full Text Available Severe Combined Immune Deficiency (SCID is a primary immune deficiency disorder manifested with severe infections upon first months of life, which is characterized by diverse genetic defects in T and B lymphocyte functions and occasionally in NK cells. ADA deficiency is a form of SCID progressing with severe lymphopenia and immune deficiency caused by toxic metabolites of ADA. Bone marrow transplantation (BMT is the only curative treatment although prophylactic anti-microbial therapy, intravenous immunoglobulin (IVIG and enzyme replacement can achieve transient improvements. Early diagnosis before development of severe infections and organ injury and referral to pediatric immunology clinics will make considerable contributions to prognosis. Here, we presented 2 cousins with SCID who had positive family history with deceased sibling; presented with tanning at skin, severe neonatal infections and Q246X (c736C>T non-sense mutation in exon 8 in ADA gene  in order to emphasize this rare mutation and pediatric emergencies associated with this disorder.

  4. Phenomenological uncertainty analysis of containment building pressure load caused by severe accident sequences

    International Nuclear Information System (INIS)

    Highlights: • Phenomenological uncertainty analysis has been applied to level 2 PSA. • The methodology provides an alternative to simple deterministic analyses and sensitivity studies. • A realistic evaluation provides a more complete characterization of risks. • Uncertain parameters of MAAP code for the early containment failure were identified. - Abstract: This paper illustrates an application of a severe accident analysis code, MAAP, to the uncertainty evaluation of early containment failure scenarios employed in the containment event tree (CET) model of a reference plant. An uncertainty analysis of containment pressure behavior during severe accidents has been performed for an optimum assessment of an early containment failure model. The present application is mainly focused on determining an estimate of the containment building pressure load caused by severe accident sequences of a nuclear power plant. Key modeling parameters and phenomenological models employed for the present uncertainty analysis are closely related to the in-vessel hydrogen generation, direct containment heating, and gas combustion. The basic approach of this methodology is to (1) develop severe accident scenarios for which containment pressure loads should be performed based on a level 2 PSA, (2) identify severe accident phenomena relevant to an early containment failure, (3) identify the MAAP input parameters, sensitivity coefficients, and modeling options that describe or influence the early containment failure phenomena, (4) prescribe the likelihood descriptions of the potential range of these parameters, and (5) evaluate the code predictions using a number of random combinations of parameter inputs sampled from the likelihood distributions

  5. Severe Hydronephrosis Caused by Uterine Prolapse with Non Specific Symptoms and Normal Renal Function

    Directory of Open Access Journals (Sweden)

    Muammer Altok

    2013-09-01

    Full Text Available Pelvic organ prolapse (POP, is the descent of pelvic organs (bladder, uterus, rectum until protrusion through the vagina and related to the loss of normal attachment and support of the pelvic floor. Pelvic organ prolapse (POP is a common problem in elderly women and usually causes various urologic symptoms. One of the most important complications of POP is hydronephrosis. The hydronephrosis is usually mild. Severe hydronephrosis is very rare. Hydronephrosis caused by POP may lead to renal dysfunction and serious urinary infections. Early detection and treatment is very important for preventing irreversible renal damage.Hereby, we report a case of 65-years-old woman who had massive uterine prolapse with silent severe bilateral hydronephrosis. She had no complaint except a protruding tissue out of her vagina. Renal function was normal and hydronephrosis was detected incidentally. The symptoms may be non-specific and silent until a serious infection or renal dysfunction. Therefore patients with a POP especially with severe POP need to have evaluation and imaging about the condition or the urinary system before a serious pathology occur

  6. A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus.

    Science.gov (United States)

    Bucaretchi, F; Baracat, E C; Nogueira, R J; Chaves, A; Zambrone, F A; Fonseca, M R; Tourinho, F S

    1995-01-01

    From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1%) or Tityus bahiensis (84.9%) presented severe envenoming. Of these 17 patients (1-11 years old; median = 2 yr) 14 were stung by T. serrulatus and three by T. bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median = 2 h). On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (7), arterial hypotension (5), tremors (5), hypothermia (4), hyperglycemia (17), leukocytosis (16/16), hypokalemia (13/17), increased CK-MB enzyme activity (> 6% of the total CK, 11/12), hyperamylasemia (11/14), sinusal tachycardia (16/17) and a myocardial infarction-like pattern (11/17). Six patients stung by T. serrulatus had depressed left ventricular systolic function assessed by means of echocardiography. Of these, five presented pulmonary edema and four had shock. A child aged two-years old presented severe respiratory failure and died 65 h after being stung by T. serrulatus. Severe envenomations caused by T. serrulatus were 26.2 times more frequent than those caused by T. bahiensis (p < 0.001). PMID:8599062

  7. Diagnosis of autoimmune neutropenia by neutrophil-bound IgG and IgM antibodies.

    Science.gov (United States)

    Ito, Taichi; Taniuchi, Shoichiro; Tsuji, Shoji; Iharada, Anna; Hasui, Masafumi; Kaneko, Kazunari

    2011-10-01

    Autoimmune neutropenia (AIN) in infancy is caused by antineutrophil (granulocyte-specific) autoantibodies. These antibodies are rarely found in circulation because their serum levels are extremely low. We hypothesized that a direct granulocyte immunofluorescence test (D-GIFT) that enables us to detect neutrophil-bound autoantibodies consisting of both immunoglobulin (Ig) G and IgM has better diagnostic value than the detection of circulating autoantibodies. Whole blood (100 μL) was obtained from 50 infants with AIN, 12 infants with transient neutropenia, and 37 control infants. D-GIFT was performed using both fluorescein isothiocyanate-conjugated antihuman IgG Fc portion monoclonal antibodies and fluorescein isothiocyanate antihuman IgM monoclonal antibodies. Results were assessed as relative fluorescence intensity (RFI). The RFIs of antineutrophil IgG-bound and antineutrophil IgM-bound cells in patients with AIN were significantly higher than those in patients with transient neutropenia and in controls. Positive results, as assessed by RFI scores of more than 1.81 in either antineutrophil IgG-bound or antineutrophil IgM-bound cells, showed the sensitivity and specificity of D-GIFT, and the areas under the receiver operating characteristic curve (0.98, 0.98, and 0.997, respectively) in the diagnosis of AIN. D-GIFT detecting both neutrophil-bound IgG autoantibodies and IgM autoantibodies has discriminatory power for identifying patients with AIN and, therefore, can be a useful diagnostic test. PMID:21941149

  8. Duodenal duplication cyst causing severe pancreatitis:Imaging findings and pathological correlation

    Institute of Scientific and Technical Information of China (English)

    Alessandro Guarise; Niccolo' Faccioli; Mauro Ferrari; Luigi Romano; Alice Parisi; Massimo Falconi

    2006-01-01

    We here report a case of a 18-year-old man with a history of recurrent abdominal pain and a previous episode of severe acute pancreatitis. Abdominal ultrasonography,contrast enhanced multislice computer tomography,endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and magnetic resonance imaging demonstrated a cystic mass lesion. Only on delayed phase magnetic resonance images after GadoliniumBOPTA injection, it was possible to demonstrate the lesion's relationship with the biliary tree, differentiating the lesion from intraluminal duodenal diverticulum, and to achieve the diagnosis of duodenal duplication cyst, a recognized rare cause of acute pancreatitis. The diagnosis was confirmed by histology.

  9. Endophytic Fusarium verticillioides reduces disease severity caused by Ustilago maydis on maize.

    Science.gov (United States)

    Lee, Keunsub; Pan, Jean J; May, Georgiana

    2009-10-01

    Endophytic fungi represent diverse taxa that inhabit plant hosts without causing disease symptoms. We used endophytic isolates of Fusarium verticillioides (Sacc.) Nirenberg to understand how endophytic fungi interact with pathogens, in this case, the corn smut pathogen, Ustilago maydis DC (Corda). Endophytic F. verticillioides strains were inoculated onto maize seedlings before, simultaneously, or after inoculation with U. maydis, and the effects on smut disease severity and on plant growth were assessed. When F. verticillioides is simultaneously coinoculated with U. maydis, smut disease severity is significantly decreased and plant growth is increased, compared with other treatments. Controls show that F. verticillioides by itself does not have measurable effects on plant growth. Together, our results suggest that a commonly occurring fungal endophyte on maize, F. verticillioides, ameliorates the effects of a host-specific pathogen, U. maydis, by interfering with the early infection process and limiting disease development, resulting in increased plant growth. PMID:19694816

  10. Evidence of increasing drought severity caused by temperature rise in southern Europe

    International Nuclear Information System (INIS)

    We use high quality climate data from ground meteorological stations in the Iberian Peninsula (IP) and robust drought indices to confirm that drought severity has increased in the past five decades, as a consequence of greater atmospheric evaporative demand resulting from temperature rise. Increased drought severity is independent of the model used to quantify the reference evapotranspiration. We have also focused on drought impacts to drought-sensitive systems, such as river discharge, by analyzing streamflow data for 287 rivers in the IP, and found that hydrological drought frequency and severity have also increased in the past five decades in natural, regulated and highly regulated basins. Recent positive trend in the atmospheric water demand has had a direct influence on the temporal evolution of streamflows, clearly identified during the warm season, in which higher evapotranspiration rates are recorded. This pattern of increase in evaporative demand and greater drought severity is probably applicable to other semiarid regions of the world, including other Mediterranean areas, the Sahel, southern Australia and South Africa, and can be expected to increasingly compromise water supplies and cause political, social and economic tensions among regions in the near future. (paper)

  11. Comparing the Pain Severity Caused by Muscular Injection of Tramadole in Z and Bulb Methods

    Directory of Open Access Journals (Sweden)

    SH Najafi Doulatabad

    2008-01-01

    Full Text Available ABSTRACT: Introduction & Objective: Pain, rather than any other problems, would persuade people to pursue remedy and treatment. Muscular injections are among pain producing factors. This technique of prescription can be followed by some complications from which pain is the most prevalent one. This study was performed to compare the pain severity caused by muscular injection of Tramadole in Z and Bulb methods. Materials & Methods: This is a clinical trial study in which 90 women who referred to the emergency ward of Shahid Beheshti hospital in Yasooj in 2006 were randomly selected. Data collection instrument was questionnaire. The pain severity was evaluated by visual scale. Data were analyzed by descriptive statistical method, independent T and chi square test using SPSS software. Results: Mean of pain severity in bulb method was 2.84±1.242 and in Z method was 4.56±1.659. The independent T test indicated that the differences in pain severity in two injection methods were statistically significant (p=0.036. No significant differences were found between age, educational level, job, marriatal status, number of previous injections and BMI of samples between two groups. Conclusion: Bulb method injection induces less pain in comparison with Z method therefore it is an ideal method for muscular injections. As such, health care workers, especially nurses, can, through this method, minimize the patients’ pain, which is one of the most important injection complaints.

  12. Superior Mesenteric Vein Occlusion Causing Severe Gastrointestinal Haemorrhage in Two Paediatric Cases

    Directory of Open Access Journals (Sweden)

    Anna L. Fox

    2012-01-01

    Full Text Available Reports about superior mesenteric vein thrombosis in childhood are very rare and have not been associated with gastrointestinal bleeding. We describe two cases of severe bleeding from the upper and lower gastrointestinal tract in children who had undergone complex abdominal surgery at considerable time before. The first child had a tracheoesophageal fistula, corrected by division, gastrostomy insertion, and repair of duodenal rupture. The child presented with severe bleeding from the gastrostomy site and was diagnosed with a thrombosis of the proximal superior mesenteric vein. The second child had a gastroschisis and duodenal atresia, and required duodenoplasty, gastrostomy insertion, hemicolectomy, and adhesiolysis. The child presented with intermittent severe lower gastrointestinal bleeding, resulting from collateral vessels at location of the surgical connections. He was diagnosed with a thrombosis of the superior mesenteric vein. In both children, the extensive previous surgery and anastomosis were considered the cause of the mesenteric thrombosis. CT angiography confirmed the diagnosis in both cases, in addition to characteristic findings on endoscopy. Paediatricians should suspect this condition in children with severe gastrointestinal bleeding, particularly in children with previous, complex abdominal surgery.

  13. LOWER DIGESTIVE TRACT HAEMORRHAGE AND SEVERE SUBSEQUENT ANAEMIA DUE TO A RARE CAUSE

    Directory of Open Access Journals (Sweden)

    D. Munteanu

    2006-10-01

    Full Text Available BACKGROUND: to discuss and analyse the evolutive, diagnostic and therapeutic features in a patient with recurrent episodes of bleeding from the lower gastrointestinal tract, due to a rare cause. METHODS: the case of a zoung male patient with a severe acute posthaemorrhagic anaemia caused by an serious episode of bleeding from the lower gastrointestinal tract is disscussed. We comment upon the efficiency of our diagnostic procedures and therapeutic strategy in this case, with a final review of the literature. RESULTS: gastro-duodenal endoscopy and colonoscopy couldn't establish the source of bleeding but gave a valuable guide for our suspicions. Not even the scintigraphic study with Tc –99m per technectate was able to give us more information. Laparotomy revealed a Meckel's diverticulum with a bleeding ulcer; segmentary enterectomy was performed. CONCLUSIONS: obviously neither upper nor lower endoscopy could establish the source of bleeding in our case; still they guiding our suspicions toward this kind of lesion. Laparoscopy if available could have established the diagnosis and give the terapeutic solution at the time. Considering the severity of bleeding episods, laparotomy was, at that time, the single valid option; we think it should have been performed much earlier, after the first bleeding episodes.

  14. Severe Neonatal Hyperbilirubinemia; Causes and Contributing Factors Leading to Exchange Transfusion at Ghaem Hospital in Mashhad

    Directory of Open Access Journals (Sweden)

    Farhad Heydarian

    2010-12-01

    Full Text Available Hyperbilirubinemia is common in neonates; it can have a serious rising course. Due to its critical morbidity called "kernicterus", severe neonatal hyperbilirubinemia causes which lead to exchange transfusion, should be clarified. This descriptive cross sectional study performed with reviewing of files of 118 neonates weighting 2kg and more who had exchange transfusion in pediatrics ward at Ghaem training hospital in Mashhad from April 2004 to March 2007. Among 118 patients, 75 (63.6% were male, and 43 patients (36.4% were female. The most common cause of exchange transfusion was ABO incompatibility (38.1%. In order of frequency, unknown etiology (25.4%, Rh incompatibility (16.1% with no immune hydrops, Sepsis(8.5%, urinary tract infection (5.1% and others (3.4% (Including Crigler-Najjar and cephalohematoma were next ones. Vaginal delivery and exclusive breast feeding were detected as associated factors. Mean serum bilirubin levels was 28.7 mg/dl (SD. 9.2 ABO incompatibility. ABO incompatibility was the main cause of exchange transfusion. Male gender, vaginal delivery and exclusive breast feeding were seen more among patients who need to be exchanged. So in case of ABO incompatibility especially when delivery route is vaginal, newborns should be visited soon again after early discharge from hospital.

  15. Severe visual Impairment and blindness in infants: Causes and opportunities for control

    Directory of Open Access Journals (Sweden)

    Parikshit Gogate

    2011-01-01

    Full Text Available Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. Severe visual impairment (SVI and blindness in infants must be detected as early as possible to initiate immediate treatment to prevent deep amblyopia. Although difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos, microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy of prematurity, and cortical visual impairment are acquired during the perinatal period. Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts should occur within the first 4 months of life. Anterior vitrectomy and primary posterior capsulotomy are required, followed by aphakic glasses with secondary intraocular lens implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature in response to relative hypoxia in a premature infant. Screening in the first few weeks of life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however, enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants, nurses, and ophthalmologists should be sensitive to a parent′s complaints of poor vision in an infant and ensure adequate follow-up to determine the cause. If required, evaluation under anesthesia should be performed, which includes funduscopy, refraction

  16. Severe ionosphere disturbances caused by the sudden response of evening subequatorial ionospheres to geomagnetic storms

    International Nuclear Information System (INIS)

    By monitoring C band beacon signals from geostationary satellites in Japan, we have observed anomalously strong ionospheric scintillations several times during three years from 1978 to 1980. These severe scinitillations occur associated with geomagnetic storms and accompany sudden and intense ionospheric perturbations in the low-latiude region. Through the analysis of these phenomena we have identified a new type of ionospheric disturbances characterized by intensifications of equatorial anomalies and successive severe ionospheric scintillations that extend to the C band range. The events occur only during a limited local time interval after the sunset, when storm time decreases of midlatitude geomagnetic fields in the same meridan take place during the same time interval. From the viewpoint of ionospheric storms, these disturbances precede the occurrence of midlatitude negative phases and storm time depressions of equatorial anomalies to indicate that the cause of the events is different from distrubed thermospheric circulations. The timing and magnitude of substorms at high-latitudes not always correlate with the events. We have concluded that the phenomena are closely related with penetrations toward low-latitudes of electric fields owing to the partial closure of asymmetrical ring currents

  17. Staphylococcus aureus seroproteomes discriminate ruminant isolates causing mild or severe mastitis

    Directory of Open Access Journals (Sweden)

    Le Maréchal Caroline

    2011-02-01

    Full Text Available Abstract Staphylococcus aureus is a major cause of mastitis in ruminants. In ewe mastitis, symptoms range from subclinical to gangrenous mastitis. S. aureus factors or host-factors contributing to the different outcomes are not completely elucidated. In this study, experimental mastitis was induced on primiparous ewes using two S. aureus strains, isolated from gangrenous (strain O11 or subclinical (strain O46 mastitis. Strains induced drastically distinct clinical symptoms when tested in ewe and mice experimental mastitis. Notably, they reproduced mild (O46 or severe (O11 mastitis in ewes. Ewe sera were used to identify staphylococcal immunoreactive proteins commonly or differentially produced during infections of variable severity and to define core and accessory seroproteomes. Such SERological Proteome Analysis (SERPA allowed the identification of 89 immunoreactive proteins, of which only 52 (58.4% were previously identified as immunogenic proteins in other staphylococcal infections. Among the 89 proteins identified, 74 appear to constitute the core seroproteome. Among the 15 remaining proteins defining the accessory seroproteome, 12 were specific for strain O11, 3 were specific for O46. Distribution of one protein specific for each mastitis severity was investigated in ten other strains isolated from subclinical or clinical mastitis. We report here for the first time the identification of staphylococcal immunogenic proteins common or specific to S. aureus strains responsible for mild or severe mastitis. These findings open avenues in S. aureus mastitis studies as some of these proteins, expressed in vivo, are likely to account for the success of S. aureus as a pathogen of the ruminant mammary gland.

  18. Agricultural measures to reduce radiation doses to man caused by severe nuclear accidents

    International Nuclear Information System (INIS)

    Agricultural land and products may become contaminated after a severe nuclear accident. If radiation doses to man caused by the ingestion of contaminated agricultural products from such areas will be unacceptably high, measures to reduce this radiation dose will have to be taken. Radiation doses to man can be estimated by using models which describe quantitatively the transfer of radionuclides through the biosphere. The following processes and pathways are described in this study: accidental releases into atmospheric environments and subsequent nearby deposition; contamination of crops by direct deposition and the subsequent short term pathway (e.g. grass-cow-milk-man); contamination of soil and the subsequent long term pathway (e.g. soil-crop-man, soil-grass-cattle-milk/meat-man). Depending on the degree of contamination and on the estimated radiation doses to man, various measures are advised. (Auth.)

  19. All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders

    DEFF Research Database (Denmark)

    Johannsen, Benedicte Marie Winther; Larsen, Janne Tidselbak; Laursen, Thomas Munk; Meltzer-Brody, Samantha; Munk-Olsen, Trine

    2016-01-01

    OBJECTIVE: The postpartum period is associated with a high risk of psychiatric episodes. The authors studied mortality in women with first-onset severe psychiatric disorders following childbirth and compared their mortality rates with those in women from the background population including other...... postpartum, and 96 of these died during follow-up. Women with postpartum psychiatric disorders had a higher MRR (3.74; 95% CI=3.06-4.57) than non-postpartum-onset mothers (MRR=2.73; 95% CI=2.67-2.79) when compared with mothers with no psychiatric history. However, childless women with psychiatric diagnoses...... had the highest MRR (6.15; 95% CI=5.94-6.38). Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis, suicide risk was drastically increased (MRR=289.42; 95% CI=144.02-581.62) when compared with mothers with...

  20. Imbalances in serum angiopoietin concentrations are early predictors of septic shock development in patients with post chemotherapy febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Lorand-Metze Irene

    2010-05-01

    Full Text Available Abstract Background Febrile neutropenia carries a high risk of sepsis complications, and the identification of biomarkers capable to identify high risk patients is a great challenge. Angiopoietins (Ang - are cytokines involved in the control microvascular permeability. It is accepted that Ang-1 expression maintains endothelial barrier integrity, and that Ang-2 acts as an antagonizing cytokine with barrier-disrupting functions in inflammatory situations. Ang-2 levels have been recently correlated with sepsis mortality in intensive care units. Methods We prospectively evaluated concentrations of Ang-1 and Ang-2 at different time-points during febrile neutropenia, and explored the diagnostic accuracy of these mediators as potential predictors of poor outcome in this clinical setting before the development of sepsis complications. Results Patients that evolved with septic shock (n = 10 presented higher levels of Ang-2 measured 48 hours after fever onset, and of the Ang-2/Ang-1 ratio at the time of fever onset compared to patients with non-complicated sepsis (n = 31. These levels correlated with sepsis severity scores. Conclusions Our data suggest that imbalances in the concentrations of Ang-1 and Ang-2 are independent and early markers of the risk of developing septic shock and of sepsis mortality in febrile neutropenia, and larger studies are warranted to validate their clinical usefulness. Therapeutic strategies that manipulate this Ang-2/Ang-1 imbalance can potentially offer new and promising treatments for sepsis in febrile neutropenia.

  1. Potential of a COX-2 inhibitor in lowering chemotherapy-induced neutropenia%Potential of a COX-2 inhibitor in lowering chemotherapy induced neutropenia

    Institute of Scientific and Technical Information of China (English)

    Louis Wing-Cheong Chow; Adrian Yun-San Yip; Eleanor Yuen-Yuen Ong; Chi-Kei Lam; Masakazu Toi

    2010-01-01

    Objective This study was initially designed to evaluate the effect of celecoxib on the regimen of 5 fluorouracil, epirubicin, and cyclophosphamide (FEC) combination, followed by docetaxel (T) in neoadjuvant setting. An unplanned preliminary review on safety was conducted after a halt of the study due to the concerned potential cardiovascular risk of using COX 2 inhibitors.Methods We studied 23 consecutive cases of operable breast cancer having received four cycles of FEC(500 mg/m2, 100 mg/m2, 500 mg/m2) followed by four cycles of T(100 mg/m2) with concurrent celecoxib (400 mg twice daily) (group A) or same chemotherapy regimen but without concurrent celecoxib (group B). These combined chemotherapies were administered every 3 weeks. The Chi square test or Fisher's exact test were used to assess the difference in incidence of limiting hematological toxicites between groups. Results 23 patients (group A: n=12; group B, n=11) received a total of 183 out of 184 planned treatment cycles; one (4%, 1/23) of them omitted the fourth cycle of FEC owing to repeated incidences of febrile neutropenia. Received dose intensity (RDI) for FEC in group A (90%±11%) was higher than that in group B (80%±8%) while RDI for T was similar between group A (93%±8%) and group B (96%±9%). Of the first 91 treatment cycles of FEC, limiting hematological toxicity, severe neutropenia including febrile neutropenia, was significantly different between group A and B [(10.4%, 5/48) vs.( 32.6%, 14/43), P=0.009]. Other toxicities commonly observed in chemotherapy receiving patients were manageable. Conclusions Neoadjuvant use of FEC followed by T with concurrent celecoxib appeared to be safe for treatment of operable invasive breast cancer. The observed lower incidence of chemotherapy induced neutropenia is possibly contributed by the administration of COX inhibitor. We believe that further investigation might provide more evidence on the use of COX 2 inhibitors in breast cancer.

  2. Pulmonary Veno-Occlusive Disease: A Newly Recognized Cause of Severe Pulmonary Hypertension in Dogs.

    Science.gov (United States)

    Williams, K; Andrie, K; Cartoceti, A; French, S; Goldsmith, D; Jennings, S; Priestnall, S L; Wilson, D; Jutkowitz, A

    2016-07-01

    Pulmonary hypertension is a well-known though poorly characterized disease in veterinary medicine. In humans, pulmonary veno-occlusive disease (PVOD) is a rare cause of severe pulmonary hypertension with a mean survival time of 2 years without lung transplantation. Eleven adult dogs (5 males, 6 females; median age 10.5 years, representing various breeds) were examined following the development of severe respiratory signs. Lungs of affected animals were evaluated morphologically and with immunohistochemistry for alpha smooth muscle actin, desmin, CD31, CD3, CD20, and CD204. All dogs had pulmonary lesions consistent with PVOD, consisting of occlusive remodeling of small- to medium-sized pulmonary veins, foci of pulmonary capillary hemangiomatosis (PCH), and accumulation of hemosiderophages; 6 of 11 dogs had substantial pulmonary arterial medial and intimal thickening. Ultrastructural examination and immunohistochemistry showed that smooth muscle cells contributed to the venous occlusion. Increased expression of CD31 was evident in regions of PCH indicating increased numbers of endothelial cells in these foci. Spindle cells strongly expressing alpha smooth muscle actin and desmin co-localized with foci of PCH; similar cells were present but less intensely labeled elsewhere in non-PCH alveoli. B cells and macrophages, detected by immunohistochemistry, were not co-localized with the venous lesions of canine PVOD; small numbers of CD3-positive T cells were occasionally in and around the wall of remodeled veins. These findings indicate a condition in dogs with clinically severe respiratory disease and pathologic features resembling human PVOD, including foci of pulmonary venous remodeling and PCH. PMID:26926086

  3. Novel NEK8 Mutations Cause Severe Syndromic Renal Cystic Dysplasia through YAP Dysregulation.

    Science.gov (United States)

    Grampa, Valentina; Delous, Marion; Zaidan, Mohamad; Odye, Gweltas; Thomas, Sophie; Elkhartoufi, Nadia; Filhol, Emilie; Niel, Olivier; Silbermann, Flora; Lebreton, Corinne; Collardeau-Frachon, Sophie; Rouvet, Isabelle; Alessandri, Jean-Luc; Devisme, Louise; Dieux-Coeslier, Anne; Cordier, Marie-Pierre; Capri, Yline; Khung-Savatovsky, Suonavy; Sigaudy, Sabine; Salomon, Rémi; Antignac, Corinne; Gubler, Marie-Claire; Benmerah, Alexandre; Terzi, Fabiola; Attié-Bitach, Tania; Jeanpierre, Cécile; Saunier, Sophie

    2016-03-01

    Ciliopathies are a group of genetic multi-systemic disorders related to dysfunction of the primary cilium, a sensory organelle present at the cell surface that regulates key signaling pathways during development and tissue homeostasis. In order to identify novel genes whose mutations would cause severe developmental ciliopathies, >500 patients/fetuses were analyzed by a targeted high throughput sequencing approach allowing exome sequencing of >1200 ciliary genes. NEK8/NPHP9 mutations were identified in five cases with severe overlapping phenotypes including renal cystic dysplasia/hypodysplasia, situs inversus, cardiopathy with hypertrophic septum and bile duct paucity. These cases highlight a genotype-phenotype correlation, with missense and nonsense mutations associated with hypodysplasia and enlarged cystic organs, respectively. Functional analyses of NEK8 mutations in patient fibroblasts and mIMCD3 cells showed that these mutations differentially affect ciliogenesis, proliferation/apoptosis/DNA damage response, as well as epithelial morphogenesis. Notably, missense mutations exacerbated some of the defects due to NEK8 loss of function, highlighting their likely gain-of-function effect. We also showed that NEK8 missense and loss-of-function mutations differentially affect the regulation of the main Hippo signaling effector, YAP, as well as the expression of its target genes in patient fibroblasts and renal cells. YAP imbalance was also observed in enlarged spheroids of Nek8-invalidated renal epithelial cells grown in 3D culture, as well as in cystic kidneys of Jck mice. Moreover, co-injection of nek8 MO with WT or mutated NEK8-GFP RNA in zebrafish embryos led to shortened dorsally curved body axis, similar to embryos injected with human YAP RNA. Finally, treatment with Verteporfin, an inhibitor of YAP transcriptional activity, partially rescued the 3D spheroid defects of Nek8-invalidated cells and the abnormalities of NEK8-overexpressing zebrafish embryos

  4. Brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis

    Institute of Scientific and Technical Information of China (English)

    QIAN Bang-ping; QIU Yong; WANG Bin; YU Yang; ZHU Ze-zhang

    2007-01-01

    Objective: To explore the clinical features and treatment results of brachial plexus palsy caused by halo traction before posterior correction in patients with severe scoliosis.Methods: A total of 300 cases of severe scoliosis received halo traction before posterior correction in our department from July 1997 to November 2004. Among them, 7 cases were complicated with brachial plexus palsy.The average Cobb angle was 110° (range, 90°-135°).Diagnoses were made as idiopathic scoliosis in 1 case,congenital scoliosis in 3 cases, and neuromuscular scoliosis in 3 cases. Additionally, diastematomyelia and tethered cord syndrome were found in 3 cases and thoracolumbar kyphosis in 2 cases. Weight of traction was immediately reduced when the patient developed any abnormal neurological symptoms in the upper extremity, and rehabilitation training was undertaken. Simultaneously,neurotrophic pharmacotherapy was applied, and the neurological function restoration of the upper limbs and the recovery time were documented.Results: Traction was used for an average of 3.5 weeks (range, 2-6 weeks) before spinal fusion for these 7 patients. The average traction weight was 8 kg, which was 19% on average (range, 13%-26%) of the average body weight (40.2 kg). These 7 patients had long and thin body configuration with a mean height of 175 cm. The duration between symptoms of brachial plexus paralysis and the diagnosis was 1-3 hours. All of these 7 patients presented various degrees of numbness in the ulnar side of the hand and forearm. Median nerve paresis was found in 3 cases and ulnar nerve paresis in 4 cases. Complete recovery of the neurological function had been achieved by the end of three months.Conclusions: The clinical features of brachial plexus palsy caused by halo traction include median nerve paresis,ulnar nerve paralysis, and numbness in the ulnar side of the hand and forearm, which may be due to the injury of the inferior part of the brachial plexus, i.e. , damage of Cs and

  5. Spontaneous recovery of cochlear fibrocytes after severe degeneration caused by acute energy failure

    Directory of Open Access Journals (Sweden)

    KunioMizutari

    2014-08-01

    Full Text Available Cochlear fibrocytes in the lateral wall region play a critical role in the regulation of inner ear ion and fluid homeostasis, although these are nonsensory cells. Along with other nonsensory cells, fibrocytes in the spiral ligament have been reported to repopulate themselves after damage. However, the studies of regeneration of cochlear fibrocytes have been difficult because a suitable fibrocyte-specific degeneration model did not exist. Therefore, we analyzed cochlear fibrocytes using a rat model of acute cochlear energy failure induced by a mitochondrial toxin. This model is unique because hearing loss is caused by apoptosis of fibrocytes in the cochlear lateral wall not by damage to sensory cells. Although this model involves severe damage to the cochlear lateral wall, delayed spontaneous regeneration occurs without any treatment. Moreover, partial hearing recovery is accompanied by morphological remodeling of the cochlear lateral wall. Two hypotheses are conceivable regarding this spontaneous recovery of cochlear fibrocytes. One is that residual cochlear fibrocytes proliferate spontaneously, followed by remodeling of the functional region of the lateral wall. Another is that some foreign cells such as bone marrow-derived cells promote morphological and functional recovery of the lateral wall. Acceleration of the lateral wall recovery promoted by these mechanisms may be a new therapeutic strategy against hearing loss.

  6. Spontaneous recovery of cochlear fibrocytes after severe degeneration caused by acute energy failure.

    Science.gov (United States)

    Mizutari, Kunio

    2014-01-01

    Cochlear fibrocytes in the lateral wall region play a critical role in the regulation of inner ear ion and fluid homeostasis, although these are non-sensory cells. Along with other non-sensory cells, fibrocytes in the spiral ligament have been reported to repopulate themselves after damage. However, the studies of regeneration of cochlear fibrocytes have been difficult because a suitable fibrocyte-specific degeneration model did not exist. Therefore, we analyzed cochlear fibrocytes using a rat model of acute cochlear energy failure induced by a mitochondrial toxin. This model is unique because hearing loss is caused by apoptosis of fibrocytes in the cochlear lateral wall not by damage to sensory cells. Although this model involves severe damage to the cochlear lateral wall, delayed spontaneous regeneration occurs without any treatment. Moreover, partial hearing recovery is accompanied by morphological remodeling of the cochlear lateral wall. Two hypotheses are conceivable regarding this spontaneous recovery of cochlear fibrocytes. One is that residual cochlear fibrocytes proliferate spontaneously, followed by remodeling of the functional region of the lateral wall. Another is that some foreign cells such as bone marrow-derived cells promote morphological and functional recovery of the lateral wall. Acceleration of the lateral wall recovery promoted by these mechanisms may be a new therapeutic strategy against hearing loss. PMID:25206337

  7. Guanylate cyclase C deficiency causes severe inflammation in a murine model of spontaneous colitis.

    Directory of Open Access Journals (Sweden)

    Eleana Harmel-Laws

    Full Text Available BACKGROUND: Guanylate Cyclase C (GC-C; Gucy2c is a transmembrane receptor expressed in intestinal epithelial cells. Activation of GC-C by its secreted ligand guanylin stimulates intestinal fluid secretion. Familial mutations in GC-C cause chronic diarrheal disease or constipation and are associated with intestinal inflammation and infection. Here, we investigated the impact of GC-C activity on mucosal immune responses. METHODS: We utilized intraperitoneal injection of lipopolysaccharide to elicit a systemic cytokine challenge and then measured pro-inflammatory gene expression in colonic mucosa. GC-C(+/+ and GC-C(-/- mice were bred with interleukin (IL-10 deficient animals and colonic inflammation were assessed. Immune cell influx and cytokine/chemokine expression was measured in the colon of wildtype, IL-10(-/-, GC-C(+/+IL-10(-/- and GC-C(-/-IL-10(-/- mice. GC-C and guanylin production were examined in the colon of these animals and in a cytokine-treated colon epithelial cell line. RESULTS: Relative to GC-C(+/+ animals, intraperitoneal lipopolysaccharide injection into GC-C(-/- mice increased proinflammatory gene expression in both whole colon tissue and in partially purified colonocyte isolations. Spontaneous colitis in GC-C(-/-IL-10(-/- animals was significantly more severe relative to GC-C(+/+IL-10(-/- mice. Unlike GC-C(+/+IL-10(-/- controls, colon pathology in GC-C(-/-IL-10(-/- animals was apparent at an early age and was characterized by severely altered mucosal architecture, crypt abscesses, and hyperplastic subepithelial lesions. F4/80 and myeloperoxidase positive cells as well as proinflammatory gene expression were elevated in GC-C(-/-IL-10(-/- mucosa relative to control animals. Guanylin was diminished early in colitis in vivo and tumor necrosis factor α suppressed guanylin mRNA and protein in intestinal goblet cell-like HT29-18-N2 cells. CONCLUSIONS: The GC-C signaling pathway blunts colonic mucosal inflammation that is initiated by

  8. Biallelic Mutations in TMEM126B Cause Severe Complex I Deficiency with a Variable Clinical Phenotype.

    Science.gov (United States)

    Alston, Charlotte L; Compton, Alison G; Formosa, Luke E; Strecker, Valentina; Oláhová, Monika; Haack, Tobias B; Smet, Joél; Stouffs, Katrien; Diakumis, Peter; Ciara, Elżbieta; Cassiman, David; Romain, Nadine; Yarham, John W; He, Langping; De Paepe, Boel; Vanlander, Arnaud V; Seneca, Sara; Feichtinger, René G; Płoski, Rafal; Rokicki, Dariusz; Pronicka, Ewa; Haller, Ronald G; Van Hove, Johan L K; Bahlo, Melanie; Mayr, Johannes A; Van Coster, Rudy; Prokisch, Holger; Wittig, Ilka; Ryan, Michael T; Thorburn, David R; Taylor, Robert W

    2016-07-01

    Complex I deficiency is the most common biochemical phenotype observed in individuals with mitochondrial disease. With 44 structural subunits and over 10 assembly factors, it is unsurprising that complex I deficiency is associated with clinical and genetic heterogeneity. Massively parallel sequencing (MPS) technologies including custom, targeted gene panels or unbiased whole-exome sequencing (WES) are hugely powerful in identifying the underlying genetic defect in a clinical diagnostic setting, yet many individuals remain without a genetic diagnosis. These individuals might harbor mutations in poorly understood or uncharacterized genes, and their diagnosis relies upon characterization of these orphan genes. Complexome profiling recently identified TMEM126B as a component of the mitochondrial complex I assembly complex alongside proteins ACAD9, ECSIT, NDUFAF1, and TIMMDC1. Here, we describe the clinical, biochemical, and molecular findings in six cases of mitochondrial disease from four unrelated families affected by biallelic (c.635G>T [p.Gly212Val] and/or c.401delA [p.Asn134Ilefs(∗)2]) TMEM126B variants. We provide functional evidence to support the pathogenicity of these TMEM126B variants, including evidence of founder effects for both variants, and establish defects within this gene as a cause of complex I deficiency in association with either pure myopathy in adulthood or, in one individual, a severe multisystem presentation (chronic renal failure and cardiomyopathy) in infancy. Functional experimentation including viral rescue and complexome profiling of subject cell lines has confirmed TMEM126B as the tenth complex I assembly factor associated with human disease and validates the importance of both genome-wide sequencing and proteomic approaches in characterizing disease-associated genes whose physiological roles have been previously undetermined. PMID:27374774

  9. Clericuzio-type Poikiloderma with Neutropenia Syndrome in a Turkish Family: a Three Report of Siblings with Mutation in the C16orf57 gene

    OpenAIRE

    Turkan Patiroglu; H Haluk Akar

    2015-01-01

    Clericuzio-type poikiloderma with neutropenia (PN) is characterized by poikiloderma, non-cyclic  neutropenia,  recurrent  sinopulmonary  infections,  pachyonychia,  and  palmo- plantar hyperkeratosis. Mutations in the C16orf57 gene, which is located on chromosome 16q13, have been identified as the cause of PN. PN was first described by Clericuzio in Navajo Indians. Herein, we reported the clinical presentations and laboratory investigations of PN in three siblings from Turkey.The older siblin...

  10. Disruption of germination and seedling development in Brassica napus by mutations causing severe seed hormonal imbalance

    Directory of Open Access Journals (Sweden)

    Tung eNguyen

    2016-03-01

    Full Text Available The Brassica napus (oilseed rape accession 1012-98 shows a disturbed germination phenotype that was thought to be associated with its lack of testa pigmentation and thin seed coat. Here we demonstrate that the disturbed germination and seedling development are actually due to independent mutations that disrupt the balance of hormone metabolites and their regulators in the seeds. High-throughput UPLC-MS/MS hormone profiling of seeds and seedlings before and after germination revealed that 1012-98 has a severely disturbed hormone balance with extremely atypical, excessive quantities of auxin and ABA metabolites. The resulting hypersensitivity to abscisic acid (ABA and a corresponding increase in dormancy often results in death of the embryo after imbibition or high frequencies of disturbed, often lethal developmental phenotypes, resembling Arabidopsis mutants for the auxin regulatory factor gene ARF10 or the auxin-overproducing transgenic line iaaM-OX. Molecular cloning of Brassica ARF10 orthologues revealed four loci in normal B. napus, two derived from the Brassica A genome and two from the C genome. On the other hand, the phenotypic mutant 1012-98 exhibited amplification of C-genome BnaC.ARF10 copy number along with a chimeric allele originating from recombination between homoeologous A and C genome loci which lead to minor increase of Bna.ARF10 transcription on the critical timepoint for seed germination, the indirect regulator of ABI3, the germinative inhibitor. Bna.GH3.5 expression was upregulated to conjugate free auxin to IAA-asp between 2-6 DAS. Functional amino acid changes were also found in important DNA binding domains of one BnaC.ARF10 locus, suggesting that regulatory changes in Bna.ARF10 are collectively responsible for the observed phenotpyes in 1012-98. To our knowledge, this study is the first to report disruption of germination and seedling development in Brassica napus caused by the crosstalk of auxin-ABA and the

  11. Fluconazole for empiric antifungal therapy in cancer patients with fever and neutropenia

    Directory of Open Access Journals (Sweden)

    Peterson Josh F

    2006-12-01

    Full Text Available Abstract Background Several clinical trials have demonstrated the efficacy of fluconazole as empiric antifungal therapy in cancer patients with fever and neutropenia. Our objective was to assess the frequency and resource utilization associated with treatment failure in cancer patients given empiric fluconazole antifungal therapy in routine inpatient care. Methods We performed a retrospective cohort study of cancer patients treated with oral or intravenous fluconazole between 7/97 and 6/01 in a tertiary care hospital. The final study cohort included cancer patients with neutropenia (an absolute neutrophil count below 500 cells/mm3 and fever (a temperature above 38°C or 100.4°F, who were receiving at least 96 hours of parenteral antibacterial therapy prior to initiating fluconazole. Patients' responses to empiric therapy were assessed by reviewing patient charts. Results Among 103 cancer admissions with fever and neutropenia, treatment failure after initiating empiric fluconazole antifungal therapy occurred in 41% (95% confidence interval (CI 31% – 50% of admissions. Patients with a diagnosis of hematological malignancy had increased risk of treatment failure (OR = 4.6, 95% CI 1.5 – 14.8. When treatment failure occurred the mean adjusted increases in length of stay and total costs were 7.4 days (95% CI 3.3 – 11.5 and $18,925 (95% CI 3,289 – 34,563, respectively. Conclusion Treatment failure occurred in more than one-third of neutropenic cancer patients on fluconazole as empiric antifungal treatment for fever in routine clinical treatment. The increase in costs when treatment failure occurs is substantial.

  12. Severe Facet Joint Arthrosis Caused C7/T1 Myelopathy: A Case Report

    OpenAIRE

    Eiji Itoi; Takeshi Hoshikawa; Hiroshi Ozawa; Toshimi Aizawa; Takashi Kusakabe

    2009-01-01

    Cervical myelopathy is caused by degenerative processes of the spine including intervertebral disc herniation and posterior spur usually developing at C3/4 to C5/6. C7/T1 single level myelopathy is very rare because of the anatomical characteristics. Facet joint arthrosis can be a cause of cervical myelopathy but only a few cases have been reported. The authors report an extremely rare case of C7/T1 myelopathy caused by facet joint arthrosis. A 58-year-old male presented with hand and gait cl...

  13. Lacrimal punctum occlusion in the treatment of severe keratoconjunctivitis sicca caused by Sjogren syndrome - A uniocular evaluation

    NARCIS (Netherlands)

    Mansour, Khaled; Leonhardt, Carolien J.; Kalk, Wouter W.; Bootsma, Hendrika; Bruin, Klaas J.; Blanksma, Lieuwe J.

    2007-01-01

    Purpose: A controlled uniocular study to evaluate the short-term efficacy of lacrimal punctum occlusion in the treatment of severe dry eye caused by Sjogren syndrome. Methods: Uniocular punctum occlusion by punctum plug in the upper and lower puncta in 1 eye was performed in 20 patients with severe

  14. Severe Spinal Cord Injury Causes Immediate Multi-cellular Dysfunction at the Chondro-Osseous Junction

    OpenAIRE

    Morse, Leslie R; XU, Yan(Department of Music,Guangxi Normal University); Solomon, Bethlehem; Boyle, Lara; Yoganathan, Subbiah; Stashenko, Philip; Battaglino, Ricardo A.

    2011-01-01

    Spinal cord injury is associated with rapid bone loss and arrested long bone growth due to mechanisms that are poorly understood. In this study, we sought to determine the effects of severe T10 contusion spinal cord injury on the sublesional bone microenvironment in adolescent rats. A severe lower thoracic (vertebral T10) spinal cord injury was generated by weight drop (10 g×50 mm). Severely injured and body weight-matched uninjured male Sprague–Dawley rats were studied. At 3 and 5 days post-...

  15. Mucosal damage and neutropenia are required for Candida albicans dissemination

    OpenAIRE

    Koh, A.Y.; Kohler, J.R.; Coggshall, K.T.; Rooijen, van, N.; Pier, G B

    2008-01-01

    Candida albicans fungemia in cancer patients is thought to develop from initial gastrointestinal (GI) colonization with subsequent translocation into the bloodstream after administration of chemotherapy. It is unclear what components of the innate immune system are necessary for preventing C. albicans dissemination from the GI tract, but we have hypothesized that both neutropenia and GI mucosal damage are critical for allowing widespread invasive C. albicans disease. We investigated these par...

  16. 中性粒细胞弹性蛋白酶基因突变致先天性粒细胞减少症2例并文献复习%Two Chinese cases of congenital neutropenia caused by ELANE gene mutations and literature review

    Institute of Scientific and Technical Information of China (English)

    侯佳; 王莹; 刘丹如; 应文静; 孙金峤; 惠晓莹; 王晓川

    2014-01-01

    Objective To identify ELANE gene mutations in 2 Chinese cases with congenital neutropenia and to better understand the clinical characters,diagnosis and treatment of this rare disease. Methods Clinical data of the two cases with congenital neutropenia were collected,including clinical manifestations,trends of the absolute neutrophil count( ANC ),and immunological function. All 5 exons and flanking regions of ELANE gene were sequenced for the two cases and their families. Results Two cases were diagnosed as neutropenia at the age of 3 months and 1 month respectively,characterized with recurrent infections,including recurrent pneumonia in one case and oral mucosa ulcer in the other. Two cases presented with persistent neutropenia with the ANC less than 1. 5 × 109 ·L-1 ,the lowest ANC reached 0. 01 × 109 ·L-1 for case 1 and 0. 09 × 109 ·L-1 for case 2,respectively. Screening of blood serum and bone marrow was performed to exclude pathogenic infection,autoimmune disease and hematological malignancies. The respiratory burst of neutrophils and cellular immune function of both cases were normal,except for the elevated serum IgG level. Case 1 had c. 661G>GT(p. G221GX)heterozygous nonsense mutation in ELANE gene,case 2 had c. 377C>CT(p. S126SL)heterozygous missense mutation. No mutation was found in their family members. Case 2 received hematopoietic stem cell transplantation( HSCT)and presented with normal ELANE gene afterwards,case 1 was treated with G-CSF,both were followed up. Conclusion ELANE gene is the critical pathogenic gene for congenital neutropenia. HSCT is the effective radical treatment for this rare disease.%目的:总结2例中性粒细胞弹性蛋白酶( ELANE)基因突变的先天性粒细胞减少症患儿的临床特征、基因诊断及治疗方法,提高对该病的认识。方法分析2例先天性粒细胞减少症患儿的临床表现,外周血中性粒细胞绝对计数( ANC)变化,中性粒细胞呼吸爆发功能及其体

  17. Biosimilars in the management of neutropenia: focus on filgrastim

    Directory of Open Access Journals (Sweden)

    Caselli D

    2016-02-01

    Full Text Available Désirée Caselli,1 Simone Cesaro,2 Maurizio Aricò1 1Medical Department, Pediatric Unit, Azienda Sanitaria Provinciale Ragusa, Ragusa, 2Department of Pediatrics, Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Abstract: Advances in chemotherapy and surgery allows the majority of patients to survive cancer diseases. Yet, the price may be a proportion of patients dying of complications due to treatment-induced infectious complications, such as neutropenia. With the aim of decreasing morbidity and mortality related to infectious complications, recombinant human granulocyte colony-stimulating factor (G-CSF, filgrastim, and pegylated filgrastim have been used to reduce time and degree of neutropenia. A biosimilar is a copy of an approved original biologic medicine whose data protection has expired. The patent for filgrastim expired in Europe in 2006 and in the US in 2013. This review analyses the available evidence to be considered in order to design a strategy of use of G-CSF and its biosimilars. The clinical and safety outcomes of biosimilars are well within the range of historically reported data for originator filgrastim. This underscores the clinical effectiveness and safety of biosimilar filgrastim in daily clinical practice. Biosimilars can play an important role by offering the opportunity to reduce costs, thus contributing to the financial sustainability of treatment programs. Keywords: neutropenia, filgrastim, biosimilars, G-CSF, fever, prophylaxis

  18. COST OF FEBRILE NEUTROPENIA TREATMENT IN BOSNIA AND HERZEGOVINA

    Science.gov (United States)

    Catic, Tarik; Mekic-Abazovic, Alma; Sulejmanovic, Samra

    2016-01-01

    Febrile neutropenia is common chemotherapy complication significantly impacting patient’s outcomes, quality of life and costs, too. Febrile neutropenia (FN) often leads to hospitalization, the need for intravenous antibiotics and use of granulocyte colony-stimulating factors (GCSF) in order to avoid its complications. Cost of febrile neutropenia is well described in literature, but no study has been performed in Bosnia and Herzegovina. We have conducted observational cohort study with aim to describe and present costs of FN treatment from payers’ (provider’s) perspective. Only direct medical costs from one middle-sized oncology Clinic in Bosnia and Herzegovina database have been included and presented. We found that overall cost in five months period (January-May 2015) were almost 30.000 euros, or 1.0035 euro per episode/patient in average. The highest cost are allocated to hospitalization (40%), followed by GCSF (36%), while rest of costs are generated by laboratory tests performed and drug application. Proportion of costs is in line with other published studies even with huge differences in absolute values, mainly to low prices of services in Bosnia and Herzegovina. This was the first study on costs of chemotherapy induced FN in Bosnia and Herzegovina suggesting that significant costs are inquired by this conditions and that further research should be performed including larger patient population and other clinical oncology data, including pharmacoeconomic analysis.

  19. Neutropenia in rheumatoid arthritis and large granular lymphocyte leucosis

    Directory of Open Access Journals (Sweden)

    V A Doronin

    2003-01-01

    Full Text Available Objective. Pts with chronic clonal proliferation of large granular lymphocytes (LGL leukemia often have neutropenia, splenomegaly, and rheumatoid arthritis (RA, thereby resembling the manifestations observed in pts with Felty’s syndrome. The present study sought to indicate that pts with these disorders represent two distinct subsets. We compare clinical, hematological, immunophenotiping and immunogenetic features in Felty’s syndrome pts with and without the LGL leukemia. Material and methods 10 pts with T-LGL leukemia were studied. Surface phenotype was estimated using monoclonal antibodies CD8-PE and CD3-FITC/CD16-PE (two-color (Caltag, USA by the flow cytometric analysis (Partec, Daco. Analysis of TCR gene rearrangement was performed by using PCR-LIS SSCP (low ionic strength single strand conformational polymorphism. Comparison with Felty s syndrome and RA pts based on the review of literature. Results. LGL leukemia is a distinct clinicopathologic entity often associated with RA. LGL leukemia pts with RA showed the same immunogenetis associations seen in RA/Felty’s syndrome, while LGL leukemia pts without arthritis did not. Conclusion. Hematologic, immunophenotyping and molecular genetic analysis are very important and highly representative tools in differential diagnosis of neutropenia in RA, and propose that Felty’s syndrome and LGL leukemia represent different variants of broader syndrome comprising RA, neutropenia, LGL expansions, and splenomegaly.

  20. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Gunes Ali

    2002-09-01

    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  1. Neutropenia, neutrophil dysfunction, and inflammatory bowel disease in glycogen storage disease type Ib : Results of the European Study on Glycogen Storage Disease Type I

    NARCIS (Netherlands)

    Visser, G; Rake, JP; Fernandes, J; Labrune, P; Leonard, JV; Moses, S; Ullrich, K; Smit, GPA

    2000-01-01

    Objective: To investigate the incidence, the severity, and the course of neutropenia, neutrophil dysfunction, and inflammatory bowel disease (IBD) in glycogen storage disease (GSD) type Ib. Method: As part of a collaborative European Study on GSD type I, a retrospective registry was established in 1

  2. Aberrant coagulation causes a hyper-inflammatory response in severe influenza pneumonia.

    Science.gov (United States)

    Yang, Yan; Tang, Hong

    2016-07-01

    Influenza A virus (IAV) infects the respiratory tract in humans and causes significant morbidity and mortality worldwide each year. Aggressive inflammation, known as a cytokine storm, is thought to cause most of the damage in the lungs during IAV infection. Dysfunctional coagulation is a common complication in pathogenic influenza, manifested by lung endothelial activation, vascular leak, disseminated intravascular coagulation and pulmonary microembolism. Importantly, emerging evidence shows that an uncontrolled coagulation system, including both the cellular (endothelial cells and platelets) and protein (coagulation factors, anticoagulants and fibrinolysis proteases) components, contributes to the pathogenesis of influenza by augmenting viral replication and immune pathogenesis. In this review, we focus on the underlying mechanisms of the dysfunctional coagulatory response in the pathogenesis of IAV. PMID:27041635

  3. Premature closure of the upper esophageal sphincter as a cause of severe deglutition disorder in infancy

    DEFF Research Database (Denmark)

    Nielsen, Rasmus; Husby, Steffen; Kruse-Andersen, Søren

    2005-01-01

    Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these...... causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with...... balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures....

  4. The Long Myocardial Bridging Case Causing Severe Systolic Narrowing; How Should Approach?

    OpenAIRE

    ERCAN, Süleyman; Alıcı, Mehmet Hayri; DAVUTOĞLU, Vedat; Çakıcı, Musa; Oylumlu, Muhammed

    2012-01-01

    Myocardial bridging, characterized in myocardial systolic blood flow is prevented due to compression of a coronary artery segment. This condition detected by coronary angiography is usually accepted benign. A 52 years old man, who had effort angina for three months, has been diagnosed non-critical plaque and long segment myocardial bridging by coronary angiography. We want to share with this case, non-critical plaque together with myocardial bridging caused stable angina and we aimed to appro...

  5. The Long Myocardial Bridging Case Causing Severe Systolic Narrowing; How Should Approach?

    OpenAIRE

    Süleyman Ercan; Mehmet Hayri Alıcı; Vedat Davutoğlu; Musa Çakıcı; Muhammed Oylumlu

    2013-01-01

    Myocardial bridging, characterized in myocardial systolic blood flow is prevented due to compression of a coronary artery segment. This condition detected by coronary angiography is usually accepted benign. A 52 years old man, who had effort angina for three months, has been diagnosed non-critical plaque and long segment myocardial bridging by coronary angiography. We want to share with this case, non-critical plaque together with myocardial bridging caused stable angina and we aimed to app...

  6. Celiac disease causing severe osteomalacia: an association still present in Morocco!

    OpenAIRE

    Tahiri, Latifa; Azzouzi, Hamida; Squalli, Ghita; Abourazzak, Fatimazahra; Harzy, Taoufik

    2014-01-01

    Celiac disease (CD), a malabsorption syndrome caused by hypersensitivity to gliadin fraction of gluten. CD can manifest with classic symptoms; however, significant myopathy and multiple fractures are rarely the predominant presentation of untreated celiac disease. Osteomalacia complicating celiac disease had become more and more rare. We describe here a case of osteomalacia secondary to a longstanding untreated celiac disease. This patient complained about progressive bone and muscular pain, ...

  7. Severe Gingival Recession Caused by Traumatic Occlusion and Mucogingival Stress: A Case Report

    OpenAIRE

    Ustun, Kemal; Sari, Zafer; ORUCOGLU, HASAN; Duran, Ismet; Hakki, Sema S.

    2008-01-01

    Gingival recession is displacement of the soft tissue margin apically leading to root surface exposure. Tooth malpositions, high muscle attachment, frenal pull have been associated with gingival tissue recession. Occlusal trauma is defined as injury resulting in tissue changes within the attachment apparatus as a result of occlusal forces. Trauma from occlusion may cause a shift in tooth position and the direction of the movement depends on the occlusal force. We present the clinical and radi...

  8. Severe community-acquired pneumonia caused by Mycoplasma pneumoniae in young female patient

    Directory of Open Access Journals (Sweden)

    Milancic Nena

    2015-09-01

    Full Text Available Mycoplasma pneumonia is common agent causing community acquired pneumonia in younger population. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a 27 years old female patient with unilateral pneumonia followed by pleural effusion and adhesions on the same side. This potential source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  9. Staphylococcus aureus seroproteomes discriminate ruminant isolates causing mild or severe mastitis

    OpenAIRE

    Le Maréchal Caroline; Jardin Julien; Jan Gwenaël; Even Sergine; Pulido Coralie; Guibert Jean-Michel; Hernandez David; François Patrice; Schrenzel Jacques; Demon Dieter; Meyer Evelyne; Berkova Nadia; Thiéry Richard; Vautor Eric; Le Loir Yves

    2011-01-01

    Abstract Staphylococcus aureus is a major cause of mastitis in ruminants. In ewe mastitis, symptoms range from subclinical to gangrenous mastitis. S. aureus factors or host-factors contributing to the different outcomes are not completely elucidated. In this study, experimental mastitis was induced on primiparous ewes using two S. aureus strains, isolated from gangrenous (strain O11) or subclinical (strain O46) mastitis. Strains induced drastically distinct clinical symptoms when tested in ew...

  10. X-ray analysis of 80 patients with severe endemic fluorosis caused by coal burning

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Z.P.; Yuan, M.B.; Liu, G.F. [Luzhou Medical College, Luzhou (China)

    1996-05-01

    Radiographs of 80 patients with severe endemic fluorosis of coalburning type (CBFF) - 49 males and 31 females aged 30 to 70 years - were analysed to examine the changes to the bone substance, peripheral structure of bone, and joints. The changes to bone substance were: (1) osteosclerosis type, 62 cases (77.5%); (2) mixed type, 16 cases (21.25%); (3) osteoporosis type, one case (1.25%); (4) osteomalacia type, one case (1.25%). The changes to the joints were found in the hips and elbows in 79 cases (98.75%), and in the knees in 75 cases (93.75%). When combinations of the above three changes occur, the classification of the disease is according to the most severe one of the three. Our findings can increase the accuracy of X-ray diagnosis, making it more consistent with clinical diagnosis, thus improving prevention and treatment of CBEF.

  11. The Long Myocardial Bridging Case Causing Severe Systolic Narrowing; How Should Approach?

    Directory of Open Access Journals (Sweden)

    Süleyman Ercan

    2013-03-01

    Full Text Available Myocardial bridging, characterized in myocardial systolic blood flow is prevented due to compression of a coronary artery segment. This condition detected by coronary angiography is usually accepted benign. A 52 years old man, who had effort angina for three months, has been diagnosed non-critical plaque and long segment myocardial bridging by coronary angiography. We want to share with this case, non-critical plaque together with myocardial bridging caused stable angina and we aimed to approach to patient with myocardial bridging.

  12. Linoleic acid metabolite drives severe asthma by causing airway epithelial injury

    OpenAIRE

    Mabalirajan, Ulaganathan; Rehman, Rakhshinda; Ahmad, Tanveer; Kumar, Sarvesh; Singh, Suchita; Leishangthem, Geeta D.; Aich, Jyotirmoi; Kumar, Manish; Khanna, Kritika; Singh, Vijay P.; Dinda, Amit K; Biswal, Shyam; Agrawal, Anurag; Ghosh, Balaram

    2013-01-01

    Airway epithelial injury is the hallmark of various respiratory diseases, but its mechanisms remain poorly understood. While 13-S-hydroxyoctadecadienoic acid (13-S-HODE) is produced in high concentration during mitochondrial degradation in reticulocytes little is known about its role in asthma pathogenesis. Here, we show that extracellular 13-S-HODE induces mitochondrial dysfunction and airway epithelial apoptosis. This is associated with features of severe airway obstruction, lung remodeling...

  13. Severe diabetes and leptin resistance cause differential hepatic and renal transporter expression in mice

    OpenAIRE

    More, Vijay R.; Wen, Xia; Thomas, Paul E.; Aleksunes, Lauren M.; Slitt, Angela L.

    2012-01-01

    Background Type-2 Diabetes is a major health concern in the United States and other Westernized countries, with prevalence increasing yearly. There is a need to better model and predict adverse drug reactions, drug-induced liver injury, and drug efficacy in this population. Because transporters significantly contribute to drug clearance and disposition, it is highly significant to determine whether a severe diabetes phenotype alters drug transporter expression, and whether diabetic mouse mode...

  14. Haemorrhagic pancreatitis--a cause of death in severe potassium permanganate poisoning.

    OpenAIRE

    Middleton, S J; Jacyna, M.; McClaren, D.; Robinson, R; Thomas, H C

    1990-01-01

    Severe potassium permanganate poisoning (more than 10 g of potassium permanganate) is invariably associated with massive systemic upset and death. Multiple organ damage has been recognized as an inevitable consequence of such an overdose, although pancreatitis has not been previously reported. Death due to cardiovascular collapse and profound hypotension is a common end point in those who reach hospital, but the pathogenesis is uncertain. We report a case of haemorrhagic pancreatitis followin...

  15. Severe esophageal injuries caused by accidental button battery ingestion in children

    OpenAIRE

    Sara Fuentes; Indalecio Cano; María Isabel Benavent; Andrés Gómez

    2014-01-01

    Introduction: Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports. Material and Methods: Chart review and literature search. Case Reports: We treated three children between 2-7- years old with button batteries lodged at esophagus. They all present...

  16. Mild and severe muscular dystrophy caused by a single {gamma}-sarcoglycan mutation

    Energy Technology Data Exchange (ETDEWEB)

    McNally, E.M.; Boennemann, C.G.; Lidov, H.G.W. [Brigham and Women`s Hospital, Boston, MA (United States)] [and others

    1996-11-01

    Autosomal recessive muscular dystrophy is genetically heterogeneous. One form of this disorder, limb-girdle muscular dystrophy type 2C (LGMD 2C), is prevalent in northern Africa and has been shown to be associated with a single mutation in the gene encoding the dystrophin-associated protein {gamma}-sarcoglycan. The previous mutation analysis of {gamma}-sarcoglycan required the availability of muscle biopsies. To establish a mutation assay for genomic DNA, the intron-exon structure of the {gamma}-sarcoglycan gene was determined, and primers were designed to amplify each of the exons encoding {gamma}-sarcoglycan. We studied a group of Brazilian muscular dystrophy patients for mutations in the {gamma}-sarcoglycan gene. These patients were selected on the basis of autosomal inheritance and/or the presence of normal dystrophin and/or deficiency of {alpha}-sarcoglycan immunostaining. Four of 19 patients surveyed had a single, homozygous mutation in the {gamma}-sarcoglycan gene. The mutation identified in these patients, all of African-Brazilian descent, is identical to that seen in the North African population, suggesting that even patients of remote African descent may carry this mutation. The phenotype in these patients varied considerably. Of four families with an identical mutation, three have a severe Duchenne-like muscular dystrophy. However, one family has much milder symptoms, suggesting that other loci may be present that modify the severity of the clinical course resulting from {gamma}-sarcoglycan gene mutations. 19 refs., 5 figs., 3 tabs.

  17. An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium.

    Science.gov (United States)

    Thacker, S B; Bennett, J V; Tsai, T F; Fraser, D W; McDade, J E; Shepard, C C; Williams, K H; Stuart, W H; Dull, H B; Eickhoff, T C

    1978-10-01

    In January 1977 an unsolved outbreak of infection at St. Elizabeth's Hospital (Washington, D.C.) that occurred in 1965 was linked with Legionnaires' disease. The link was made by fluorescent antibody testing with the bacterium isolated from tissues of persons with Legionnaires' disease in the 1976 outbreak in Philadelphia. In July and August 1965, an epidemic of severe respiratory disease characterized by abrupt onset of high fever, weakness, malaise, and nonproductive cough, frequently accompanied by radiographic evidence of pneumonia, affected at least 81 patients at St. Elizabeth's Hospital, a general psychiatric hospital. Fourteen (17%) of the affected patients died. Intensive epidemiologic and laboratory investigations in 1965 did not determine the etiology. The etiologic organism may have become airborne from sites of soil excavation. PMID:361897

  18. Dilated aortic root and severe aortic regurgitation causing dilated cardiomyopathy in classic Ehlers-Danlos syndrome.

    Science.gov (United States)

    Zainal, Abir; Hamad, Mahmoud Nidal; Naqvi, Syed Yaseen

    2016-01-01

    Ehlers-Danlos syndrome (EDS) is a group of heritable disorders characterised by vast clinical heterogeneity ranging from the classic constellation of symptoms including skin hyperextensibility, joint hypermobility and skin fragility to the exceedingly critical consequences of arterial rupture and visceral perforation. We describe the case of a 65-year-old male with a history of classic EDS who reported of dyspnoea on exertion, orthopnoea, fatigue and palpitations. He was found to have dilated cardiomyopathy with an ejection fraction of 35%, aortic root dilation and severe aortic valve regurgitation. The authors intend to draw attention to the rare cardiac manifestations of this condition and the therapeutic challenges involved in managing such patients. PMID:27413024

  19. [Rare infection--prolonged A. naeslundii bacteremia caused by severe caries].

    Science.gov (United States)

    Abozaid, Said; Peretz, Avi; Nasser, Wael; Zarfin, Yehoshua

    2013-07-01

    Actinomyces is an anaerobic, gram positive, rod shape bacteria that doesn't create spores. Actinomyces is part of the mouth, intestines, vagina and upper respiratory system flora. The infection appears mostly on the face, neck, abdomen and pelvis in cases of mucosa injury and most common in immunosuppressed patients. The spread of Actinomyces through the blood system is rare. In this article we present a 9 year old male patient with no history of diseases who was diagnosed with prolonged bacteremia of A. naeslundii without specific infection excluding severe caries. Characterization of bacteria from the blood culture was performed by molecular biology and the patient was treated with Ampicillin and tooth extraction that led to the disappearance of the bacteremia. PMID:23957079

  20. Risk factors for neutropenia with lenalidomide plus dexamethasone therapy for multiple myeloma.

    Science.gov (United States)

    Mitani, Y; Usami, E; Kimura, M; Nakao, T; Okada, K; Matsuoka, T; Kokuryou, T; Yoshimura, T; Yamakawa, M

    2016-06-01

    Neutropenia may develop as an adverse event in patients with multiple myeloma receiving lenalidomide (LEN) plus dexamethasone (DEX) therapy. In the present study, we examined the risk factors associated with grade 3/4 neutropenia during the first cycle of LEN plus DEX therapy. We observed that hemoglobin level (≤ 8.5 g/dl) was a significant risk factor for grade 3/4 neutropenia during the first cycle of therapy (odds ratio: 19.40; 95% confidence interval: 2.68-141.00; p neutropenia in patients receiving LEN plus DEX therapy. PMID:27455556

  1. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report.

    Science.gov (United States)

    Omori, Kazuhiro; Hanayama, Yoshihisa; Naruishi, Koji; Akiyama, Kentaro; Maeda, Hiroshi; Otsuka, Fumio; Takashiba, Shogo

    2014-12-01

    It has been suggested that vitamin C deficiency/scurvy is associated with gingival inflammatory changes; however, the disorder is very infrequently encountered in the modern era. Here, we report a case of extensive gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection. PMID:25548632

  2. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report

    OpenAIRE

    Omori, Kazuhiro; Hanayama, Yoshihisa; Naruishi, Koji; Akiyama, Kentaro; Maeda, Hiroshi; Otsuka, Fumio; Takashiba, Shogo

    2014-01-01

    It has been suggested that vitamin C deficiency/scurvy is associated with gingival inflammatory changes; however, the disorder is very infrequently encountered in the modern era. Here, we report a case of extensive gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection.

  3. Outcome of Severe Dengue Viral Infection-caused Acute Liver Failure in Thai Children.

    Science.gov (United States)

    Laoprasopwattana, Kamolwish; Jundee, Puthachat; Pruekprasert, Pornpimol; Geater, Alan

    2016-06-01

    To determine clinical course and outcomes of liver functions in children with dengue viral infection-caused acute liver failure (ALF), the records of patients aged dengue hemorrhagic fever grade II, III and IV, respectively. Multiorgan failure including respiratory failure, massive bleeding and acute kidney injury occurred in 80.0%, 96.0% and 84.0% of the ALF cases, respectively, with an overall fatality rate of 68.3%. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were highest on the day that the patient developed ALF. Lactate dehydrogenase levels had positive correlations with AST (r = 0.95) and ALT (r = 0.87) (all p < 0.01). The median (interquartile range) days before the AST and ALT levels returned to lower than 200 U/L after the ALF were 10.5 (8.8, 12.8) and 10.5 (7.8, 14.0) days, respectively. PMID:26851434

  4. [Severe myocardial damage caused by leptospirosis. Report of a fatal case in Mexico].

    Science.gov (United States)

    Velasco-Castrejón, Oscar; Rivas-Sánchez, Beatriz; Soriano-Rosas, Juan; Rivera-Reyes, Héctor Hugo

    2009-01-01

    Chagasic cardiomyopathy is a common disease in Latin America, however similar clinical pictures exist that can be confused with this, as they give negative results to the tests that detects T. cruzi, like non Chagasic rural endemic chronic cardiopathy, highly common in Venezuela. Using histopathology techniques, "idiopathic cardiomyopathy" is frequently found as the cause of death when the etiology of this disease is not known. This paper presents the case of a man of 26-years-old who died of dilated cardiomyopathy secondary to leptospirosis. Clinically, in addition to the cardiac failure, jaundice, hyperbilirubinemia, transaminases increase, proteinuria and hematuria were present. Initially it was suspected Chagasic cardiomyopathy but the epidemiologic background and the parasitologic and serologic tests for T. cruzi gave negative results. The dark field microscopy videorecording of blood and urine samples, argentic impregnation and immunohistochemistry tests as well as haemoculture in EMJH medium were positive for L. interrogans serovar Pomona. Postmortem we confirmed the presence of leptospira in different tissues through of histopathology, argentic impregnation, indirect immunofluorescence and immunohistochemistry. PMID:20191987

  5. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Shimodaira Masanori

    2013-01-01

    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

  6. Severe disseminated phaeohyphomycosis in an immunocompetent patient caused by Veronaea botryosa.

    Science.gov (United States)

    Bonifaz, Alexandro; Davoudi, Mehrnaz Mohammad; de Hoog, G S; Padilla-Desgarennes, Carmen; Vázquez-González, Denisse; Navarrete, Gisela; Meis, Jacques F; Badali, Hamid

    2013-06-01

    We present a severe case of disseminated phaeohyphomycosis due to Veronaea botryosa. A 32-year-old female, native from Cuautla, Morelos, Mexico, presented a chronic dermatosis which started 10 years earlier with multiple exophytic, multilobulated, soft, and pedunculated or sessile neoformations of diverse sizes from 2 to 10 cm in diameter, which became verrucose and increased in size. The patient was immunocompetent, and no hereditary or familiar precedents of importance were known. No treatment was given, and the dermatosis remained relatively stable until the patient became pregnant in 2001 and 2003. The infection then exacerbated and worsened, leading to dissemination to the extremities, trunk, and face. The initial diagnosis was chromoblastomycosis which was treated with terbinafine and itraconazole but without visible improvement. Histopathology revealed pigmented, irregular, unbranched, and septate hyphae. Veronaea botryosa was isolated (CBS 127264 = JX566723), and its identity was confirmed by sequencing the internal transcribed spacer (ITS) rDNA. Therapy with posaconazole (800 mg/day) was started showing a gradual improvement of lesions with a reduction in size and flattening of the eruptions. PMID:23471534

  7. A rare genetic disorder causing persistent severe neonatal hypoglycaemia the diagnostic workup.

    Science.gov (United States)

    Francescato, Gaia; Salvatoni, Alessandro; Persani, Luca; Agosti, Massimo

    2012-01-01

    We report a case of familial glucocorticoid deficiency (FGD), a rare genetic autosomal-recessive disorder with typical hyperpigmentation of the skin and mucous membranes, severe hypoglycaemia, occasionally leading to seizures and coma, feeding difficulties, failure to thrive and infections. A newborn child was admitted, on his second day of life, to our neonatal intensive care unit because of seizures and respiratory insufficiency. Hyperpigmentation was not evident due to his Senegalese origin. The clinical presentation led us to consider a wide range of diagnostic hypothesis. Laboratory findings brought us to the diagnosis of FGD that was confirmed by molecular analysis showing an MC2R:p.Y254C mutation previously reported as causative of type 1 FGD and two novel heterozygous non-synonymous single-nucleotide polymorphisms in exon 2 and 3 of melanocortin 2 receptor accessory protein-α, whose role in the disease is currently unknown. The importance of an early collection and storage of blood samples during hypoglycaemic event is emphasised. PMID:22814974

  8. Gene disruption of dematin causes precipitous loss of erythrocyte membrane stability and severe hemolytic anemia.

    Science.gov (United States)

    Lu, Yunzhe; Hanada, Toshihiko; Fujiwara, Yuko; Nwankwo, Jennifer O; Wieschhaus, Adam J; Hartwig, John; Huang, Sha; Han, Jongyoon; Chishti, Athar H

    2016-07-01

    Dematin is a relatively low abundance actin binding and bundling protein associated with the spectrin-actin junctions of mature erythrocytes. Primary structure of dematin includes a loosely folded core domain and a compact headpiece domain that was originally identified in villin. Dematin's actin binding properties are regulated by phosphorylation of its headpiece domain by cyclic adenosine monophosphate-dependent protein kinase. Here, we used a novel gene disruption strategy to generate the whole body dematin gene knockout mouse model (FLKO). FLKO mice, while born at a normal Mendelian ratio, developed severe anemia and exhibited profound aberrations of erythrocyte morphology and membrane stability. Having no apparent effect on primitive erythropoiesis, FLKO mice show significant enhancement of erythroblast enucleation during definitive erythropoiesis. Using membrane protein analysis, domain mapping, electron microscopy, and dynamic deformability measurements, we investigated the mechanism of membrane instability in FLKO erythrocytes. Although many membrane and cytoskeletal proteins remained at their normal levels, the major peripheral membrane proteins spectrin, adducin, and actin were greatly reduced in FLKO erythrocytes. Our results demonstrate that dematin plays a critical role in maintaining the fundamental properties of the membrane cytoskeleton complex. PMID:27073223

  9. Severe esophageal injuries caused by accidental button battery ingestion in children

    Directory of Open Access Journals (Sweden)

    Sara Fuentes

    2014-01-01

    Full Text Available Introduction: Button batteries represent a low percentage of all foreign bodies swallowed by children and esophageal location is even less frequent. However, these cases are more likely to develop severe injuries. The aim of this essay is to report three cases treated in our institution and review previous reports. Material and Methods: Chart review and literature search. Case Reports: We treated three children between 2-7- years old with button batteries lodged at esophagus. They all presented esophageal burns (EB, which evolved in esophageal stenosis in two out of the three cases. Results: We found 29 more cases in literature and the injuries included EB, esophageal perforation (EP and tracheoesophageal fistula (TEF. Discussion: Swallowed button batteries rarely remain in esophagus, but these cases present a higher risk of tisular damage. Injuries can take place even after few hours; and therefore, endoscopy must be performed as soon as possible. Further study on button batteries′ safety and the establishment of a maximum size for them would be good preventive measures.

  10. Techniques for induction of neutropenia and granulocytosis in rats.

    Science.gov (United States)

    Popovic, V; Schaffer, R; Popovic, P

    1976-09-01

    After a single administration of vinblastine, rats develop profound neutropenia. The agranulocytosis lasts 3 days, and it is observed on the third, fourth and fifth day after vinblastine administration. The granulocytosis that develops on days 7-14 after vinblastine administration was significantly increased when androgenic steroids were administered. Deca-Durabolin induced greater granulocytosis than testosterone. The peak values were observed 10 and 12 days, respectively, after drug administration. All values of WBC's, granulocytes and hematocrit ratios were obtained in unanesthetized, unrestrained rats from an aortic cannula implanted at least 10 days prior to the experiment. PMID:976388

  11. A Case Report of Cyclic Neutropenia Associated With Pyoderma Gangrenosum

    Directory of Open Access Journals (Sweden)

    SeyedAhmad SeyedAlinaghi

    2011-11-01

    Full Text Available We present a 24-year-old female referred with non-healing wound of a few days duration on anterior aspect of her right foreleg. Biopsy of the wound was reported to be pyoderma gangrenosum on pathologic report. Further work up of the patient for high grade fever and occasional leukopenias revealed the diagnosis of cyclic neutropenia. Treatment with granulocyte colony-stimulating factor (G-CSF resulted in patients neutrophil counts correction and dramatic improvement in healing of her lower extremity wound.

  12. Severe starvation-induced hepatocyte autophagy as a cause of acute liver injury in anorexia nervosa: a case report.

    Science.gov (United States)

    Restellini, S; Spahr, L; Rubbia Brandt, L

    2013-01-01

    Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies. Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common causes of liver injury, the patient was carefully refed. As liver tests remained abnormal, liver biopsy was performed. At histology and electron microscopy, numerous signs suggestive of starvation-induced hepatocyte autophagy were found. Discussion. Severe starvation can be associated with acute liver injury that is slowly reversible with careful enteral nutrition. In this clinical situation, profound hepatic glycogen depletion in association with autophagy appears as the leading cause of liver injury. PMID:25379300

  13. Biosimilars in the management of neutropenia: focus on filgrastim.

    Science.gov (United States)

    Caselli, Désirée; Cesaro, Simone; Aricò, Maurizio

    2016-01-01

    Advances in chemotherapy and surgery allows the majority of patients to survive cancer diseases. Yet, the price may be a proportion of patients dying of complications due to treatment-induced infectious complications, such as neutropenia. With the aim of decreasing morbidity and mortality related to infectious complications, recombinant human granulocyte colony-stimulating factor (G-CSF), filgrastim, and pegylated filgrastim have been used to reduce time and degree of neutropenia. A biosimilar is a copy of an approved original biologic medicine whose data protection has expired. The patent for filgrastim expired in Europe in 2006 and in the US in 2013. This review analyses the available evidence to be considered in order to design a strategy of use of G-CSF and its biosimilars. The clinical and safety outcomes of biosimilars are well within the range of historically reported data for originator filgrastim. This underscores the clinical effectiveness and safety of biosimilar filgrastim in daily clinical practice. Biosimilars can play an important role by offering the opportunity to reduce costs, thus contributing to the financial sustainability of treatment programs. PMID:26937170

  14. Use of tunnelled catheters in haematological malignancy patients with neutropenia.

    Science.gov (United States)

    Sariosmanoglu, N; Uğurlu, B; Turgut, N H; Demirkan, F; Ozsan, H; Ergor, G; Gulay, Z; Hazan, E; Oto, O

    2008-01-01

    This prospective study analysed 83 patients (age 45 +/- 17 years) with haematological neoplasms, implanted with 93 tunnelled catheters, who were neutropenic or developed neutropenia during treatment. Catheters were implanted in the right (n = 82) or left (n = 11) jugular vein by the same surgical team using the same technique. They remained in place for 124 +/- 88 days: 29% were removed due to infection; 18% due to treatment termination and 2% due to mechanical problems. Seventeen patients died with catheters in place. At 30, 60, 90, 120 and 200 days mean catheter duration rates were 82%, 75%, 65%, 60% and 35%, respectively, and freedom from catheter removal due to infection was 92%, 88%, 80%, 77% and 67%, respectively. Patient diagnosis and history of previous catheter infection did not increase catheter infection risk, but patients undergoing stem cell transplantation had an increased infection risk. Tunnelled catheters can be used in high-risk patients with neutropenia. Systemic infections can be managed in most patients without catheter removal. PMID:18831907

  15. Late-onset dysphagia caused by severe spastic peristalsis of a free jejunal graft in a case of hypopharyngeal cancer.

    Science.gov (United States)

    Imai, Takayuki; Goto, Takahiro; Matsumoto, Ko; Kurosawa, Koreyuki; Asada, Yukinori; Saijo, Shigeru; Matsuura, Kazuto

    2016-12-01

    Free jejunal transfer is the main technique used for reconstructing a circumferential defect caused by total pharyngo-laryngo-cervical-esophagectomy in certain cancer cases. We report a rare case of severe late-onset dysphagia caused by autonomous spastic peristalsis, which led to complete obstruction of the free jejunal route. A 70-year-old man underwent treatment for hypopharyngeal cancer involving total pharyngolaryngectomy with free jejunal transfer. After uneventful peri- and postoperative recovery, he developed sudden-onset severe dysphagia 22 months later. Gastrografin fluoroscopy revealed abnormal peristalsis and contraction of the transferred jejunum, leading to complete obstruction. Nutritional treatment, application of depressants of peristalsis, and xylocaine injection into the outer space of the jejunal mucosa all failed to alleviate the dysphagia. Surgical treatment involving a longitudinal incision of the jejunal graft, and interposing a cutaneous flap, as a fixed wall, between the incised jejunal margins to prevent obstruction was performed. After further reconstructive surgery involving using a pectoralis major musculocutaneous flap and a split-thickness skin graft to close a refractory jejunum-skin fistula, the dysphagia was permanently alleviated. To our knowledge, this is the first report of severe dysphagia caused by peristalsis of a free jejunal graft. PMID:27068782

  16. Novas diretrizes na abordagem clínica da neutropenia febril e da sepse em oncologia pediátrica New guidelines for the clinical management of febrile neutropenia and sepsis in pediatric oncology patients

    Directory of Open Access Journals (Sweden)

    Ana Verena Almeida Mendes

    2007-05-01

    precoce são fundamentais para a melhora da sobrevida.OBJECTIVES: To provide a foundation for the diagnostic, prophylactic and therapeutic management of febrile neutropenia and sepsis in children with oncological diseases, with special attention to new protocols and guidelines. SOURCES: A review of the scientific literature utilizing an electronic bibliographic search on MEDLINE, Medscape, SciELO, Google, Cochrane and PubMED using the keywords febrile, neutropenic, cancer, children, sepsis, intensive, care. Articles published between 1987 and 2007 were selected, with preference given to review articles, protocols, systematic reviews, epidemiological studies, task force recommendations and phase III clinical trials. Consensus documents published by the Infectious Diseases Society of America, the Center for Diseases Control and the Infectious Diseases Working Party of the German Society of Hematology and Oncology, in addition to the recommendations of the World Federation of Pediatric Intensive and Critical Care Societies and Society of Critical Care Medicine, were also reviewed. SUMMARY OF THE FINDINGS: The use of aggressive chemotherapy regimens, bone marrow transplantation and intensive care resources have increased the survival rates of children with cancer and also their infectious morbidity, with septic complications as the principal cause of mortality. Several risk factors have been identified, such as neutropenia, oncology type, clinical signs and inflammatory response markers (polymerase chain reaction, procalcitonin and also increased resistance to antimicrobials and antifungal agents. Protocols for risk classification, diagnosis and treatment should be established at each service, taking into account the microbiological flora of each population. Pediatric intensive care has increased the short and long-term survival of these patients. CONCLUSIONS: Oncology patients are particularly vulnerable to infectious complications. Early identification and treatment are

  17. Vitamin B12 and Vitamin D Deficiencies: An Unusual Cause of Fever, Severe Hemolytic Anemia and Thrombocytopenia

    Science.gov (United States)

    Mishra, Vikas A.; Harbada, Rishit; Sharma, Akhilesh

    2015-01-01

    The array of diagnostic workup for pyrexia of unknown origin (PUO) generally revolves in searching for infections, inflammatory/autoimmune, and endocrine etiologies. A differential diagnosis of fever, hemolytic anemia, and thrombocytopenia can have etiologies varying from infections like malaria, dengue, cytomegalovirus, Ebstein barr virus, Parvovirus, infective endocarditis, to autoimmune disorder (systemic lupus erythromatosis), vasculitis, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura (TTP), autoimmune hemolytic anemia/Evan's syndrome, paroxysmal nocturnal hemoglobinuri (PNH), or drugs. Nutritional deficiencies (especially vitamin B12 deficiency) as a cause of fever, hemolytic anemia, and thrombocytopenia are very rare and therefore rarely thought of. Severe vitamin B12 deficiency may cause fever and if accompanied by concurrent hyper-homocysteinemia and hypophosphatemia can sometimes lead to severe hemolysis mimicking the above-mentioned conditions. We present a case that highlights vitamin B12 and vitamin D deficiency as an easily treatable cause of PUO, hemolytic anemia, and thrombocytopenia, which should be actively looked for and treated before proceeding with more complicated and expensive investigation or starting empiric treatments. PMID:25811010

  18. A combined LDL receptor/LDL receptor adaptor protein 1 mutation as the cause for severe familial hypercholesterolemia.

    Science.gov (United States)

    Soufi, Muhidien; Rust, Stephan; Walter, Michael; Schaefer, Juergen R

    2013-05-25

    Familial hypercholesterolemia (FH) results from impaired catabolism of plasma low density lipoproteins (LDL), thus leading to high cholesterol, atherosclerosis, and a high risk of premature myocardial infarction. FH is commonly caused by defects of the LDL receptor or its main ligand apoB, together mediating cellular uptake and clearance of plasma LDL. In some cases FH is inherited by mutations in the genes of PCSK9 and LDLRAP1 (ARH) in a dominant or recessive trait. The encoded proteins are required for LDL receptor stability and internalization within the LDLR pathway. To detect the underlying genetic defect in a family of Turkish descent showing unregular inheritance of severe FH, we screened the four candidate genes by denaturing gradient gel electrophoresis (DGGE) mutation analysis. We identified different combinatory mixtures of LDLR- and LDLRAP1-gene defects as the cause for severe familial hypercholesterolemia in this family. We also show for the first time that a heterozygous LDLR mutation combined with a homozygous LDLRAP1 mutation produces a more severe hypercholesterolemia phenotype in the same family than a homozygous LDLR mutation alone. PMID:23510778

  19. Assessment of Functional Disturbances in the Central Nervous System Caused by Severe Carbon Monoxide Poisoning in Rats.

    Science.gov (United States)

    Tolkach, P G; Basharin, V A; Grebenyuk, A N

    2016-02-01

    An experimental model was developed for assessment of disturbances in CNS functions of laboratory animals caused by severe carbon monoxide poisoning. Normalization of the state of experimental rats after acute poisoning was accompanied by the development of cognitive abnormalities. Disturbances in the long-term memory were observed on days 1 and 14 after CO poisoning, while abnormalities in the short-term memory developed on days 1, 7, and 14. Learning impairment were recorded on day 8, while the training course began on day 7. PMID:26906199

  20. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012

    OpenAIRE

    Bermingham, Alison; Chand, M.A.; Brown, C S; Aarons, E.; Tong, C; Langrish, C; Hoschler, K; Brown, Kevin; Galiano, Monica; Myers, Richard; Pebody, R. G.; Green, H.K.; Boddington, N.L.; Gopal, Robin; Price, N

    2012-01-01

    textabstractCoronaviruses have the potential to cause severe transmissible human disease, as demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2003. We describe here the clinical and virological features of a novel coronavirus infection causing severe respiratory illness in a patient transferred to London, United Kingdom, from the Gulf region of the Middle East.

  1. Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012.

    Science.gov (United States)

    Bermingham, A; Chand, M A; Brown, C S; Aarons, E; Tong, C; Langrish, C; Hoschler, K; Brown, K; Galiano, M; Myers, R; Pebody, R G; Green, H K; Boddington, N L; Gopal, R; Price, N; Newsholme, W; Drosten, C; Fouchier, R A; Zambon, M

    2012-01-01

    Coronaviruses have the potential to cause severe transmissible human disease, as demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2003. We describe here the clinical and virological features of a novel coronavirus infection causing severe respiratory illness in a patient transferred to London, United Kingdom, from the Gulf region of the Middle East. PMID:23078800

  2. APOA5 Q97X Mutation Identified through homozygosity mapping causes severe hypertriglyceridemia in a Chilean consanguineous family

    Directory of Open Access Journals (Sweden)

    Dussaillant Catalina

    2012-11-01

    Full Text Available Abstract Background Severe hypertriglyceridemia (HTG has been linked to defects in LPL, APOC2, APOA5, LMF1 and GBIHBP1 genes. However, a number of severe HTG cases are probably caused by as yet unidentified mutations. Very high triglyceride plasma levels (>112 mmol/L at diagnosis were found in two sisters of a Chilean consanguineous family, which is strongly suggestive of a recessive highly penetrant mutation. The aim of this study was to determine the genetic locus responsible for the severe HTG in this family. Methods We carried out a genome-wide linkage study with nearly 300,000 biallelic markers (Illumina Human CytoSNP-12 panel. Using the homozygosity mapping strategy, we searched for chromosome regions with excess of homozygous genotypes in the affected cases compared to non-affected relatives. Results A large homozygous segment was found in the long arm of chromosome 11, with more than 2,500 consecutive homozygous SNP shared by the proband with her affected sister, and containing the APOA5/A4/C3/A1 cluster. Direct sequencing of the APOA5 gene revealed a known homozygous nonsense Q97X mutation (p.Gln97Ter found in both affected sisters but not in non-affected relatives nor in a sample of unrelated controls. Conclusion The Q97X mutation of the APOA5 gene in homozygous status is responsible for the severe hypertriglyceridemia in this family. We have shown that homozygosity mapping correctly pinpointed the genomic region containing the gene responsible for severe hypertriglyceridemia in this consanguineous Chilean family.

  3. The D173G mutation in ADAMTS-13 causes a severe form of congenital thrombotic thrombocytopenic purpura

    KAUST Repository

    Lancellotti, S.

    2015-08-13

    Congenital thrombotic thrombocytopenic purpura (TTP) is a rare form of thrombotic microangiopathy, inherited with autosomal recessive mode as a dysfunction or severe deficiency of ADAMTS-13 (A Disintegrin And Metalloprotease with ThromboSpondin 1 repeats Nr. 13), caused by mutations in the ADAMTS-13 gene. About 100 mutations of the ADAMTS-13 gene were identified so far, although only a few characterised by in vitro expression studies. A new Asp to Gly homozygous mutation at position 173 of ADAMTS-13 sequence was identified in a family of Romanian origin, with some members affected by clinical signs of TTP. In two male sons, this mutation caused a severe (< 3 %) deficiency of ADAMTS-13 activity and antigen level, associated with periodic thrombocytopenia, haemolytic anaemia and mild mental confusion. Both parents, who are cousins, showed the same mutation in heterozygous form. Expression studies of the mutant ADAMTS-13, performed in HEK293 cells, showed a severe decrease of the enzyme’s activity and secretion, although the protease was detected inside the cells. Molecular dynamics found that in the D173G mutant the interface area between the metalloprotease domain and the disintegrin-like domain significantly decreases during the simulations, while the proline-rich 20 residues linker region (LR, 285–304) between them undergoes extensive conformational changes. Inter-domain contacts are also significantly less conserved in the mutant compared to the wild-type. Both a decrease of the inter-domain contacts along with a substantial conformational rearrangement of LR interfere with the proper maturation and folding of the mutant ADAMTS-13, thus impairing its secretion.

  4. Community-Associated Methicillin-Resistant Staphylococcus aureus Lacking PVL, as a Cause of Severe Invasive Infection Treated with Linezolid

    Directory of Open Access Journals (Sweden)

    Catarina Gouveia

    2013-01-01

    Full Text Available Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA is an emerging public health problem worldwide. Severe invasive infections have been described, mostly associated with the presence of Panton-Valentine leukocidin (PVL. In Portugal limited information exists regarding CA-MRSA infections. In this study we describe the case of a previously healthy 12-year-old female, sport athlete, who presented to the hospital with acetabulofemoral septic arthritis, myositis, fasciitis, acetabulum osteomyelitis, and pneumonia. The MRSA isolated from blood and synovial fluid was PVL negative and staphylococcal enterotoxin type P (SEP and type L (SEL positive, with a vancomycin MIC of 1.0 mg/L and resistant to clindamycin and ciprofloxacin. The patient was submitted to multiple surgical drainages and started on vancomycin, rifampicin, and gentamycin. Due to persistence of fever and no microbiological clearance, linezolid was started with improvement. This is one of the few reported cases of severe invasive infection caused by CA-MRSA in Portugal, which was successfully treated with linezolid. In spite of the severity of infection, the MRSA isolate did not produce PVL.

  5. Loss-of-function mutations in SCN4A cause severe foetal hypokinesia or 'classical' congenital myopathy.

    Science.gov (United States)

    Zaharieva, Irina T; Thor, Michael G; Oates, Emily C; van Karnebeek, Clara; Hendson, Glenda; Blom, Eveline; Witting, Nanna; Rasmussen, Magnhild; Gabbett, Michael T; Ravenscroft, Gianina; Sframeli, Maria; Suetterlin, Karen; Sarkozy, Anna; D'Argenzio, Luigi; Hartley, Louise; Matthews, Emma; Pitt, Matthew; Vissing, John; Ballegaard, Martin; Krarup, Christian; Slørdahl, Andreas; Halvorsen, Hanne; Ye, Xin Cynthia; Zhang, Lin-Hua; Løkken, Nicoline; Werlauff, Ulla; Abdelsayed, Mena; Davis, Mark R; Feng, Lucy; Phadke, Rahul; Sewry, Caroline A; Morgan, Jennifer E; Laing, Nigel G; Vallance, Hilary; Ruben, Peter; Hanna, Michael G; Lewis, Suzanne; Kamsteeg, Erik-Jan; Männikkö, Roope; Muntoni, Francesco

    2016-03-01

    Congenital myopathies are a clinically and genetically heterogeneous group of muscle disorders characterized by congenital or early-onset hypotonia and muscle weakness, and specific pathological features on muscle biopsy. The phenotype ranges from foetal akinesia resulting in in utero or neonatal mortality, to milder disorders that are not life-limiting. Over the past decade, more than 20 new congenital myopathy genes have been identified. Most encode proteins involved in muscle contraction; however, mutations in ion channel-encoding genes are increasingly being recognized as a cause of this group of disorders. SCN4A encodes the α-subunit of the skeletal muscle voltage-gated sodium channel (Nav1.4). This channel is essential for the generation and propagation of the muscle action potential crucial to muscle contraction. Dominant SCN4A gain-of-function mutations are a well-established cause of myotonia and periodic paralysis. Using whole exome sequencing, we identified homozygous or compound heterozygous SCN4A mutations in a cohort of 11 individuals from six unrelated kindreds with congenital myopathy. Affected members developed in utero- or neonatal-onset muscle weakness of variable severity. In seven cases, severe muscle weakness resulted in death during the third trimester or shortly after birth. The remaining four cases had marked congenital or neonatal-onset hypotonia and weakness associated with mild-to-moderate facial and neck weakness, significant neonatal-onset respiratory and swallowing difficulties and childhood-onset spinal deformities. All four surviving cohort members experienced clinical improvement in the first decade of life. Muscle biopsies showed myopathic features including fibre size variability, presence of fibrofatty tissue of varying severity, without specific structural abnormalities. Electrophysiology suggested a myopathic process, without myotonia. In vitro functional assessment in HEK293 cells of the impact of the identified SCN4A

  6. Assessing factors causing severe injuries in crashes of high-deck buses in long-distance driving on freeways.

    Science.gov (United States)

    Chu, Hsing-Chung

    2014-01-01

    High-deck buses that have a higher center of gravity traveling at an excessive speed have a higher likelihood of causing serious and fatal accidents when drivers lose control of the vehicle. In addition, drivers who suffer from fatigue in long-distance driving increase the likelihood of serious accident. This paper examines the effects of risk factors contributing to severe crashes associated with high-deck buses used for long-distance driving on freeways. An ordered logit and latent class models are used to examine significant factors on the severity of injuries in crashes related to high-deck buses. Driver fatigue, drivers or passengers not wearing a seat belt, reckless driving, drunk driving, crashes occurred between midnight and dawn, and crashes occurred at interchange ramps were found to significantly affect the severity of injuries in crashes involving high-deck buses. Safety policies to prevent severe injuries in crashes involving high deck buses used for long-distance runs on freeways include: (1) restricting drivers from exceeding the limit of daily driving hours and mandating sufficient rest breaks; (2) installing an automatic sleep-warning device in the vehicle; (3) drivers with obstructive sleep apnea syndrome or sleep disorders should be tested and treated before they are allowed to perform long hours of driving tasks; (4) educating the public or even amending the seatbelt legislation to require all passengers to wear a seat belt and thus reduce the chance of ejection from a high-deck bus and prevent serious injuries in a crash while traveling at a higher speed on freeways. PMID:24144498

  7. Failure of titer of contact hypersensitivity to correlate with clinical severity and therapeutic response in contact dermatitis caused by parthenium

    Directory of Open Access Journals (Sweden)

    Verma Kaushal

    2004-07-01

    Full Text Available Background: The titer of contact hypersensitivity (TCH has been used to determine the degree of contact hypersensitivity in patients with contact dermatitis. The values have been found to vary in different individuals and also in the same individual at different times apparently due to the varying severity of the disease. We evaluated the correlation of TCH with disease severity and therapeutic response in patients of contact dermatitis caused by the plant Parthenium hysterophorus. Methods: Forty-two patients, 30 (71.4% males and 12 (28.6% females, aged between 30-75 years, having air-borne contact dermatitis to Parthenium hysterophorus for 0.5-20 years were included in the study. The disease severity and TCH at baseline were recorded in all the patients. They were treated with azathioprine and followed up every month for 4-69 months. The TCH was repeated every 3 months and the last recorded TCH value was taken for analysis in each patient. Results: The baseline clinical severity score (CSS varied from 10-80 (mean ± SD: 35.47 ± 19.41 in these patients. It ranged from 10-30 in 22 (52.4% patients, from 31-50 in 14 (33.3% patients, and was more than 50 in 6 (14.3% patients. The baseline TCH to Parthenium was undiluted (UD in 2 (4.8%, 1:10 in 15 (35.7%, 1:100 in 20 (47.6%, and 1:1000 in 5 (11.9% patients respectively. At the end of the study, the clinical severity of the disease decreased in most of the patients. The CSS came down to 0 in 31 patients, to 10-20, and to 50 in 4 patients each, but remained stable in three patients who had baseline CSS from 20-40. The overall mean CSS came down from 35.47 ± 19.41 to 4.76 ± 9.43 (p = 0.002. However, there was no significant change in the TCH levels over time (p = 0.153. The last TCH value was negative in 2 (4.8% patients, undiluted in 5 (11.9%, 1:10 in 10 (23.8%, 1:100 in 18 (42.9%, and 1:1000 in 7 (16.7% patients. There was no change in the TCH values in 16 (38.1% patients while it increased or

  8. Clericuzio-type Poikiloderma with Neutropenia Syndrome in a Turkish Family: a Three Report of Siblings with Mutation in the C16orf57 gene.

    Science.gov (United States)

    Patiroglu, Turkan; Akar, H Haluk

    2015-06-01

    Clericuzio-type poikiloderma with neutropenia (PN) is characterized by poikiloderma, non-cyclic neutropenia, recurrent sinopulmonary infections, pachyonychia, and palmo-plantar hyperkeratosis. Mutations in the C16orf57 gene, which is located on chromosome 16q13, have been identified as the cause of PN. PN was first described by Clericuzio in Navajo Indians. Herein, we reported the clinical presentations and laboratory investigations of PN in three siblings from Turkey. The older siblings presented with typical cutaneous poikiloderma, plantar keratoderma, pachyonychia of toenails, and recurrent upper respiratory infections. As the most affected patient, in addition to classic manifestations, the youngest sibling had recurrent pneumonia, hepatosplenomegaly, dental caries, failure to thrive, and hand malformation. Genetic study revealed a homozygous mutation (c.531delA) in the C16orf57 gene in siblings. With the presented study, we aimed to draw attention to PN which can be a predisposing factor to malignancies. PMID:26546903

  9. Cost Minimization Analysis of the Use of Meropenem and Ceftazidime in Febrile Neutropenia Therapy

    Directory of Open Access Journals (Sweden)

    Rizky Abdulah

    2016-06-01

    Full Text Available Use of antibiotics is required in febrile neutropenia therapy. The variety choice on the use of antibiotics has increased the role of pharmacoeconomics study to determine the most effective and efficient antibiotic in a specific area. The purpose of this study was to investigate the lowest cost antibiotic between meropenem and ceftazidime that were used as one of febrile neutropenia treatments at one of referral hospitals in West Java province during 2011–2013. This study was a retrospective, observational and analytical study that was performed on February 2014 by collecting medical record data related to febrile neutropenia inpatient who received meropenem or ceftazidime therapy. The result showed that although it was not statistically significant, the total cost for ceftazidime therapy was IDR7,082,523, which was lower than meropenem therapy (IDR11,094,147. Hopefully, this result can assist the health professionals in the management of febrile neutropenia therapy.

  10. Moxifloxacin Compared With Ciprofloxacin/Amoxicillin in Treating Fever and Neutropenia in Patients With Cancer

    Science.gov (United States)

    2012-09-20

    Chronic Myeloproliferative Disorders; Fever, Sweats, and Hot Flashes; Infection; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Neutropenia; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

  11. Health care-associated infections in hematology-oncology patients with neutropenia: a method of surveillance.

    Science.gov (United States)

    Ibrahim, Karim Yaqub; Pierrotti, Ligia Camera; Freire, Maristela Pinheiro; Gutierrez, Patricia Pinheiro; Duarte, Laiane do Prado Gil; Bellesso, Marcelo; Pereira, Juliana; de Alencar Fischer Chamone, Dalton; Abdala, Edson

    2013-11-01

    We present a prospective method of surveillance of health care-associated infection in hematology-oncology inpatients with neutropenia. Incidence rates were calculated on the basis of the number of hospitalized patients, the duration of hospital stay (in days), the number of days of neutropenia, and (in cases of central line-associated blood stream infection) the number of central line-days. We detected 11.4 and 66.4 episodes of febrile neutropenia per 1,000 hospital-days and per 1,000 days of neutropenia, respectively. The incidence of central line-associated blood stream infection was 2.6 per 1,000 central line-days. Gram-negative bacteria were the most prevalent pathogens. Efforts should be made to monitor infection rates on hematology-oncology wards. PMID:23769835

  12. Promotive effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on recovery from neutropenia induced by fractionated irradiation in mice

    International Nuclear Information System (INIS)

    The effect of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the recovery from neutropenia induced by fractionated whole-body irradiation was investigated in mice. Male 7-week old C3H/HeN mice received a total of ten exposures of 0.25 Gy/day from day 1 to 5 and from day 8 to 12. Peripheral neutropenia with a nadir on day 17 was caused by the fractionated irradiation. Daily subcutaneous injections of rhG-CSF at 0.25 and 2.5 μg/body/day from day from day 1 to 21 promoted the recovery of neutrophils in a dose-dependent manner. The kinetics of morphologically identifiable bone marrow cells were studied to clarify the mechanism behind the promotive effect of this factor. A slight decrease in mitotic immature granulocytes, such as myeloblasts, promyelocytes and myelocytes on day 5, and a drastic decrease in metamyelocytes and marrow neutrophils on days 5, 9, and 17 were seen in the femur of irradiated mice. Treatment using rhG-CSF caused an increase in immature granulocytes of all differential stages in the femur. Microscopic findings of the femurs and spleens also reveals an increase in immature granulocytes in these organs in mice injected with rhG-CSF. These results indicate that rhG-CSF accelerates granulopoiesis in the femur and spleen, thereby promoting recovery from neutropenia induced by fractionated irradiation. (author)

  13. Cost Minimization Analysis of the Use of Meropenem and Ceftazidime in Febrile Neutropenia Therapy

    OpenAIRE

    Rizky Abdulah; Raine D. Kumamba; Rano K. Sinuraya; Cherry Rahayu; Melisa I. Barliana

    2016-01-01

    Use of antibiotics is required in febrile neutropenia therapy. The variety choice on the use of antibiotics has increased the role of pharmacoeconomics study to determine the most effective and efficient antibiotic in a specific area. The purpose of this study was to investigate the lowest cost antibiotic between meropenem and ceftazidime that were used as one of febrile neutropenia treatments at one of referral hospitals in West Java province during 2011–2013. This study was a retrospective,...

  14. Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Emily Banks

    Full Text Available BACKGROUND: Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. METHODS AND FINDINGS: We conducted a prospective population-based Australian study (the 45 and Up Study linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality. Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95, heart failure (8.00, 2.64-24.2, peripheral vascular disease (1.92, 1.12-3.29, "other" CVD (1.26, 1.05-1.51, all CVD combined (1.35, 1.19-1.53, and all-cause mortality (1.93, 1.52-2.44. For men with previous CVD, corresponding RRs (95% CI were 1.70 (1.46-1.98, 4.40 (2.64-7.33, 2.46 (1.63-3.70, 1.40 (1.21-1.63, 1.64 (1.48-1.81, and 2.37 (1.87-3.01, respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26, atrioventricular and left bundle branch

  15. Prospective cohort study of febrile neutropenia in breast cancer patients with neoadjuvant and adjuvant chemotherapy: CSPOR-BC FN study.

    Science.gov (United States)

    Ishikawa, Takashi; Sakamaki, Kentaro; Narui, Kazutaka; Kaise, Hiroshi; Tsugawa, Koichiro; Ichikawa, Yasushi; Mukai, Hirofumi

    2016-07-01

    With the increasing use of adjuvant chemotherapy for treating early breast cancer, febrile neutropenia management has become crucial. Guidelines for febrile neutropenia management are mostly based on a Caucasian population survey although ethnic differences are reported in terms of adverse events. We survey the current status of febrile neutropenia and risk factors in Japanese female breast cancer patients receiving neoadjuvant and adjuvant chemotherapy regimens potential for febrile neutropenia. Subsequently, we plan to conduct a multicenter prospective cohort study involving 1000 patients with operable breast cancer. With the current state of oral antibiotics being routinely prescribed without hematology tests, we survey febrile neutropenia based on two different definitions, namely, true febrile neutropenia: ≥37.5°C and Grade 4 neutropenia, and surrogate febrile neutropenia: ≥37.5°C and oral antibiotic and antipyretic intake. The comparison of true febrile neutropenia and surrogate febrile neutropenia incidences is anticipated to provide information on the safety and feasibility of chemotherapy management without performing blood tests. PMID:27162322

  16. [Efficacy of Levofloxacin Hydrate in Febrile Neutropenia for Outpatient Chemotherapy].

    Science.gov (United States)

    Inagaki, Manato; Sato, Junya; Nihei, Satoru; Kashiwaba, Masahiro; Kudo, Kenzo

    2016-05-01

    Management of febrile neutropenia (FN) is important for the safety of patients undergoing outpatient chemotherapy. Oral antimicrobials are usually prescribed as the initial treatment for FN, and outpatients are instructed to begin medication prior to chemotherapy. However, the effectiveness and safety of the use of these oral antibiotics have not yet been established. In this study, we investigated the effectiveness and safety of levofloxacin hydrate (LVFX) for breast cancer patients with FN, and the factors associated with the onset of FN in 134 breast cancer patients who underwent chemotherapy including the anticancer drug anthracycline (total, 513 courses), in an outpatient chemotherapy department. The effectiveness and safety of LVFX were defined respectively as defervescence within 5 days, and the appearance of side effects such as diarrhea and rashes. Fever was observed in 89 (66%) of the 134 patients, and during 164 (32%) of 513 courses. Defervescence was observed with the LVFX medication in 149 (93%) of 160 courses. The primary side effect was the development of rashes, and only 2 (1%) of the 160 courses were discontinued. Onset of stomatitis during chemotherapy was observed as a factor of FN (odds ratio: 1.36, p<0.05). Our results suggest that the use of LVFX according to the patients' discretion might be an effective and safe option for the management of FN during outpatient chemotherapy. PMID:27210089

  17. Loss-of-function mutations in SCN4A cause severe foetal hypokinesia or ‘classical’ congenital myopathy

    Science.gov (United States)

    Zaharieva, Irina T.; Thor, Michael G.; Oates, Emily C.; van Karnebeek, Clara; Hendson, Glenda; Blom, Eveline; Witting, Nanna; Rasmussen, Magnhild; Gabbett, Michael T.; Ravenscroft, Gianina; Sframeli, Maria; Suetterlin, Karen; Sarkozy, Anna; D’Argenzio, Luigi; Hartley, Louise; Matthews, Emma; Pitt, Matthew; Vissing, John; Ballegaard, Martin; Krarup, Christian; Slørdahl, Andreas; Halvorsen, Hanne; Ye, Xin Cynthia; Zhang, Lin-Hua; Løkken, Nicoline; Werlauff, Ulla; Abdelsayed, Mena; Davis, Mark R.; Feng, Lucy; Phadke, Rahul; Sewry, Caroline A.; Morgan, Jennifer E.; Laing, Nigel G.; Vallance, Hilary; Ruben, Peter; Hanna, Michael G.; Lewis, Suzanne; Kamsteeg, Erik-Jan; Männikkö, Roope

    2016-01-01

    See Cannon (doi:10.1093/brain/awv400) for a scientific commentary on this article. Congenital myopathies are a clinically and genetically heterogeneous group of muscle disorders characterized by congenital or early-onset hypotonia and muscle weakness, and specific pathological features on muscle biopsy. The phenotype ranges from foetal akinesia resulting in in utero or neonatal mortality, to milder disorders that are not life-limiting. Over the past decade, more than 20 new congenital myopathy genes have been identified. Most encode proteins involved in muscle contraction; however, mutations in ion channel-encoding genes are increasingly being recognized as a cause of this group of disorders. SCN4A encodes the α-subunit of the skeletal muscle voltage-gated sodium channel (Nav1.4). This channel is essential for the generation and propagation of the muscle action potential crucial to muscle contraction. Dominant SCN4A gain-of-function mutations are a well-established cause of myotonia and periodic paralysis. Using whole exome sequencing, we identified homozygous or compound heterozygous SCN4A mutations in a cohort of 11 individuals from six unrelated kindreds with congenital myopathy. Affected members developed in utero- or neonatal-onset muscle weakness of variable severity. In seven cases, severe muscle weakness resulted in death during the third trimester or shortly after birth. The remaining four cases had marked congenital or neonatal-onset hypotonia and weakness associated with mild-to-moderate facial and neck weakness, significant neonatal-onset respiratory and swallowing difficulties and childhood-onset spinal deformities. All four surviving cohort members experienced clinical improvement in the first decade of life. Muscle biopsies showed myopathic features including fibre size variability, presence of fibrofatty tissue of varying severity, without specific structural abnormalities. Electrophysiology suggested a myopathic process, without myotonia. In vitro

  18. Neutropenia y fiebre en el paciente con cáncer Neutropenia and fever in the patient with cancer

    Directory of Open Access Journals (Sweden)

    A. Manterola

    2004-01-01

    Full Text Available La infección en el huésped inmunocomprometido supone una situación clínica de gravedad por su alta morbi-mortalidad y es una de las complicaciones más frecuentes del paciente con cáncer. En los pacientes tratados con quimioterapia, el riesgo de infección depende fundamentalmente de la duración e intensidad de la neutropenia. Es fundamental evaluar cuál es el patógeno involucrado con mayor probabilidad para iniciar el tratamiento, a priori, más adecuado, así como la situación clínica general del paciente, que nos obligará a realizar un tratamiento más o menos agresivo desde el inicio, teniendo en cuenta que es posible el manejo domiciliario en aquel grupo de pacientes considerado de "bajo riesgo" de complicaciones. Estas cuestiones las podremos conocer evaluando los antecedentes y la historia clínica del paciente, la exploración física y los datos de exploraciones de laboratorio y radiológicas. El inicio precoz de la antibioterapia de amplio espectro es crucial, y revisaremos en este capítulo, las recomendaciones terapéuticas más recientes.Infection in the immunocompromised host is a serious clinical situation due to its high morbi-mortality and is one of the most frequent complications in the patient with cancer. In patients treated with chemotherapy, the risk of infection basically depends on the duration and intensity of the neutropenia. It is essential to evaluate, the most probable pathogen involved to initiate, a priori, the most suitable treatment, and also to evaluate the general clinical situation of the patient, because from the very beginning the treatment is quite aggressive. Outpatient care is possible for patients at "low risk" of complications. By evaluating the antecedents and clinical history of the patient, through physical exploration and from the data of laboratory and radiological explorations these points can be acknowledged. The early start of broad spectrum antibiotherapy is crucial, and in this

  19. Recessive Inactivating Mutations in TBCK, Encoding a Rab GTPase-Activating Protein, Cause Severe Infantile Syndromic Encephalopathy.

    Science.gov (United States)

    Chong, Jessica X; Caputo, Viviana; Phelps, Ian G; Stella, Lorenzo; Worgan, Lisa; Dempsey, Jennifer C; Nguyen, Alina; Leuzzi, Vincenzo; Webster, Richard; Pizzuti, Antonio; Marvin, Colby T; Ishak, Gisele E; Ardern-Holmes, Simone; Richmond, Zara; Bamshad, Michael J; Ortiz-Gonzalez, Xilma R; Tartaglia, Marco; Chopra, Maya; Doherty, Dan

    2016-04-01

    Infantile encephalopathies are a group of clinically and biologically heterogeneous disorders for which the genetic basis remains largely unknown. Here, we report a syndromic neonatal encephalopathy characterized by profound developmental disability, severe hypotonia, seizures, diminished respiratory drive requiring mechanical ventilation, brain atrophy, dysgenesis of the corpus callosum, cerebellar vermis hypoplasia, and facial dysmorphism. Biallelic inactivating mutations in TBCK (TBC1-domain-containing kinase) were independently identified by whole-exome sequencing as the cause of this condition in four unrelated families. Matching these families was facilitated by the sharing of phenotypic profiles and WES data in a recently released web-based tool (Geno2MP) that links phenotypic information to rare variants in families with Mendelian traits. TBCK is a putative GTPase-activating protein (GAP) for small GTPases of the Rab family and has been shown to control cell growth and proliferation, actin-cytoskeleton dynamics, and mTOR signaling. Two of the three mutations (c.376C>T [p.Arg126(∗)] and c.1363A>T [p.Lys455(∗)]) are predicted to truncate the protein, and loss of the major TBCK isoform was confirmed in primary fibroblasts from one affected individual. The third mutation, c.1532G>A (p.Arg511His), alters a conserved residue within the TBC1 domain. Structural analysis implicated Arg511 as a required residue for Rab-GAP function, and in silico homology modeling predicted impaired GAP function in the corresponding mutant. These results suggest that loss of Rab-GAP activity is the underlying mechanism of disease. In contrast to other disorders caused by dysregulated mTOR signaling associated with focal or global brain overgrowth, impaired TBCK function results in progressive loss of brain volume. PMID:27040692

  20. Association of oesophageal radiation dose volume metrics, neutropenia and acute radiation oesophagitis in patients receiving chemoradiotherapy for non-small cell lung cancer

    International Nuclear Information System (INIS)

    The relationship between oesophageal radiation dose volume metrics and dysphagia in patients having chemoradiation (CRT) for non-small cell lung cancer (NSCLC) is well established. There is also some evidence that neutropenia is a factor contributing to the severity of oesophagitis. We retrospectively analysed acute radiation oesophagitis (ARO) rates and severity in patients with NSCLC who received concurrent chemotherapy and high dose radiation therapy (CRT). We investigated if there was an association between grade of ARO, neutropenia and radiation dose volume metrics. Patients with NSCLC having concurrent CRT who had RT dose and toxicity data available were eligible. Exclusion criteria included previous thoracic RT, treatment interruptions and non-standard dose regimens. RT dosimetrics included maximum and mean oesophageal dose, oesophagus dose volume and length data. Fifty four patients were eligible for analysis. 42 (78 %) patients received 60 Gy. Forty four (81 %) patients received carboplatin based chemotherapy. Forty eight (89 %) patients experienced ARO ≥ grade 1 (95 % CI: 78 % to 95 %). ARO grade was associated with mean dose (rs = 0.27, p = 0.049), V20 (rs = 0.31, p = 0.024) and whole oesophageal circumference receiving 20 Gy (rs = 0.32 p = 0.019). In patients who received these doses, V20 (n = 51, rs = 0.36, p = 0.011), V35 (n = 43, rs = 0.34, p = 0.027) and V60 (n = 25, rs = 0.59, P = 0.002) were associated with RO grade. Eleven of 25 (44 %) patients with ARO ≥ grade 2 also had ≥ grade 2 acute neutropenia compared with 5 of 29 (17 %) patients with RO grade 0 or 1 (p = 0.035). In addition to oesophageal dose-volume metrics, neutropenia may also be a risk factor for higher grades of ARO

  1. A recessive homozygous p.Asp92Gly SDHD mutation causes prenatal cardiomyopathy and a severe mitochondrial complex II deficiency.

    Science.gov (United States)

    Alston, Charlotte L; Ceccatelli Berti, Camilla; Blakely, Emma L; Oláhová, Monika; He, Langping; McMahon, Colin J; Olpin, Simon E; Hargreaves, Iain P; Nolli, Cecilia; McFarland, Robert; Goffrini, Paola; O'Sullivan, Maureen J; Taylor, Robert W

    2015-08-01

    Succinate dehydrogenase (SDH) is a crucial metabolic enzyme complex that is involved in ATP production, playing roles in both the tricarboxylic cycle and the mitochondrial respiratory chain (complex II). Isolated complex II deficiency is one of the rarest oxidative phosphorylation disorders with mutations described in three structural subunits and one of the assembly factors; just one case is attributed to recessively inherited SDHD mutations. We report the pathological, biochemical, histochemical and molecular genetic investigations of a male neonate who had left ventricular hypertrophy detected on antenatal scan and died on day one of life. Subsequent postmortem examination confirmed hypertrophic cardiomyopathy with left ventricular non-compaction. Biochemical analysis of his skeletal muscle biopsy revealed evidence of a severe isolated complex II deficiency and candidate gene sequencing revealed a novel homozygous c.275A>G, p.(Asp92Gly) SDHD mutation which was shown to be recessively inherited through segregation studies. The affected amino acid has been reported as a Dutch founder mutation p.(Asp92Tyr) in families with hereditary head and neck paraganglioma. By introducing both mutations into Saccharomyces cerevisiae, we were able to confirm that the p.(Asp92Gly) mutation causes a more severe oxidative growth phenotype than the p.(Asp92Tyr) mutant, and provides functional evidence to support the pathogenicity of the patient's SDHD mutation. This is only the second case of mitochondrial complex II deficiency due to inherited SDHD mutations and highlights the importance of sequencing all SDH genes in patients with biochemical and histochemical evidence of isolated mitochondrial complex II deficiency. PMID:26008905

  2. Key Molecular Mechanisms of Chaiqinchengqi Decoction in Alleviating the Pulmonary Albumin Leakage Caused by Endotoxemia in Severe Acute Pancreatitis Rats

    Science.gov (United States)

    Wu, Wei; Luo, Ruijie; Lin, Ziqi; Xia, Qing

    2016-01-01

    To reveal the key molecular mechanisms of Chaiqinchengqi decoction (CQCQD) in alleviating the pulmonary albumin leakage caused by endotoxemia in severe acute pancreatitis (SAP) rats. Rats models of SAP endotoxemia-induced acute lung injury were established, the studies in vivo provided the important evidences that the therapy of CQCQD significantly ameliorated the increases in plasma levels of lipopolysaccharide (LPS), sCd14, and Lbp, the elevation of serum amylase level, the enhancements of systemic and pulmonary albumin leakage, and the depravation of airways indicators, thus improving respiratory dysfunction and also pancreatic and pulmonary histopathological changes. According to the analyses of rats pulmonary tissue microarray and protein-protein interaction network, c-Fos, c-Src, and p85α were predicted as the target proteins for CQCQD in alleviating pulmonary albumin leakage. To confirm these predictions, human umbilical vein endothelial cells were employed in in vitro studies, which provide the evidences that (1) LPS-induced paracellular leakage and proinflammatory cytokines release were suppressed by pretreatment with inhibitors of c-Src (PP1) or PI3K (LY294002) or by transfection with siRNAs of c-Fos; (2) fortunately, CQCQD imitated the actions of these selective inhibitions agents to inhibit LPS-induced high expressions of p-Src, p-p85α, and c-Fos, therefore attenuating paracellular leakage and proinflammatory cytokines release.

  3. Successful use of N-acetylcysteine to treat severe hepatic injury caused by a dietary fitness supplement.

    Science.gov (United States)

    El Rahi, Cynthia; Thompson-Moore, Nathaniel; Mejia, Patricia; De Hoyos, Patricio

    2015-06-01

    In the absence of adequate premarketing efficacy and safety evaluations, adverse events from over-the-counter supplements are emerging as a public health concern. Specifically, bodybuilding products are being identified as a frequent cause of drug-induced liver injury. We present a case of a 20-year-old Hispanic male who presented with acute nausea and vomiting accompanied by severe right upper quadrant abdominal pain, shivering, and shortness of breath. Laboratory data pointed to mixed cholestatic and hepatocellular damage, and after exclusion of known alternate etiologies, the patient was diagnosed with acute drug-induced liver injury secondary to the use of "Friction," a bodybuilding supplement. Treatment with N-acetylcysteine (NAC) 20% oral solution was initiated empirically at a dose of 4000 mg [DOSAGE ERROR CORRECTED] (70 mg/kg) every 4 hours and was continued once the diagnosis was made. Within 48 hours of admission to our hospital, the patient began to show clinical resolution of right abdominal pain and tolerance to oral diet associated with a significant decline toward normal in his liver function tests and coagulopathy. The WHO-UMC causality assessment system suggested a "certain causality" between exposure to the supplement and the acute liver injury. In the event of suspected drug-induced liver injury, treatment with NAC should be considered given its favorable risk-benefit profile. PMID:25823877

  4. Flow cytometric analysis of lymphocyte subset in patients with neutropenia among atomic bomb survivors

    International Nuclear Information System (INIS)

    In 51 patients (atomic bomb survivors 50, unexposed persons 1) who have had neutropenia for two years or more under indistinct cause, cell surface antigen was analyzed by flow cytometry. Twenty-nine cases of survivors were diagnosed as NK cell leukemia or NK cell cytosis because analysis data showed CD3(-), CD56(+) and CD57(+/-). Six cases were diagnosed as NK like T cell hypercytosis because analysis data showed CD3(+), CD56(+/-) and CD57(+). As for 15 cases, CD56(+) cell number was in range of 15.96±5.35 of a normal person, and no relation with NK cell was recognized. But, CD4/CD8 ratio was higher than 2.1, and gain of T helper cell was recognized. One unexposed persons was diagnosed as chronic NK cell leukemia because analysis data showed CD3(-), CD56(+) and CD57(+). Anti-neutrophil antibody wasn't recognized. Cytotoxic activity for K562 and Raji cell line showed high value compared with that of a normal person. Epstein Barr virus wasn't detected. (K.H.)

  5. 先天性中性粒细胞减少症的研究进展%Progress of congenital neutropenia

    Institute of Scientific and Technical Information of China (English)

    王娟娟

    2010-01-01

    先天性中性粒细胞减少症是一种少见的原发性免疫缺陷病,属于吞噬细胞数目先天性缺陷.主要的临床症状为婴幼儿期严重的中性粒细胞减少伴感染,骨髓分化受累和向白血病转化的风险.有散发、常染色体显性遗传、常染色体隐性遗传和X-连锁四种遗传方式.近年来多种基因缺陷的发现加深了对该病的认识.治疗上主要是粒细胞集落刺激因子和造血干细胞移植.%Congenital neutropenia is a rare primary immunodeficiency,which is classified into congenital defects of phagocyte number. It is characterized by significantly reduced number of circulating neutrophiles,often associated with early-onset severe infections, a block in bone marrow myeloid differentiation at the promyelocyte stage and high risk for development of leukemia. Congenital neutropenia occurs with sporadic, autosomal dominant,autosomal recessive and Xlinked inheritance. Recently, the numerous genes mutated in congenital neutropenia were found. Definitive cmre is provided by granulocyte colony-stimulating factor treatment and hematopoietic stem cell transplantation.

  6. Appearance of febrile neutropenia episodes after cytostatic therapy on oncology patients

    International Nuclear Information System (INIS)

    Treatment of oncology patient using cytotoxic drugs has the neutropenia and its infectious complications as the commonest dose-limiting toxicity. Its appearance provokes dose delays and reduction during post-chemotherapy cycles, as well as the quality of life deterioration of patients. Oncology Medicine Group including the Pharmacy Service carried out a study to analyze the appearance of febrile neutropenia after cytotoxic therapy administration, and the presence of other factors that may to increase the risk to these reactions. A total of 42 patients were studied admitted with febrile neutropenia after above therapy from February to August, 2007. Biomedical variables from included patient group were achieved and the previously applied cytostatic therapy. The prevalent age-group was those patients aged over 50 and predominance of male sex and advanced stages with associated affections. The more frequent tumor locations were in breast, lung, and non-Hodgkin lymphoma. The cytostatic agent more used in cases of febrile neutropenia was Adriamycin (71.4 %) followed by Cyclophosphamide (52.4 %). The factors more associated with febrile neutropenia appearance were: Anthracycline chemotherapy, age over 50, advanced stages, and presence of associated diseases

  7. Searching of Main Cause Leading to Severe Influenza A Virus Mutations and Consequently to Influenza Pandemics/Epidemics

    Directory of Open Access Journals (Sweden)

    Guang Wu

    2005-01-01

    Full Text Available The unpredictable mutations in the proteins from influenza A virus lead to the great difficulty in prevention of possible outbreak of bird flu and pandemic/epidemic of influenza. This unpredictability is due to the fact that we know little about the causes that lead to the mutations. In three of our recent studies on the hemagglutinins from influenza A virus, we unintentionally noticed the periodicity of mutations in hemagglutinins similar to the periodicity of sunspot. We calculated the amino-acid pair predictability and amino-acid distribution rank, which are developed by us over last several years and can numerically present the evolution of proteins in question, of 1217 full-length hemagglutinins from influenza A viruses. We then used the fast Fourier transform to determine the periodicity of mutations in the hemagglutinins. We compare the periodicities of mutations in influenza A virus hemagglutinins with those of solar and galactic cosmic rays and find a main periodicity of the mutations identical to that of sunspot and neutron rate (11 years/circle. Then we plot the sunspot number with respect to the historical pandemics/epidemics/non-pandemic new strains over last three centuries and compare the recorded sunspots with the historical pandemics before 1700. Both show a good agreement between sunspot activity and influenza related events. As the histories of Sun and galaxy are incomparably much longer than the history of influenza virus, the only logical deduction is that the hemagglutinin periodicities, which are identical to the periodicities of solar and galactic cosmic rays, are attribute to the solar and galactic activity. As the hemagglutinin is a sample of influenza A virus, we can logically deduce the role of migratory wild birds on the outbreak of bird flu and influenza, that is, cosmic rays are heading towards the polar regions, where more mutations occur in influenza A virus either within the wild birds or in their living

  8. Draft Genome Sequence of Vibrio parahaemolyticus Strain M0605, Which Causes Severe Mortalities of Shrimps in Mexico.

    Science.gov (United States)

    Gomez-Gil, Bruno; Soto-Rodríguez, Sonia; Lozano, Rodolfo; Betancourt-Lozano, Miguel

    2014-01-01

    Acute hepatopancreatic necrosis disease (AHPND), also known as early mortality syndrome (EMS), causes high mortalities in cultured shrimps in Asia (L. Tran et al., Dis. Aquat. Organ. 105:45-55, 2013, http://dx.doi.org/10.3354/dao02621). Here, we report the draft genome sequence of one Mexican strain of Vibrio parahaemolyticus that causes similar clinical signs in diseased shrimps. PMID:24604636

  9. Draft Genome Sequence of Vibrio parahaemolyticus Strain M0605, Which Causes Severe Mortalities of Shrimps in Mexico

    OpenAIRE

    Gomez-Gil, Bruno; Soto-Rodríguez, Sonia; Lozano, Rodolfo; Betancourt-Lozano, Miguel

    2014-01-01

    Acute hepatopancreatic necrosis disease (AHPND), also known as early mortality syndrome (EMS), causes high mortalities in cultured shrimps in Asia (L. Tran et al., Dis. Aquat. Organ. 105:45–55, 2013, http://dx.doi.org/10.3354/dao02621). Here, we report the draft genome sequence of one Mexican strain of Vibrio parahaemolyticus that causes similar clinical signs in diseased shrimps.

  10. Erectile Dysfunction Severity as a Risk Marker for Cardiovascular Disease Hospitalisation and All-Cause Mortality: A Prospective Cohort Study

    OpenAIRE

    Banks, Emily; Joshy, Grace; Abhayaratna, Walter P.; Kritharides, Leonard; Macdonald, Peter S; Korda, Rosemary J.; Chalmers, John P.

    2013-01-01

    Editors' Summary Background Erectile dysfunction is the medical term used when a man is unable to achieve or sustain an erection of his penis suitable for sexual intercourse. Although a sensitive topic that can cause much embarrassment and distress, erectile dysfunction is very common, with an estimated 40% of men over the age of 40 years experiencing frequent or occasional difficulties. The most common causes of erectile dysfunction are medications, chronic illnesses such as diabetes, and dr...

  11. Loss-of-function mutations in SCN4A cause severe foetal hypokinesia or ‘classical’ congenital myopathy

    OpenAIRE

    Zaharieva, Irina T.; Thor, Michael G.; Oates, Emily C.; Van Karnebeek, Clara; Hendson, Glenda; Blom, Eveline; Witting, Nanna; Rasmussen, Magnhild; Gabbett, Michael T.; Ravenscroft, Gianina; Sframeli, Maria; Suetterlin, Karen; Sarkozy, Anna; D’Argenzio, Luigi; Hartley, Louise

    2015-01-01

    See Cannon (doi:10.1093/brain/awv400) for a scientific commentary on this article. Dominant gain-of-function mutations in SCN4A, which encodes the α-subunit of the voltage-gated sodium channel, are a common cause of myotonia and periodic paralysis. Zaharieva et al. now report recessive loss-of-function SCN4A mutations in 11 patents with congenital myopathy. The mutations cause fully non-functional channels or result in reduced channel activity.

  12. Adaptor Protein Complex 4 Deficiency Causes Severe Autosomal-Recessive Intellectual Disability, Progressive Spastic Paraplegia, Shy Character, and Short Stature

    OpenAIRE

    Abou Jamra, Rami; Philippe, Orianne; Raas-Rothschild, Annick; Eck, Sebastian H.; Graf, Elisabeth; Buchert, Rebecca; Borck, Guntram; Ekici, Arif; Brockschmidt, Felix F.; Nöthen, Markus M.; Munnich, Arnold; Strom, Tim M.; Reis, Andre; Colleaux, Laurence

    2011-01-01

    Intellectual disability inherited in an autosomal-recessive fashion represents an important fraction of severe cognitive-dysfunction disorders. Yet, the extreme heterogeneity of these conditions markedly hampers gene identification. Here, we report on eight affected individuals who were from three consanguineous families and presented with severe intellectual disability, absent speech, shy character, stereotypic laughter, muscular hypotonia that progressed to spastic paraplegia, microcephaly,...

  13. Stochastic hypothesis of transition from inborn neutropenia to AML: Interactions of cell population dynamics and population genetics

    Directory of Open Access Journals (Sweden)

    Marek eKimmel

    2013-04-01

    Full Text Available We present a stochastic model of driver mutations in the transition from severe congenital neutropenia to myelodysplastic syndrome to acute myeloid leukemia (AML. The model has the form of a multitype branching process. We derive equations for the distributions of the times to consecutive driver mutations and set up simulations involving a range of hypotheses regarding acceleration of the mutation rates in successive mutant clones. Our model reproduces the clinical distribution of times at diagnosis of secondary AML. Surprisingly, within the framework of our assumptions, stochasticity of the mutation process is incapable of explaining the spread of times at diagnosis of AML in this case; it is necessary to additionally assume a wide spread of proliferative parameters among disease cases. This finding is unexpected but generally consistent with the wide heterogeneity of characteristics of human cancers.

  14. Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Christensen, Rune Haubo Bojesen; Kammersgaard, Lars;

    2007-01-01

    Background and Purpose - Evidence of a causal relation between serum cholesterol and stroke is inconsistent. We investigated the relation between total serum cholesterol and both stroke severity and poststroke mortality to test the hypothesis that hyperch....

  15. Acute life-threatening arrhythmias caused by severe hyperkalemia after induction of anesthesia in an infant with methylmalonic acidemia.

    Science.gov (United States)

    Chao, Pei-Wen; Chang, Wen-Kuei; Lai, I-Wen; Liu, Chinsu; Chan, Kwok-Hon; Tsao, Cheng-Ming

    2012-05-01

    Methylmalonic acidemia (MMA) is a very rare genetic disease of metabolism that progressively leads to neurological and renal sequelae. This report describes an unusual case of a patient with MMA who developed severe hyperkalemia and severe dysrhythmia during anesthesia. A 13-month-old male infant with MMA underwent urgent insertion of a port-a-cath under general anesthesia. A life-threatening arrhythmia suddenly occurred, with severe hyperkalemia (up to 7.4 mmol/L), immediately following induction of anesthesia. Emergent resuscitation was successfully carried out, with a complete neurological recovery after 7 days after surgery. Although MMA is a rare complication, the possibility of severe hyperkalemia should be considered in the differential diagnosis of patients with MMA presenting with wide QRS complex tachycardia. The management and intraoperative complications of this disorder are reported here, and the available literature is reviewed. PMID:22632992

  16. Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand

    OpenAIRE

    Q Sue Huang; Michael Baker; Colin McArthur; Sally Roberts; Deborah Williamson; Cameron Grant; Adrian Trenholme; Conroy Wong; Susan Taylor; Lyndsay LeComte; Graham Mackereth; Don Bandaranayake; Tim Wood; Ange Bissielo; Ruth Seeds

    2014-01-01

    Background: Recent experience with pandemic influenza A(H1N1)pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI)...

  17. Changes in severe thunderstorm environment frequency during the 21st century caused by anthropogenically enhanced global radiative forcing

    OpenAIRE

    Trapp, Robert J.; Diffenbaugh, Noah S.; Brooks, Harold E.; Baldwin, Michael E.; Robinson, Eric D.; Pal, Jeremy S.

    2007-01-01

    Severe thunderstorms comprise an extreme class of deep convective clouds and produce high-impact weather such as destructive surface winds, hail, and tornadoes. This study addresses the question of how severe thunderstorm frequency in the United States might change because of enhanced global radiative forcing associated with elevated greenhouse gas concentrations. We use global climate models and a high-resolution regional climate model to examine the larger-scale (or “environmental”) meteoro...

  18. Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

    Science.gov (United States)

    Ul Haq, Muhammad Irfan; Shamim, Faisal; Lal, Shankar; Shafiq, Faraz

    2015-12-01

    Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope. PMID:26691367

  19. Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial.

    Science.gov (United States)

    Lima, Stella Sala Soares; Nobre, Vandack; de Castro Romanelli, Roberta Maia; Clemente, Wanessa Trindade; da Silva Bittencourt, Henrique Neves; Melo, Ana Catarina Mourão; Salomão, Luciana Caetano Botelho; Serufo, José Carlos

    2016-06-01

    Febrile neutropenia (FN) requires immediate use of antibiotics (ATB), and procalcitonin (PCT) is proven to be useful in guiding antibiotic therapy in different settings. This study investigated the use of PCT as a guide for the duration of ATB in FN. A randomized controlled trial was carried out from January-December 2010. A total of 62 hematological adult patients with FN were randomized, in 1:1 ratio, into two groups: (1) PCT group: length of ATB guided by institutional protocol plus PCT dynamics, and (2) control group: duration of ATB in accordance with institutional protocol. There was no difference between groups regarding the use of ATB for the first episode of fever (HR 1.14, 95 % CI 0.66-1.95, p = 0.641), with equivalent median duration of ATB therapy (PCT group 9.0 days and control group 8.0 days, p = 0.67), and median number of days without ATB (0 days, IQR 0-2 days for both groups, p = 0.96). We observed no difference in clinical cure rate (p = 0.68), infection relapse (p = 1.0), superinfection (p = 0.85), length of hospitalization (p = 0.64), and mortality at 28 days (p = 0.39) and at 90 days (p = 0.72). Considering the cut-off of 0.5 ng/ml, PCT was correlated with bacteremia (sensitivity of 51.9 % and specificity of 76.5 %). In this randomized controlled trial, adding a PCT-guided protocol to the standard recommendations did not reduce the use of antibiotics in febrile neutropenia, although no apparent harm was caused. PCT proved to be a marker of bacteremia in this setting. PMID:27118539

  20. Anesthetic Management of a Patient with Sustained Severe Metabolic Alkalosis and Electrolyte Abnormalities Caused by Ingestion of Baking Soda

    OpenAIRE

    Jose Soliz; Jeffrey Lim; Gang Zheng

    2014-01-01

    The use of alternative medicine is prevalent worldwide. However, its effect on intraoperative anesthetic care is underreported. We report the anesthetic management of a patient who underwent an extensive head and neck cancer surgery and presented with a severe intraoperative metabolic alkalosis from the long term ingestion of baking soda and other herbal remedies.

  1. A Novel Mutation in the EDAR Gene Causes Severe Autosomal Recessive Hypohidrotic Ectodermal Dysplasia

    DEFF Research Database (Denmark)

    Henningsen, Emil; Svendsen, Mathias Tiedemann; Lildballe, D. L.; Jensen, P. K. A.

    2014-01-01

    We report on a 2-year-old girl presenting with a severe form of hypohidrotic ectodermal dysplasia (HED). The patient presented with hypotrichosis, anodontia, hypohidrosis, frontal bossing, prominent lips and ears, dry, pale skin, and dermatitis. The patient had chronic rhinitis with malodorous na...

  2. Perceived causes of severe mental disturbance and preferred interventions by the Borana semi-nomadic population in southern Ethiopia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Teferra Solomon

    2012-07-01

    Full Text Available Abstract Background Culture affects the way people conceptualize causes of severe mental disturbance which may lead to a variation in the preferred intervention methods. There is a seemingly dichotomous belief regarding what causes severe mental disturbance: people living in western countries tend to focus mainly on biological and psychosocial risk factors; whereas, in non-western countries the focus is mainly on supernatural and religious factors. These belief systems about causation potentially dictate the type of intervention preferred. Studying such belief systems in any society is expected to help in planning and implementation of appropriate mental health services. Methods A qualitative study was conducted among the Borana semi-nomadic population in southern Ethiopia to explore perceived causes of severe mental disturbance and preferred interventions. We selected, using purposive sampling, key informants from three villages and conducted a total of six focus group discussions: three for males and three for females. Results The views expressed regarding the causes of mental disturbance were heterogeneous encompassing supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirit in postnatal women and biopsychosocial causes such as infections (malaria, loss, ‘thinking too much’, and alcohol and khat abuse. The preferred interventions for severe mental disturbance included mainly indigenous approaches, such as consulting Borana wise men or indigenous healers, prayer, holy water treatment and seeking modern mental health care as a last resort. Conclusions These findings will be of value for health care planners who wish to expand modern mental health care to this population, indicating the need to increase awareness about the causes of severe mental disturbance and their interventions and collaborate with influential people and indigenous healers to increase

  3. 547 An Earlier, More Severe Presentation of G6pc3 Deficiency in a Male Infant From Mexico

    OpenAIRE

    Cruz, Alonso

    2012-01-01

    Background Severe congenital neutropenia is a bone marrow failure syndrome characterized by severe neutropenia present from birth. We present a case of G6PC3 deficiency presenting at an earlier age, with a more severe clinical picture than previously reported. Case report A 3-month-old boy, born to nonconsanguineous parents was delivered by C-section at 35 weeks gestation. He was admitted to neonatal intensive care unit for prematurity and poor respiratory effort requiring mechanical ventilat...

  4. Vascular disease as a cause of death in patients with severe disability due to osteoarthritis and rheumatoid arthritis

    OpenAIRE

    Smith, Ann Marie; Lingard, Liz; Heslop, Peta; Gray, Janine; Walker, David J

    2015-01-01

    Objectives The mechanism of the increased risk of cardiovascular disease in rheumatoid arthritis (RA) remains uncertain. We had the opportunity to compare the causes and ages of death in a population of osteoarthritis (OA) and RA patients who had had similar lower limb disability. Methods Death certificates were sought for a population of OA and RA patients who had had knee joint replacements performed by a single orthopaedic surgeon over a 10 year period with a minimum follow up period of 18...

  5. Mutation causing severe myasthenia reveals functional asymmetry of AChR signature cystine loops in agonist binding and gating

    OpenAIRE

    Shen, Xin-Ming; Ohno, Kinji; Tsujino, Akira; Brengman, Joan M.; Gingold, Monique; Sine, Steven M.; Engel, Andrew G.

    2003-01-01

    We describe a highly disabling congenital myasthenic syndrome (CMS) associated with rapidly decaying, low-amplitude synaptic currents, and trace its cause to a valine to leucine mutation in the signature cystine loop (cys-loop) of the AChR α subunit. The recently solved crystal structure of an ACh-binding protein places the cys-loop at the junction between the extracellular ligand-binding and transmembrane domains where it may couple agonist binding to channel gating. We therefore analyzed th...

  6. Primary blast causes mild, moderate, severe and lethal TBI with increasing blast overpressures: Experimental rat injury model

    Science.gov (United States)

    Mishra, Vikas; Skotak, Maciej; Schuetz, Heather; Heller, Abi; Haorah, James; Chandra, Namas

    2016-06-01

    Injury severity in blast induced Traumatic Brain Injury (bTBI) increases with blast overpressure (BOP) and impulse in dose-dependent manner. Pure primary blast waves were simulated in compressed gas shock-tubes in discrete increments. Present work demonstrates 24 hour survival of rats in 0–450 kPa (0–800 Pa•s impulse) range at 10 discrete levels (60, 100, 130, 160, 190, 230, 250, 290, 350 and 420 kPa) and determines the mortality rate as a non-linear function of BOP. Using logistic regression model, predicted mortality rate (PMR) function was calculated, and used to establish TBI severities. We determined a BOP of 145 kPa as upper mild TBI threshold (5% PMR). Also we determined 146–220 kPa and 221–290 kPa levels as moderate and severe TBI based on 35%, and 70% PMR, respectively, while BOP above 290 kPa is lethal. Since there are no standards for animal bTBI injury severity, these thresholds need further refinements using histopathology, immunohistochemistry and behavior. Further, we specifically investigated mild TBI range (0–145 kPa) using physiological (heart rate), pathological (lung injury), immuno-histochemical (oxidative/nitrosative and blood-brain barrier markers) as well as blood borne biomarkers. With these additional data, we conclude that mild bTBI occurs in rats when the BOP is in the range of 85–145 kPa.

  7. Severe Starvation-Induced Hepatocyte Autophagy as a Cause of Acute Liver Injury in Anorexia Nervosa: A Case Report

    OpenAIRE

    Rubbia Brandt, L.; Spahr, L; S. Restellini

    2013-01-01

    Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies. Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common c...

  8. Severe Hypertriglyceridemia Causing Acute Pancreatitis in a Child with New Onset Type I Diabetes Mellitus Presenting in Ketoacidosis

    OpenAIRE

    Wolfgram, Peter M.; MacDonald, Michael J.

    2013-01-01

    A 10 year old girl presented with severe diabetic ketoacidosis (DKA) and a hemoglobin A1C of 17.9%. On hospital day 2 after acidosis had improved it worsened and she developed excruciating abdominal pain. Her serum triglycerides and lipase levels were found to be extremely high and ultrasound analysis of the pancreas was consistent with acute pancreatitis. She was diagnosed with acute pancreatitis secondary to hypertriglyceridemia. The pancreatitis resolved completely and two months later her...

  9. Auditory agnosia due to long-term severe hydrocephalus caused by spina bifida - specific auditory pathway versus nonspecific auditory pathway.

    Science.gov (United States)

    Zhang, Qing; Kaga, Kimitaka; Hayashi, Akimasa

    2011-07-01

    A 27-year-old female showed auditory agnosia after long-term severe hydrocephalus due to congenital spina bifida. After years of hydrocephalus, she gradually suffered from hearing loss in her right ear at 19 years of age, followed by her left ear. During the time when she retained some ability to hear, she experienced severe difficulty in distinguishing verbal, environmental, and musical instrumental sounds. However, her auditory brainstem response and distortion product otoacoustic emissions were largely intact in the left ear. Her bilateral auditory cortices were preserved, as shown by neuroimaging, whereas her auditory radiations were severely damaged owing to progressive hydrocephalus. Although she had a complete bilateral hearing loss, she felt great pleasure when exposed to music. After years of self-training to read lips, she regained fluent ability to communicate. Clinical manifestations of this patient indicate that auditory agnosia can occur after long-term hydrocephalus due to spina bifida; the secondary auditory pathway may play a role in both auditory perception and hearing rehabilitation. PMID:21413843

  10. Voriconazole versus amphotericin B or fluconazole in cancer patients with neutropenia

    DEFF Research Database (Denmark)

    Jørgensen, Karsten Juhl; Gøtzsche, Peter C; Dalbøge, Christina S;

    2014-01-01

    and fluconazole when used for prevention or treatment of invasive fungal infections in cancer patients with neutropenia. SEARCH METHODS: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2014, Issue 1 2014), MEDLINE (to January 2014). Letters, abstracts and unpublished...

  11. A patient with common glycogen storage disease type Ib mutations without neutropenia or neutrophil dysfunction

    NARCIS (Netherlands)

    Martens, DHJ; Kuijpers, TW; Maianski, NA; Rake, JP; Smit, GPA; Visser, G

    2006-01-01

    We describe a 16-year old boy with glycogen storage disease type Ib, homozygous for the common 1211-1212delCT mutation, who never experienced neutropenia, and did not suffer from frequent infections or inflammatory bowel disease. In addition, neutrophil function tests showed no abnormalities.

  12. Sunitinib-associated hypertension and neutropenia as efficacy biomarkers in metastatic renal cell carcinoma patients

    DEFF Research Database (Denmark)

    Donskov, Frede; Michaelson, M Dror; Puzanov, Igor;

    2015-01-01

    ), neutropenia (grade ⩾2), thrombocytopenia (grade ⩾2), hand-foot syndrome (grade >0), and asthenia/fatigue (grade >0)) were analysed in multivariate analyses of progression-free survival (PFS) and overall survival (OS) end points. RESULTS: On-treatment neutropenia and hypertension were associated with longer...... PFS (P=0.0276 and P<0.0001, respectively) and OS (P=0.0014 and P<0.0001, respectively), independent of baseline prognostic factors, including International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria. By 12-week landmark analysis, neutropenia was significantly associated with...... longer PFS and OS (P=0.013 and P=0.0122, respectively) and hypertension or hand-foot syndrome with longer OS (P=0.0036 and P=0.0218, respectively). The concordance index was 0.65 (95% CI: 0.63-0.67) for IMDC classification alone and 0.72 (95% CI: 0.70-0.74) when combined with hypertension and neutropenia...

  13. Amphotericin B lipid soluble formulations versus amphotericin B in cancer patients with neutropenia

    DEFF Research Database (Denmark)

    Johansen, Helle Krogh; Gøtzsche, Peter C

    2014-01-01

    fever. OBJECTIVES: To compare the benefits and harms of lipid soluble formulations of amphotericin B with conventional amphotericin B in cancer patients with neutropenia. SEARCH METHODS: We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles. SELECTION CRITERIA...

  14. G-CSF in Peg-IFN induced neutropenia in liver transplanted patients with HCV recurrence

    Institute of Scientific and Technical Information of China (English)

    Francesca Lodato; Francesco Azzaroli; Maria Rosa Tamè; Maria Di Girolamo; Federica Buonfiglioli; Natalia Mazzella; Paolo Cecinato; Enrico Roda; Giuseppe Mazzella

    2009-01-01

    AIM: To evaluate the efficacy of granulocyte colony stimulating factors (G-CSF) in liver transplanted patients with hepatitis C (HCV) recurrence and Pegylated-IFN α-2b induced neutropenia, and to evaluate the impact of G-CSF administration on virological response.METHODS: Sixty-eight patients undergoing antiviral treatment for post-liver transplantation (OLT) HCV recurrence were enrolled.All patients developing neutropenia received G-CSF.RESULTS: Twenty three (34%) received G-CSF.Mean neutrophil count at the onset of neutropenia was 700/mmc (range 400-750/mmc); after 1 mo of G-CSF it increased to 1210/mmc (range 300-5590/mmc) ( P < 0.0001).Three patients did not respond to G-CSF.Treatment duration was similar in neutropenic and non-neutropenic patients.No differences in the rate of discontinuation, infections or virological response were observed between the two groups.G-CSF was protective for the onset of de novo autoimmune hepatitis ( P < 0.003).CONCLUSION: G-CSF administration is effective in the case of Peg-IFN induced neutropenia increasing neutrophil count, prolonging treatment and leading to sustained virological response (SVR) rates comparable to non-neutropenic patients.It prevents the occurrence of de novo autoimmune hepatitis.

  15. Outpatient management of febrile neutropenia: time to revise the present treatment strategy

    DEFF Research Database (Denmark)

    Carstensen, M.; Sørensen, Jens Benn

    2008-01-01

    We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low-risk febr......We reviewed medical literature on the efficacy and safety of outpatient versus hospital-based therapy of low-risk febrile neutropenia in adult cancer patients. A PubMed search for all studies evaluating the outpatient treatment of adults diagnosed with solid tumors who suffered from low......-risk febrile neutropenia was completed; reference lists from identified articles also were used. In all, 10 trials were included in the analysis, which showed no significant difference in clinical failure rates and mortality for ambulatory regimens and standard hospital-based therapy. Subgroup analysis...... treatment failure (P < 0.04). These findings need to be confirmed by further trials. Thus, outpatient management of adult cancer patients with low-risk febrile neutropenia is safe, effective, and comparable to standard hospital-based therapy. Patients at low risk are outpatients and are hemodynamically...

  16. MtDNA mutations are a common cause of severe disease phenotypes in children with Leigh syndrome.

    Science.gov (United States)

    Naess, Karin; Freyer, Christoph; Bruhn, Helene; Wibom, Rolf; Malm, Gunilla; Nennesmo, Inger; von Döbeln, Ulrika; Larsson, Nils-Göran

    2009-05-01

    Leigh syndrome is a common clinical manifestation in children with mitochondrial disease and other types of inborn errors of metabolism. We characterised clinical symptoms, prognosis, respiratory chain function and performed extensive genetic analysis of 25 Swedish children suffering from Leigh syndrome with the aim to obtain insights into the molecular pathophysiology and to provide a rationale for genetic counselling. We reviewed the clinical history of all patients and used muscle biopsies in order to perform molecular, biochemical and genetic investigations, including sequencing the entire mitochondrial DNA (mtDNA), the mitochondrial DNA polymerase (POLGA) gene and the surfeit locus protein 1 (SURF1) gene. Respiratory chain enzyme activity measurements identified five patients with isolated complex I deficiency and five with combined enzyme deficiencies. No patient presented with isolated complex IV deficiency. Seven patients had a decreased ATP production rate. Extensive sequence analysis identified eight patients with pathogenic mtDNA mutations and one patient with mutations in POLGA. Mutations of mtDNA are a common cause of LS and mtDNA analysis should always be included in the diagnosis of LS patients, whereas SURF1 mutations are not a common cause of LS in Sweden. Unexpectedly, age of onset, clinical symptoms and prognosis did not reveal any clear differences in LS patients with mtDNA or nuclear DNA mutations. PMID:19103152

  17. Severe coagulation factor VII deficiency caused by a novel homozygous mutation (p. Trp284Gly) in loop 140s.

    Science.gov (United States)

    Hao, Xiuping; Cheng, XiaoLi; Ye, Jiajia; Wang, Yingyu; Yang, LiHong; Wang, Mingshan; Jin, Yanhui

    2016-06-01

    Congenital coagulation factor VII (FVII) deficiency is a rare disorder caused by mutation in F7 gene. Herein, we reported a patient who had unexplained hematuria and vertigo with consanguineous parents. He has been diagnosed as having FVII deficiency based on the results of reduced FVII activity (2.0%) and antigen (12.8%). The thrombin generation tests verified that the proband has obstacles in producing thrombin. Direct sequencing analysis revealed a novel homozygous missense mutation p.Trp284Gly. Also noteworthy is the fact that the mutational residue belongs to structurally conserved loop 140s, which majorly undergo rearrangement after FVII activation. Model analysis indicated that the substitution disrupts these native hydrophobic interactions, which are of great importance to the conformation in the activation domain of FVIIa. PMID:26761581

  18. The neutropenia induced by the thalidomide analogue CC-4047 in patients with multiple myeloma is associated with an increased percentage of neutrophils bearing CD64.

    Science.gov (United States)

    McCarthy, Desmond A; Macey, Marion G; Streetly, Matthew; Schey, Stephen A; Brown, K Alun

    2006-07-01

    A major limitation to the treatment of multiple myeloma by the thalidomide analogue CC-4047 (Actimid) is the development of a severe neutropenia. We investigated the hypothesis that this effect may have been due to CC-4047 enhancing the removal of neutrophils from the circulation by altering the expression of surface adhesion molecules required for endothelial binding, by binding to platelets, or by enhancing apoptosis. Flow cytometric analysis was used to examine the expression of neutrophil surface molecules, platelet binding and apoptosis in whole blood samples from 19 patients with multiple myeloma who were assigned to receive either 1, 2, 5 or 10 mg of CC-4047 every other day (e.o.d.) for 28 days. CC-4047 induced dose-related decreases in neutrophil numbers and increases in the percentage of CD64-positive neutrophils, but had little, or no effect on the expression of CD11b, CD62L or CD162, neutrophil-platelet binding, or apoptosis. Relative decreases in the neutrophil count were inversely associated with relative increases in the intensity of CD64 expression on neutrophils (r=- 0.307; p=0.028). Although seven patients developed severe neutropenia, none suffered severe or recurrent bacterial infections. The percentage of CD64-positive neutrophils was still increased in eight patients who continued receiving 1-5 mg CC-4047 e.o.d. for several months afterwards, but neutrophil counts were similar to pre-treatment values. PMID:16714224

  19. Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand

    Directory of Open Access Journals (Sweden)

    Q Sue Huang

    2014-05-01

    Full Text Available Background: Recent experience with pandemic influenza A(H1N1pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI cases was established in New Zealand on 30 April 2012. The aims were to measure incidence, prevalence, risk factors, clinical spectrum and outcomes for SARI and associated influenza and other respiratory pathogen cases as well as to understand influenza contribution to patients not meeting SARI case definition. Methods/Design: All inpatients with suspected respiratory infections who were admitted overnight to the study hospitals were screened daily. If a patient met the World Health Organization’s SARI case definition, a respiratory specimen was tested for influenza and other respiratory pathogens. A case report form captured demographics, history of presenting illness, co-morbidities, disease course and outcome and risk factors. These data were supplemented from electronic clinical records and other linked data sources. Discussion: Hospital-based SARI surveillance has been implemented and is fully functioning in New Zealand. Active, prospective, continuous, hospital-based SARI surveillance is useful in supporting pandemic preparedness for emerging influenza A(H7N9 virus infections and seasonal influenza prevention and control.

  20. Increasing severity of damage caused by floods in the Spanish Mediterranean coast (1960-2014), climate change or vulnerability?

    Science.gov (United States)

    Perez, Alfredo; Gil, Salvador; Lopez, Francisco; Barriendos, Mariano

    2016-04-01

    In recent decades, there has been an increase in physical and economic losses (WMO, CRED and UCL, 2014) that raises serious concerns in society. Climate change projections may explain the rise in flood losses; however, these shouldn't be considered yet (Bouwer, 2011). According to IPCC (2014), there is low confidence in anthropogenic climate change affecting the frequency and magnitude of fluvial floods on a global scale. In other words, this increase in flood events is not completely related to the higher frequency of heavy rainfall. To illustrate the aforementioned, a spatial example can be seen in the study area. In the Spanish Mediterranean coast, we see an increase in economic losses within the last 50 years due to flood events (Gil et al., 2014). It seems that the socio-economic growth and the rise of housing construction (Gaja, 2008) have led to an increase in vulnerability and exposure which are mainly responsible for those losses and the increase in severity of flood events (Pérez et al., 2015). Furthermore, this situation will probably become more precarious if some climate forecasts are met [IPCC, 2014; AEMET, 2015], and if the economic model fails to adopt efficient adaptive measures. Therefore, it is interesting to focus attention on social factors either within the present or future scenario in order to minimise the potential consequences and improve the adaptation. The main objective of this work focuses on the study of the evolution of the severity of the floods in the Spanish Mediterranean coast for the period (1960-2015). To do that, a statistical analysis of the data base [Gil et al., 2014; extended to the entire Spanish Mediterranean coast (MEDIFLOOD)] and a multiscale mapping (local, provincial and regional level) of the frequency of these events will take place in order to make comparisons and show spatiotemporal patterns according to the severity events evolution. Preliminary results show some interesting statistically significant

  1. Mutation p.Leu354Pro in EDA causes severe hypohidrotic ectodermal dysplasia in a Chinese family.

    Science.gov (United States)

    Liu, Ying; Yu, Xiaoyan; Wang, Lei; Li, Chang; Archacki, Stephen; Huang, Changzheng; Liu, Jing Yu; Wang, Qing; Liu, Mugen; Tang, Zhaohui

    2012-01-10

    X-linked recessive hypohidrotic ectodermal dysplasia (XLHED) is characterized by the defective morphogenesis of teeth, hair, and eccrine sweat glands. It is associated with mutations in the EDA gene. Up to now, more than 100 mutations in the EDA gene have been reported to cause XLHED. The product of EDA gene is a trimeric type II transmembrane protein that belongs to the tumor necrosis factor (TNF) family of ligands. In this study, we identified a Chinese family with XLHED. Direct DNA sequencing of the whole coding region of EDA revealed a novel missense mutation, p.Leu354Pro in a patient affected with XLHED. This mutation was not found in either unaffected male individuals of the family or 168 normal controls. The substitution of Leu354 with Pro was found to be located in the TNF-like domain of EDA and may influence the epithelial signaling pathway required for the normal ectodermal development through altering the topology of EDA. Our finding broadens the spectrum of EDA mutations and may help to understand the molecular basis of XLHED and aid genetic counseling. PMID:22008666

  2. Neutropenia predicts better prognosis in patients with metastatic gastric cancer on a combined epirubicin, oxaliplatin and 5-fluorouracil regimen

    Science.gov (United States)

    Zhao, Xiaoying; Peng, Wei; Sun, Si; Cao, Jun; Ji, Dongmei; Wang, Chenchen; Guo, Weijian; Li, Jin; Yin, Jiliang; Zhu, Xiaodong

    2015-01-01

    Chemotherapy-induced neutropenia (CIN) reportedly indicated better prognosis for some cancers. We retrospectively analyzed 150 evaluable metastatic gastric cancer (MGC) patients who had received first-line EOF5 (combination regimen of epirubicin, oxaliplatin and 5-day continuous infusion of 5-fluorouracil) treatment. We divided patients into three groups according to the worst grade of CIN: absent group (grade 0), moderate group (grade 1–2) and severe group (grade 3–4). Multivariate analyses of overall survival (OS) proved moderate and severe CIN were important prognostic factors whether regarding CIN as a time-varying covariate (TVC) or not. Compared with absent CIN, hazard ratio (HR) for moderate and severe CIN were 0.31 (95% confidential interval (CI): 0.17–0.55; P < 0.001) and 0.36 (95% CI: 0.20–0.64; P = 0.001) respectively with TVC; and were 0.31 (95% CI: 0.17–0.56; P < 0.001) and 0.34 (95% CI: 0.19–0.61; P < 0.001) respectively without TVC. In progression-free survival (PFS) analyses, moderate and severe CIN showed similar results. In the landmark group (n = 122 patients) analyses with TVC, moderate and severe CIN remained prognostic factors for PFS, while only moderate CIN was prognostic factor for OS. CIN predicted longer OS and PFS in MGC patients treated with first-line EOF5 chemotherapy. PMID:26528696

  3. Reprodaetion of an animal model of multiple intestinal injuries mimicking "lethal triad" caused by severe penetrating abdominal trauma

    Directory of Open Access Journals (Sweden)

    Peng-fei WANG

    2011-03-01

    Full Text Available Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature,acidosis and coagulopathy.Methods Six female domestic outbred pigs were anesthetized,and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid.The animals were shot with a gun to create a severe penetrating abdominal trauma.Immediately after the shooting,50% of total blood volume(35ml/kg hemorrhage was drawn from the carotid artery in 20min.After a 40min shock period,4h of pre-hospital phase was mimicked by normal saline(NS resuscitation to maintain systolic blood pressure(SBP > 80mmHg or mean arterial pressure(MAP > 60mmHg.When SBP > 80mmHg or MAP > 60mmHg,no fluid infusion or additional bleeding was given.Hemodynamic parameters were recorded,and pathology of myocardium,lung,small intestine and liver was observed.Results There were multiple intestinal perforations(8-10 site injuries/pig leading to intra-abdominal contamination,mesenteric injury(1-2 site injuries/pig resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury.One pig died before the completion of the model establishment(at the end of pre-hospital resuscitation.The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals.Low temperature(33.3±0.5℃,acidosis(pH=7.242±0.064,and coagulopathy(protrombin time and activated partial thromboplasting time prolonged were observed after pre-hospital resuscitation.Pathology showed that myocardium,lung,small intestine and liver were severely injured.Conclusions A new model,simulating three stages of "traumatic hemorrhagic shock,pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution,has been successfully established.This model has good stability and high reproducibility.The survival animals can be

  4. Oak forest exploitation and black-locust invasion caused severe shifts in epiphytic lichen communities in Northern Italy.

    Science.gov (United States)

    Nascimbene, Juri; Marini, Lorenzo

    2010-10-15

    In the last two centuries, native European oak forests have undergone a dramatic decline related to increasing human pressure for agriculture and urbanization. Oak forests were either completely eradicated and transformed into agricultural landscapes or replaced by second-growth formations. Intensive forest management and the replacement of native forests with production forests or arable lands are recognized amongst the main threats to many lichens in Europe. In this study, we used historical information on the epiphytic lichen biota which was hosted in a native oak-dominated forest of Northern Italy to identify shifts of lichen communities due to the changes in land use which occurred during the last two centuries. We also compared the epiphytic lichen communities inhabiting remnant oak forests with those found in the habitats that have replaced native forests: black-locust forests and agrarian landscapes. Almost all the species sampled during the 19th century are now extinct. The loss of native habitat and the subsequent invasion by black locust were probably the most influential factors which affected the composition of lichen communities, causing the local extinction of most of the species historically recorded. Despite the fact that oak remnants host only a few species which were historically recorded, and that they currently are the lichen poorest habitat in the study region, they host lichen assemblages differing from those of black-locust forests and agrarian stands. In these habitats lichen assemblages are mainly composed of species adapted to well-lit, dry conditions and tolerating air pollution and eutrophication. This pattern is likely to be common also in other lowland and hilly regions throughout Northern Italy where oak forests are targeted among the habitats of conservation concern at the European level. For this reason, a national strategy for biodiversity conservation and monitoring of lowlands forests should provide the framework for local

  5. Analysis of causes and sequences of the accident on Fukushima NPP as a factor of sever accidents prevention in the vessel reactor

    International Nuclear Information System (INIS)

    In this monograph, the provisional analysis of the causes and sequences of the sever accidents on the Fukushima NPP is presented. The analysis of the possibility of the origin of extreme events connected with the flooding of Zaporizhzhia NPP industrial site, emergency of the steam-gas explosions on NPPs with WWER and other phenomena occurred under sever accidents was carried out. It was presented the authors original working-out on symptom-oriented approaches of sever accident initiating event list identification, on criteria substantiation of explosion safety and optimization of processes management at sever accidents, as well as on the methodological support of the accident beyond the design basis management at the WWER for prevention of their transition in the stage of sever accidents.

  6. Severe Weather Caused by Heat Island and Sea Breeze Effects in the Metropolitan Area of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Felipe Vemado

    2016-01-01

    Full Text Available The Metropolitan Area of São Paulo (MASP is one of the most populated regions of the planet with one of the largest impervious regions as well. This research work aims to characterize MASP heat island (HI effect and its interaction with the local sea breeze (SB inflow in rainfall amounts and deep convection. The combined SB-HI produces direct circulation over the MASP and produces severe weather and socioeconomic impacts. All SB-HI episodes between 2005 and 2008 are identified and analyzed with surface and upper air measurements, weather radar, and satellite data. The current work indicates that intense SB-HI episodes are related to air and dew point temperatures above 30°C and 20°C, respectively, right after the passage of the SB front over MASP. Results indicate that the precipitation related to SB-HI episodes is up to 600 mm or about four times higher than that in rural or less urbanized areas in its surroundings. Measurements indicate that 74% of SB-HI episodes are related to NW winds in earlier afternoon hours. Moving cold fronts in southern Brazil tend to intensify the SB-HI circulation in MASP. A conceptual model of these patterns is presented in this paper.

  7. Severe vitamin D deficiency in a case of primary hyperparathyroidism caused by parathyroid lipoadenoma, effect of 25OHD3 treatment.

    Science.gov (United States)

    Coen, G; Bondatti, F; de Matteis, A; Ballanti, P; Mazzaferro, S; Sardella, D; Smacchi, A

    1989-01-01

    This report describes the case of a 60-year-old woman with severe metabolic bone disease and fractures due to vitamin D deficiency and hyperparathyroidism. 25OHDH3 and 1,25(OH)2D3 serum levels were undetectable and increased immediately following 25OHD3 oral administration. Serum 1,25(OH)2D3 following vitamin D repletion reached values above the normal range, and remained elevated with strict dependence on the serum 25OHD3 levels. Parathyroid hormone and alkaline phosphatase decreased during treatment, without reaching normality during 1 year of observation. Bone biopsies before and after 8-month 25OHD3 treatment showed disappearance of the osteomalacic and hyperparathyroid lesions. During treatment an increase in serum and urine calcium and formation of renal stones were observed. The patient underwent neck exploration with the finding and removal of a lipoadenoma, a rare parathyroid tumor, followed by complete and permanent remission of the disease. In conclusion, this case is suggestive of the key role played by the long-term vitamin D status in the clinical expression of primary hyperparathyroidism. PMID:2615720

  8. Mutations in CIT, encoding citron rho-interacting serine/threonine kinase, cause severe primary microcephaly in humans.

    Science.gov (United States)

    Shaheen, Ranad; Hashem, Amal; Abdel-Salam, Ghada M H; Al-Fadhli, Fatima; Ewida, Nour; Alkuraya, Fowzan S

    2016-10-01

    Primary microcephaly is a clinical phenotype in which the head circumference is significantly reduced at birth due to abnormal brain development, primarily at the cortical level. Despite the marked genetic heterogeneity, most primary microcephaly-linked genes converge on mitosis regulation. Two consanguineous families segregating the phenotype of severe primary microcephaly, spasticity and failure to thrive had overlapping autozygomes in which exome sequencing identified homozygous splicing variants in CIT that segregate with the phenotype within each family. CIT encodes citron, an effector of the Rho signaling that is required for cytokinesis specifically in proliferating neuroprogenitors, as well as for postnatal brain development. In agreement with the critical role assigned to the kinase domain in effecting these biological roles, we show that both splicing variants predict variable disruption of this domain. The striking phenotypic overlap between CIT-mutated individuals and the knockout mice and rats that are specifically deficient in the kinase domain supports the proposed causal link between CIT mutation and primary microcephaly in humans. PMID:27503289

  9. Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report.

    Science.gov (United States)

    Kim, Sung-Hoon; Son, Hyo-Jung; Kim, Jae-Won; Kong, Yu-Gyeong; Hwang, Jai-Hyun; Kim, Young-Kug

    2016-04-01

    Laser enucleation and morcellation of the prostate is an increasingly used surgical management of benign prostatic hyperplasia. However, it can cause several complications including capsular perforation, ureteral orifice injury, and bladder mucosal morcellation injury. Herein, we report a case of severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser surgery of the prostate. The patient experienced massive abdominal distension and severe respiratory difficulty after the procedure. Although immediate postoperative cystogram showed no leakage of contrast dye, the computed tomography scan of the abdomen and pelvis showed massive fluid collection in the abdominal pelvic cavity suggesting bladder wall injury. After percutaneous drainage of intraperitoneal fluid, abdominal distention and dyspnea were relieved. PMID:27066210

  10. Phylogenetic evidence for intratypic recombinant events in a novel human adenovirus C that causes severe acute respiratory infection in children.

    Science.gov (United States)

    Wang, Yanqun; Li, Yamin; Lu, Roujian; Zhao, Yanjie; Xie, Zhengde; Shen, Jun; Tan, Wenjie

    2016-01-01

    Human adenoviruses (HAdVs) are prevalent in hospitalized children with severe acute respiratory infection (SARI). Here, we report a unique recombinant HAdV strain (CBJ113) isolated from a HAdV-positive child with SARI. The whole-genome sequence was determined using Sanger sequencing and high-throughput sequencing. A phylogenetic analysis of the complete genome indicated that the CBJ113 strain shares a common origin with HAdV-C2, HAdV-C6, HAdV-C1, HAdV-C5, and HAdV-C57 and formed a novel subclade on the same branch as other HAdV-C subtypes. BootScan and single nucleotide polymorphism analyses showed that the CBJ113 genome has an intra-subtype recombinant structure and comprises gene regions mainly originating from two circulating viral strains: HAdV-1 and HAdV-2. The parental penton base, pVI, and DBP genes of the recombinant strain clustered with the HAdV-1 prototype strain, and the E1B, hexon, fiber, and 100 K genes of the recombinant clustered within the HAdV-2 subtype, meanwhile the E4orf1 and DNA polymerase genes of the recombinant shared the greatest similarity with those of HAdV-5 and HAdV-6, respectively. All of these findings provide insight into our understanding of the dynamics of the complexity of the HAdV-C epidemic. More extensive studies should address the pathogenicity and clinical characteristics of the novel recombinant. PMID:26960434

  11. Aspergilosis pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report

    OpenAIRE

    Miguel E. Pinto; Claudia Banda; Carlos Seas

    2012-01-01

    Se reporta el caso de una paciente de 48 años de edad con diagnóstico reciente de enfermedad de Graves, quien acudió a emergencia por presentar fiebre, palpitaciones y dolor faríngeo. Su tratamiento regular incluía metimazol. Al ingreso, los análisis mostraron TSH suprimido, T4 libre elevado y neutropenia. La paciente fue hospitalizada, se administraron antibióticos y factor estimulante de colonia. Después de diez días de tratamiento, la paciente presentó leucocitosis, fiebre y hemoptisis. La...

  12. Performance of Interleukin-6 and Interleukin-8 serum levels in pediatric oncology patients with neutropenia and fever for the assessment of low-risk

    Directory of Open Access Journals (Sweden)

    Kontny Udo

    2008-03-01

    Full Text Available Abstract Background Patients with chemotherapy-related neutropenia and fever are usually hospitalized and treated on empirical intravenous broad-spectrum antibiotic regimens. Early diagnosis of sepsis in children with febrile neutropenia remains difficult due to non-specific clinical and laboratory signs of infection. We aimed to analyze whether IL-6 and IL-8 could define a group of patients at low risk of septicemia. Methods A prospective study was performed to assess the potential value of IL-6, IL-8 and C-reactive protein serum levels to predict severe bacterial infection or bacteremia in febrile neutropenic children with cancer during chemotherapy. Statistical test used: Friedman test, Wilcoxon-Test, Kruskal-Wallis H test, Mann-Whitney U-Test and Receiver Operating Characteristics. Results The analysis of cytokine levels measured at the onset of fever indicated that IL-6 and IL-8 are useful to define a possible group of patients with low risk of sepsis. In predicting bacteremia or severe bacterial infection, IL-6 was the best predictor with the optimum IL-6 cut-off level of 42 pg/ml showing a high sensitivity (90% and specificity (85%. Conclusion These findings may have clinical implications for risk-based antimicrobial treatment strategies.

  13. Whole exome sequencing in family trios reveals de novo mutations in PURA as a cause of severe neurodevelopmental delay and learning disability

    OpenAIRE

    Hunt, D; Leventer, R.J.; Simons, C.; Taft, R; Swoboda, K.J.; Gawne-Cain, M; Magee, A.C.; Turnpenny, P D; Baralle, D

    2014-01-01

    Background: De novo mutations are emerging as an important cause of neurocognitive impairment, and whole exome sequencing of case-parent trios is a powerful way of detecting them. Here, we report the findings in four such trios. Methods: The Deciphering Developmental Disorders study is using whole exome sequencing in family trios to investigate children with severe, sporadic, undiagnosed developmental delay. Three of our patients were ascertained from the first 1133 children to have been...

  14. Abdominal complications following neutropenia and haematopoietic stem cell transplantation: CT findings

    International Nuclear Information System (INIS)

    In haematology units, acute abdominal symptoms are common and often challenging for the clinician in charge. Two haematological conditions that may induce specific diagnoses are of particular concern: neutropenia and haematopoietic stem cell transplantation. Clinical and biological manifestations, including abdominal pain, fever, diarrhoea, hepatic cytolysis, or cholestasis are often non-specific. Computed tomography is often the primary imaging screening technique performed in such patients, as it is widely available, performs well for this indication, and may demonstrate evocative findings. The aim of this review is to provide the spectrum of specific diagnoses encountered and the corresponding key CT features in patients presenting with acute abdominal disorders following neutropenia and/or haematopoietic stem cell transplantation

  15. A novel mutation (4040-4045 nt. delA in exon 14 of the factor VIII gene causing severe hemophilia A

    Directory of Open Access Journals (Sweden)

    Habib Onsori

    2011-01-01

    Full Text Available Hemophilia A is an X-linked congenital bleeding disorder caused by Factor VIII deficiency. Different mutations including point mutations, deletions, insertions and inversions have been reported in the FVIII gene, which cause hemophilia A. In the current study, with the use of conformational sensitive gel electrophoresis (CSGE analysis, we report a novel 1-nt deletion in the A6 sequence at codons 1328-1330 (4040-4045 nt delA occurring in exon 14 of the FVIII gene in a seven-year-old Iranian boy with severe hemophilia A. This mutation that causes frameshift and premature stop-codon at 1331 has not previously been reported in the F8 Hemophilia A Mutation, Structure, Test and Resource Site (HAMSTeRS database.

  16. Role of recombinant granulocyte-macrophage colony - stimulating factors in reducing the duration of neutropenia

    International Nuclear Information System (INIS)

    Objective: To evaluate the role of recombinant Granulocyte-Macrophage Colony-Stimulating Factor (rGM-CSF) in reducing the duration of neutropenia and hospital stay after induction chemotherapy in acute myeloid leukemia (AML). Design: A randomised control trial. Place and Duration of Study: The study was carried out at Liaquat National Postgraduate Medical Center, Karachi from December 1995 to January 1999. Subjects and Methods: Twenty two newly diagnosed cases of AML< 11 males and 11 females with median age of 27.5(6-60) years were selected. The induction chemotherapy given was Doxorubicin 45 mg/m2/day intravenous for three consecutive days (day 1-3) and Ara C 100mg/m2/day intravenous infusion for seven consecutive days (day 1-7). Bone marrow aspiration was repeated on day 7 to exclude the presence of residual blast cells. The patients were then randomized to receive rGM-CSF in a dose of 7 micrograms /kg/day subcutaneously (Group-A) or placebo (Group-B). Duration of neutropenia (ANC<0.5*109/L) and length of hospital stay was recorded. Results: In Group-A mean duration of neutropenia was 19.3 days which is statistically non-significant (p=<0.05) as compared to Group-B i. e. 17.4 days and mean duration of hospital stay was 22.2 days which is also statistically non-significant (p=<0.05) as compared to Group-B i. e. 19.6 days. Conclusion: rGM-CSF failed to reduce the duration of neutropenia and hospital stay after induction chemotherapy in AML. (author)

  17. Comparison of anti-anaerobic antimicrobial strategies in cancer patients with febrile neutropenia and gastrointestinal symptoms

    OpenAIRE

    Rosa, Regis G; dos Santos, Rodrigo P; Goldani, Luciano Z.

    2014-01-01

    Background The current study sought to compare 28-day mortality rates in cancer patients with febrile neutropenia (FN) and gastrointestinal (GI) symptoms who underwent monotherapy using an antibiotic with antipseudomonal and anti-anaerobic activity (piperacillin-tazobactam or a carbapenem) and a group treated with a combination of cefepime-metronidazole. Findings We performed a prospective cohort study in a single tertiary hospital from October 2009 to August 2011. All consecutive adult cance...

  18. Clopidogrel-Induced Neutropenia after Coronary Stenting: Is Cilostazol a Good Alternative?

    OpenAIRE

    Massimo Montalto; Italo Porto; Antonella Gallo; Claudia Camaioni; Roberta Della Bona; Antonio Grieco; Filippo Crea; Raffaele Landolfi

    2011-01-01

    Dual antiplatelet therapy with aspirin plus thienopyridines has become the standard treatment of patients undergoing coronary stenting. Clopidogrel has mostly replaced the use of ticlopidine due to its more favourable adverse event profile. However, also the use of clopidogrel is not without side effects. Clopidogrel major adverse events are represented by marrow suppression, manifesting with aplastic anaemia, thrombocytopenia and neutropenia. When clopidogrel toxicity occurs, there are few a...

  19. Features and prognosis of severe malaria caused by Plasmodium falciparum, Plasmodium vivax and mixed Plasmodium species in Papua New Guinean children.

    Directory of Open Access Journals (Sweden)

    Laurens Manning

    Full Text Available BACKGROUND: Mortality from severe pediatric falciparum malaria appears low in Oceania but Plasmodium vivax is increasingly recognized as a cause of complications and death. The features and prognosis of mixed Plasmodium species infections are poorly characterized. Detailed prospective studies that include accurate malaria diagnosis and detection of co-morbidities are lacking. METHODS AND FINDINGS: We followed 340 Papua New Guinean (PNG children with PCR-confirmed severe malaria (77.1% P. falciparum, 7.9% P. vivax, 14.7% P. falciparum/vivax hospitalized over a 3-year period. Bacterial cultures were performed to identify co-incident sepsis. Clinical management was under national guidelines. Of 262 children with severe falciparum malaria, 30.9%, 24.8% and 23.2% had impaired consciousness, severe anemia, and metabolic acidosis/hyperlactatemia, respectively. Two (0.8% presented with hypoglycemia, seven (2.7% were discharged with neurologic impairment, and one child died (0.4%. The 27 severe vivax malaria cases presented with similar phenotypic features to the falciparum malaria cases but respiratory distress was five times more common (P=0.001; one child died (3.7%. The 50 children with P. falciparum/vivax infections shared phenotypic features of mono-species infections, but were more likely to present in deep coma and had the highest mortality (8.0%; P=0.003 vs falciparum malaria. Overall, bacterial cultures were positive in only two non-fatal cases. 83.6% of the children had alpha-thalassemia trait and seven with coma/impaired consciousness had South Asian ovalocytosis (SAO. CONCLUSIONS: The low mortality from severe falciparum malaria in PNG children may reflect protective genetic factors other than alpha-thalassemia trait/SAO, good nutrition, and/or infrequent co-incident sepsis. Severe vivax malaria had similar features but severe P. falciparum/vivax infections were associated with the most severe phenotype and worst prognosis.

  20. Clericuzio-type Poikiloderma with Neutropenia Syndrome in a Turkish Family: a Three Report of Siblings with Mutation in the C16orf57 gene

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    Turkan Patiroglu

    2015-10-01

    Full Text Available Clericuzio-type poikiloderma with neutropenia (PN is characterized by poikiloderma, non-cyclic  neutropenia,  recurrent  sinopulmonary  infections,  pachyonychia,  and  palmo- plantar hyperkeratosis. Mutations in the C16orf57 gene, which is located on chromosome 16q13, have been identified as the cause of PN. PN was first described by Clericuzio in Navajo Indians. Herein, we reported the clinical presentations and laboratory investigations of PN in three siblings from Turkey.The older siblings presented with typical cutaneous poikiloderma, plantar keratoderma, pachyonychia of toenails, and recurrent upper respiratory infections. As the most affected patient, in addition to classic manifestations, the youngest sibling had recurrent pneumonia, hepatosplenomegaly, dental caries, failure to thrive, and hand malformation.Genetic study revealed a homozygous mutation (c.531delA in the C16orf57 gene in siblings.With the presented study, we aimed to draw attention to PN which can be a predisposing factor to malignancies.

  1. Plasmodium falciparum variant surface antigen expression varies between isolates causing severe and nonsevere malaria and is modified by acquired immunity

    DEFF Research Database (Denmark)

    Nielsen, Morten A; Staalsoe, Trine; Kurtzhals, Jørgen; Goka, Bamenla Q; Dodoo, Daniel; Alifrangis, Michael; Theander, Thor G; Akanmori, Bartholomew D; Hviid, Lars

    2002-01-01

    In areas of endemic parasite transmission, protective immunity to Plasmodium falciparum malaria is acquired over several years with numerous disease episodes. Acquisition of Abs to parasite-encoded variant surface Ags (VSA) on the infected erythrocyte membrane is important in the development of...... immunity, as disease-causing parasites appear to be those not controlled by preexisting VSA-specific Abs. In this work we report that VSA expressed by parasites from young Ghanaian children with P. falciparum malaria were commonly and strongly recognized by plasma Abs from healthy children in the same area......, whereas recognition of VSA expressed by parasites from older children was weaker and less frequent. Independent of this, parasites isolated from children with severe malaria (cerebral malaria and severe anemia) were better recognized by VSA-specific plasma Abs than parasites obtained from children with...

  2. Atypical radiological and intraoperative findings of acute cerebral hemorrhage caused by ruptured cerebral aneurysm in a patient with severe chronic anemia.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Nakagawa, Shunsuke; Kato, Taisei; Kitamura, Takayuki; Sekine, Tetsuro; Takagi, Ryo; Teramoto, Akira

    2014-01-01

    Acute intracerebral hemorrhage (ICH) associated with mild anemia is commonly observed on radiological examination, and there are several reports of ruptured aneurysms occurring with ICH but without accompanying subarachnoid hemorrhage. However, the relationship among computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia has been rarely reported and is poorly understood. Here, we report atypical radiological and intraoperative findings of acute ICH caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. A 64-year-old man with anemia was admitted to our hospital after he experienced left hemiparesis and a disturbance of consciousness. At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104×10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6×10(4)/μL). Both CT and MRI showed a right frontal ICH. The outer ring of the hematoma appeared as low-density area on CT, a low-intensity area on T1-weighted MRI, and a high-intensity area on T2-weighted MRI with a serous component. The patient received a blood transfusion and underwent surgical removal of the hematoma the following day. The white serous effusion visualized with CT and MRI was identified as a blood clot in the hematoma cavity. The blood that leaks from blood vessels appears as a high-intensity area on CT because it undergoes plasma absorption in a solidification shrinkage process, and is, therefore, concentrated. Although we did not examine the white effusion to determine if serous components were present, we speculated that the effusion may have contained serous components. Therefore, we removed the part of the effusion that appeared as a low-density area on CT. The presence of ICH without subarachnoid hemorrhage suggested the possible adhesion and rupture of a previous

  3. The Effect of Recombinant Granulocyte Colony-Stimulating Factor on Oral and Periodontal Manifestations in a Patient with Cyclic Neutropenia: A Case Report

    Directory of Open Access Journals (Sweden)

    Sergio Matarasso

    2009-01-01

    Full Text Available Cyclic Neutropenia (CN is characterized by recurrent infections, fever, oral ulcerations, and severe periodontitis as result of the reduced host defences. The previous studies have established the effectiveness of recombinant granulocyte colony-stimulating factor (GCSF to increase the number and the function of neutrophils in the peripheral blood in this disease. In a 20-year-old Caucasian female with a diagnosis of cyclic neutropenia, oral clinical examination revealed multiple painful ulcerations of the oral mucosa, poor oral hygiene conditions, marginal gingivitis, and moderate periodontitis. The patient received a treatment with G-CSF (Pegfilgrastim, 6 mg/month in order to improve her immunological status. Once a month nonsurgical periodontal treatment was carefully performed when absolute neutrophil count (ANC was ≥500/L. The treatment with G-CSF resulted in a rapid increase of circulating neutrophils that, despite its short duration, leaded to a reduction in infection related events and the resolution of the multiple oral ulcerations. The disappearance of oral pain allowed an efficacy nonsurgical treatment and a normal tooth brushing that determined a reduction of probing depth (PD≤4 mm and an improvement of the oral hygiene conditions recorded at 6-month follow-up.

  4. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients.

    Directory of Open Access Journals (Sweden)

    Crystel M Gijsberts

    Full Text Available Coronary artery disease (CAD is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI with taxus and cardiac surgery" (SYNTAX score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays.We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians and Singapore (Chinese, Indians and Malays. Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI. We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality.Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years, multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30 occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02.Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians

  5. Review of five investigation committees' reports on the Fukushima Dai-ichi Nuclear Power Plant severe accident. Focusing on accident progression and causes

    International Nuclear Information System (INIS)

    On March 11, 2011, the Tohoku District-off the Pacific Ocean Earthquake and the subsequent tsunami resulted in the severe core damage at TEPCO's Fukushima Dai-ichi Nuclear Power Station Units 1-3, involving hydrogen explosions at Units 1, 3, and 4 and the large release of radioactive materials to the environment. Four independent committees were established by the Japanese government, the Diet of Japan, the Rebuild Japan Initiative Foundation, and TEPCO to investigate the accident and published their respective reports. Also, the Nuclear and Industrial Safety Agency carried out an analysis of accident causes to obtain the lessons learned from the accident and made its report public. This article reviews the reports and clarifies the differences in their positions, from the technological point of view, focusing on the accident progression and causes. Moreover, the undiscussed issues are identified to provide insights useful for the near-term regulatory activities including accident investigation by the Nuclear Regulation Authority. (author)

  6. Aspergilosis pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report

    Directory of Open Access Journals (Sweden)

    Miguel E. Pinto

    2012-06-01

    Full Text Available Se reporta el caso de una paciente de 48 años de edad con diagnóstico reciente de enfermedad de Graves, quien acudió a emergencia por presentar fiebre, palpitaciones y dolor faríngeo. Su tratamiento regular incluía metimazol. Al ingreso, los análisis mostraron TSH suprimido, T4 libre elevado y neutropenia. La paciente fue hospitalizada, se administraron antibióticos y factor estimulante de colonia. Después de diez días de tratamiento, la paciente presentó leucocitosis, fiebre y hemoptisis. La tomografía de tórax mostró una cavidad con múltiples nódulos en el lóbulo superior derecho. Los cultivos fueron positivos a Aspergillus fumigatus y Aspergillus flavus. Se inició tratamiento con anfotericina B y luego se cambió a voriconazol, a pesar de lo cual no hubo mejoría del cuadro. La paciente falleció por falla multiorgánica.A 48-year old woman with a recent diagnosis of Graves’ disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf. After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.

  7. Novel mutations in DNAJB6 gene cause a very severe early-onset limb-girdle muscular dystrophy 1D disease.

    Science.gov (United States)

    Palmio, Johanna; Jonson, Per Harald; Evilä, Anni; Auranen, Mari; Straub, Volker; Bushby, Kate; Sarkozy, Anna; Kiuru-Enari, Sari; Sandell, Satu; Pihko, Helena; Hackman, Peter; Udd, Bjarne

    2015-11-01

    DNAJB6 is the causative gene for limb-girdle muscular dystrophy 1D (LGMD1D). Four different coding missense mutations, p.F89I, p.F93I, p.F93L, and p.P96R, have been reported in families from Europe, North America and Asia. The previously known mutations cause mainly adult-onset proximal muscle weakness with moderate progression and without respiratory involvement. A Finnish family and a British patient have been studied extensively due to a severe muscular dystrophy. The patients had childhood-onset LGMD, loss of ambulation in early adulthood and respiratory involvement; one patient died of respiratory failure aged 32. Two novel mutations, c.271T > A (p.F91I) and c.271T > C (p.F91L), in DNAJB6 were identified by whole exome sequencing as a cause of this severe form of LGMD1D. The results were confirmed by Sanger sequencing. The anti-aggregation effect of the mutant DNAJB6 was investigated in a filter-trap based system using transient transfection of mammalian cell lines and polyQ-huntingtin as a model for an aggregation-prone protein. Both novel mutant proteins show a significant loss of ability to prevent aggregation. PMID:26338452

  8. Mutations in CDC14A, Encoding a Protein Phosphatase Involved in Hair Cell Ciliogenesis, Cause Autosomal-Recessive Severe to Profound Deafness.

    Science.gov (United States)

    Delmaghani, Sedigheh; Aghaie, Asadollah; Bouyacoub, Yosra; El Hachmi, Hala; Bonnet, Crystel; Riahi, Zied; Chardenoux, Sebastien; Perfettini, Isabelle; Hardelin, Jean-Pierre; Houmeida, Ahmed; Herbomel, Philippe; Petit, Christine

    2016-06-01

    By genetic linkage analysis in a large consanguineous Iranian family with eleven individuals affected by severe to profound congenital deafness, we were able to define a 2.8 Mb critical interval (at chromosome 1p21.2-1p21.1) for an autosomal-recessive nonsyndromic deafness locus (DFNB). Whole-exome sequencing allowed us to identify a CDC14A biallelic nonsense mutation, c.1126C>T (p.Arg376(∗)), which was present in the eight clinically affected individuals still alive. Subsequent screening of 115 unrelated individuals affected by severe or profound congenital deafness of unknown genetic cause led us to identify another CDC14A biallelic nonsense mutation, c.1015C>T (p.Arg339(∗)), in an individual originating from Mauritania. CDC14A encodes a protein tyrosine phosphatase. Immunofluorescence analysis of the protein distribution in the mouse inner ear showed a strong labeling of the hair cells' kinocilia. By using a morpholino strategy to knockdown cdc14a in zebrafish larvae, we found that the length of the kinocilia was reduced in inner-ear hair cells. Therefore, deafness caused by loss-of-function mutations in CDC14A probably arises from a morphogenetic defect of the auditory sensory cells' hair bundles, whose differentiation critically depends on the proper growth of their kinocilium. PMID:27259055

  9. Severe 2010 Cold-Water Event Caused Unprecedented Mortality to Corals of the Florida Reef Tract and Reversed Previous Survivorship Patterns

    Science.gov (United States)

    Lirman, Diego; Schopmeyer, Stephanie; Manzello, Derek; Gramer, Lewis J.; Precht, William F.; Muller-Karger, Frank; Banks, Kenneth; Barnes, Brian; Bartels, Erich; Bourque, Amanda; Byrne, James; Donahue, Scott; Duquesnel, Janice; Fisher, Louis; Gilliam, David; Hendee, James; Johnson, Meaghan; Maxwell, Kerry; McDevitt, Erin; Monty, Jamie; Rueda, Digna; Ruzicka, Rob; Thanner, Sara

    2011-01-01

    Background Coral reefs are facing increasing pressure from natural and anthropogenic stressors that have already caused significant worldwide declines. In January 2010, coral reefs of Florida, United States, were impacted by an extreme cold-water anomaly that exposed corals to temperatures well below their reported thresholds (16°C), causing rapid coral mortality unprecedented in spatial extent and severity. Methodology/Principal Findings Reef surveys were conducted from Martin County to the Lower Florida Keys within weeks of the anomaly. The impacts recorded were catastrophic and exceeded those of any previous disturbances in the region. Coral mortality patterns were directly correlated to in-situ and satellite-derived cold-temperature metrics. These impacts rival, in spatial extent and intensity, the impacts of the well-publicized warm-water bleaching events around the globe. The mean percent coral mortality recorded for all species and subregions was 11.5% in the 2010 winter, compared to 0.5% recorded in the previous five summers, including years like 2005 where warm-water bleaching was prevalent. Highest mean mortality (15%–39%) was documented for inshore habitats where temperatures were climatic events can have on the persistence of coral reefs. Moreover, habitats and species most severely affected were those found in high-coral cover, inshore, shallow reef habitats previously considered the “oases” of the region, having escaped declining patterns observed for more offshore habitats. Thus, the 2010 cold-water anomaly not only caused widespread coral mortality but also reversed prior resistance and resilience patterns that will take decades to recover. PMID:21853066

  10. Prevalence of Resistant Gram-Negative Bacilli in Bloodstream Infection in Febrile Neutropenia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Single Center Retrospective Cohort Study.

    Science.gov (United States)

    Wang, Ling; Wang, Ying; Fan, Xing; Tang, Wei; Hu, Jiong

    2015-11-01

    Bloodstream infection (BSI) is an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). To evaluate the causative bacteria and identify risk factors for BSI associated mortality in febrile neutropenia patients undergoing HSCT, we collected the clinical and microbiological data from patients underwent HSCT between 2008 and 2014 and performed a retrospective analysis. Throughout the study period, among 348 episodes of neutropenic fever in patients underwent HSCT, 89 episodes in 85 patients had microbiological defined BSI with a total of 108 isolates. Gram-negative bacteria (GNB) were the most common isolates (76, 70.3%) followed by gram-positive bacteria (GPB, 29, 26.9%) and fungus (3, 2.8%). As to the drug resistance, 26 multiple drug resistance (MDR) isolates were identified. Resistant isolates (n = 23) were more common documented in GNB, mostly Escherichia coli (9/36, 25%) and Klebsiella pneumonia (6/24, 25%). A total of 12 isolated were resistant to carbapenem including 4 K pneumoniae (4/24, 16.7%), 3 Stenotrophomonas maltophilia, and 1 Pseudomonas aeruginosa and other 4 GNB isolates (Citrobacter freumdii, Pseudomonas stutzeri, Acinetobacter baumanii, and Chryseobacterium indologenes). As to the GPB, only 3 resistant isolates were documented including 2 methicillin-resistant isolates (Staphylococcus hominis and Arcanobacterium hemolysis) and 1 vancomycin-resistant Enterococcus faecium. Among these 85 patients with documented BSI, 11 patients died of BSI as primary or associated cause with a BSI-related mortality of 13.1 ± 3.7% and 90-day overall survival after transplantation at 80.0 ± 4.3%. Patients with high-risk disease undergoing allo-HSCT, prolonged neutropenia (≥15 days) and infection with carbapenem-resistant GNB were associated with BSI associated mortality in univariate and multivariate analyses. Our report revealed a prevalence of GNB in BSI of neutropenic patients undergoing

  11. Somatic-cell selection is a major determinant of the blood-cell phenotype in heterozygotes for glucose-6-phosphate dehydrogenase mutations causing severe enzyme deficiency

    Energy Technology Data Exchange (ETDEWEB)

    Filosa, S.; Giacometti, N.; Wangwei, C.; Martini, G. [Istituto Internazionale di Genetica e Biofisica, Naples (Italy)] [and others

    1996-10-01

    X-chromosome inactivation in mammals is regarded as an essentially random process, but the resulting somatic-cell mosaicism creates the opportunity for cell selection. In most people with red-blood-cell glucose-6-phosphate dehydrogenase (G6PD) deficiency, the enzyme-deficient phenotype is only moderately expressed in nucleated cells. However, in a small subset of hemizygous males who suffer from chronic nonspherocytic hemolytic anemia, the underlying mutations (designated class I) cause more-severe G6PD deficiency, and this might provide an opportunity for selection in heterozygous females during development. In order to test this possibility we have analyzed four heterozygotes for class I G6PD mutations: two with G6PD Portici (1178G{r_arrow}A) and two with G6PD Bari (1187C{r_arrow}T). We found that in fractionated blood cell types (including erythroid, myeloid, and lymphoid cell lineages) there was a significant excess of G6PD-normal cells. The significant concordance that we have observed in the degree of imbalance in the different blood-cell lineages indicates that a selective mechanism is likely to operate at the level of pluripotent blood stem cells. Thus, it appears that severe G6PD deficiency affects adversely the proliferation or the survival of nucleated blood cells and that this phenotypic characteristic is critical during hematopoiesis. 65 refs., 6 figs., 3 tabs.

  12. CLIMATIC SEVERITY VICTIMS OF UPSTREAM WATER PIRACY STRONGLY EVIDENCING INLAND WATER DEPLETION-CAUSED GLOBAL WARMING VIS-A-VIS COOLING

    Directory of Open Access Journals (Sweden)

    Miah M. Adel

    2014-01-01

    Full Text Available Since the 80’s, the northwestern and the southwestern parts of the tropical Bangladesh located in the downstream Ganges basin have been having summer temperature above 109°F and winter temperature as low as 37°F. Every year people, particularly, the infants die from heat-and cold-related diseases and hospitals become packed-up with the victims of severe climatic condition. The objective of this research is to find the reason for the appearances of the extreme climate in certain parts of the country. Water bodies being reservoirs of heat, the condition of the rivers and other surface water resources has been examined. It is found that the continued water piracy at the upstream from the downstream Bangladesh Ganges discharge, the major source of water for the northwestern and southwestern parts, has depleted surface water resources and sunken the down the groundwater table. About 60% evaporation of the massively extracted groundwater to make up for the surface water shortage goes to merely increase the relative humidity without causing rainfall. Summer time lingering high temperature and high humidity cause the severity of summer weather. In the absence of the virgin surface water bodies, there is little room for storing heat for wintertime warming. The entire Ganges basin loses at least 10 times the heat it used to store in the water-abundant days. Summertime maximum temperature, HDDs and CDDs are negatively and wintertime minimum temperature is positive correlated with the decline of the Ganges’s discharge. Indian Government has to decommission her dams and barrages to mitigate the sufferings of the downstream people in Bangladesh. The greatest implication of this research is the accountability of the anthropogenic actions-caused depleting inland water bodies through storing, distribution via multi-channeling, irrigation, industrial and domestic use, for the occurrences of global heating vis-à-vis cooling and not CO2 and other

  13. Prophylaxis against febrile neutropenia with pegfilgrastim in Italy: a budget impact analysis

    Directory of Open Access Journals (Sweden)

    Giovanni Rosti

    2011-09-01

    Full Text Available Introduction: prophylaxis with granulocyte colony-stimulating factors (G-CSF is indicated for reduction in the duration of neutropenia and the incidence of febrile neutropenia in patients treated with cytotoxic chemotherapy for malignancy.
Objective: to evaluate the budgetary impact for the Italian NHS.
Design: a decision-analytic model has been developed to analyze the budget impact from the national health care system perspective. Costs include direct healthcare costs to the public payer of G-CSFs as well as their administration costs and costs of FN-related events. The comparison has been done using prophylaxis with G‑CSF (filgrastim for 11 days, pegfilgrastim, lenograstim for 11 days and antibiotics.
Patients and participants: The population of interest for the analysis were patients with breast cancer in stage II and III and patients with non-Hodgkin’s lymphoma (NHL.
Main outcome measures and results: for all the three patients group (NHL, Breast II and III, and for all the chemotherapy regimens (CHOP 21 and R-CHOP 21 for NHL, AC-T, TAC and TC for Breast stage II and III the budget impact analyses shows a cost reduction for the Italian NHS, as a result of an increase of the use of pegfilgrastim.
Conclusions: in Italy, a treatment strategy including pegfilgrastim as either primary or secondary prophylaxis provides value for money.


  14. Is preemptive antifungal therapy a good alternative to empirical treatment in prolonged febrile neutropenia?

    Directory of Open Access Journals (Sweden)

    Erica Koch

    2016-06-01

    Full Text Available La neutropenia febril prolongada conlleva un alto riesgo de desarrollar infecciones fúngicas invasoras, por lo que habitualmente se administra terapia antifúngica empírica en estos casos. Sin embargo, esta se asocia a importantes efectos adversos, por lo que se ha propuesto como alternativa la estrategia "preemptive" o anticipada, es decir, la indicación de antifúngicos sólo ante la evidencia indirecta de infección fúngica invasora. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos tres revisiones sistemáticas que en conjunto incluyen doce estudios. Cuatro estudios aleatorizados evaluaron la pregunta abordada en este artículo. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que no está claro si la estrategia "preemptive" tiene algún efecto sobre la mortalidad porque la certeza de la evidencia es muy baja, pero podría disminuir levemente el uso de antifúngicos en pacientes con neutropenia febril prolongada.

  15. Caracterización de pacientes pediátricos con neutropenia enviados a un hospital de referencia

    OpenAIRE

    Gustavo Adolfo Lazo-Páez; Oscar Porras

    2010-01-01

    Objetivo: La neutropenia es un motivo relativamente frecuente de referencia al Servicio de Inmunología y Reumatología Pediátrica del Hospital Nacional de Niños; el estudio pretende caracterizar los casos de neutropenia referidos a este Servicio en el periodo comprendido entre noviembre de 1988 y junio de 2008. Métodos: Se estudiaron 84 pacientes entre 0 y 12 años de edad, referidos entre el 6 de noviembre de 1988 y el 1 de junio de 2008. Se efectuó un análisis descriptivo global de las caract...

  16. Quality of Life and Neutropenia in Patients with Early Stage Breast Cancer: A Randomized Pilot Study Comparing Additional Treatment with Mistletoe Extract to Chemotherapy Alone

    OpenAIRE

    Tröger, Wilfried; Jezdić, Svetlana; Ždrale, Zdravko; Tišma, Nevena; Hamre, Harald J; Matijašević, Miodrag

    2009-01-01

    Background: Chemotherapy for breast cancer often deteriorates quality of life, augments fatigue, and induces neutropenia. Mistletoe preparations are frequently used by cancer patients in Central Europe. Physicians have reported better quality of life in breast cancer patients additionally treated with mistletoe preparations during chemotherapy. Mistletoe preparations also have immunostimulant properties and might therefore have protective effects against chemotherapy-induced neutropenia. Pati...

  17. Quality of Life and Neutropenia in Patients with Early Stage Breast Cancer: A Randomized Pilot Study Comparing Additional Treatment with Mistletoe Extract to Chemotherapy Alone

    OpenAIRE

    Wilfried Tröger; Svetlana Jezdić; Zdravko Ždrale; Nevena Tišma; Hamre, Harald J; Miodrag Matijašević

    2009-01-01

    Background: Chemotherapy for breast cancer often deteriorates quality of life, augments fatigue, and induces neutropenia. Mistletoe preparations are frequently used by cancer patients in Central Europe. Physicians have reported better quality of life in breast cancer patients additionally treated with mistletoe preparations during chemotherapy. Mistletoe preparations also have immunostimulant properties and might therefore have protective effects against chemotherapy-induced neutropenia.Patie...

  18. An international, multicenter, prospective, observational study of neutropenia in patients being treated with lenalidomide + dexamethasone for relapsed or relapsed/refractory multiple myeloma (RR-MM).

    Science.gov (United States)

    Leleu, Xavier; Terpos, Evangelos; Sanz, Ramón García; Cooney, Julian; O'Gorman, Peter; Minarik, Jiri; Greil, Richard; Williams, Catherine; Gray, Diep; Szabo, Zsolt

    2016-08-01

    Neutropenia is a well-known dose-limiting toxicity associated with lenalidomide plus dexamethasone treatment in patients with multiple myeloma; however, little is known about its management and associated outcomes in the real world setting. The present prospective, multicenter, observational study evaluated the incidence, management, and outcomes of grade 3/4 neutropenia in patients with relapsed or relapsed/refractory multiple myeloma who initiated treatment with lenalidomide plus dexamethasone. Of 198 patients, 62 (31%, 95% CI: 25, 38) experienced grade 3/4 neutropenia, and half of these patients experienced 3 or more events during the 12-month observational period. Grade 3/4 neutropenia occurred throughout lenalidomide treatment, with a median time to first event of 8.8 weeks (Q1, Q3: 5.9, 17.3). In a multivariate analysis, diagnosis of relapsed and refractory disease was associated with grade 3/4 neutropenia. Lenalidomide exposure reduction, use of G-CSF, unplanned hospitalization, and outpatient clinic visits were more common in patients who experienced grade 3/4 neutropenia than in those who did not. In conclusion, grade 3/4 neutropenia is a common toxicity and patients are at continued risk throughout treatment with lenalidomide and dexamethasone. Further efforts should be made to improve the recommendations for neutropenia management in this population. Am. J. Hematol. 91:806-811, 2016. © 2016 Wiley Periodicals, Inc. PMID:27169523

  19. A novel splice variant in the N-propeptide of COL5A1 causes an EDS phenotype with severe kyphoscoliosis and eye involvement.

    Directory of Open Access Journals (Sweden)

    Sofie Symoens

    Full Text Available BACKGROUND: The Ehlers-Danlos Syndrome (EDS is a heritable connective tissue disorder characterized by hyperextensible skin, joint hypermobility and soft tissue fragility. The classic subtype of EDS is caused by mutations in one of the type V collagen genes (COL5A1 and COL5A2. Most mutations affect the type V collagen helical domain and lead to a diminished or structurally abnormal type V collagen protein. Remarkably, only two mutations were reported to affect the extended, highly conserved N-propeptide domain, which plays an important role in the regulation of the heterotypic collagen fibril diameter. We identified a novel COL5A1 N-propeptide mutation, resulting in an unusual but severe classic EDS phenotype and a remarkable splicing outcome. METHODOLOGY/PRINCIPAL FINDINGS: We identified a novel COL5A1 N-propeptide acceptor-splice site mutation (IVS6-2A>G, NM_000093.3_c.925-2A>G in a patient with cutaneous features of EDS, severe progressive scoliosis and eye involvement. Two mutant transcripts were identified, one with an exon 7 skip and one in which exon 7 and the upstream exon 6 are deleted. Both transcripts are expressed and secreted into the extracellular matrix, where they can participate in and perturb collagen fibrillogenesis, as illustrated by the presence of dermal collagen cauliflowers. Determination of the order of intron removal and computational analysis showed that simultaneous skipping of exons 6 and 7 is due to the combined effect of delayed splicing of intron 7, altered pre-mRNA secondary structure, low splice site strength and possibly disturbed binding of splicing factors. CONCLUSIONS/SIGNIFICANCE: We report a novel COL5A1 N-propeptide acceptor-splice site mutation in intron 6, which not only affects splicing of the adjacent exon 7, but also causes a splicing error of the upstream exon 6. Our findings add further insights into the COL5A1 splicing order and show for the first time that a single COL5A1 acceptor-splice site

  20. Identification of a novel SERPINA-1 mutation causing alpha-1 antitrypsin deficiency in a patient with severe bronchiectasis and pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Milger K

    2015-05-01

    Full Text Available Katrin Milger,1 Lesca Miriam Holdt,2 Daniel Teupser,2 Rudolf Maria Huber,1 Jürgen Behr,1 Nikolaus Kneidinger1 1Department of Internal Medicine V, University of Munich, Comprehensive Pneumology Center, Member of the German Center for Lung Research, 2Institute of Laboratory Medicine, University of Munich, Munich, Germany Abstract: Deficiency in the serine protease inhibitor, alpha-1 antitrypsin (AAT, is known to cause emphysema and liver disease. Other manifestations, including airway disease or skin disorders, have also been described. A 44-year-old woman presented to our emergency department with dyspnea and respiratory insufficiency. She had never smoked, and had been diagnosed with COPD 9 years earlier. Three months previously, she had suffered a pulmonary embolism. Chest computed tomography scan revealed severe cystic bronchiectasis with destruction of the lung parenchyma. The sweat test was normal and there was no evidence of the cystic fibrosis transmembrane conductance regulator (CFTR mutation. Capillary zone electrophoresis showed a decrease of alpha-1 globin band and AAT levels were below the quantification limit (<25 mg/dL. No S or Z mutation was identified, but sequencing analysis found a homozygous cytosine and adenine (CA insertion in exon 2 of the SERPINA-1 gene, probably leading to a dysfunctional protein (PI Null/Null. This mutation has not been previously identified. The atypical presentation of the patient, with severe cystic bronchiectasis, highlights AAT deficiency as a differential diagnosis in bronchiectasis. Further, awareness should be raised regarding a possible increased risk of thromboembolism associated with AAT deficiency. Keywords: alpha-1 antitrypsin deficiency, bronchiectasis, SERPINA-1 mutation, pulmonary embolism

  1. Analisi Costo-Efficacia di Amfotericina B Liposomiale (L-AmB versus Amfotericina B Complesso Lipidico (ABLC nel trattamento empirico della neutropenia febbrile

    Directory of Open Access Journals (Sweden)

    Mario Eandi

    2005-12-01

    Full Text Available Current international guidelines for the management of immuno-compromised patients with febrile neutropenia recommend a systemic antimicrobial therapy if fever hasn’t receded after three days of antibiotic treatment. Amphotericin B remains the gold standard because of its broad spectrum fungicidal action and minimal resistance development risk. Nonetheless, therapeutic use of the standard formulation, Amphotericin B deoxycholate, is limited by its toxicity, especially on the kidneys. To counteract this, amphotericin B has been encapsulated in liposomes, a process which reduces its toxicity and allows higher doses to be given. Three lipid formulations have been developed and are now available in most countries: amB colloidal dispersion (ABCD, amB lipid complex (ABLC, and liposomal amB (L-AmB. These lipid formulations differ in pharmacodynamics and pharmacokinetics, and can’t therefore be considered interchangeable. Besides, they are more expensive than Amphotericin B deoxycholate. Aim of the study is to perform a cost/effectiveness analysis (CEA comparing L-AmB (3mg/kg/die or 5mg/kg/ die and ABLC (5mg/kg/die as first-line antimicrobial empirical treatments in immuno-compromised patients with febrile neutropenia resistant to broad spectrum antibiotics. Secondly, we present a cost-minimization analysis (CMA of the considered alternatives, assuming the same efficacy for all treatments. At the end we value the principal cost items from the point of view of the Italian Health Service, with a particular focus on the economic burden caused by adverse reactions.

  2. Molecular composition and size distribution of sugars, sugar-alcohols and carboxylic acids in airborne particles during a severe urban haze event caused by wheat straw burning

    Science.gov (United States)

    Wang, Gehui; Chen, Chunlei; Li, Jianjun; Zhou, Bianhong; Xie, Mingjie; Hu, Shuyuan; Kawamura, Kimitaka; Chen, Yan

    2011-05-01

    Molecular compositions and size distributions of water-soluble organic compounds (WSOC, i.e., sugars, sugar-alcohols and carboxylic acids) in particles from urban air of Nanjing, China during a severe haze event caused by field burning of wheat straw were characterized and compared with those in the summer and autumn non-haze periods. During the haze event levoglucosan (4030 ng m -3) was the most abundant compound among the measured WSOC, followed by succinic acid, malic acid, glycerol, arabitol and glucose, being different from those in the non-haze samples, in which sucrose or azelaic acid showed a second highest concentration, although levoglucosan was the highest. The measured WSOC in the haze event were 2-20 times more than those in the non-hazy days. Size distribution results showed that there was no significant change in the compound peaks in coarse mode (>2.1 μm) with respect to the haze and non-haze samples, but a large difference in the fine fraction (glucose and related sugar-alcohols whose concentrations significantly increased in the fine haze samples are unclear. Compared to that in the fresh smoke particles of wheat straw burning an increase in relative abundance of succinic acid to levoglucosan during the haze event suggests a significant production of secondary organic aerosols during transport of the smoke plumes.

  3. A series of abnormal climatic conditions caused the most severe outbreak of first-generation adults of the meadow moth ( Loxostege sticticalis L.) in China

    Science.gov (United States)

    Chen, Xiao; Zeng, Juan; Zhai, Baoping

    2016-06-01

    The meadow moth, Loxostege sticticalis L., is a destructive migratory pest in the northern temperate zone. The outbreak mechanism of first-generation adults in China remains unclear. In 2008, the density of first-generation larvae was very low or even negligible in most sites in China. However, a great number of first-generation adults appeared unexpectedly in late July, and their offspring caused the most severe infestation on record. The present study aims to determine where the large influx of immigrant adults originated from and how this unprecedented population was established. Source areas were explored by trajectory analysis, and climatic patterns related to the population increase were investigated. Results showed that the outbreak population mainly immigrated from Northeast Mongolia and the Chita State of Russia, and the buildup of such a large population could be attributed to an exceptional northward migration of overwintered adults from North China to East Mongolia in the spring of 2007 and unusually favourable climatic conditions in the next two growth seasons. These results indicated that the population dynamics of meadow moth in Northeast Asia would be difficult to predict when only considering local climatic factors and population size within one country. International joint monitoring and information sharing related to this pest between China, Mongolia and Russia should be implemented.

  4. Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions.

    Science.gov (United States)

    Watanabe, Hideaki; Kamiyama, Taisuke; Sasaki, Shun; Kobayashi, Kae; Fukuda, Kenichiro; Miyake, Yasufumi; Aruga, Tohru; Sueki, Hirohiko

    2016-03-01

    Toxic epidermal necrolysis (TEN) is an adverse reaction that can be induced by various drugs; the associated mortality rate is 20-25%. A previous report showed a weak association between TEN and acetaminophen. Recently, the US Food and Drug Administration declared that acetaminophen is associated with a risk of serious skin reactions, including TEN. Here, we describe the case of a 43-year-old Japanese woman with TEN caused by acetaminophen. She had poorly controlled ulcerative colitis and was treated with high doses of prednisolone, infliximab, acetaminophen and lansoprazole. Nine days after administrating acetaminophen, targetoid erythematous and bullous lesions appeared on the patient's trunk, palms and the soles of her feet. The skin lesions expanded rapidly; within 3 weeks, skin detachment was detected across nearly 100% of the patient's body. However, no mucosal involvement of the eyes, oral cavity or genitalia was found. We performed lymphocyte transformation tests using various drugs; however, a high stimulation index was obtained only with acetaminophen. The patient recovered following treatment with plasmapheresis, i.v. immunoglobulin therapy, topical medication and supportive therapy. Acetaminophen is included in many prescription and over-the-counter products; thus, clinicians should monitor their patients for severe drug reactions, including TEN. PMID:26362011

  5. A series of abnormal climatic conditions caused the most severe outbreak of first-generation adults of the meadow moth (Loxostege sticticalis L.) in China

    Science.gov (United States)

    Chen, Xiao; Zeng, Juan; Zhai, Baoping

    2015-10-01

    The meadow moth, Loxostege sticticalis L., is a destructive migratory pest in the northern temperate zone. The outbreak mechanism of first-generation adults in China remains unclear. In 2008, the density of first-generation larvae was very low or even negligible in most sites in China. However, a great number of first-generation adults appeared unexpectedly in late July, and their offspring caused the most severe infestation on record. The present study aims to determine where the large influx of immigrant adults originated from and how this unprecedented population was established. Source areas were explored by trajectory analysis, and climatic patterns related to the population increase were investigated. Results showed that the outbreak population mainly immigrated from Northeast Mongolia and the Chita State of Russia, and the buildup of such a large population could be attributed to an exceptional northward migration of overwintered adults from North China to East Mongolia in the spring of 2007 and unusually favourable climatic conditions in the next two growth seasons. These results indicated that the population dynamics of meadow moth in Northeast Asia would be difficult to predict when only considering local climatic factors and population size within one country. International joint monitoring and information sharing related to this pest between China, Mongolia and Russia should be implemented.

  6. A clinical analysis of 361 cases of Graves disease combined with neutropenia or agranulocytosis%Graves 病合并粒细胞减少或缺乏361例临床分析

    Institute of Scientific and Technical Information of China (English)

    闫文博; 秦贵军

    2016-01-01

    Objective To explore the prevalence and the correlation factors of neutropenia or agranulocytosis in patients with Graves disease.Methods The clinical data of 361 patients diagnosed as Graves disease in General Hospital of Pingmei Shenma Medical Group from February of 201 0 to February of 201 5 were analyzed retrospectively.Results Among 361 patients,there were altogether 1 27 patients with neutropenia or agranulocytosis(35.1 8%),1 23 with neutropenia(34.07%),4 with agranulocy-tosis(1 .1 1 %).Among the 1 27 cases,72 (56.69%)were caused by Graves disease,and 55 were caused by antithyroid drugs (ATD)(43.31 %).Among neutropenia or agranulocytosis caused by Graves disease itself,the neutrophil count were negatively correlated with age,free triiodothyronine (FT3 ),free thyroxine(FT4 )and TSH receptor stimulation antibody(TSAb).Conclu-sion The incidence of neutropenia was relatively high in patients with Graves disease,and the neutropenia induced by Graves disease itself may be related with the degree of hyperthyroidism.%目的:探讨 Graves 病患者合并粒细胞减少或缺乏的发生率及相关因素。方法对平煤神马医疗集团总医院2010年2月至2015年2月收治的361例 Graves 患者的临床资料进行回顾性分析。结果361例 Graves 患者中,粒细胞减少或缺乏127例(35.18%):粒细胞减少123例(34.07%),粒细胞缺乏4例(1.11%)。其中 Graves 疾病本身导致者72例(56.69%),抗甲状腺药物(ATD)导致者55例(43.31%)。在 Graves 疾病本身所致的粒细胞减少或缺乏中,粒细胞计数与年龄、FT3、FT4、TSH 受体刺激性抗体(TSAb)呈负相关。结论Graves 病患者合并粒细胞减少的发生率较高,其疾病本身所导致的粒细胞减少可能与甲亢的病情程度相关。

  7. Caracterización de pacientes pediátricos con neutropenia enviados a un hospital de referencia

    Directory of Open Access Journals (Sweden)

    Gustavo Adolfo Lazo-Páez

    2010-06-01

    Full Text Available Objetivo: La neutropenia es un motivo relativamente frecuente de referencia al Servicio de Inmunología y Reumatología Pediátrica del Hospital Nacional de Niños; el estudio pretende caracterizar los casos de neutropenia referidos a este Servicio en el periodo comprendido entre noviembre de 1988 y junio de 2008. Métodos: Se estudiaron 84 pacientes entre 0 y 12 años de edad, referidos entre el 6 de noviembre de 1988 y el 1 de junio de 2008. Se efectuó un análisis descriptivo global de las características presentadas por estos pacientes en términos de evolución clínica, patrón de infección, gérmenes más frecuentes causantes de infección, complicaciones y tratamiento. Resultados: El 52.2% de los pacientes analizados resolvieron su neutropenia espontáneamente, por lo que fueron catalogados como neutropenia transitoria; el 21.7% de los casos evolucionó como neutropenia cíclica; el 13% de los pacientes fueron catalogados como neutropenia crónica benigna; el 7.2% evolucionaron como neutropenia crónica grave sintomática; el 2.9% tuvieron neutropenia asociada a glucogenosis tipo 1B, y el 2.9% de los casos no fueron clasificables en las categorías propuestas. El 56.5% de los casos se asoció a un patrón de infección anormal, sea por incremento en la frecuencia, mayor gravedad, compromiso multisistémico o presencia de microorganismos oportunistas. El sistema más afectado por infección fue la vía respiratoria superior. El 39.1% de los casos de neutropenia evaluados ameritaron uso de antibióticos profilácticos, y el 11.6% de los casos requirieron usar factor estimulante de colonias granulocíticas, en algún momento de su evolución. Los gérmenes más frecuentemente involucrados en infección fueron Pseudomona aeruginosa, Staphylococcus spp y E. coli. Conclusión: La gran mayoría de los pacientes neutropénicos estudiados tiene un curso clínico benigno caracterizado por pocas hospitalizaciones y una intervención farmacol

  8. Prolonged or Standard Infusion of Cefepime Hydrochloride in Treating Patients With Febrile Neutropenia

    Science.gov (United States)

    2013-07-10

    Adult Acute Lymphoblastic Leukemia; Adult Acute Myeloid Leukemia; Adult Burkitt Lymphoma; Adult Diffuse Large Cell Lymphoma; Adult Diffuse Mixed Cell Lymphoma; Adult Diffuse Small Cleaved Cell Lymphoma; Adult Hodgkin Lymphoma; Adult Immunoblastic Large Cell Lymphoma; Adult Lymphoblastic Lymphoma; Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative; Breast Cancer; Chronic Eosinophilic Leukemia; Chronic Lymphocytic Leukemia; Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; Chronic Neutrophilic Leukemia; Cutaneous T-cell Non-Hodgkin Lymphoma; Disseminated Neuroblastoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Grade 1 Follicular Lymphoma; Grade 2 Follicular Lymphoma; Grade 3 Follicular Lymphoma; Malignant Testicular Germ Cell Tumor; Mantle Cell Lymphoma; Marginal Zone Lymphoma; Multiple Myeloma; Mycosis Fungoides/Sezary Syndrome; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Neutropenia; Nodal Marginal Zone B-cell Lymphoma; Ovarian Epithelial Cancer; Ovarian Germ Cell Tumor; Plasma Cell Neoplasm; Poor Prognosis Metastatic Gestational Trophoblastic Tumor; Primary Myelofibrosis; Prolymphocytic Leukemia; Small Lymphocytic Lymphoma; Splenic Marginal Zone Lymphoma

  9. Rituximab-induced neutropenia in a patient with inflammatory myopathy and systemic sclerosis overlap disease

    Science.gov (United States)

    Roberts, Mark; Oddis, Chester; Herrick, Arianne; Chinoy, Hector

    2016-01-01

    Rituximab (RTX) is a monoclonal chimeric antibody directed against the CD20 antigen of B lymphocytes. Late onset neutropenia (LON) is a recognised complication of rituximab usually occurring 4 weeks after the last dose and is reported in both haematological and rheumatological conditions. However, it has never been described in a patient with myositis and systemic sclerosis overlap disease. We describe a case of LON in a 54-year-old man who was diagnosed with myositis and then systemic sclerosis overlap disease. It resolved within 7 days, and the patient did not suffer neutropenic sepsis or any other complications. We propose similar mechanisms for LON as described in other conditions and routine blood monitoring in such patients. PMID:27407275

  10. Fever and neutropenia hospital discharges in children with cancer: A 2012 update.

    Science.gov (United States)

    Mueller, Emily L; Croop, James; Carroll, Aaron E

    2016-02-01

    Fever and neutropenia (FN) is a common precipitant for hospitalization among children with cancer, but hospital utilization trends are not well described. This study describes national trends for hospital discharges for FN among children with cancer for the year 2012, compared with the authors' previous analysis from 2009. Data were analyzed from the Kids' Inpatient Database (KID), an all-payer US hospital database, for 2012. Pediatric patients with cancer who had a discharge for FN were identified using age ≤19 years, urgent or emergent admit type, nontransferred, and a combination of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for fever and neutropenia. The authors evaluated factors associated with a "short length of stay" (SLOS). Sampling weights were used to permit national inferences. In 2012, children with cancer accounted for 1.8% of pediatric hospital discharges (n = 120,675), with 12.2% (n = 13,456) of cancer-related discharges meeting FN criteria. Two fifths of FN discharges had a SLOS, which accounted for $91 million (2015 US$) in hospital charges. The majority had no serious infections; most common infections were viral infection (9.6%) or upper respiratory infection (9.6%). Factors significantly associated with SLOS included having a diagnosis of ear infection (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.03), soft tissue sarcoma (OR = 1.47, CI: 1.10-1.95), and Hodgkin lymphoma (OR = 1.51, CI: 1.09-2.10), as compared with not having those diagnoses. SLOS admissions continue to be rarely associated with serious infections, but contribute substantially to the burden of hospitalization for pediatric FN. Implementation of risk stratification schemas to identify patients who meet low-risk criteria may decrease financial burden. PMID:26900730

  11. Overexpression of AtDREB1A causes a severe dwarf phenotype by decreasing endogenous gibberellin levels in soybean [Glycine max (L. Merr].

    Directory of Open Access Journals (Sweden)

    Haicui Suo

    Full Text Available Gibberellic acids (GAs are plant hormones that play fundamental roles in plant growth and developmental processes. Previous studies have demonstrated that three key enzymes of GA20ox, GA3ox, and GA2ox are involved in GA biosynthesis. In this study, the Arabidopsis DREB1A gene driven by the CaMV 35S promoter was introduced into soybean plants by Agrobacterium- mediated transformation. The results showed that the transgenic soybean plants exhibited a typical phenotype of GA-deficient mutants, such as severe dwarfism, small and dark-green leaves, and late flowering compared to those of the non-transgenic plants. The dwarfism phenotype was rescued by the application of exogenous GA(3 once a week for three weeks with the concentrations of 144 µM or three times in one week with the concentrations of 60 µM. Quantitative RT-PCR analysis revealed that the transcription levels of the GA synthase genes were higher in the transgenic soybean plants than those in controls, whereas GA-deactivated genes except GmGA2ox4 showed lower levels of expression. The transcript level of GmGA2ox4 encoding the only deactivation enzyme using C(20-GAs as the substrates in soybean was dramatically enhanced in transgenic plants compared to that of wide type. Furthermore, the contents of endogenous bioactive GAs were significantly decreased in transgenic plants than those of wide type. The results suggested that AtDREB1A could cause dwarfism mediated by GA biosynthesis pathway in soybean.

  12. Failure of filgrastim to prevent severe clozapine-induced agranulocytosis.

    Science.gov (United States)

    Majczenko, Tricia G; Stewart, Jonathan T

    2008-06-01

    Although a highly effective medication, the usage of clozapine is limited mostly by its 2.7% incidence of neutropenia. It is often a treatment of last resort for patients with severe psychiatric illnesses, and therefore often the only medication to which a patient has responded. There has thus been a great deal of interest in ways to continue the medication in spite of emergent blood dyscrasias. There have been several reports documenting the successful continuation of clozapine in spite of neutropenia by adding granulocyte colony-stimulating factors such as filgrastim. This strategy was unsuccessful for a 63-year-old man, resulting in severe, prolonged agranulocytosis. Although a promising strategy for such refractory patients, its inherent dangers should not be underestimated. PMID:18475227

  13. Xenopus laevis P23H rhodopsin transgene causes rod photoreceptor degeneration that is more severe in the ventral retina and is modulated by light

    OpenAIRE

    Zhang, Rui; Oglesby, Ericka; Marsh-Armstrong, Nicholas

    2008-01-01

    Rhodopsin transgenes carrying mutations that cause autosomal dominant retinitis pigmentosa in humans have been used to study rod photoreceptor degeneration in various model organisms including Xenopus laevis. To date, the only transgenes shown to cause rod photoreceptor degeneration in Xenopus laevis have been either mammalian rhodopsins or chimeric versions of rhodopsin based mainly on Xenopus laevis rhodopsin sequences but with a mammalian C-terminus. Since the C-terminal sequence of rhodop...

  14. Alcohol May Not Cause Partner Violence but It Seems to Make It Worse: A Cross National Comparison of the Relationship between Alcohol and Severity of Partner Violence

    Science.gov (United States)

    Graham, Kathryn; Bernards, Sharon; Wilsnack, Sharon C.; Gmel, Gerhard

    2011-01-01

    This study assesses whether severity of physical partner aggression is associated with alcohol consumption at the time of the incident, and whether the relationship between drinking and aggression severity is the same for men and women and across different countries. National or large regional general population surveys were conducted in 13…

  15. [Clinical Investigation of the Effects of Filgrastim BS1 on Neutropenia Following Oral Cancer Chemotherapy (TPF Therapy)].

    Science.gov (United States)

    Uchiyama, Kimio; Yamada, Manabu; Tamate, Shusuke; Iwasaki, Konomi; Mitomo, Keisuke; Nakayama, Seiichi

    2015-09-01

    The time for the neutrophil count to recover after subcutaneous injection of filgrastim BS1 or lenograstim was studied in patients suffering from neutropenia following preoperative combined chemotherapy using docetaxel, nedaplatin, or cisplatin (in divided doses for 5 days)and 5-fluorouracil for oral cancer. 1. There was no significant difference in the minimum leukocyte and neutrophil counts after chemotherapy. 2. There was no significant difference in the maximum leukocyte and neutrophil counts after chemotherapy. 3. Time for leukocytes to recover from their minimum count(>4,000/mm3)or for neutrophils to recover from their minimum count(>2,000/mm3)and the number of days on which treatment was administered tended to be shorter in the filgrastim BS1 group. Thus, it was concluded that filgrastim BS1 is just as effective as other prior G-CSF agents in treating patients suffering from neutropenia following chemotherapy(TPF therapy). PMID:26469162

  16. Giant Cell Arteritis which Developed after the Administration of Granulocyte-colony Stimulating Factor for Cyclic Neutropenia.

    Science.gov (United States)

    Umeda, Masataka; Ikenaga, Jin; Koga, Tomohiro; Michitsuji, Toru; Shimizu, Toshimasa; Fukui, Shoichi; Nishino, Ayako; Nakasima, Yoshikazu; Kawashiri, Sin-Ya; Iwamoto, Naoki; Ichinose, Kunihiro; Hirai, Yasuko; Tamai, Mami; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi

    2016-01-01

    A 78-year-old woman diagnosed with cyclic neutropenia 5 years previously had been treated with recombinant granulocyte-colony stimulating factor (G-CSF). She developed fever, tenderness and distension of temporal arteries after the treatment with G-CSF. Magnetic resonance imaging and ultrasonography revealed wall thickening of the temporal arteries. She was therefore diagnosed with giant cell arteritis (GCA). Small vessel vasculitis has been reported as a complication of G-CSF. However, the development of large vessel vasculitis after G-CSF treatment is quite rare. To our knowledge, the present case is the first report of GCA suspected to be associated with coexisting cyclic neutropenia and G-CSF treatment. PMID:27523011

  17. CONTENTS OF LYMPHOCYTE SUB-POPULATIONS IN THE CHILDREN WITH ACUTE LEUKEMIA AND LYMPHOMAS DEPENDENT ON INFECTIOUS COMPLICATION AND NEUTROPENIA

    Directory of Open Access Journals (Sweden)

    M. V. Peshikova

    2005-01-01

    Full Text Available Abstract. The aim of the present work was to evaluate the contents of some lymphocyte sub-populations in peripheral blood of the children with tumors of hematopoietic and lymphoid tissues, depending on infectious complication of cytostatic therapy and neutropenia. In all children undergoing cytostatic therapy for acute lympho-blastic leukemia and non-B cell non-Hodgkinґs lymphomas, we found significant decrease in the numbers of CD95 lymphocytes, absolute amounts of natural killer cells (CD16, CD56-lymphocytes and activated lymphocytes (СD11b, HLA-DR-cells, irrespective of neutrophile numbers in their blood and infectious complications. However, absolute number of CD25- lymphocytes was significantly decreased in the children with neutropenia. Relative contents of CD16, CD56, СD11b, HLA-DR, CD25-lymphocytes did not significantly differ from those in healthy children, or they were found to be significantly increased.

  18. CONTENTS OF LYMPHOCYTE SUB-POPULATIONS IN THE CHILDREN WITH ACUTE LEUKEMIA AND LYMPHOMAS DEPENDENT ON INFECTIOUS COMPLICATION AND NEUTROPENIA

    Directory of Open Access Journals (Sweden)

    M. V. Peshikova

    2014-07-01

    Full Text Available Abstract. The aim of the present work was to evaluate the contents of some lymphocyte sub-populations in peripheral blood of the children with tumors of hematopoietic and lymphoid tissues, depending on infectious complication of cytostatic therapy and neutropenia. In all children undergoing cytostatic therapy for acute lympho-blastic leukemia and non-B cell non-Hodgkinґs lymphomas, we found significant decrease in the numbers of CD95 lymphocytes, absolute amounts of natural killer cells (CD16, CD56-lymphocytes and activated lymphocytes (СD11b, HLA-DR-cells, irrespective of neutrophile numbers in their blood and infectious complications. However, absolute number of CD25- lymphocytes was significantly decreased in the children with neutropenia. Relative contents of CD16, CD56, СD11b, HLA-DR, CD25-lymphocytes did not significantly differ from those in healthy children, or they were found to be significantly increased.

  19. Wild Type and Mutant 2009 Pandemic Influenza A (H1N1) Viruses Cause More Severe Disease and Higher Mortality in Pregnant BALB/c Mice

    OpenAIRE

    Chan, Kwok-Hung; Zhang, Anna J. X.; To, Kelvin K. W.; Chan, Chris C. S.; Poon, Vincent K. M.; Guo, Kunyuan; Ng, Fai; Zhang, Qi-Wei; Leung, Virtual H. C.; Cheung, Annie N. Y.; Lau, Candy C. Y.; Woo, Patrick C. Y.; Tse, Herman; Wu, Wailan; Chen, Honglin

    2010-01-01

    Background: Pregnant women infected by the pandemic influenza A (H1N1) 2009 virus had more severe disease and higher mortality but its pathogenesis is still unclear. Principal Findings: We showed that higher mortality, more severe pneumonitis, higher pulmonary viral load, lower peripheral blood T lymphocytes and antibody responses, higher levels of proinflammatory cytokines and chemokines, and worse fetal development occurred in pregnant mice than non-pregnant controls infected by either wild...

  20. Febrile neutropenia in paediatric peripheral blood stem cell transplantation, in vitro sensitivity data and clinical response to empirical antibiotic therapy

    International Nuclear Information System (INIS)

    To find the in-vitro sensitivity data and clinical response in order to determine the changes required in empiric antibiotic therapy for management of febrile neutropenia in paediatric patients undergoing peripheral blood stem cell transplantation. All patients were treated according to institutional protocol for febrile neutropenia. Empirical antibiotics include Ceftriaxone and Amikacin. In non-responders, changes made included Imipenem and Amikacin, Piperacillin Tazobactum/Tiecoplanin or Vancomycin/Cloxacilin/Ceftazidime. In non-responders, amphotaracin was added until recovery. Out of 52 patients, 5 did not develop any fever; in the remaining 47 patients there were 57 episodes of febrile neutropenia. The mean days of febrile episodes were 4.71 (range 3-8). Fever of unknown origin (FUO) occurred in 31 (54.3%) episodes. Microbiologically documented infection (MDI) occurred in 17 (29.8%) episodes of fever. Clinically documented infection (CDI) occurred in 9 (15.7%) episodes. Gram-negative organisms were isolated in 10 while gram-positive organisms in 7. Klebseilla, S. aureus were the most common isolates. Empirical therapy was effective in 12 of the 33 (36%) episodes. Out of 28, 26 (92%) responded to Imipenem/Amikacin as second line therapy while those who received any other second line combination, only 11 out of 22 (50%) showed response. Systemic Amphotericin was used in 4 patients, 2 responded. Infection related mortality rate was 4%. (author)

  1. Factores de mal pronóstico en pacientes internados con Neutropenia al inicio del episodio febril Prognostic risk factors for serious complications in an inpatient population with neutropenia at the onset of a febrile episode

    Directory of Open Access Journals (Sweden)

    Carlos Gómez Roca

    2006-10-01

    Full Text Available Los pacientes con neutropenia y fiebre constituyen una población heterogénea con riesgo variable para el desarrollo de complicaciones serias y mortalidad. El objetivo de este trabajo es identificar factores que, presentes al ingreso, estuvieran asociados a mayor riesgo de complicaciones graves en pacientes que se internan por neutropenia y fiebre. Se trata de un estudio de seguimiento de una cohorte de 238 episodios de neutropenia y fiebre (neutrófilos 38.3 °C en 167 pacientes internados en sala general en nuestra institución desde 1997 a 2004. Ochenta y dos por ciento de los pacientes tenían enfermedad hematológica, 14% tumores sólidos y 4% no asociados a quimioterapia. Se registraron 67 eventos adversos (46% de insuficiencia renal, 27% de hipotensión refractaria, 15% de insuficiencia respiratoria y 12% con sangrado mayor. Se hallaron diferencias significativas en presencia de comorbilidades previas, temperatura mayor a 39 °C, frecuencia cardíaca mayor a 120 latidos por minuto, frecuencia respiratoria mayor a 24 por minuto, tensión arterial sistólica menor a 90 mm Hg, presencia de 3 o más valores de laboratorio alterados al ingreso, presencia de foco clínico y hemocultivos positivos. En el análisis multivariado de regresión logística mantuvieron asociación independiente con mayor riesgo de eventos graves: hipotensión arterial sistólica (OR=7, pPatients with neutropenia and fever conform a heterogeneous population with a variable risk of serious complications and mortality. The goal of this study was to identify prognostic risk factors present at the beginning of the episode, for adverse events and serious complications in patients admitted in a general ward with fever and neutropenia. A cohort of 238 episodes with neutropenia and fever (neutrophils 38.3 °C in 167 patients admitted to our general hospital between 1997 and 2004 was followed. Eighty two percent of the patients had hematologic malignancies, 14% solid tumors

  2. A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro) in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?

    OpenAIRE

    Nelson Jorge da Silva; Kalley Ricardo Clementino Ferreira; Raimundo Nonato Leite Pinto; Steven Douglas Aird

    2015-01-01

    Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae), in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. T...

  3. Disease-associated mutations in the actin-binding domain of filamin B cause cytoplasmic focal accumulations correlating with disease severity

    DEFF Research Database (Denmark)

    Daniel, Philip B; Morgan, Tim; Alanay, Yasemin;

    2012-01-01

    -containing cytoplasmic focal accumulations of the substituted protein to a degree that was correlated with the severity of the associated phenotypes. In contrast, study of mutations leading to substitutions in the FLNB rod domain that result in the same phenotypes as ABD mutations, demonstrated that with only one...

  4. Poliartritis y tenosinovitis grave por Streptococcus agalactiae en un paciente con hipoesplenia funcional Severe polyarthritis and tenosynovitis caused by Streptococcus agalactiae in a patient with functional hyposplenia

    Directory of Open Access Journals (Sweden)

    Domingo C. Balderramo

    2002-08-01

    Full Text Available La artritis por Streptococcus agalactiae es infrecuente. No conocemos publicaciones de casos sobre la afección tendinosa por este microorganismo. Se presenta una mujer de 46 años que consultó por fiebre, poliartralgias, mialgias, diarrea y vómitos. Como antecedentes presentaba carcinoma papilar de tiroides e hipoesplenia funcional. Al examen se encontraba hemodinámicamente inestable, febril, con artritis de mano izquierda, muñecas, codos, hombro derecho y tobillo izquierdo. Presentaba tenosinovitis en ambos pies y en la mano izquierda. Los hemocultivos y el cultivo de la bursa olecraniana derecha fueron positivos para S. agalactiae. La ecografía mostró signos de tenosinovitis del tibial anterior izquierdo. Completó 20 días de tratamiento endovenoso con cefazolina y 12 días de cefuroxima oral. El cuadro articular revirtió completamente en 60 días. El Streptococcus agalactiae puede causar, en forma infrecuente, un síndrome de poliartritis, tenosinovitis y fiebre similar al producido por la infección gonocócica.Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal

  5. H3N2 canine influenza virus causes severe morbidity in dogs with induction of genes related to inflammation and apoptosis

    OpenAIRE

    Kang, Young Myong; Kim, Heui Man; Ku, Keun Bon; Park, Eun Hye; Yum, Jung; Seo, Sang Heui

    2013-01-01

    Dogs are companion animals that live in close proximity with humans. Canine H3N2 influenza virus has been isolated from pet dogs that showed severe respiratory signs and other clinical symptoms such as fever, reduced body weight, and interstitial pneumonia. The canine H3N2 influenza virus can be highly transmissible among dogs via aerosols. When we analyzed global gene expression in the lungs of infected dogs, the genes associated with the immune response and cell death were greatly elevated....

  6. Sustained oxidative stress causes late acute renal failure via duplex regulation on p38 MAPK and Akt phosphorylation in severely burned rats.

    Directory of Open Access Journals (Sweden)

    Yafei Feng

    Full Text Available BACKGROUND: Clinical evidence indicates that late acute renal failure (ARF predicts high mortality in severely burned patients but the pathophysiology of late ARF remains undefined. This study was designed to test the hypothesis that sustained reactive oxygen species (ROS induced late ARF in a severely burned rat model and to investigate the signaling mechanisms involved. MATERIALS AND METHODS: Rats were exposed to 100°C bath for 15 s to induce severe burn injury (40% of total body surface area. Renal function, ROS generation, tubular necrosis and apoptosis, and phosphorylation of MAPK and Akt were measured during 72 hours after burn. RESULTS: Renal function as assessed by serum creatinine and blood urea nitrogen deteriorated significantly at 3 h after burn, alleviated at 6 h but worsened at 48 h and 72 h, indicating a late ARF was induced. Apoptotic cells and cleavage caspase-3 in the kidney went up slowly and turned into significant at 48 h and 72 h. Tubular cell ROS production shot up at 6 h and continuously rose during the 72-h experiment. Scavenging ROS with tempol markedly attenuated tubular apoptosis and renal dysfunction at 72 h after burn. Interestingly, renal p38 MAPK phosphorylation elevated in a time dependent manner whereas Akt phosphorylation increased during the first 24 h but decreased at 48 h after burn. The p38 MAPK specific inhibitor SB203580 alleviated whereas Akt inhibitor exacerbated burn-induced tubular apoptosis and renal dysfunction. Furthermore, tempol treatment exerted a duplex regulation through inhibiting p38 MAPK phosphorylation but further increasing Akt phosphorylation at 72 h postburn. CONCLUSIONS: These results demonstrate that sustained renal ROS overproduction induces continuous tubular cell apoptosis and thus a late ARF at 72 h after burn in severely burned rats, which may result from ROS-mediated activation of p38 MAPK but a late inhibition of Akt phosphorylation.

  7. Clinical analysis of 280 children with infection associated neutropenia%感染相关性儿童中性粒细胞减少症280例临床分析

    Institute of Scientific and Technical Information of China (English)

    刘雪; 刘瑞清; 邓军霞; 张国成; 成胜权; 陈彩平; 孙新; 许东亮; 邓跃林; 林海波

    2013-01-01

    Objectives To explore the related factors and clinical characteristics of infection associted neutropenia in children. Methods Retrospectively reviewed the medical records of 280 neutropenia in-patients from September 2010 to August 2011. Their clinical features, laboratory investigations, treatment and prognosis were analyzed. Serum immunoglobulins were compared with 65 healthy control children. Results Among 280 children, 78% of them were younger than 3 years old and 62.5% were male, arid 90.7% were with respiratory infection. The medical records indicated the number of patients was slightly increased in January, March and August when compared with other months throughout the year. Virus infection was the most common cause of acquired neutropenia. In patients younger than 12 month old, IgM was higher and IgG was lower than those of control group (all P<0.05). In the first week of infection 79.7% of patients were found with neutropenia, and drugs that can increase granuloeytes would shorten the recovery time. Conclusions Neutropenia associated infection are more common in male infants and usually caused by viral infection accompanied with immune dysfunction. Used properly and timely, antiviral drugs and antibiotics can shorten the duration of symptoms.%目的 探讨儿童感染相关性中性粒细胞减少症的影响因素及临床特点.方法 收集2010年9月至2011年8月住院并符合中性粒细胞减少症诊断标准的患儿280例,对其病史资料、临床表现、实验室检查、临床治疗及预后进行回顾性分析,并与65名正常对照儿童作血清免疫球蛋白比较.结果 280例中性粒细胞减少症患儿中,3岁以下占78%,男性占62.5%;呼吸道感染占90.7%;全年均可发病,1、3、8月份患儿数量增多.病毒感染是引起儿童继发性中性粒细胞减少的主要原因.<12个月患儿的IgM高于正常对照儿童,IgG低于正常对照儿童,差异均有统计学意义 (P 均<0.05).感染第1

  8. CAUSES THAT LEAD TO THE SEVERE DECLINE IN THE NUMBER OF CATTLE BRED BY SUBSISTENCE FARMERS IN PLATARESTI COMMUNE, CALARASI COUNTY, ROMANIA

    Directory of Open Access Journals (Sweden)

    Ana-Maria-Loredana PREDA

    2013-01-01

    Full Text Available Romania is a country of contrasts especially as agriculture is concerned. On one side we have state of the art machinery and equipment being used on farms larger than 100 ha and on the other side we have small subsistence farms operated by an aging and poor population. The paper aims to highlight few causes that have stressed even more the difficult situation of the rural population of this country; especially those that have been brought about by the financial crisis initiated in 2008 and that have gotten even worse with the passing of time. We have performed a qualitative and quantitative analysis showing the decline in the number of cattle bred, either for milk or meat, by the subsistence farmers from Plataresti commune, Calarasi County, Romania, allowing us to identify few causes that could be counteracted by a proactive social measure. The results of our research indicate one possible measure meant to counteract negative effects that subsistence farmers are now facing.

  9. CLIMATIC SEVERITY VICTIMS OF UPSTREAM WATER PIRACY STRONGLY EVIDENCING INLAND WATER DEPLETION-CAUSED GLOBAL WARMING VIS-A-VIS COOLING

    OpenAIRE

    Miah M. Adel; Mahmood R. Hossain; Saiyeeda F. Hossain

    2014-01-01

    Since the 80’s, the northwestern and the southwestern parts of the tropical Bangladesh located in the downstream Ganges basin have been having summer temperature above 109°F and winter temperature as low as 37°F. Every year people, particularly, the infants die from heat-and cold-related diseases and hospitals become packed-up with the victims of severe climatic condition. The objective of this research is to find the reason for the appearances of the extreme climate in certain ...

  10. Report of 15 injuries caused by lionfish (pterois volitans) in aquarists in Brazil: a critical assessment of the severity of envenomations.

    Science.gov (United States)

    Haddad, Vidal; Stolf, Hamilton Ometto; Risk, José Yamin; França, Francisco Os; Cardoso, João Luiz Costa

    2015-01-01

    Lionfish are venomous fish that belong to the Scorpaenidae family. Individuals of this family and those of the Synanceiidae family comprise most of the existing venomous fish in the world. Lionfish are originally found in the Indo-Pacific, but they have received special attention in the last years for their dissemination in the Atlantic Ocean, with the emergence of large populations in the USA, Caribbean and South America. Because of its beauty, this fish has always been present in private and commercial aquariums around the world. Herein, we describe 15 envenomations in aquarists registered in a period of eighteen years (1997-2014). The stings caused excruciating pain and marked inflammation, with local erythema, edema, heat, paleness and cyanosis. In one case, it was possible to observe vesicles and blisters. There were no skin necroses or marked systemic manifestations. We discuss the possible coming of the fish to South America and the circumstances and clinical impact of the envenomations. PMID:25810712

  11. Mutations in the substrate binding glycine-rich loop of the mitochondrial processing peptidase-α protein (PMPCA) cause a severe mitochondrial disease.

    Science.gov (United States)

    Joshi, Mugdha; Anselm, Irina; Shi, Jiahai; Bale, Tejus A; Towne, Meghan; Schmitz-Abe, Klaus; Crowley, Laura; Giani, Felix C; Kazerounian, Shideh; Markianos, Kyriacos; Lidov, Hart G; Folkerth, Rebecca; Sankaran, Vijay G; Agrawal, Pankaj B

    2016-05-01

    We describe a large Lebanese family with two affected members, a young female proband and her male cousin, who had multisystem involvement including profound global developmental delay, severe hypotonia and weakness, respiratory insufficiency, blindness, and lactic acidemia-findings consistent with an underlying mitochondrial disorder. Whole-exome sequencing was performed on DNA from the proband and both parents. The proband and her cousin carried compound heterozygous mutations in the PMPCA gene that encodes for α-mitochondrial processing peptidase (α-MPP), a protein likely involved in the processing of mitochondrial proteins. The variants were located close to and postulated to affect the substrate binding glycine-rich loop of the α-MPP protein. Functional assays including immunofluorescence and western blot analysis on patient's fibroblasts revealed that these variants reduced α-MPP levels and impaired frataxin production and processing. We further determined that those defects could be rescued through the expression of exogenous wild-type PMPCA cDNA. Our findings link defective α-MPP protein to a severe mitochondrial disease. PMID:27148589

  12. A convenient model of severe, high incidence autoimmune gastritis caused by polyclonal effector T cells and without perturbation of regulatory T cells.

    Directory of Open Access Journals (Sweden)

    Eric Tu

    Full Text Available Autoimmune gastritis results from the breakdown of T cell tolerance to the gastric H(+/K(+ ATPase. The gastric H(+/K(+ ATPase is responsible for the acidification of gastric juice and consists of an α subunit (H/Kα and a β subunit (H/Kβ. Here we show that CD4(+ T cells from H/Kα-deficient mice (H/Kα(-/- are highly pathogenic and autoimmune gastritis can be induced in sublethally irradiated wildtype mice by adoptive transfer of unfractionated CD4(+ T cells from H/Kα(-/- mice. All recipient mice consistently developed the most severe form of autoimmune gastritis 8 weeks after the transfer, featuring hypertrophy of the gastric mucosa, complete depletion of the parietal and zymogenic cells, and presence of autoantibodies to H(+/K(+ ATPase in the serum. Furthermore, we demonstrated that the disease significantly affected stomach weight and stomach pH of recipient mice. Depletion of parietal cells in this disease model required the presence of both H/Kα and H/Kβ since transfer of H/Kα(-/- CD4(+ T cells did not result in depletion of parietal cells in H/Kα(-/- or H/Kβ(-/- recipient mice. The consistency of disease severity, the use of polyclonal T cells and a specific T cell response to the gastric autoantigen make this an ideal disease model for the study of many aspects of organ-specific autoimmunity including prevention and treatment of the disease.

  13. [Hypopotassemia and prolongation of the Q-T interval in a patient with severe malnutrition caused by bulimia and post-prandial vomiting].

    Science.gov (United States)

    Contaldo, F; Di Paolo, M R; Mazzacano, C; Di Biase, G; Giumetti, D

    1990-04-01

    Patient L.A. (f., 20 yrs), affected by bulimia and self-induced vomiting, was hospitalized because of severe malnutrition (BMI 13.1), hypopotassemia (2.8 mEq/l) and prolonged QTc interval (0.469"). Intensive care treatment aimed to normalize mineral balance mainly serum potassium, consisted of administering e.v. potassium (mg 2346/day), magnesium (mg 72/day), calcium (mg 80/day), phosphorus (mg 769/day), chloride (mg 710/day), iron (mg 40/day). Dietary treatment was deliberately chosen to be slightly above minimum energy requirements in order to avoid possible side effects of forced hyperalimentation. The patient, immediately after hospitalization, interrupted vomiting and 2 wks later weight increased by 5 kg (from 34.9 kg to 40.0 kg). On the other hand normalization of serum potassium levels was slow and QTc interval reached normal range only after the 10th day of treatment (0.447"). This case supports the hypothesis that major ECG abnormalities may be present in severe malnutrition due to anorexia nervosa or bulimia with self-induced vomiting. The dangers of these complications were substantiated by the fact that intensive care treatment allowed prompt body weight recovery but normalization of electrolytic balance and cardiac function was very slow. For such patients, electrocardiographic monitoring should be routine. PMID:2377804

  14. Dose-Dependent Effect of Granulocyte Transfusions in Hematological Patients with Febrile Neutropenia.

    Science.gov (United States)

    Teofili, Luciana; Valentini, Caterina Giovanna; Di Blasi, Roberta; Orlando, Nicoletta; Fianchi, Luana; Zini, Gina; Sica, Simona; De Stefano, Valerio; Pagano, Livio

    2016-01-01

    It is still under debate whether granulocyte transfusions (GTs) substantially increase survival in patients with febrile neutropenia. We retrospectively examined data relative to 96 patients with hematological malignancies receiving 491 GTs during 114 infectious episodes (IE). Patients were grouped according to the median doses of granulocytes transfused during the infectious episode (low-dose group: 3.0x108 cells/Kg). The impact of clinical, microbiological and GT-related variables on the infection-related mortality (IRM) was investigated. The IRM was not influenced by the number of GTs or by the total amount of granulocytes received, whereas a dose-related effect of the median dose received for IE was detected at univariate analysis (IRM of 18.4% in the standard-dose group, 44.4% in the low-dose group and 48.4% in the high-dose group, p = 0.040) and confirmed at multivariate analysis (OR 3.7, IC 95% 1.5-8.9; 0.004 for patients not receiving standard doses of GTs). Moreover, patients receiving GTs at doses lower or greater than standard had increased risk for subsequent ICU admission and reduced overall survival. The dose-related effect of GTs was confirmed in bacterial but not in fungal infections. Preliminary findings obtained from a subgroup of patients candidate to GTs revealed that levels of inflammatory response mediators increase in a dose-related manner after GTs, providing a possible explanation for the detrimental effect exerted by high-dose transfusions. GTs can constitute a valuable tool to improve the outcome of infections in neutropenic patients, provided that adequate recipient-tailored doses are supplied. Further investigations of the immunomodulatory effects of GTs are recommended. PMID:27487075

  15. Efficacy of intravenous ciprofloxacin in patients with febrile neutropenia refractory to initial therapy.

    Science.gov (United States)

    Matsuoka, Hitoshi; Tsukamoto, Atsuko; Shirahashi, Akihiko; Koga, Shin; Suzushima, Hitoshi; Shibata, Keisuke; Uozumi, Kimiharu; Yamashita, Kiyoshi; Okamura, Seiichi; Kawano, Fumio; Tamura, Kazuo

    2006-08-01

    We previously reported that monotherapy with carbapenem or cefepime exhibited efficacy equivalent to cefepime plus an aminoglycoside as initial therapy for febrile neutropenia (FN), achieving an adequate response in two-thirds of the patients. However, only one-third of the remaining poor responders to monotherapy became afebrile after an aminoglycoside was added to the initial carbapenem or cefepime. The present study was designed to evaluate the benefit of intravenous ciprofloxacin for neutropenic patients with fever who were refractory to initial therapy given for the first 3 days. Patients with FN--as defined by an axillary temperature >or=37.5 degrees C and a neutrophil count ciprofloxacin 600 mg/day. They were otherwise managed according to the Japanese guidelines for FN. An adequate response was defined as a decline of temperature to ciprofloxacin treatment. Thirty-one patients with FN (seventeen male and fourteen female; mean age 53.1 +/- 14.8 years) were entered in the study. The initial antibiotics were cefepime (2 - 4 g/day) in twenty and carbapenem (1 - 2 g/day) in eleven. Three patients were excluded from analysis, leaving 28 patients for evaluation of efficacy. The response rate was 16/31 patients (51.6%),with four patients judged non-assessable due to adverse effects, protocol violation or early change to other agents. Adverse events occurred in seventeen patients, but all were mild and reversible. Only three patients had adverse events (skin rash, hepatic dysfunction and elevation of alkaline phosphatase in one patient, respectively) considered related to ciprofloxacin. These findings indicate that addition of intravenous ciprofloxacin is effective against FN refractory to initial antibiotic therapy and has acceptable toxicity. PMID:16966275

  16. 静注人免疫球蛋白致严重过敏反应1例%One Case of Severe Allergic Reaction Caused by Intravenous Immunoglobulin

    Institute of Scientific and Technical Information of China (English)

    张金连; 贾书平; 雷招宝

    2016-01-01

    A female patient at age of 25 years,with primary immune-related infertility was given 50 mL(2.5 g) of intravenous human immunoglobulin(PH4)by intravenous drip at a rate of 20 drops / min. Systemic skin rash, most of which in neck and face,appeared 5 mins,while the symptoms such as sudden screaming,abdominal pain, feeling of shit,systemic skin flushing,rash(especially in neck and face)and shortness of breath,10 mins after drip,which was considered as allergic reaction caused by intravenous immunoglobulin. The symptoms were relieved 30 mins and disappeared 1 h after the drip was stopped immediately and anti-anaphylaxis therapy was adopted. It suggests that the allergic reactions caused by intravenous immunoglobulin shoud be cautioned.%1例25岁女性患者,因原发性不孕症(免疫相关性)就诊,予静注人免疫球蛋白(PH4)50 mL(2.5 g)静脉滴注(滴速20滴/min),5 min后患者出现全身皮肤点状皮疹(以颈部、脸部多见),至10 min时患者突然出现尖叫、腹痛、便意、全身皮肤发红、皮疹(以颈部、面部为甚,皮疹高出皮肤)、呼吸急促等症状。考虑为静注人免疫球蛋白(PH4)所致的过敏反应。立即停药,予抗过敏治疗,30 min后症状缓解,1 h后恢复正常。提示应警惕静注人免疫球蛋白的过敏反应。

  17. A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?

    Directory of Open Access Journals (Sweden)

    Nelson Jorge da Silva

    2015-06-01

    Full Text Available Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae, in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. Then antibiotic was suspended; however, after two more days and additional tests, cephalosporin therapy was initiated, and proved successful. Pain worsened despite increasingly powerful analgesics, until debridement of the wound was performed after one month. The wound finally closed ~70 days after the accident, but the patient continued to have problems wearing shoes even eight months later. Chemistry and pharmacology of Potamotrygon venom and mucus, and clinical management of freshwater stingray envenomations are reviewed in light of the present case. Bacterial infections of stingray puncture wounds may account for more long-term morbidity than stingray venom. Simultaneous prophylactic use of multiple antibiotics is recommended for all but the most superficial stingray wounds. Distinguishing relative contributions of venom, mucus, and bacteria will require careful genomic and transcriptomic investigations of stingray tissues and contaminating bacteria.

  18. A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro) in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?

    Science.gov (United States)

    da Silva, Nelson Jorge; Ferreira, Kalley Ricardo Clementino; Pinto, Raimundo Nonato Leite; Aird, Steven Douglas

    2015-06-01

    Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae), in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. Then antibiotic was suspended; however, after two more days and additional tests, cephalosporin therapy was initiated, and proved successful. Pain worsened despite increasingly powerful analgesics, until debridement of the wound was performed after one month. The wound finally closed ~70 days after the accident, but the patient continued to have problems wearing shoes even eight months later. Chemistry and pharmacology of Potamotrygon venom and mucus, and clinical management of freshwater stingray envenomations are reviewed in light of the present case. Bacterial infections of stingray puncture wounds may account for more long-term morbidity than stingray venom. Simultaneous prophylactic use of multiple antibiotics is recommended for all but the most superficial stingray wounds. Distinguishing relative contributions of venom, mucus, and bacteria will require careful genomic and transcriptomic investigations of stingray tissues and contaminating bacteria. PMID:26094699

  19. A Severe Accident Caused by an Ocellate River Stingray (Potamotrygon motoro) in Central Brazil: How Well Do We Really Understand Stingray Venom Chemistry, Envenomation, and Therapeutics?

    Science.gov (United States)

    da Silva, Nelson Jorge; Clementino Ferreira, Kalley Ricardo; Leite Pinto, Raimundo Nonato; Aird, Steven Douglas

    2015-01-01

    Freshwater stingrays cause many serious human injuries, but identification of the offending species is uncommon. The present case involved a large freshwater stingray, Potamotrygon motoro (Chondrichthyes: Potamotrygonidae), in the Araguaia River in Tocantins, Brazil. Appropriate first aid was administered within ~15 min, except that an ice pack was applied. Analgesics provided no pain relief, although hot compresses did. Ciprofloxacin therapy commenced after ~18 h and continued seven days. Then antibiotic was suspended; however, after two more days and additional tests, cephalosporin therapy was initiated, and proved successful. Pain worsened despite increasingly powerful analgesics, until debridement of the wound was performed after one month. The wound finally closed ~70 days after the accident, but the patient continued to have problems wearing shoes even eight months later. Chemistry and pharmacology of Potamotrygon venom and mucus, and clinical management of freshwater stingray envenomations are reviewed in light of the present case. Bacterial infections of stingray puncture wounds may account for more long-term morbidity than stingray venom. Simultaneous prophylactic use of multiple antibiotics is recommended for all but the most superficial stingray wounds. Distinguishing relative contributions of venom, mucus, and bacteria will require careful genomic and transcriptomic investigations of stingray tissues and contaminating bacteria. PMID:26094699

  20. 儿童恶性肿瘤化疗后中性粒细胞减少并发脓毒症的早期识别%Early identification of sepsis in cancer children with neutropenia after chemotherapy

    Institute of Scientific and Technical Information of China (English)

    杨燕文; 王莹; 汤静燕; 李璧如

    2012-01-01

    .Conclusion High initial temperature,long duration of neutropenia,severely reduced ANC,increases of CRP and PCT,and culture-positive are correlated with sepsis in cancer children.

  1. The quantum yield of CO2 fixation is reduced for several minutes after prior exposure to darkness. Exploration of the underlying causes.

    Science.gov (United States)

    Kirschbaum, M U F; Oja, V; Laisk, A

    2005-01-01

    Previous work has shown that the apparent quantum yield of CO2 fixation can be reduced for up to several minutes after prior exposure to darkness. In the work reported here, we investigated this phenomenon more fully and have deduced information about the underlying processes. This was done mainly by concurrent measurements of O2 and CO2 exchange in an oxygen-free atmosphere. Measurements of O2 evolution indicated that photochemical efficiency was not lost through dark adaptation, and that O2 evolution could proceed immediately at high rates provided that there were reducible pools of photosynthetic intermediates. Part of the delay in reaching the full quantum yield of CO2 fixation could be attributed to the need to build up pools of photosynthetic intermediates to high enough levels to support steady rates of CO2 fixation. There was no evidence that Rubisco inactivation contributed towards delayed CO2 uptake (under measurement conditions of low light). However, we obtained evidence that an enzyme in the reaction path between triose phosphates and RuBP must become completely inactivated in the dark. As a consequence, in dark-adapted leaves, a large amount of triose phosphates were exported from the chloroplast over the first minute of light rather than being converted to RuBP for CO2 fixation. That pattern was not observed if the pre-incubation light level was increased to just 3-5 micromol quanta m(-2) s(-1). The findings from this work underscore that there are fundamental differences in enzyme activation between complete darkness and even a very low light level of only 3-5 micromol quanta m(-2) s(-1) which predispose leaves to different gas exchange patterns once leaves are transferred to higher light levels. PMID:15666215

  2. Neutrophil dynamics during concurrent chemotherapy and G-CSF administration: Mathematical modelling guides dose optimisation to minimise neutropenia.

    Science.gov (United States)

    Craig, Morgan; Humphries, Antony R; Nekka, Fahima; Bélair, Jacques; Li, Jun; Mackey, Michael C

    2015-11-21

    The choice of chemotherapy regimens is often constrained by the patient's tolerance to the side effects of chemotherapeutic agents. This dose-limiting issue is a major concern in dose regimen design, which is typically focused on maximising drug benefits. Chemotherapy-induced neutropenia is one of the most prevalent toxic effects patients experience and frequently threatens the efficient use of chemotherapy. In response, granulocyte colony-stimulating factor (G-CSF) is co-administered during chemotherapy to stimulate neutrophil production, increase neutrophil counts, and hopefully avoid neutropenia. Its clinical use is, however, largely dictated by trial and error processes. Based on up-to-date knowledge and rational considerations, we develop a physiologically realistic model to mathematically characterise the neutrophil production in the bone marrow which we then integrate with pharmacokinetic and pharmacodynamic (PKPD) models of a chemotherapeutic agent and an exogenous form of G-CSF (recombinant human G-CSF, or rhG-CSF). In this work, model parameters represent the average values for a general patient and are extracted from the literature or estimated from available data. The dose effect predicted by the model is confirmed through previously published data. Using our model, we were able to determine clinically relevant dosing regimens that advantageously reduce the number of rhG-CSF administrations compared to original studies while significantly improving the neutropenia status. More particularly, we determine that it could be beneficial to delay the first administration of rhG-CSF to day seven post-chemotherapy and reduce the number of administrations from ten to three or four for a patient undergoing 14-day periodic chemotherapy. PMID:26343861

  3. Efficacy and safety of ior LeukoCIM (G-CSF) in patients with neutropenia after chemotherapy

    International Nuclear Information System (INIS)

    Neutropenia and infections are the most restrictive side effects during chemotherapy application. The granulocytic colonies stimulating factor activates the neutrophils, shortens the neutropenic period and can be effective against the potential risk of infection. The purpose of this study was to evaluate the efficacy and safety of LeukoCIM (CIMAB, Havana). A retrospective observational study was carried out with data from the patients with neutropenic episodes enrolled in the open-label, non-randomized, multicenter, phase IV clinical trial. These patients were from Gustavo Aldereguia Lima hospital. They had been evaluated for one year. Demographic information, clinical data and side effects were analyzed. As prophylaxis indication LeukoCIM was administrated 24-72 h after the last chemotherapy dose and as treatment when neutropenia was diagnosed. In both cases, a daily single 300 μg dose was administrated subcutaneously. The application of the next chemotherapy cycle on time was the main variable of response and the product safety was assessed by measuring the side effects. Forty seven patients with 95 neutropenic episodes were enrolled. The 82.1 % of episodes received their next chemotherapy cycle on time. The most frequent side effects were: bone pain and fever (11.2 % respectively), hyperuricemia (9.2 %), leukocytosis and neutrophilia (7.1 %) and increased LDH (6.1 %). LeukoCIM was effective in patients receiving chemotherapy, because it accelerated neutrophil recovery, decreased the incidence of febrile neutropenia and improved delivery of protocol doses of chemotherapy on time. Additionally, this product was considered safe for the studied patients since just known adverse events were reported

  4. Use of inflammatory molecules to predict the occurrence of fever in onco-hematological patients with neutropenia

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, A.F. Tibúrcio; Nobre, V.; Neuenschwander, L.C. [Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Teixeira, A.L. [Laboratório de Imunofarmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Xavier, S.G.; Paula, F.D.F. [Departamento de Propedêutica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Teixeira, M.M. [Laboratório de Imunofarmacologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil); Teixeira, J.C.A.; Bittencourt, H. [Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG (Brazil)

    2013-02-01

    Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM) may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group) and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02). Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients.

  5. Use of inflammatory molecules to predict the occurrence of fever in onco-hematological patients with neutropenia

    Directory of Open Access Journals (Sweden)

    A.F. Tiburcio Ribeiro

    2013-02-01

    Full Text Available Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α, soluble TNF-α I and II receptors (sTNFRI and sTNFRII, monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif ligand 2 (CCL2], macrophage inflammatory protein-1α (MIP-1α or CCL3, eotaxin (CCL11, interleukin-8 (IL-8 or CXCL8, and interferon-inducible protein-10 (IP-10 or CXCL10 in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15 before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02. Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients.

  6. Use of inflammatory molecules to predict the occurrence of fever in onco-hematological patients with neutropenia

    International Nuclear Information System (INIS)

    Febrile neutropenia remains a frequent complication in onco-hematological patients, and changes in the circulating level of inflammatory molecules (IM) may precede the occurrence of fever. The present observational prospective study was carried out to evaluate the behavior of plasma tumor necrosis factor alpha (TNF-α), soluble TNF-α I and II receptors (sTNFRI and sTNFRII), monocyte chemoattractant protein-1 [MCP-1 or chemokine (c-c motif) ligand 2 (CCL2)], macrophage inflammatory protein-1α (MIP-1α or CCL3), eotaxin (CCL11), interleukin-8 (IL-8 or CXCL8), and interferon-inducible protein-10 (IP-10 or CXCL10) in 32 episodes of neutropenia in 26 onco-hematological patients. IM were tested on enrollment and 24-48 h before the onset of fever and within 24 h of the first occurrence of fever. Eight of 32 episodes of neutropenia did not present fever (control group) and the patients underwent IM tests on three different occasions. sTNFRI levels, measured a median of 11 h (1-15) before the onset of fever, were significantly higher in patients presenting fever during follow-up compared to controls (P = 0.02). Similar results were observed for sTNFRI and CCL2 levels (P = 0.04 for both) in non-transplanted patients. A cut-off of 1514 pg/mL for sTNFRI was able to discriminate between neutropenic patients with or without fever during follow-up, with 65% sensitivity, 87% specificity, and 93% positive predictive value. Measurement of the levels of plasma sTNFRI can be used to predict the occurrence of fever in neutropenic patients

  7. Isquemia grave de membros inferiores por arterite por HIV Severe ischemia of lower limbs due to arteritis caused by HIV infection

    Directory of Open Access Journals (Sweden)

    Guilherme Benjamin Brandão Pitta

    2011-12-01

    Full Text Available A isquemia aguda de membros pode se manifestar, embora de forma incomum, como consequência à vasculite associada ao vírus da imunodeficiência humana (HIV. O presente caso descreve a evolução de uma paciente soropositiva para o HIV, que apresentou quadro de isquemia distal bilateral, com diminuição da temperatura de terço distal das pernas e pés, dor intensa, cianose fixa de pododátilos e ausência de pulsos distais. Submetida ao tratamento com terapia trombolítica, apresentou sinais de lesões decorrentes da isquemia e lesão tecidual de reperfusão com perda tecidual em regiões distais dos dedos, porém com melhora dos sinais e sintomas dos membros inferiores. Trata-se de um caso raro na literatura em função da associação da vasculite com o HIV e do acometimento dos vasos distais nos membros inferiores. Entretanto, o conhecimento desta associação é de extrema importância devido à repercussão na vida dos pacientes acometidos.The acute limb ischemia may manifest itself, albeit unusual, as a consequence of vasculitis associated with human immunodeficiency virus (HIV. This case report described a patient seropositive for HIV who developed bilateral distal ischemia with temperature decrease of distal legs and feet, severe pain, cyanosis of fixed toes, and absence of distal pulses. She underwent treatment with thrombolytic therapy, showed signs of injury resulting from ischemia and reperfusion tissue injury with tissue loss in the distal regions of the fingers, but with improvement of the signs and symptoms of lower limbs. It is a rare case in literature due to the association of vasculitis with HIV and to the torment of distal vases of the lower limbs. Despite of that, the knowledge of the pathology is extremely important because of the repercussion in the patients' lives.

  8. Neutropenia crónica e infección por el virus de la inmunodeficiencia humana

    OpenAIRE

    Ronald A Noguera-Valverde; Ricardo Boza-Cordero

    2008-01-01

    Se presenta el caso de un paciente masculino con neutropenia crónica e infección por el virus de inmunodeficiencia humana, con una revisión de los posibles mecanismos patogénicos. Las alteraciones hematológicas como anemia, trombocitopenia y leucopenia se presentan asociadas con frecuencia a la infección aguda por el virus de inmunodeficiencia humana. Al establecer la terapia antirretroviral y disminuir la actividad del virus, estas alteraciones tienden a mejorar. Sin embargo, algunos fármaco...

  9. Trichosporon faecale invasive infection in a patient with severe aplastic anemia: Efficacy of voriconazole and liposomal amphotericin B before neutrophil recovery

    OpenAIRE

    Baptiste Pérard; Amandine Rougeron; Simon Favre; Isabelle Accoceberry; Stéphane Vigouroux; Catherine Mohr; Noël Milpied

    2015-01-01

    We report a case of a 51-year old man with a severe aplastic anemia who developed an invasive trichosporonosis to Trichosporon faecale with fungemia and skin lesions during severe neutropenia. The treatment was successful before neutrophil recovery with a combination of voriconazole and liposomal amphotericin B.

  10. Clinical study on immune neutropenia%免疫性中性粒细胞减少症临床研究

    Institute of Scientific and Technical Information of China (English)

    银广悦; 王文红; 龚庆辉; 张继领

    2012-01-01

    Objective To explore the diagnosis and of immune neutopenia.Methods Clinical data of 150 patients with immune neutropenia were collected and analyzed.Results Of 150 patients with immune neutropenia,35 cases went male(23.3%),115 cases were female(76.7%),and male to female ratio was 1 ∶ 3.3.Based on the difference produced way of granulocytes associated antibody,all patients could be divided into alloimmune neonatal neutropenia 9 cases (6.0%),drug-induced immune neutropenia 28 cases (18.7 %),primary autoimmune neutropenia 22 cases(14.6%),and secondary autoimmune neutropenia 91 cases (60.7%).Secondary autoimmune neutropenia included 39 cases of systemic lupus erythematous,21 cases of rheumatoid arthritis,2 cases of immune hemolytic anemia accompany with neutropenia,6 cases of immune thrombocytopenia accompany with neutropenia,3 cases of autoimmune hepatitis,16 cases of autoimmune thyroiditis,and 4 cases of Sjogren's syndrome.Conclusion The majority of primary immune neutropenia are female,which is usually secondary to autoimmune diseases.The diagnosis of primary immune neutropenia is very complicated,which requires a long period of clinical observation and follow-up.The majority of granulocytes associated antibody is IgG in the autoimmune neutropenia patients.Yet sometimes two or three kinds of antibodies were increased as well.%目的 探讨免疫性粒细胞减少症的诊断及治疗.方法 收集150例住院及门诊免疫性中性粒细胞减少症患者临床资料.利用SPSS 13.0进行数据的统计分析.结果 150例患者中,男性35例(23.3%),女性115例(76.7%),男女之比为1∶3.3.依据中性粒细胞抗体产生方式不同分为新生儿同种免疫性中性粒细胞减少症9例(6.0%);药物性免疫粒细胞减少症28例(18.7%);原发性自身免疫性中性粒细胞减少症22例(14.6%);继发性免疫性粒细胞减少症91例(60.7%):包括系统性红斑狼疮39例、类风湿关节炎21例、免

  11. Febrile Neutropenia Risk Assessment and Granulocyte-Colony Stimulating Factor Support in Patients with Diffuse Large B Cell Lymphoma Receiving R-CHOP Regimens

    DEFF Research Database (Denmark)

    Salar, Antonio; Haioun, Corinne; Rossi, Francesca Gaia;

    2009-01-01

    BACKGROUND: ASCO and EORTC guidelines recommend granulocyte colony-stimulating factor (G-CSF) primary prophylaxis for cancer patients with a ≥20% overall risk of febrile neutropenia (FN), and to support delivery of dose-dense regimens. CHOP-like regimens (with rituximab [R]) are the current...... standard of care for the management of aggressive non-Hodgkin lymphoma (NHL), but they are often associated with significant myelosuppression. Neutropenic events, particularly febrile neutropenia (FN), can be life-threatening and may lead to dose delays or reductions that compromise the efficacy of......-CSF primary prophylaxis. Across all cycles, 29% of R-CHOP-21 patients had an unplanned hospitalization, with neutropenia/FN being the main reason. Subsequently, 67% of patients achieved a relative dose intensity (RDI) of ≥90% of their planned treatment (with respect to cyclophosphamide, doxorubicin, and...

  12. A review of the causes of depression among disabled soldiers (Janbazan) with the severity of disability more than 40 percent in Isfahan within 1370 and the presentation of guideline

    OpenAIRE

    Shojaiezadeh D

    1997-01-01

    This study is a review of the causes of depression among disabled soldiers (Janbazan) with severity of disability more than 40 percent. In this study, the total population is 1186. This population is classified based on the percentage of severity of the disability (40-49%, 50-69% and >70%). There are respectively in each. Classes 680, 272 and 234 cases. 10 percent of each class (totally 12 persons) were selected randomely. It must to be mentioned that 4 cases was absent because of diff...

  13. The R46Q, R131Q and R154H Polymorphs of Human DNA Glycosylase/β-Lyase hOgg1 Severely Distort the Active Site and DNA Recognition Site but do not Cause Unfolding†

    OpenAIRE

    Anderson, Peter C.; Daggett, Valerie

    2009-01-01

    Reactive oxygen species can cause widespread cellular damage, including base alterations and strand breaks in DNA. An array of DNA-repair enzymes constitutes an essential part of the line of defense that cells use against oxidative damage to the genome. A DNA glycosylase/β-lyase enzyme, Ogg1, scavenges the genome for 8-oxoguanine, a major mutagenic DNA adduct induced by reactive oxygen species, and catalyzes its excision and subsequent cleavage of the DNA phosphate backbone. Several polymorph...

  14. Caracterización de pacientes pediátricos con neutropenia enviados a un hospital de referencia Characterization of neutropenic pediatric patients sent to a referral centre

    OpenAIRE

    Gustavo Adolfo Lazo-Páez; Oscar Porras

    2010-01-01

    Objetivo: La neutropenia es un motivo relativamente frecuente de referencia al Servicio de Inmunología y Reumatología Pediátrica del Hospital Nacional de Niños; el estudio pretende caracterizar los casos de neutropenia referidos a este Servicio en el periodo comprendido entre noviembre de 1988 y junio de 2008. Métodos: Se estudiaron 84 pacientes entre 0 y 12 años de edad, referidos entre el 6 de noviembre de 1988 y el 1 de junio de 2008. Se efectuó un análisis descriptivo global de las caract...

  15. Diversity and severity of adverse reactions to quinine: A systematic review.

    Science.gov (United States)

    Liles, Nathan W; Page, Evaren E; Liles, Amber L; Vesely, Sara K; Raskob, Gary E; George, James N

    2016-05-01

    Quinine is a common cause of drug-induced thrombocytopenia and the most common cause of drug-induced thrombotic microangiopathy. Other quinine-induced systemic disorders have been described. To understand the complete clinical spectrum of adverse reactions to quinine we searched 11 databases for articles that provided sufficient data to allow evaluation of levels of evidence supporting a causal association with quinine. Three reviewers independently determined the levels of evidence, including both immune-mediated and toxic adverse reactions. The principal focus of this review was on acute, immune-mediated reactions. The source of quinine exposure, the involved organ systems, the severity of the adverse reactions, and patient outcomes were documented. One hundred-fourteen articles described 142 patients with definite or probable evidence for a causal association of quinine with acute, immune-mediated reactions. These reactions included chills, fever, hypotension, painful acral cyanosis, disseminated intravascular coagulation, hemolytic anemia, thrombocytopenia, neutropenia, acute kidney injury, rhabdomyolysis, liver toxicity, cardiac ischemia, respiratory failure, hypoglycemia, blindness, and toxic epidermal necrolysis. One hundred-two (72%) reactions were caused by quinine pills; 28 (20%) by quinine-containing beverages; 12 (8%) by five other types of exposures. Excluding 41 patients who had only dermatologic reactions, 92 (91%) of 101 patients had required hospitalization for severe illness; 30 required renal replacement therapy; three died. Quinine, even with only minute exposure from common beverages, can cause severe adverse reactions involving multiple organ systems. In patients with acute, multi-system disorders of unknown origin, an adverse reaction to quinine should be considered. PMID:26822544

  16. Plasma IL-8 and IL-6 levels can be used to define a group with low risk of septicaemia among cancer patients with fever and neutropenia

    NARCIS (Netherlands)

    de Bont, ESJM; Vellenga, E; Swaanenburg, JCJM; Fidler, [No Value; Visser-van Brummen, PJ; Kamps, WA

    1999-01-01

    The standard therapy for patients with fever and chemotherapy-related neutropenia is hospitalization and infusion of broad-spectrum antibiotics. Early discharge of a defined group of patients at low risk for septicaemia would be of great advantage for these patients. Ih this study plasma interleukin

  17. Neutropenia crónica e infección por el virus de la inmunodeficiencia humana

    Directory of Open Access Journals (Sweden)

    Ronald A Noguera-Valverde

    2008-09-01

    Full Text Available Se presenta el caso de un paciente masculino con neutropenia crónica e infección por el virus de inmunodeficiencia humana, con una revisión de los posibles mecanismos patogénicos. Las alteraciones hematológicas como anemia, trombocitopenia y leucopenia se presentan asociadas con frecuencia a la infección aguda por el virus de inmunodeficiencia humana. Al establecer la terapia antirretroviral y disminuir la actividad del virus, estas alteraciones tienden a mejorar. Sin embargo, algunos fármacos antirretrovirales, como la zidovudina, poseen toxicidad medular y pueden producir o empeorar las alteraciones hematológicas en estos pacientes, lo cual lleva a cambios en los esquemas de tratamiento. Los citotóxicos y antimetabolitos empleados en el tratamiento de neoplasias asociadas tienen conocida actividad depresora sobre la médula ósea. Algunos antimicrobianos utilizados en la profilaxis de infecciones poseen también toxicidad hematológica conocida, como el trimetoprim-sulfametoxazol, por lo que deben ser utilizados con precaución en pacientes con infección por el virus de inmunodeficiencia humana. Por otro lado, se plantean mecanismos alternativos que causan neutropenia en estos pacientes, como la formación de anticuerpos antineutrófilos, daño primario del progenitor granulocítico, por desbalance en la producción de neutrófilos, por anticuerpos contra la glicoproteína gp120 de la cápside viral del VIH, y deficiencias vitamínicas. En el caso del paciente neutropénico febril, en quien se sospecha infección bacteriana grave, se pueden utilizar los factores estimulantes de las colonias de granulocitos para aumentar los conteos absolutos de neutrófilos y mejorar la recuperación clínica.

  18. Variation in Management of Fever and Neutropenia Among Pediatric Patients With Cancer: A Survey of Providers in Michigan.

    Science.gov (United States)

    Mueller, Emily L; Walkovich, Kelly J; Yanik, Gregory A; Clark, Sarah J

    2015-01-01

    Considerable variation in the management of fever and neutropenia (FN) exists, with factors associated with treatment variation not well described. An online survey of 90 pediatric cancer providers in Michigan was performed in Spring 2014. The survey frame was pediatric patients with cancer receiving treatment, with a Port-a-cath, who were clinically stable. Criteria for "Decreased" and "Increased" risk groups were defined by respondents. Survey questions addressed FN definitions, risk groups conceptualization, routine clinical practice, and management guidelines, in the context of risk groups and distance to treating institution. Fifty providers responded (56%); the majority defined a febrile event as temperature >38.3°C and/or 2 events >38.0°C within a 24-hour period. Neutropenia was defined as current or anticipated absolute neutrophil count (ANC) 2 hours away. Respondents were significantly more likely to have a "Decreased Risk" patient travel over 2 hours if they rated the local ED as "Poor to Fair" on ability to access Port-a-caths (P = .048). Most respondents would discharge patients who are afebrile for 24 hours, blood cultures negative for 48 hours, and neutrophil count of greater than 200/μL; 40% preferred discharge on oral antibiotics when the ANC <500/μL. Triaging for febrile pediatric patients with cancer is significantly influenced by the providers' perceptions of local EDs. Future investigation of local hospitals' ability to provide urgent evaluation, combined with parental perspectives, could lead to improvements in timely and effective management. PMID:26086779

  19. Quality of Life and Neutropenia in Patients with Early Stage Breast Cancer: A Randomized Pilot Study Comparing Additional Treatment with Mistletoe Extract to Chemotherapy Alone

    Directory of Open Access Journals (Sweden)

    Wilfried Tröger

    2009-01-01

    Full Text Available Background: Chemotherapy for breast cancer often deteriorates quality of life, augments fatigue, and induces neutropenia. Mistletoe preparations are frequently used by cancer patients in Central Europe. Physicians have reported better quality of life in breast cancer patients additionally treated with mistletoe preparations during chemotherapy. Mistletoe preparations also have immunostimulant properties and might therefore have protective effects against chemotherapy-induced neutropenia.Patients and Methods: We conducted a prospective randomized open label pilot study with 95 patients randomized into three groups. Two groups received Iscador® M special (IMS or a different mistletoe preparation, respectively, additionally to chemotherapy with six cycles of cyclophosphamide, adriamycin, and 5-fluoro-uracil (CAF. A control group received CAF with no additional therapy. Here we report the comparison IMS (n = 30 vs. control (n = 31. Quality of life including fatigue was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30. Neutropenia was defined as neutrophil counts <1,000/µl and assessed at baseline and one day before each CAF cycle.Results: In the descriptive analysis all 15 scores of the EORTC-QLQ-C30 showed better quality of life in the IMS group compared to the control group. In 12 scores the differences were significant (p < 0.02 and nine scores showed a clinically relevant and significant difference of at least 5 points. Neutropenia occurred in 3/30 IMS patients and in 8/31 control patients (p = 0.182.Conclusions: This pilot study showed an improvement of quality of life by treating breast cancer patients with IMS additionally to CAF. CAF-induced neutropenia showed a trend to lower frequency in the IMS group.

  20. Research Progress in Hand-Foot-Mouth Disease Caused by Severe Enterovirus 71 Infection%重症肠道病毒71型感染手足口病研究进展

    Institute of Scientific and Technical Information of China (English)

    郭靖

    2015-01-01

    常见的手足口病由重症肠道病毒71型引起,并在世界范围内流行。为了更加科学地认识肠道病毒71型与手足口病的关系,该文就重症肠道病毒71型引起的手足口病的病原学、发病机制、临床症状、流行病学、预防与诊治等方面的研究进展进行了综述。%Common hand-foot-mouth disease is caused by the severe enterovirus 71, and is prevalent around the world. In order to more scientifically understand the relationship between enterovirus 71 and hand-foot-mouth disease, this paper conducts the detailed review on the research progress of the severe enterovirus 71 caused hand-foot-mouth disease in the aspects of the etiology, pathogenesis, clinical symptom, epidemiology, prevention and treatment.

  1. The role of carbon dioxide (and intracellular pH) in the pathomechanism of several mental disorders. Are the diseases of civilization caused by learnt behaviour, not the stress itself?

    Science.gov (United States)

    Sikter, András; Faludi, Gábor; Rihmer, Zoltán

    2009-09-01

    The role of carbon dioxide (CO2) is underestimated in the pathomechanism of neuropsychiatric disorders, though it is an important link between psyche and corpus. The actual spiritual status also influences respiration (we start breathing rarely, frequently, irregularly, etc.) causing pH alteration in the organism; on the other hand the actual cytosolic pH of neurons is one of the main modifiers of Ca2+-conductance, hence breathing directly, quickly, and effectively influences the second messenger system through Ca2+-currents. (Decreasing pCO2 turns pH into alkalic direction, augments psychic arousal, while increasing pCO2 turns pH acidic, diminishes arousal.) One of the most important homeostatic function is to maintain or restore the permanence of H+-concentration, hence the alteration of CO2 level starts cascades of contraregulation. However it can be proved that there is no perfect compensation, therefore compensational mechanisms may generate psychosomatic disorders causing secondary alterations in the "milieu interieur". Authors discuss the special physico-chemical features of CO2, the laws of interweaving alterations of pCO2 and catecholamine levels (their feedback mechanism), the role of acute and chronic hypocapnia in several hyperarousal disorders (delirium, panic disorder, hyperventilation syndrome, generalized anxiety disorder, bipolar disorder), the role of "locus minoris resistentiae" in the pathomechanism of psychosomatic disorders. It is supposed that the diseases of civilization are caused not by the stress itself but the lack of human instinctive reaction to it, and this would cause long-lasting CO2 alteration. Increased brain-pCO2, acidic cytosol pH and/or increased basal cytosolic Ca2+ level diminish inward Ca2+-current into cytosol, decrease arousal--they may cause dysthymia or depression. This state usually co-exists with ATP-deficiency and decreased cytosolic Mg2+ content. This energetical- and ion-constellation is also typical of ageing

  2. Life-threatening hemorrhagic pneumonia caused by Stenotrophomonas maltophilia in the treatment of hematologic diseases.

    Science.gov (United States)

    Mori, Minako; Tsunemine, Hiroko; Imada, Kazunori; Ito, Kiminari; Kodaka, Taiichi; Takahashi, Takayuki

    2014-06-01

    Since the late 1990s, Stenotrophomonas maltophilia (S. maltophilia) has become one of the most common nonfermenting Gram-negative bacilli that cause opportunistic infection. Patients with hematologic diseases are the most risky candidate for S. maltophilia pneumonia or sepsis because of chemotherapy-induced neutropenia or immunodeficiency. Frequent exposure to broad-spectrum antibiotics and prolonged insertion of central venous catheter further enhance the risk of S. maltophilia infection. One of the most severe S. maltophilia infections is hemorrhagic pneumonia. This type of infection is mostly fatal because of pulmonary alveolar hemorrhage that leads to acute respiratory failure. Furthermore, S. maltophilia exhibits a high-level intrinsic resistance to conventional antibiotics such as β-lactams and aminoglycosides and, more recently, the increasing acquired resistance to co-trimoxazole and quinolones. According to our experienced and previously reported cases, all of the patients with hemorrhagic pneumonia caused by S. maltophilia had a fatal course within a few days after the onset of the pneumonia. In this article, we perform a systematic review on a total 30 cases of hemorrhagic pneumonia induced by S. maltophilia from our institutions and the literature, and we describe its early diagnosis, prophylaxis, and recommended therapeutic strategy for the infection in the treatment of hematologic disease. PMID:24535696

  3. 血浆置换术抢救25例蜂毒致急性重度溶血性贫血临床观察%The clinical abservation of TPE rescue acute severe hemolysis caused by bee venom

    Institute of Scientific and Technical Information of China (English)

    陈劲松; 吴华新; 范萍

    2009-01-01

    目的:观察血浆置换术(TPE)治疗蜂毒致急性重度溶血性贫血的疗效.方法:对25例已被确诊为蜂毒致急性重度溶血性贫血患者,在应用糖皮质激素的基础上进行TPE治疗,并观察其治疗效果.结果:25例患者中,22例患者经1~2次TPE治疗后,中毒症状很快缓解,血氧饱和度上升到90%~99%,溶血基本控制,血红蛋白尿、高胆红素血症消失,降低了多脏器功能衰竭的发生率,有效率为88%,平均住院12.5 d.结论:TPE能快速有效地清除蜂毒及红细胞溶解产物,可阻断因溶血及蜂毒导致的脏器功能衰竭,是抢救蜂毒危重者的有效方法.%Objective:To observe the effect of the rapeutic plasma exchange in acute severe hemolysis which was caused by bee venom.Methods:25 patients were made a definite diagnosis to acute severe hemolysis which was caused by bee venom.Corticosteroid and plasma exchange were given to them.Results:Among 25 patients,22 patients who have undergone 1 to 2 times TPE.During the operation and end of TPE, the symptom of toxicosis remitted at once.The SaO2 rised to 90%- 99%.Hospitalization time was 12.5 days,hemolysis were controlled,hemoglobinnria and hyperbilirubinemia disappeared, the incidence of organ function failure decreased,effective rate was 88%.Conclusion:Plasma exchange can quickly remove the apitoxin and product of crythrolysis,TPE can bolck the organ function failure caused by hemolysis and apitoxin and is an effective method for rescue severe patients by bee venom.

  4. Decreased numbers of chemotactic factor receptors in chronic neutropenia with defective chemotaxis: spontaneous recovery from the neutrophil abnormalities during early childhood

    International Nuclear Information System (INIS)

    Childhood chronic neutropenia with decreased numbers of chemotactic factor receptors as well as defective chemotaxis was first demonstrated in an 8-month-old girl. Chemotactic factor receptors on neutrophils were assayed using tritiated N-formyl-methionyl-leucyl-phenylalanine (3H-FMLP). The patient's neutrophils had decreased numbers of the receptors: numbers of the receptors were 20,000 (less than 3 SD) as compared with those of control cells of 52,000 +/- 6000 (mean +/- SD) (n = 10). The neutropenia disappeared spontaneously by 28 months of age parallel with the improvement of chemotaxis and increase in numbers of chemotactic factor receptors. These results demonstrate a transient decrease of neutrophil chemotactic factor receptors as one of the pathophysiological bases of a transient defect of neutrophil chemotaxis in this disorder

  5. Cortical synaptic transmission in CaV2.1 knockin mice with the S218L missense mutation which causes a severe familial hemiplegic migraine syndrome in humans.

    Directory of Open Access Journals (Sweden)

    Dania eVecchia

    2015-02-01

    Full Text Available Familial hemiplegic migraine type 1 (FHM1 is caused by gain-of-function mutations in CaV2.1 (P/Q-type Ca2+ channels. Knockin (KI mice carrying the FHM1 R192Q missense mutation show enhanced cortical excitatory synaptic transmission at pyramidal cell synapses but unaltered cortical inhibitory neurotransmission at fast-spiking interneuron synapses. Enhanced cortical glutamate release was shown to cause the facilitation of cortical spreading depression (CSD in R192Q KI mice. It, however, remains unknown how other FHM1 mutations affect cortical synaptic transmission. Here, we studied neurotransmission in cortical neurons in microculture from KI mice carrying the S218L mutation, which causes a severe FHM syndrome in humans and an allele-dosage dependent facilitation of experimental CSD in KI mice, which is larger than that caused by the R192Q mutation. We show gain-of-function of excitatory neurotransmission, due to increased action-potential evoked Ca2+ influx and increased probability of glutamate release at pyramidal cell synapses, but unaltered inhibitory neurotransmission at multipolar interneuron synapses in S218L KI mice. In contrast with the larger gain-of-function of neuronal CaV2.1 current in homozygous than heterozygous S218L KI mice, the gain-of-function of evoked glutamate release, the paired-pulse ratio and the Ca2+ dependence of the EPSC were all similar in homozygous and heterozygous S218L KI mice, suggesting compensatory changes in the homozygous mice. Furthermore, we reveal a unique feature of S218L KI cortical synapses which is the presence of a fraction of mutant CaV2.1 channels being open at resting potential. Our data suggest that, while the gain-of-function of evoked glutamate release may explain the facilitation of CSD in heterozygous S218L KI mice, the further facilitation of CSD in homozygous S218L KI mice is due to other CaV2.1-dependent mechanisms, that likely include Ca2+ influx at voltages sub-threshold for action

  6. Novel C16orf57 mutations in patients with Poikiloderma with Neutropenia: bioinformatic analysis of the protein and predicted effects of all reported mutations

    Directory of Open Access Journals (Sweden)

    Colombo Elisa A

    2012-01-01

    Full Text Available Abstract Background Poikiloderma with Neutropenia (PN is a rare autosomal recessive genodermatosis caused by C16orf57 mutations. To date 17 mutations have been identified in 31 PN patients. Results We characterize six PN patients expanding the clinical phenotype of the syndrome and the mutational repertoire of the gene. We detect the two novel C16orf57 mutations, c.232C>T and c.265+2T>G, as well as the already reported c.179delC, c.531delA and c.693+1G>T mutations. cDNA analysis evidences the presence of aberrant transcripts, and bioinformatic prediction of C16orf57 protein structure gauges the mutations effects on the folded protein chain. Computational analysis of the C16orf57 protein shows two conserved H-X-S/T-X tetrapeptide motifs marking the active site of a two-fold pseudosymmetric structure recalling the 2H phosphoesterase superfamily. Based on this model C16orf57 is likely a 2H-active site enzyme functioning in RNA processing, as a presumptive RNA ligase. According to bioinformatic prediction, all known C16orf57 mutations, including the novel mutations herein described, impair the protein structure by either removing one or both tetrapeptide motifs or by destroying the symmetry of the native folding. Finally, we analyse the geographical distribution of the recurrent mutations that depicts clusters featuring a founder effect. Conclusions In cohorts of patients clinically affected by genodermatoses with overlapping symptoms, the molecular screening of C16orf57 gene seems the proper way to address the correct diagnosis of PN, enabling the syndrome-specific oncosurveillance. The bioinformatic prediction of the C16orf57 protein structure denotes a very basic enzymatic function consistent with a housekeeping function. Detection of aberrant transcripts, also in cells from PN patients carrying early truncated mutations, suggests they might be translatable. Tissue-specific sensitivity to the lack of functionally correct protein accounts for the

  7. Evaluation of ticarcillin/clavulanic acid versus ceftriaxone plus amikacin for fever and neutropenia in pediatric patients with leukemia and lymphoma

    Directory of Open Access Journals (Sweden)

    Petrilli Antonio Sérgio

    2003-01-01

    Full Text Available BACKGROUND: The empirical use of antibiotic treatments is widely accepted as a means to treat cancer patients in chemotherapy who have fever and neutropenia. Intravenous monotherapy, with broad spectrum antibiotics, of patients with a high risk of complications is a possible alternative. METHODS: We conducted a prospective open-label, randomized study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy. Patients received either monotherapy with ticarcillin/clavulanic acid (T or ceftriaxone plus amikacin (C+A. RESULTS: Seventy patients who presented 136 episodes were evaluated, 68 in each arm of the study. The mean neutrophil counts at admission were 217cells/mm³ (T and 201cells/mm³ (C+A. The mean duration of neutropenia was 8.7 days (T and 7.6 days (C+A. Treatment was successful without the need for modifications in 71% of the episodes in the T group and 81% in the C+A group (p=0.23. Treatment was considered to have failed because of death in two episodes (3% in the T group and three episodes (4% in the C+A group, and because of a change in the drug applied in one episode in the T group and two episodes in the C+A group. Overall success was 96% (T and 93% (C+A. Adverse events that occurred in group T were not related to the drugs used in this study. CONCLUSION: In pediatric and adolescent patients with leukemia or lymphoma, who presented with fever and neutropenia, during chemotherapy, ticarcillin/clavulanic acid was as successful as the combination of ceftriaxone plus amikacin. It should be considered an appropriate option for this group of patients at high risk for infections.

  8. The diagnostic value of soluble urokinase plasminogen activator receptor compared with C-reactive protein and procalcitonin in children with febrile neutropenia.

    Science.gov (United States)

    Sirinoglu, Melis; Soysal, Ahmet; Karaaslan, Ayşe; Kepenekli Kadayifci, Eda; Cinel, Ismail; Koç, Ahmet; Tokuç, Gülnur; Yaman, Ali; Haklar, Goncagül; Şirikçi, Önder; Turan, Serap; Altınkanat Gelmez, Gülşen; Söyletir, Güner; Bakır, Mustafa

    2016-04-01

    The aim of the present study was to determine the diagnostic value of soluble urokinase plasminogen activator receptor (suPAR) in pediatric patients with febrile neutropenia. A prospective case-control study was performed. Patients included 29 children with febrile neutropenia (FN) and 27 control subjects without any infection or immunosuppressive condition. Blood samples were obtained on the day of admission and on the 4th to 7th days of the hospital stay. The median (minimum-maximum) serum levels of suPAR obtained on the first day of the admission were 2.08 (0.93-9.42) and 2.22 (1.08-5.13) ng/mL for the FN group and the control group, respectively. The median serum levels of suPAR in the FN and control groups were not significantly different (P = .053). The mean serum suPAR level was significantly higher in nonsurvivors than in survivors in the FN group (P < .05). In the FN group, the area under the receiver operating characteristics curve (AUCROC) for suPAR was 0.546, but no optimum cutoff value, sensitivity, specificity, negative predictive value (NPV), or positive predictive value (PPV) was obtained. We conclude that suPAR is not useful as a diagnostic biomarker in children with febrile neutropenia; however, persistent high serum suPAR level may predict mortality in FN in children. PMID:27057782

  9. CORRECTION OF NEUTROPENIA BY GM-CSF IN PATIENTS WITH A LARGE GRANULAR LYMPHOCYTE-PROLIFERATION

    NARCIS (Netherlands)

    MULDER, AB; DEWOLF, JTM; SMIT, JW; VANOOSTVEEN, JW; VELLENGA, E

    1992-01-01

    The in vivo and in vitro effects of GM-CSF were tested in four patients with large granular lymphocyte proliferation (LGLP) and severe granulocytopenia. All patients had an increased percentage of LGL cells (> 20%), whereas 3/4 patients demonstrated rearranged T-cell-receptor genes. An effect on the

  10. Magnitude and Causes of Low Vision Disability (Moderate and Severe Visual Impairment among Students of Al-Noor Institute for the Blind in Al-Hassa, Saudi Arabia; A case series

    Directory of Open Access Journals (Sweden)

    Fahad Al-Wadani

    2012-02-01

    Full Text Available Objectives: This study aimed to estimate the magnitude and causes of low vision disability (severe visual impairment [SVI] and moderate visual impairment [MVI] among students at Al-Noor Institute for the Blind (NIB in Al-Hassa, Saudi Arabia in 2006. Methods: An optometrist conducted refraction of 122 eyes of the 61 students (27 boys and 34 girls with MVI (vision <6/18 to 6/60 and SVI (vision <6/60 to 3/60. Ophthalmologists examined the anterior and posterior segments, and analysed the outcomes of additional investigations to finalise the diagnosis. The results were categorised as ‘preventable’, ‘treatable’ and ‘not amenable to treatment’. The low vision care was also reviewed. Results: In 12 (9.8% eyes, visual acuity was ≥6/18 and in 28 (23% eyes, it was <3/60. MVI and SVI were found in 82 eyes (67.2%. Hereditary retinal disorders were found in 68 (55.7% eyes. Although refractive errors were found in 112 (91.8% eyes, isolated refractive error was found in only 9 students. Congenital glaucoma and cataract were responsible for visual impairment in 16 (13.1% and 9 (7.4% eyes. These students were prescribed optical and non-optical low vision aids. Conclusion: Retinal disease was the main cause of SVI and MVI in our series. Some students at Al-Noor Institute for the Blind have curable low vision conditions. Rehabilitation of low vision disability should be different from that offered to the absolutely blind.

  11. The study on the causes of Early death and the pireoperative management of cardiac valve replacement in patients with severe diseases%危重心脏瓣膜置换早期死亡原因及对策

    Institute of Scientific and Technical Information of China (English)

    李鲁; 马黎明; 褚衍林; 林毅; 程前进; 王志鸿; 李祥

    2012-01-01

    Objective To study the causes of early death and peri-operative management of cardiac valve replacement in patients with severe diseases. Methods Valve replacements were performed in 420 cases with severe cardiac valve diseases from April 1996 to July 2009. There were 202 male and 218 female, with an age ranged from 12 to 78 years. Preoperative heart function (NYHA) in 92 cases were chass III and 328 cases were in class IV, Mitral valve replacement were performed in 237 cases, Aortic replacement in 20, both mitral and aortic in 142, three valves with mitral, aortic and tricuspid in 15, and bicuspid in 6. 569 mechanical valves and 23 bioprostheses were implanted. Associated procedures were tricuspid annuloplasty in 242 cases, left atrium thrombectomy in 62, annuloplasty in 42, coronary artery bypass grafting in 52 cases, closing of patent ductus arteriosus transpuhnonary artery in 14,repair of ventricular septal defect in 6, and repair of aneurysm of the sinus of valsalva in 12, and repair of unroofed coronary sinus and surgical interruption of the Bundle of Kent in patient with W-P-W syndrome in 2 respectively. Results Thirteen(3.09%) patients were defined as early deaths. Low cardiac output, ventricular fibrillation, respiratory failure and multiple organ failure were the most frequent causes of mortality. Conclusion According to characteristics of severe patients, paying attention In preoperative preparation, selecting the most appropriate operative chance and correcting pathological changes, avoiding operative complications, and strengthening management of postoperative complication may have an excellent results in severe patients.%目的 探讨危重心脏瓣膜病手术早期死亡因素及对策.方法 总结420例危重心脏瓣膜病施行瓣膜置换的患者的临床资料,男202例,女218例,年龄(40.0±8.7)岁.术前心功能Ⅲ级92例,Ⅳ级328例.二尖瓣置换237例,主动脉瓣置换20例;二尖瓣+主动脉瓣置换142例;二尖瓣置换+

  12. What Causes Cystic Fibrosis?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Causes Cystic Fibrosis? A defect in the CFTR gene causes cystic ... in the severity of the disease. How Is Cystic Fibrosis Inherited? Every person inherits two CFTR genes—one ...

  13. Analysis of 73 Cases of Severe Adverse Drug Reactions Caused by Cephalosporin%73例头孢菌素类药物严重不良反应分析

    Institute of Scientific and Technical Information of China (English)

    吕冬莲; 龙萍; 吴方建

    2012-01-01

    目的:了解头孢菌素类药物引起的严重不良反应(SADR)的发生规律,发掘药物警戒信号,为临床安全合理用药提供参考.方法:收集武汉市不良反应监测系统数据库中2009~2011年头孢菌素类严重的(包括新的严重的)不良反应报告,从中筛选出符合标准的73例进行分析.结果:73例SADR涉及头孢菌素19个品种,其中以头孢曲松的比例最高;临床表现以过敏性休克和过敏样反应为主的全身性损害最为突出;41例SADR发生时间在30 min内;50岁以上的老年人及10岁以下儿童ADR构成比较高.从ADR病例报告中反映存在相当数量的不合理用药现象.结论:临床应高度重视头孢菌素类药物引起的过敏性休克等SADR,增强合理用药意识,以减少和避免SADR的发生.%Ohjective:To realize the regularity of severe adverse drug reaction(SADR) of cephalosporin, exploring the signal of drug alert, and providing the reference of rational use of drugs for clinical safety. Methods; Analyzed 73 oases which were up to standard from severe( including new severe) adverse reaction reports of cephalosporin from 2009 to 2011 in Wuhan adverse reaction monitoring system database. Results:'The SADR involved 19 kinds of cephalosporin, and the highest rercenlage was ceftriaxone Clinical perfor mance based on the principle of anaphylactoid reaction and anaphylac-tic shock. 41 cases SADRs appeared wilhin 30 minutes after administration, the constituent ratios of elder above 50 years old and the children under the age of 10 were a relatively high. And the reports of the SADR cases reflected a number of irrational drug use phenomenon. Conclusion: Clinical should pay high attention to anaphylactic shock and other SADRs caused by cephalosporin. To enhance the consciousness of rational drug use, in order lo reduce and avoid the happening of SADRs.

  14. Enteral nutrition support and nursing to batched severe burn patients caused by explosions%成批爆炸致特重度烧伤患者肠内营养支持的护理

    Institute of Scientific and Technical Information of China (English)

    王静云; 李小珍

    2015-01-01

    目的:探讨成批爆炸致特重度烧伤患者肠内营养支持护理要点。方法对本科室收治的15例特重度烧伤患者进行肠内营养支持治疗,并配合做好护理工作。结果5例患者伤后45~87 d因缺少自体皮源,并发脓毒血症死亡,10例患者经过肠内营养支持、抗感染等治疗护理,营养状况得到改善,安全度过感染期,进入恢复期;患者ICU住院时间54~115 d,平均(90.63±30.37)d。结论特重度烧伤患者采取早期肠内营养支持及护理,能够有效改善患者营养状况,促进患者康复。营养支持期间应做好管饲护理,预防早期肠内营养发生的并发症等,其是顺利完成肠内营养支持的重要措施。%Objective To explore nursing points on the enteral nutrition support to batched patients with severe burn caused by explosion. Method An enteral nutrition support was carried out for 15 patients with severe burns admitted in our department and pertinent nursing was performed. Results Five patients died because of lack of autologous skin sources and complications of sepsis in 45~87 d after burn. Ten patients got a good recovery after enteral nutrition support, anti-infection treatment and nursing. They lived through the infection period, went into the recovery period. The hospital stay of these patients in ICU was 54~115 d with an average of (90.63 ± 30.37)d. Conclusion Early enteral nutrition support and nursing to the patients with severe burn can improve the nutritional status of patients effectively and promote the rehabilitation of patients.

  15. A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus Estudo comparativo do envenenamento escorpiônico grave em crianças provocado por Tityus bahiensis e Tityus serrulatus

    Directory of Open Access Journals (Sweden)

    Fábio Bucaretchi

    1995-08-01

    Full Text Available From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1% or Tityus bahiensis (84.9% presented severe envenoming. Of these 17 patients (1-11 years old; median=2 yr 14 were stung by T.serrulatus and three by T.bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median=2h. On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17, diaphoresis (15, tachycardia (14, prostration (10, tachypnea (8, arterial hypertension (7, arterial hypotension (5, tremors (5, hypothermia (4, hyperglycemia (17, leukocytosis (16/16, hypokalemia (13/17, increased CK-MB enzyme activity (>6% of the total CK, 11/12, hyperamylasemia (11/14, sinusal tachycardia (16/17 and a myocardial infarction-like pattern (11/17. Six patients stung by T.serrulatus had depressed left ventricular systolic function assessed by means of echocardiography. Of these, five presented pulmonary edema and four had shock. A child aged two-years old presented severe respiratory failure and died 65 h after being stung by T.serrulatus. Severe envenomations caused by T.serrulatus were 26.2 times more frequent than those caused by T.bahiensis (pNo período de janeiro de 1984 a maio de 1994, de 239 crianças com até 15 anos de idade, picadas por escorpiões pertencentes às espécies T.bahiensis (84,9% e T.serrulatus (15,1%, 17 apresentaram envenenamento grave. Destes 17 pacientes, cuja idade variou de 1 a 11 anos (mediana=2anos, 14 foram picados por T.serrulatus e 3 por T.bahiensis. Todos receberam anti-veneno escorpiônico i.v. entre 45 min. e 5 hs após o acidente (mediana=2 horas. À admissão, as principais manifestações clínicas, alterações laboratoriais e eletrocardiográficas observadas foram: vômitos(17, sudorese profusa(15, taquicardia(14, prostração(10, taquipnéia (8, hipertensão arterial(7, hipotensão arterial(5, tremores(5

  16. 69例小儿中性粒细胞减少症的治疗方法及疗效分析%The treatment method and curative effect of 69 children with neutropenia disease

    Institute of Scientific and Technical Information of China (English)

    牛江英

    2012-01-01

    Objective: To investigate the treatment method and curative effect of the children with neutropenia disease. Methods; Sixty - nine children with neutropenia disease treated in our hospital from January 2009 to August 2010 were chosen and randomly divided into group A (treatment group) with 35 cases and group B (control group) with 34 cases. The children in group A were taken routine use of antiviral drugs and supportive care plus Mannatide or Lee Jun - liter white blood cells trealmeny. The children in group B were used support routine use of antiviral drugs and treatment. The leukocytes and neutrophils for the two groups before and after treatment were compared. The cure rate for the two groups after treatment were also compared. Results; After treatment and intensive care, 26 patients returned to normal neutrophils in the treatment group, the total effective rate was 74. 3% , while 20 cases were normal in the control group, the total effective rate was 58. 8%. There was significant difference between the two groups, P <0.01. Conclusion; Children neutropenia is a serious disease endangering the health of children, it should be based on clinical prevention, take rational use of antibiotics, early detection and early action for the cause of comprehensive treatment for treatment to avoid serious damage to the children.%目的:分析小儿中性粒细胞减少症的治疗方法及疗效.方法:将2009年1月~2010年8月收治的小儿中性粒细胞减少症69例患儿随机分为A组(治疗组)35例和B组(对照组)34例.A组除常规应用抗病毒药物及支持治疗外,加用甘露聚糖肽或利可君升白细胞药物治疗;B组常规应用抗病毒药物及支持治疗.比较两组治疗前后的白细胞总数、中性粒细胞绝对值及治愈率.结果:治疗组26例恢复正常,总有效率为74.3%;对照组20例恢复正常,总有效率为58.8%.两组比较P<0.01.结论:小儿粒细胞减少症是严重危害小儿健康的疾病,临床应以

  17. Severe Sarcoidosis.

    Science.gov (United States)

    Kouranos, Vasileios; Jacob, Joe; Wells, Athol U

    2015-12-01

    In sarcoidosis, reduction in mortality and the prevention of disability due to major organ involvement are treatment goals. Thus, it is important to recognize severe disease and identify patients at higher risk of progression to severe disease. In this article, fibrotic lung disease and cardiac sarcoidosis are reviewed as the major contributors to sarcoidosis mortality and morbidity. In the absence of a standardized definition of severe pulmonary disease, a multidisciplinary approach to clinical staging is suggested, based on symptoms, pulmonary function tests, and imaging findings at presentation, integrated with the duration of disease and longitudinal disease behavior during early follow-up. PMID:26593144

  18. Sever's Disease

    Science.gov (United States)

    ... results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics. Sever's disease also can result from ...

  19. Metagenomic analysis of bloodstream infections in patients with acute leukemia and therapy-induced neutropenia.

    Science.gov (United States)

    Gyarmati, P; Kjellander, C; Aust, C; Song, Y; Öhrmalm, L; Giske, C G

    2016-01-01

    Leukemic patients are often immunocompromised due to underlying conditions, comorbidities and the effects of chemotherapy, and thus at risk for developing systemic infections. Bloodstream infection (BSI) is a severe complication in neutropenic patients, and is associated with increased mortality. BSI is routinely diagnosed with blood culture, which only detects culturable pathogens. We analyzed 27 blood samples from 9 patients with acute leukemia and suspected BSI at different time points of their antimicrobial treatment using shotgun metagenomics sequencing in order to detect unculturable and non-bacterial pathogens. Our findings confirm the presence of bacterial, fungal and viral pathogens alongside antimicrobial resistance genes. Decreased white blood cell (WBC) counts were associated with the presence of microbial DNA, and was inversely proportional to the number of sequencing reads. This study could indicate the use of high-throughput sequencing for personalized antimicrobial treatments in BSIs. PMID:26996149

  20. Necrosis cutánea severa por picadura de raya en el miembro inferior: presentación de un caso y revisión de la literatura Stingray injury causing severe cutaneous necrosis: case report and literature review

    Directory of Open Access Journals (Sweden)

    M.A. Hoyos Franco

    2009-12-01

    Full Text Available El propósito de este trabajo es presentar nuestra experiencia con un caso de picadura por raya en el área maleolar interna del pie derecho de un hombre de 25 años, que sufrió mientras pescaba. Inicialmente presentó dolor urente, seguido de edema severo, con necrosis de la piel suprayacente. Ingresa a nuestra institución 24 horas después y con edema, eritema y secreción purulenta en el sitio afectado. Se inicia tratamiento con antibióticos sistémicos y se realizan tres lavados y desbridamientos en días subsecuentes. Evolucionó con solución de continuidad y exposición ósea sobre el maléolo interno en un área de 7 x 5 cms que se cubrió con un colgajo safeno interno de flujo reverso que evolucionó satisfactoriamente. Las lesiones ocasionadas por la picadura de raya (Myliobatidae son escasamente referidas en Cirugía Plástica, pues la lesión tisular severa de las extremidades es poco frecuente. Revisamos la fisiopatología, los tipos de lesiones que se producen y los principios de tratamiento.The purpose of this paper is to present our experience with one case of stingray injury, in a 25 years old man, while he was fishing, compromising his right feet at the internal malleolus. At the beginning he had severe pain, and during the first hours after the accident progressive edema was evident. He arrived to our hospital 24 hours later, when purulent discharge and eritem was obvious. Intravenous antibiotics were initiated and three surgical debridements where performed during the following week. After the process was complete, a soft tissue defect was created on the internal malleolus (7 x 5 cm. Reconstruction was achieved using a reverse internal saphenous flap that evolved satisfactorily. Severe skin injuries caused by stingrays (Myliobatidae have been reported shortly in plastic surgery literature, because these lesions usually heal without surgical procedures. We review skin injury physiopathology, showing the different kind of

  1. Analysis of concurrent severe sciatica without pressure cause following lumbar spinal surgery%腰椎管术后并发无致压因素剧烈坐骨神经痛的剖析

    Institute of Scientific and Technical Information of China (English)

    倪凤民; 宋恒平; 王平均; 张皓; 陈睿; 杨小龙

    2013-01-01

    Objective To explore the reasons of concurrent severe sciatica without pressure cause following lumbar spinal surgery in a short term,to provide ideas for processing. Methods The patient characteristics and treatment of 12 cases of concurrent severe sciatica following lumbar spinal surgery shortly which appeared between October 2004 to August 2011 lumbar are reviewed, analyze the possible factors,and evaluate the effectiveness of treatment measures. Results The males in 12 cases are 3 cases, females are 9 cases,2 cases broke out after anesthesia disappear hours latter, the others for 1-2 days after the operations,presented lower limb pain just like which were tored or were cut by knife, pure sick limb pain are 10 cases,only healthy limb pain in 1,1 case of sick limb pain with healthy limb. Nothing had been found to pressure roots during the healing process. Calm、diminish inflammation、 dehydration,nourish nerve and so on,all patients get rid of their pain during staying be in hospital, the longest condition lasted 1 month,follow-up half year-2 years, did not see the repetition symptoms. Conclusion The physique factors, segmental aseptic inflammation around nerve root, root sensitization and root reaction caused by the sudden change of roots pathological environment and so on may be the reasons which lead to their emergency response sciatica.%目的 探讨腰椎管手术后短期内出现无椎管内致压因素的剧烈坐骨神经痛的原因,为处理提供思路.方法 对2004-10-2011-08月腰椎术后短期内发生剧烈坐骨神经痛的12例患者的病情特点及治疗进行回顾,分析产生症状的可能因素,评价处置措施的有效性.结果 12例中男3例,女9例,2例术后麻醉消失数小时后发作,其他为术后1~2 d发作,呈现撕裂样、刀割样下肢串痛,单纯患肢痛10例,单纯健肢痛1例,伴有健肢痛1例.治疗过程中未发现手术节段有任何致压物.镇静、消炎、脱水、神经营养神经治疗后,

  2. Analysis of the Causes of Several Costly Chinese Medicine Adulteration and Identiifcation Methods%几种贵重中药掺假成因分析及鉴别方法分析

    Institute of Scientific and Technical Information of China (English)

    张举良

    2015-01-01

    目的:分析几种贵重中药掺假成因分析及鉴别方法。方法购买海马、麝香、冬虫夏草等贵重中药,并采购相应的掺假中药进行对比分析,总结两者特性,并记录其鉴别方法。结果在本次研究中,对海马、麝香、冬虫夏草等三种名贵掺假中药进行了详细对比分析,总结了其鉴别方法,为其鉴别提供了重要价值。结论利用多种方法对本次研究的这几味中药进行鉴定,可提高掺假中药的鉴别率,实际应用价值良好。%Objective To analysis the causes and several precious Chinese medicine adulteration identification method. Methods The purchase of hippocampus, musk, Cordyceps sinensis and precious traditional Chinese medicine, Chinese medicine and procurement adulteration corresponding comparative analysis, summarize the characteristics of the two, and record the differential method. Results In this study, the hippocampus, musk, Cordyceps three kinds of precious Chinese medicine contrast adulteration in detail, summarizes the identification method, and provides an important value for its identiifcation. Conclusion Through this a few herbs were identiifed in this study from many aspects, and can improve the identiifcation of adulterated in traditional Chinese medicine rate, good practical application value.

  3. Analysis of the Causes of Several Costly Chinese Medicine Adulteration and Identiifcation Methods%几种贵重中药掺假成因分析及鉴别方法分析

    Institute of Scientific and Technical Information of China (English)

    张举良

    2015-01-01

    Objective To analysis the causes and several precious Chinese medicine adulteration identification method. Methods The purchase of hippocampus, musk, Cordyceps sinensis and precious traditional Chinese medicine, Chinese medicine and procurement adulteration corresponding comparative analysis, summarize the characteristics of the two, and record the differential method. Results In this study, the hippocampus, musk, Cordyceps three kinds of precious Chinese medicine contrast adulteration in detail, summarizes the identification method, and provides an important value for its identiifcation. Conclusion Through this a few herbs were identiifed in this study from many aspects, and can improve the identiifcation of adulterated in traditional Chinese medicine rate, good practical application value.%目的:分析几种贵重中药掺假成因分析及鉴别方法。方法购买海马、麝香、冬虫夏草等贵重中药,并采购相应的掺假中药进行对比分析,总结两者特性,并记录其鉴别方法。结果在本次研究中,对海马、麝香、冬虫夏草等三种名贵掺假中药进行了详细对比分析,总结了其鉴别方法,为其鉴别提供了重要价值。结论利用多种方法对本次研究的这几味中药进行鉴定,可提高掺假中药的鉴别率,实际应用价值良好。

  4. Antifungal prophylaxis in chemotherapy-associated neutropenia: a retrospective, observational study

    Directory of Open Access Journals (Sweden)

    Martin Thomas

    2007-07-01

    Full Text Available Abstract Background In August 2002, the antifungal prophylaxis algorithm for neutropenic hematology/oncology (NHO patients at the Medical Center was changed from conventional amphotericin (AMB to an azole (AZ based regimen (fluconazole [FLU] in low-risk and voriconazole [VOR] in high-risk patients. The aim of our study was to compare outcomes associated with the two regimens, including breakthrough fungal infection, adverse drug events, and costs. Methods Adult, non-febrile, NHO patients who received prophylactic AMB from 8/01/01-7/30/02 or AZ from 8/01/02-7/30/03 were retrospectively evaluated. Results A total of 370 patients (AMB: n = 181; AZ: n = 216 associated with 580 hospitalizations (AMB: n = 259; AZ: n = 321 were included. The incidence of probable/definite breakthrough Aspergillus infections was similar among regimens (AMB: 1.9% vs AZ: 0.6%; p=0.19. A greater incidence of mild/moderate (24.7% vs. 5.3%; p $9,000 increase in mean total costs/hospitalization, the mean acquisition cost associated with AZ was only $947/hospitalization more than AMB. Conclusion While an AZ-based regimen is associated with increased cost, the reduced rate of nephrotoxicity and availability of oral dosage forms, suggests that azoles be used preferentially over AMB. However, an increased rate of severe hepatic toxicity may be associated with VOR.

  5. 重型肝炎与肝硬化患者医院感染病原菌的耐药性分析%Drug resistance of pathogens causing nosocomial infections in patients with severe hepatitis and liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    郑颖; 陈亮; 鲁艳

    2014-01-01

    OBJECTIVE To approach the species of pathogenic bacteria causing nosocomial infections in the patients with severe hepatitis and liver cirrhosis and analyze the drug resistance so as to provide guidance clinical use of an-tibiotics .METHODS The clinical data of 251 severe hepatitis and liver cirrhosis patients complicated with secondary nosocomial infections were reviewed ,then the isolation ,culture ,and identification of the pathogens were per-formed by referring to the criteria of clinical microorganism laboratory examination ;the drug susceptibility testing was performed by using K-B method ,the drug susceptibility ,intermediate ,and resistance were determined ac-cording to the latest breakpoints of CLSI ,and the whole process of examination was carried out under the qualified indoor quality control .RESULTS Among the patients with severe hepatitis and liver cirrhosis ,the patients with ab-dominal infections accounted for 27 .6% ,the patients with respiratory tract infections 19 .2% ,the patients with urinary tract infections 16 .9% .A total of 195 strains of pathogens have been isolated ,including 195 (70 .1% ) strains of gram-negative bacteria ,60 (21 .6% ) strains of gram-positive bacteria and 23 (8 .3% ) strains of fungi;the Escherichia coli ,Enterococcus ,K lebsiella pneumoniae ,and Pseudomonas aeruginosa ranked the top four spe-cies of pathogens ,accounting for 23 .4% ,17 .6% ,16 .9% ,and 11 .9% ,respectively .The drug susceptibility rates of the E .coli and K .pneumoniae to imipenem and meropenem were 100 .0% ,and the drug resistance rates to cefoperazone-sulbactam and amikacin were less than 15 .4% ;the drug resistance rates of the P .aeruginosa to pip-eracillin-tazobactam and cefoperazone-sulbactam were less than 18 .2% .The isolation rates of the imipenem-resist-ant P .aeruginosa and Acinetobacter baumannii were 38 .5% and 33 .3% ,respectively ;the isolation rates of the extended-spectrum β-lactamases (ESBLs)-producing E .coli and K .pneumoniae were

  6. Analysis of a Severe Convective Weather Caused by Isolated Cloud Cluster on 22 May 2013 in Shanxi Province%孤立云团造成的一次强对流天气分析

    Institute of Scientific and Technical Information of China (English)

    赵桂香; 王思鳭; 邱贵强; 王晓丽

    2015-01-01

    ,and excited isolated cloud clusters nearby. The vertical structure with high - level divergence and low - level convergence above the cloud clusters made the upward motion strengthen continuously. Consequently,the isolated cloud clusters maintained and developed. These meso-γand meso-αscale clus-ters were the direct cause leading to this severe convective weather. The dry frontogenesis caused by surface continuous strengthening of water vapor from the sea at the back of high pressure system and the invading of dry air at the front of ridge,was an important triggering mechanism of the strong convective weather. From the radar mosaic products of composite reflectivity,this process resulted from the de-velopment and merging of convective cells. The evolution of these cells went through a process from“convective cell,merging,ribbon echo,bow echo to weakening and vanishing”,and the whole process was divided into two stages,when the area,intensity and moving speed of echoes were different,the characteristics of convective weather were different too. Obvious differences among three types dur-ing this process existed in temperature and humidity profiles and environmental parameters,which could be served as judging the severe convective weathers.

  7. Ontong Java volcanism initiated long-term climate warming that caused substantial changes in terrestrial vegetation several tens of thousand years before the onset of OAE1a (Early Aptian, Cretaceous)

    Science.gov (United States)

    Keller, Christina E.; Hochuli, Peter A.; Giorgioni, Martino; Garcia, Therese I.; Bernasconi, Stefano M.; Weissert, Helmut

    2010-05-01

    During Cretaceous times, several intense volcanic episodes are proposed as trigger for episodic climate warming, for changes in marine circulation patterns and for elevated marine productivity, which resulted in the widespread black shale deposits of the Oceanic Anoxic Events (OAE). In the sediments underlying the early Aptian OAE1a black shales, a prominent negative carbon isotope excursion is recorded. Its origin had long been controversial (e.g. Arthur, 2000; Jahren et al., 2001) before recent studies attributed it to the Ontong Java volcanism (Méhay et al., 2009; Tejada et al., 2009). Volcanic outgassing results in an increased pCO2 and should lead to a rise in global temperatures. We therefore investigated if the volcanically-induced increase in pCO2 at the onset of OAE1a in the early Aptian led to a temperature rise that was sufficient to affect terrestrial vegetation assemblages. In order to analyse changes in terrestrial palynomorph assemblages, we examined 15 samples from 12 black shale horizons throughout the early Aptian negative C-isotope spike interval of the Pusiano section (Maiolica Formation; N-Italy). These sediments were deposited at the southern continental margin of the alpine Tethys Ocean and have been bio- and magnetostratigraphically dated by Channell et al. (1995). In order to obtain a continuous palynological record of the negative C-isotope spike interval and the base of OAE1a, we combined this pre-OAE1a interval of Pusiano with the OAE1a interval of the nearby Cismon section (Hochuli et al., 1999). The sporomorph assemblages at the base of this composite succession feature abundant bisaccate pollen, which reflects a warm-temperate climate. Rather arid conditions are inferred from low trilete spore percentages. Several tens of thousand years before the onset of OAE1a, C-isotope values started to decrease. Some thousand years later, bisaccate pollen began to decrease, whereas an increase of Classopollis spp. and Araucariacites spp

  8. Neutropenia induced in outbred mice by a simplified low-dose cyclophosphamide regimen: characterization and applicability to diverse experimental models of infectious diseases

    Directory of Open Access Journals (Sweden)

    Zapata Ana X

    2006-03-01

    Full Text Available Abstract Background For its low cost and ease of handling, the mouse remains the preferred experimental animal for preclinical tests. To avoid the interaction of the animal immune system, in vivo antibiotic pharmacodynamic studies often employ cyclophosphamide (CPM to induce neutropenia. Although high doses (350–450 mg/kg are still used and their effects on mouse leukocytes have been described, a lower dose (250 mg/kg is widely preferred today, but the characteristics and applicability of this approach in outbred mice have not been determined. Methods Fifteen female ICR mice were injected intraperitoneally with 150 and 100 mg/kg of CPM on days 1 and 4, respectively. Blood samples (~160 μL were drawn from the retro-orbital sinus of each mouse on days 1, 4, 5, 6, 7 and 11. Leukocytes were counted manually and the number of granulocytes was based on microscopic examination of Wright-stained smears. The impact of neutropenia induced by this method was then determined with a variety of pathogens in three different murine models of human infections: pneumonia (Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, meningoencephalitis (S. pneumoniae, and the thigh model (S. aureus, Escherichia coli, Bacteroides fragilis. Results The basal count of leukocytes was within the normal range for outbred mice. On day 4, there was an 84% reduction in total white blood cells, and by day 5 the leukopenia reached its nadir (370 ± 84 cells/mm3. Profound neutropenia (≤10 neutrophils/mm3 was demonstrated at day 4 and persisted through days 5 and 6. Lymphocytes and monocytes had a 92% and 96% decline between days 1 and 5, respectively. Leukocytes recovered completely by day 11. Mice immunosupressed under this protocol displayed clinical and microbiological patterns of progressive and lethal infectious diseases after inoculation in different organs with diverse human pathogens. Conclusion A CPM total dose of 250 mg/kg is sufficient to induce

  9. Prognostic impact of neoadjuvant chemotherapy induced neutropenia on operable breast cancer%新辅助化疗诱导的粒细胞减少症对乳腺癌预后的影响

    Institute of Scientific and Technical Information of China (English)

    韩芸蔚; 王欣; 张斌; 温绍艳; 刘伟; 曹旭晨

    2011-01-01

    Objective To evaluate the relationship between neoadjuvant chemotherapy (combination of taxanes and anthracyclines ) induced-neutropenia and the efficacy of neoadjuvant chemotherapy and long-term survival in operable breast cancer patients. Methods Two hundred and eleven patients received 4 cycles of neoadjuvant chemotherapy (combination of taxanes and anthracyclines).Clinicopathological characteristics were compared between patients with neoadjuvant chemotherapy-induced neutropenia and patients without neutropenia. The efficacy of neoadjuvant chemotheray and long-term survival rate were analyzed. Results Among 211 patients there were 51 (24. 2% ) cases suffering from neutropenia and 160 (75.8%) cases were of no-neutropenia. The response to chemotherapy in patients with neutropenia were more effective than in no- neutropenia ones ( P < 0. 05 ). The 5-year disease-free survival (DFS) in patients with neutropenia was 82. 4%, while the 5-year disease-free survival ( DFS) with nonneutropenia was 60% ( P < 0. 01 ). Additionally, the 5-year overall survival ( OS ) in patients with neutropenia was 90. 2% and in patients with non-neutropenia patients was 67. 5% ( P < 0. 01 ).Conclusions Chemotherapy-induced neutropenia during neoadjuvant chemotherapy combination of taxanes and anthracyclines in patients with operable breast cancer has a better prognosis. The sensitivity of tumors given to chemotherapeutic drugs could be evaluated by chemotherapy-induced neutropenia.%目的 探讨新辅助化疗诱导的粒细胞减少症与采用蒽环类联合紫杉类新辅助化疗方案进行新辅助化疗患者的疗效及远期生存率之间的关系.方法 对接受4个周期蒽环类联合紫杉类新辅助化疗方案治疗的211例乳腺癌患者的资料进行回顾性分析.结果 211例中51(24.2%)例为嗜中性粒减少症患者,160(75.8%)例为非嗜中性粒细胞减少症患者.嗜中性粒细胞减少症患者组的新辅助化疗反应较非嗜中性粒细

  10. 恶性肿瘤患者化疗所致中性粒细胞减少与其疗效的相关性%Correlation of Neutropenia of Therioma Patients Occurring during Postoperative Chemotherapy with the Curative Effect

    Institute of Scientific and Technical Information of China (English)

    沈飞; 茅力平; 孙雅君

    2011-01-01

    Objective To investigate the correlation of neutropenia with the disease-free survival in patients with malignant tumors receiving chemotherapy. Methods Clinical data of 136 patients with malignant tumors receiving postoperative chemotherapy were retrospectively reviewed. Results The disease free survival was significantly different in patients with neutropenia,neutrophile granulocyte deficiency and no neutropenia ( P < 0. 05 ) ,hut there was no significant difference hetween the neutropenia group and the neutrophile granulocyte deficiency group( P > 0. 05 ). Conclusion Neutropenia during postoperative chemotherapy is significantly related to the disease-free survival time , while non-neutropenia cases possibly indicate lack of enough drug doses.%目的 探讨恶性肿瘤患者术后化疗过程中出现中性粒细胞减少与其无瘤生存期的相关性.方法 回顾性分析136例术后辅助化疗恶性肿瘤患者的临床资料.结果 中性粒细胞减少组/缺乏组无瘤生存期与无中性粒细胞减少组比较有显著差异(P<0.05),中性粒细胞减少组无瘤生存期与中性粒细胞缺乏组比较无显著差异(P>0.05).结论 恶性肿瘤患者化疗过程中出现中性粒细胞减少,与其无瘤生存期明显相关,而未出现中性粒细胞减少者可能提示药物剂量不足.

  11. One case of severe combined immunodeficiency caused by JAK3 mutation and literature Review%JAK3突变致严重联合免疫缺陷1例报告并文献复习

    Institute of Scientific and Technical Information of China (English)

    周雪莲; 孙立峰; 吴俊峰; 刘玮; 赵晓东

    2012-01-01

    Objective To report the first JAK3 deficiency patient in China and to have literature review. Methods On April 25,2011, the blood samples of 1 case of suspected SCID child, his parents and grandparents were detected with PCR amplification and sequencing of JAK3 gene, single nucleotide polymorphism(SNPs) and TCRVB analysis in Children's Hospital of Chongqing Medical University. Results The mutation of this patient was a compound heterozygous mutation, both alleles being missense mutations. One allele (1308G>A: R403H) was located in the eighth exon of JAK3, which came from her father, the other (3354G> A:R1085Q) located in the twenty-third exon of JAK3, which came from her mother.Her parents and grandmother were carries.We confirmed these mutations were disease-caused mutations not SNPs by sequencing the 9th and 24th exon of JAK3 gene of twenty common people. Unfortunately, we failed to detect The TCRVβ of this patient because of the limited number of circulating T cells. Up to 2007, thirty mutations and thirty-five patients had been registered for JAK3 deficiency in JAK3base. Their immunophenotype was uniformly TB+ NK-SCID, but the clinical phenotype of them varied from classical SCID to almost normal immune function. Conclusion JAK3 deficiency is a rare autosomal recessive severe combined immunodeficiency disease (SCID),characterized by recurrent bacteria and virus infection,absence of T and NK cells but normal number of poorly functioning B cells in the peripheral blood. The diagnosis depends on stat5 phosphorylation,sequencing of JAK3 gene and detect the JAK3 protein by western blot or flow cytometry, when JAK3 deficiency is suspected. The most effective treatment for JAK3 deficiency is hematopoietic stem cell transplantation (HSCT) ,and patients who don't receive HSCT will usually die in infancy.%目的 报道我国首例JAK3突变致严重联合免疫缺陷(SCID)患儿资料并文献复习.方法 2011-04-25重庆医科大学附属儿童医院对1例疑似SCID

  12. Severe Anemia in Malawian Children

    NARCIS (Netherlands)

    Calis, J.C.J.; Kamija, S.P.; Faragher, E.B.; Brabin, B.J.; Bates, I.; Cuevas, L.E.; Haan, de R.J.; Phiri, A.I.; Malange, P.; Khoka, M.; Hulshof, P.J.M.; Lieshout, L.; Beld, M.G.H.M.; Teo, Y.Y.; Rockett, K.A.; Richardson, A.; Kwiatkowski, D.P.; Molyneux, M.E.; Hensbroek, van M.B.

    2008-01-01

    Background Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. Methods We conducted a case¿control study of 381 preschool children with severe anemia (hemoglobin concentration,

  13. [VIRAL INFECTIONS: HUMAN PAPILLOMAVIRUS AND GENITAL HERPES TYPE 1 AND TYPE 2 AS A CAUSE OF CHRONIC RECURRENT CYSTITIS WITH SEVERE DYSURIA IN WOMEN WITH URETHRAL HYPERMOBILITY AND HYPOSPADIAS].

    Science.gov (United States)

    Derevjanko, T I; Ryzhkov, V V

    2015-01-01

    Female hypospadias presenting as a misplaced urethral opening is a common cause of chronic recurrent cystitis. Cystitis occurs when urogenital infection and anaerobic bacteria enter the urethra and bladder from the vagina. The authors argue that chronic infections of the lower urinary tract in women with hypospadias should be treated surgically by meatal transposition. They present a study confirming the role of the antiviral drug Panavir in prevention of inflammatory complications in the postoperative period in patients with a history of viral infection (human papillomavirus and herpes). PMID:26665761

  14. Effect of phosphate and the arbuscular mycorrhizal fungus Glomus intraradices on disease severity of root rot of peas ( Pisum sativum ) caused by Aphanomyces euteiches

    DEFF Research Database (Denmark)

    Bødker, Lars; Kjøller, Rasmus; Rosendahl, Søren

    1998-01-01

    in the growth medium. The arbuscular mycorrhizal fungus Glomus intraradices increased P uptake and the P concentration in the plant but reduced disease development in peas. Polyacrylamide gel electrophoresis followed by densitometry of glucose-6-phosphate dehydrogenase specific to A.euteiches was....... The epicotyl of mycorrhizal plants showed a reduction in disease severity although this part of the plants was not mycorrhizal. Thus, an induced systemic factor may be responsible for increased resistance in mycorrhizal plants....

  15. Study design: two long-term observational studies of the biosimilar filgrastim Nivestim™ (Hospira filgrastim) in the treatment and prevention of chemotherapy-induced neutropenia

    International Nuclear Information System (INIS)

    Nivestim™ (filgrastim) is a follow-on biologic agent licensed in the EU for the treatment of neutropenia and febrile neutropenia induced by myelosuppressive chemotherapy. Nivestim™ has been studied in phase 2 and 3 clinical trials where its efficacy and safety was found to be similar to its reference product, Neupogen®. Follow-on biologics continue to be scrutinised for safety. We present a design for two observational phase IV studies that are evaluating the safety profile of Nivestim™ for the prevention and treatment of febrile neutropenia (FN) in patients treated with cytotoxic chemotherapy in general clinical practice. The NEXT (Tolérance de Nivestim chez les patiEnts traités par une chimiothérapie anticancéreuse cytotoXique en praTique courante) and VENICE (VErträglichkeit von NIvestim unter zytotoxischer Chemotherapie in der Behandlung malinger Erkrankungen) trials are multicentre, prospective, longitudinal, observational studies evaluating the safety profile of Nivestim™ in 'real-world’ clinical practice. Inclusion criteria include patients undergoing cytotoxic chemotherapy for malignancy and receiving Nivestim as primary or secondary prophylaxis (NEXT and VENICE), or as treatment for ongoing FN (NEXT only). In accordance with European Union pharmacovigilance guidelines, the primary objective is to evaluate the safety of Nivestim™ by gathering data on adverse events in all system organ classes. Secondary objectives include obtaining information on patient characteristics, efficacy of Nivestim™ therapy (including chemotherapy dose intensity), patterns of use of Nivestim™, and physician knowledge regarding filgrastim prescription and the reasons for choosing Nivestim™. Data will be gathered at three visits: 1. At the initial inclusion visit, 2. At a 1-month follow-up visit, and 3. At the end of chemotherapy. Recruitment for VENICE commenced in July 2011 and in November 2011 for NEXT. VENICE completed recruitment in July 2013 with

  16. Interleukin-5, interleukin-6, interleukin-8 and tumour necrosis factor-alpha levels obtained within 24-h of admission do not predict high-risk infection in children with febrile neutropenia

    Directory of Open Access Journals (Sweden)

    R Aggarwal

    2013-01-01

    Full Text Available Purpose: Biomarkers that can predict the severity of febrile neutropenia (FN are potential tools for clinical practice. Objective: The objective of this study is to evaluate the reliability of plasma interleukin (IL levels as indicators of high-risk FN. Materials and Methods: Children with haematological malignancies and FN were enrolled prospectively. A blood sample was obtained within 24-h of admission for estimation of IL-5, IL-6, IL-8 and tumour necrosis factor-alpha (TNF-α level by the enzyme-linked immunosorbent assay. Patients were stratified into three groups. Group I (low-risk: No focus of infection; Group II: Clinical/radiological focus of infection; Group III: Microbiologically proven infection or FN related mortality. Groups II and III were analysed as high-risk. The cytokines were assessed at three different cut-off levels. Results: A total of 52 episodes of FN in 48 patients were evaluated. The mean age was 6 years (range: 2-13. Primary diagnosis included acute lymphoblastic leukaemia (82%, non-Hodgkin′s lymphoma (13% and acute myeloid leukaemia (5%. Absolute neutrophil count was < 200 cells/μl in half and 200-500 in 23%. Majority were categorised as Group I (69%, followed by Group II (16% and III (15%. The range of IL-5 was too narrow and similar in the two risk-groups to be of any relevance. The best sensitivity of TNF-α and IL-6 for high-risk group was 78% and 70%, respectively. The highest specificity observed was 35%. The negative predictive value of IL-6, IL-8 and TNF-α exceeded 80%. Conclusion: IL-5, IL-6, IL-8 and TNF-α failed as predictors of clinically localised or microbiologically documented infection in children with chemotherapy induced FN. However, IL-6, IL-8 and TNF-α could be useful in excluding the possibility of high-risk infection.

  17. A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus Estudo comparativo do envenenamento escorpiônico grave em crianças provocado por Tityus bahiensis e Tityus serrulatus

    OpenAIRE

    Fábio Bucaretchi; Emílio CE Baracat; Roberto J.N. Nogueira; Aniel Chaves; Flávio A.D. Zambrone; Márcia R. C. C. Fonseca; Francis S Tourinho

    1995-01-01

    From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1%) or Tityus bahiensis (84.9%) presented severe envenoming. Of these 17 patients (1-11 years old; median=2 yr) 14 were stung by T.serrulatus and three by T.bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median=2h). On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17),...

  18. Síndrome respiratória aguda grave causada por influenza A (subtipo H1N1) Severe acute respiratory syndrome caused by the influenza A (H1N1) virus

    OpenAIRE

    Sandra Aparecida Ribeiro; Graziela Sgreccia Brasileiro; Luciana Novaes Campello Soleiman; Cristiano Cruz Silva; Cláudio Shoki Kavaguti

    2010-01-01

    Frente à pandemia causada por um novo vírus, influenza A (H1N1), descrevemos o caso de um paciente de 56 anos com síndrome respiratória aguda grave causada por influenza A (H1N1) sem fatores de risco importantes. Os resultados dos exames laboratoriais e de imagem (radiografia e TC de tórax) são apresentados aqui. O paciente teve boa evolução e recebeu alta hospitalar em 14 dias.In view of the pandemic caused by a new virus, influenza A (H1N1), we report the case of a 56-year-old patient witho...

  19. Several Problems about Prevention and Control of Oil Pollution Caused by Ships in Zhu-ao Waters%防治船舶在珠澳水域油污染的几个问题

    Institute of Scientific and Technical Information of China (English)

    李连健

    2001-01-01

    系统分析了船舶在珠澳水域造成的油污染情况,从现场管理的角度,结合近10年来发生的油污事故,针对不同污染途径找出了防治工作中的一些不足,并对水质分析、油品鉴定、防治重点、防治基金分配等方面提出一些建议。%Based on the analysis of oil pollution in Zhu-ao Waters caused by vessels in the past 10 years,some deficiencies in pollution prevention and control are pointed out from aspect of the field management.And some proposals are made for water quality analysis,oil type identification,prevention focal points and distribution of pollution prevention funds.

  20. Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    V Roy

    2010-01-01

    Full Text Available Background: Use of antimicrobials (AM and granulocyte colony stimulating factors (G-CSF affect the outcome and cost of treatment of febrile neutropenia (FN. There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1% were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE was Rs 4694.45 ± 296.35 (113.95 ± 7.19$. G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.

  1. The Role Of Multidetector Computed Tomography In The Early Diagnosis Of Invasive Pulmonary Aspergıllosis In Patients With Febrile Neutropenia Undergoing Hematopoietic Stem Cell Transplantation

    Directory of Open Access Journals (Sweden)

    Nazan Çiledağ

    2012-03-01

    Full Text Available OBJECTIVE: To evaluate the vessel involvement and the role of multidedector computed tomograpy (MDCT in the early diagnosis of invasive pulmonary aspergillosis (IPA at MDCT in autologous bone morrow transplantation patients with febrile neutropenia and antibiotic-resistant fever of unknown origin with clinically suspected IPA. METHODS: 74 pulmonary MDCT examinations of 37 consecutive hematopoietic stem cell transplantation patients with febrile neutropenia with clinically suspected IPA were retrospectively evaluated. RESULTS: The diagnosis of IPA was made according to according to the Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Consensus Group criteria and 0, 14, 11 patients were diagnosed as proven, probable, possible IPA, respectively. Among 25 cases accepted as probable and possible IPA, all patients had pulmonary MDCT findings consistent with IPA. Remaining 12 patients were accepted as having fever of unknown origin (FUO and in these 12, MDCT showed patent vessel. In patients with probable/possible IPA, 72 focal pulmonary lesions were detected. In 41 of 72 (57%, vascular occlusion was detected. The CT halo sign was present in 25 of 41 (61% lesions. A clinical improvement, resolution of fever was observed following antifungal therapy in 19 (76% of 25 patients with probable/possible IPA. Six (25% patients diagnosed as IPA died during follow-up. Transplant related mortality at day 100 in patients with IPA and FUO were found to be 24% and 0%, respectively. CONCLUSION: In conclusion, MDCT has a potential role in early diagnosis of IPA by detection of vessel occlusion.

  2. Modified apolipoprotein (apo) A-I by artificial sweetener causes severe premature cellular senescence and atherosclerosis with impairment of functional and structural properties of apoA-I in lipid-free and lipid-bound state.

    Science.gov (United States)

    Jang, Wookju; Jeoung, Nam Ho; Cho, Kyung-Hyun

    2011-05-01

    Long-term consumption of artificial sweeteners (AS) has been the recent focus of safety concerns. However, the potential risk of the AS in cardiovascular disease and lipoprotein metabolism has not been investigated sufficiently. We compared the influence of AS (aspartame, acesulfame K, and saccharin) and fructose in terms of functional and structural correlations of apolipoprotein (apo) A-I and high-density lipoproteins (HDL), which have atheroprotective effects. Long-term treatment of apoA-I with the sweetener at physiological concentration (3 mM for 168 h) resulted in loss of antioxidant and phospholipid binding activities with modification of secondary structure. The AS treated apoA-I exhibited proteolytic cleavage to produce 26 kDa-fragment. They showed pro-atherogenic properties in acetylated LDL phagocytosis of macrophages. Each sweetener alone or sweetener-treated apoA-I caused accelerated senescence in human dermal fibroblasts. These results suggest that long-term consumption of AS might accelerate atherosclerosis and senescence via impairment of function and structure of apoA-I and HDL. PMID:21533907

  3. PCI postoperative tirofiban cause severe thrombocytopenia three cases of clinical analysis%PCI术后应用替罗非班致重度血小板减少3例临床分析

    Institute of Scientific and Technical Information of China (English)

    赵国伟

    2015-01-01

    ObjectiveDiscussion after PCI tirofiban-induced platelet reducing acute severe clinical symptoms, diagnosis and treatment strategies.MethodsOur hospital in January 2014 --2015 in three cases in May after PCI tirofiban-induced thrombocytopenia in patients with severe reduction of clinical data were retrospectively analyzed.Result 3 patients on admission were within the normal range of platelets, PCI postoperative intravenous infusion of tirofiban people, 0.5-2 hours of the onset chills, fever and other symptoms, severe thrombocytopenia Jicha confirmed, promptly disable tirofiban and other antiplatelet drugs, hormone therapy, the platelet count in 10 hours to 5 days to return to normal, fatal bleeding and thrombosis and other adverse events did not occur.ConclusionApplication should be after PCI tirofiban should be closely observed for the disease, chills, fever and other symptoms of acute thrombocytopenia taking into account the possibility of acute check platelets, disable the anti-platelet drugs, hormone and other drugs, to avoid serious adverse events occur.%目的:探讨P C I术后替罗非班致急性血小板重度减少的临床症状,诊断及处理策略。方法:收集我院2014年1月-2015年5月的3例PCI术后替罗非班致血小板重度减少患者的病例资料,进行回顾性分析。结果:3例患者入院时血小板均在正常范围,PCI术后应用替罗非班静脉泵人,0.5-2小时发生寒颤,高热等症状,急查证实血小板重度减少,及时停用替罗非班及其他抗血小板药物,应用激素等治疗,血小板计数于10小时-5天恢复正常,未发生致命性出血及血栓等不良事件。结论:PCI术后应用替罗非班时应严密观察病情,出现寒颤,高热等症状时应考虑到急性血小板减少的可能,急性查血小板,停用抗血小板药物,应用激素等药物治疗,避免严重不良事件发生。

  4. Direct observation from sounding of the warming caused by homogeneous freezing in a severe storm%强对流风暴中同质冻结增温的直接探空观测

    Institute of Scientific and Technical Information of China (English)

    徐小红; 余兴; 戴进; 刘贵华; 朱延年; 岳治国

    2011-01-01

    通过两个强对流风暴个例,利用探空资料辅以卫星反演方法,揭示了强对流风暴中同质冻结增温这一事实。探空观测到在强风暴中同质冻结潜热释放造成该层内的空气增温达5℃以上,风暴中强上升气流使云滴没有足够的时间长大,云水向雨水转化和云的晶化会被推到更高的高度,在到达同质冻结高度之前,异质核化过程没有太多的时间消耗大量云水,多数云滴被带到同质冻结高度以上时迅速冻结,造成潜热的集中释放,使周围的空气增温。NOAA卫星观测到的云顶的大量由同质冻结形成的小冰粒子以及过顶现象,进一步证实了同质冻结潜热增温。当探空仪靠近风暴、对%By using the radiosonde data and the satellite retrieval and observation,the phenomenon that the homogeneous freezing latent heat warms the air in severe storms is revealed.It was found that the temperature can increase by as much as 5.0 ℃ within that layer in the severe convective storm because of homogeneous freezing.It is mainly because the updrafts are so strong that the cloud drops have no enough time to grow larger and the conversion of cloud drops to hydrometeors and the glaciation of the cloud are delayed to higher heights.Heterogeneous ice nucleation does not have time to deplete much of the cloud water before reaching the homogeneous glaciation level.Thus most cloud drops are carried to the height of homogenous freezing and are instantly frozen into ice crystals,which releases the latent and warm the ambient air.The phenomenon is also verified by the NOAA satellite observation that small ice particles formed by homogenous freezing on the cloud top and overshooting top.The warm effect of homogeneous freezing could be detected by the sounding when it is close to the storm and the tropopause is close to the height of homogeneous freezing.

  5. Multicentre open-label randomised controlled trial to compare colistin alone with colistin plus meropenem for the treatment of severe infections caused by carbapenem-resistant Gram-negative infections (AIDA): a study protocol

    Science.gov (United States)

    Dickstein, Yaakov; Leibovici, Leonard; Yahav, Dafna; Eliakim-Raz, Noa; Daikos, George L; Skiada, Anna; Antoniadou, Anastasia; Carmeli, Yehuda; Nutman, Amir; Levi, Inbar; Adler, Amos; Durante-Mangoni, Emanuele; Andini, Roberto; Cavezza, Giusi; Mouton, Johan W; Wijma, Rixt A; Theuretzbacher, Ursula; Friberg, Lena E; Kristoffersson, Anders N; Zusman, Oren; Koppel, Fidi; Dishon Benattar, Yael; Altunin, Sergey; Paul, Mical

    2016-01-01

    Introduction The emergence of antibiotic-resistant bacteria has driven renewed interest in older antibacterials, including colistin. Previous studies have shown that colistin is less effective and more toxic than modern antibiotics. In vitro synergy studies and clinical observational studies suggest a benefit of combining colistin with a carbapenem. A randomised controlled study is necessary for clarification. Methods and analysis This is a multicentre, investigator-initiated, open-label, randomised controlled superiority 1:1 study comparing colistin monotherapy with colistin–meropenem combination therapy for infections caused by carbapenem-resistant Gram-negative bacteria. The study is being conducted in 6 centres in 3 countries (Italy, Greece and Israel). We include patients with hospital-associated and ventilator-associated pneumonia, bloodstream infections and urosepsis. The primary outcome is treatment success at day 14, defined as survival, haemodynamic stability, stable or improved respiratory status for patients with pneumonia, microbiological cure for patients with bacteraemia and stability or improvement of the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes include 14-day and 28-day mortality as well as other clinical end points and safety outcomes. A sample size of 360 patients was calculated on the basis of an absolute improvement in clinical success of 15% with combination therapy. Outcomes will be assessed by intention to treat. Serum colistin samples are obtained from all patients to obtain population pharmacokinetic models. Microbiological sampling includes weekly surveillance samples with analysis of resistance mechanisms and synergy. An observational trial is evaluating patients who met eligibility requirements but were not randomised in order to assess generalisability of findings. Ethics and dissemination The study was approved by ethics committees at each centre and informed consent will be obtained for all patients. The

  6. Claviceps cyperi, a new cause of severe ergotism in dairy cattle consuming maize silage and teff hay contaminated with ergotised Cyperus esculentus (nut sedge on the Highveld of South Africa

    Directory of Open Access Journals (Sweden)

    T.W. Naude

    2005-09-01

    late seasonal rain had resulted in mature, heavily ergotised nut sedge being cut with the silage. Claviceps cyperi sclerotia, collected on the affected fields in the following autumn contained 3 600-4 000 ppm ergocryptine. That the dominant alkaloid produced by this particular fungus was indeed ergocryptine, was confirmed by negative ion chemical ionization MS/MS. In one further outbreak in another Holstein herd, teff hay contaminated with ergotised nut sedge and containing 1 200 ppb alkaloids, was incriminated as the cause of the condition. This is the first report of bovine ergotism not associated with the Poaceae infected with Claviceps purpureum or endophytes but with the family Cyperaceae and this particular fungal phytopathogen.

  7. Claviceps cyperi, a new cause of severe ergotism in dairy cattle consuming maize silage and teff hay contaminated with ergotised Cyperus esculentus (nut sedge) on the Highveld of South Africa.

    Science.gov (United States)

    Naudè, T W; Botha, C J; Vorster, J H; Roux, C; Van der Linde, E J; Van der Walt, S I; Rottinghaus, G E; Van Jaarsveld, L; Lawrence, A N

    2005-03-01

    resulted in mature, heavily ergotised nut sedge being cut with the silage. Claviceps cyperi sclerotia, collected on the affected fields in the following autumn contained 3600-4000 ppm ergocryptine. That the dominant alkaloid produced by this particular fungus was indeed ergocryptine, was confirmed by negative ion chemical ionization MS/MS. In one further outbreak in another Holstein herd, teff hay contaminated with ergotised nut sedge and containing 1200 ppb alkaloids, was incriminated as the cause of the condition. This is the first report of bovine ergotism not associated with the Poaceae infected with Claviceps purpureum or endophytes but with the family Cyperaceae and this particular fungal phytopathogen. PMID:15991703

  8. 93例莫西沙星致严重不良反应报告分析%Analysis of 93 Cases of Severe Adverse Drug Reactions Caused by Moxifloxacin

    Institute of Scientific and Technical Information of China (English)

    周冰; 张俊; 张黎明

    2011-01-01

    目的 分析93例莫西沙星致严重不良反应报告,探讨莫西沙星致严重不良反应的特点和规律,为临床安全合理用药提供参考.方法 对2004年1月1日至2009年12月31日,北京市药品不良反应监测中心收到的93例莫西沙星致严重不良反应报告按人群、药品、不良反应情况等方面进行统计、分析.结果 临床使用莫西沙星多数能够按照药品使用说明书使用,少数存在不合理用药现象.结论 使用莫西沙星应严格按药品使用说明书用药,加强用药过程监护,减少药品带来的伤害.%Objective To probe into the general pattern and characteristics of severs ADRs indused by moxifloxacin so as to procide references for clinic retional use of moxifloxacin. Methods A total of 93 cases indused by moxifloxacin received from 2004 to 2009 in Beijing were analyzed statistically. Results The clinical use of moxifloxacin most can defer to the drugs instruction, the minority exists the irreasonabl phenomenon. Conclusion The use of moxifloxacin should strictly accord to the drugs instruction, enhance medication monitoring process, reduce the injury which the drugs bring.

  9. SLC19 A1遗传多态性与大剂量甲氨蝶呤化疗后骨髓抑制及轻度粒细胞缺乏伴感染的相关性分析%Association analysis of polymorphism in SLC19A1 and myelosuppression induced febrile neutropenia co-infection after high-dose methotrexate

    Institute of Scientific and Technical Information of China (English)

    王捷; 武云; 陈瑢; 王建华; 赵军

    2015-01-01

    Objective To research the association between gene polymorphism of SLC19A1 and myelosuppression induced febrile neutro-penia after high -dose methotrexate. Methods The CALLG2008, Hyper-CVAD and BFM90 regimens were adopted .The Kit assay was used to extract DNA by blood samples , and the polymorphism of SLC19 A1 A80 G was detected by PCR -restriction fragment length polymorphism ( PCR-RFLP ) .The data of peripheral blood cell count with high -dose methotrexate chemotherapy were monitored , and the relationship between SLC19A1 gene polymorphism and bone marrow suppression induced febrile neutropenia was analyzed .Results There were 45 patients with acute lymphoblastic leukemia and 10 patients with malignant lymphoma included in the study . It was found that the frequency of SLC19A1 A80G was 16.36%(AA), 60.00%(AG), and 23.64% ( GG ) . The incidence of Ⅲ myelosuppression showed association of 11.11% in AA genotype , 30.30% in AG genotype and 23.08%in GG genotype , therefore, there was no significant difference in the three genotypes of SLC 19 A1 A80 G and myelosuppression .There were 25 cases of mild neutropenia after chemotherapy , 7 cases of severe neutropenia and 2 cases of febrile neutropenia co-infection.According to the study, patients with the GG genotype in SLC19A1 showed a greater occurrence of febrile neutropenia co-infection than other types ( P <0.05 ) .Conclusion The genotype of SLC19A1 may be an effective genetic marker to predict HD-MTX induced toxic reaction .%目的:探讨SLC19A1基因多态性与大剂量甲氨蝶呤化疗后急性白血病及恶性淋巴瘤骨髓抑制及感染的相关性。方法治疗方案用CALLG2008方案、Hyper-CVAD方案及BFM90方案,提取基因组DNA,聚合酶链式反应-限制性片段长度多态性技术(PCR-RFLP)分析SLC19A1 A80G多态性。监测患者大剂量甲氨蝶呤化疗期间的外周血细胞计数,分析SLC19 A1基因多态性与大剂量甲氨蝶呤化疗后骨髓抑制及粒细胞缺乏

  10. Pharmacological causes of hyperprolactinemia

    OpenAIRE

    Torre, Daria La; Falorni, Alberto

    2007-01-01

    Hyperprolactinemia is a common endocrinological disorder that may be caused by several physiological and pathological conditions. Several drugs may determine a significant increase in prolactin serum concentration that is frequently associated with symptoms. The so-called typical antipsychotics are frequently responsible for drug-related hyperprolactinemia. Risperidone is one of the atypical neuroleptics most likely to induce hyperprolactinemia, while other atypical drugs are unfrequenlty and...

  11. Correlation between Ultrastructural Abnormality of Bone Marrow Cells and Anemia and Neutropenia in Myelodysplastic Syndrome%骨髓增生异常综合症骨髓细胞结构异常与贫血和粒细胞减少相关性研究

    Institute of Scientific and Technical Information of China (English)

    张华梅; 刘津华; 赵轼轩; 董舒旭; 竺晓凡; 茹永新; 肖志坚

    2011-01-01

    The aim of study was to investigate the relationship of anemia and neutropenia with ultrastructural abnormalities of erythroblasts and young neutrophils in bone marrow of patients with myelodysplastic syndrome(MDS).Anemia parameters and peripheral neutrophil amount of 74 patients with MDS were measured by automatic hemocyte analyzer. According to Hb value and neutropenia degree, MDS patients were divided into 4 groups: normal, mild,middle and severe anemia or neutropenia. The morbid rate and apoptosis rate of erythroblasts and young neutrophils in bone marrow were measured by transmission electron microscopy (TEM). The results indicated that 68 out of 74 patients were consistent with anemia diagnostic criteria, and 51 out of 68 patients were with neutrocytopenia. TEM showed different abnormal features of erythroblasts and young neutrophils in all patients. The morbid rates of erythroblasts in normal, mild, middle and severe anemia groups were 37 ± 14.7%, 24 ±9%, 32 ± 16% and 34 ±21 %respectively, while apoptotic rates of erythroblasts in normal, mild, middle and severe anemia groups were 2.25 ±1.03%, 4.43 ± 2.60%, 8.78 ± 4.04% and 11.67 ± 4.57% respectively. The morbid rate and apoptotic rate of erythroblasts were correlated negatively with Hb and HCT value (p <0.05 ). The apoptotic rates of bone marrow young neutrophils in 4 groups with different degree of neutropenia were 6.00 ± 2.67%, 9.50 ±4.42%, 13.00 ± 3.54% and 17.00 ± 2.39%, which correlated negatively with peripheral neutrophil quantity (p < 0.01 ). Morbid rates of neutrophils in normal, mild, middle and severe anemia groups were 12.25 ± 16.31%, 13.5 ± 10.01%, 23 ± 8.59 % and 51.67 ±19.67% respectively, which positively correlated with its apoptotic rates (p <0.01 ). It is concluded that anemia and neutropenia in patient with MDS are correlated with apoptosis and morbid rate of erythroblasts and young neutrophils in bone marrow, which may result in

  12. Rhizomucor variabilis var. regularior and Hormographiella aspergillata Infections in a Leukemic Bone Marrow Transplant Recipient with Refractory Neutropenia

    OpenAIRE

    Abuali, Mayssa M.; Posada, Roberto; Del Toro, Gustavo; Roman, Elizabeth; Ramani, Rama; Chaturvedi, Sudha; Chaturvedi, Vishnu; LaBombardi, Vincent J.

    2009-01-01

    Rhizomucor variabilis and Hormographiella aspergillata rarely cause human infections. This report details a fatal case of a 14-year-old female with leukemia posthematopoietic cell transplant and relapse with refractory pancytopenia. The patient first developed an R. variabilis var. regularior palate infection and later developed a cutaneous H. aspergillata infection while on posaconazole and caspofungin therapy.

  13. Hyponatraemia as the cause of severe cerebral symptoms

    DEFF Research Database (Denmark)

    Sonne, David P; Overgaard-Steensen, Christian

    2013-01-01

    increase the plasma [Na+]/reveal the symptoms and 2) coma treated successfully with infusions of hypertonic saline boluses. Effective treatment is simple and involves management of airway, breathing and circulation together with bolus infusions of hypertonic saline to ensure controllable plasma [Na...

  14.  Celery – cause of severe anaphylactic shock

    Directory of Open Access Journals (Sweden)

    Krzysztof Pałgan

    2012-03-01

    Full Text Available  Background:We present a case of anaphylactic shock induced by celery ingestion in a 28-year old woman with pollinosis during allergen (50�0birch, 50�0grass immunotherapy.Case Report:A female patient, aged 28 was admitted to the clinic due to a serious anaphylactic reaction. The event took place 15 min after ingesting fresh celery. She recovered after routine treatment with adrenaline, corticosteroids and antazoline.Conclusions:Our case shows the possibility of simultaneous occurrence of hypersensitivity to inhaled allergens and food. In such cases, it is considered part of cross-reactivity We discuss the importance of cross- reactivity associated with sensitization to pollen and vegetable foods.

  15. Hyperprolactinaemia: a cause of severe postoperative complication after reduction mammaplasty.

    Science.gov (United States)

    Mestak, Ondrej; Mestak, Jan; Borsky, Jiri

    2014-12-01

    Galactorrhoea is a rare complication of wound healing after breast reduction and its association with necrosis of the areolar skin in women with no recent history of breast feeding has to our knowledge never been described. Galactorrhoea is common and there are many differential diagnoses. We report a case of a 46-year-old woman who had bilateral reductions of the breast and developed hyperprolactinaemia and galactorrhoea six weeks postoperatively. Subsequently she developed dry necrosis of both areolas. All radiographic and laboratory findings were within the reference ranges except for of prolactin. PMID:25399958

  16.  Celery – cause of severe anaphylactic shock

    OpenAIRE

    Krzysztof Pałgan; Magdalena Götz-Żbikowska; Marta Tykwińska; Katarzyna Napiórkowska; Zbigniew Bartuzi

    2012-01-01

     Background:We present a case of anaphylactic shock induced by celery ingestion in a 28-year old woman with pollinosis during allergen (50�0birch, 50�0grass) immunotherapy.Case Report:A female patient, aged 28 was admitted to the clinic due to a serious anaphylactic reaction. The event took place 15 min after ingesting fresh celery. She recovered after routine treatment with adrenaline, corticosteroids and antazoline.Conclusions:Our case shows the possibility of simultaneous occurrence of hyp...

  17. [Severe sepsis after dog bite caused by Capnocytophaga canimorsus].

    Science.gov (United States)

    Dobosz, Paweł; Martyna, Danuta; Stefaniuk, Elżbieta; Szczypa, Katarzyna; Hryniewicz, Waleria

    2015-10-01

    We describe a case of a life-threatening septicemia resulting from a previous dog bite wound. The isolated bacterium was Capnocytophaga canimorsus, a slow-growing Gram-negative bacillus commonly found in dog saliva. Known risk factors for invasive C. canimorsus infections are alcohol abuse, cigarette smoking, splenectomy or other forms of immunosuppression. Any clinician seeing patients with a history of a dog bite should consider this pathogen as a causative agent and take detailed history regarding exposure to animals. PMID:26608488

  18. A study of the relationship between neutropenia and clinical infection risk during treatment with peginterferon aifa-2a and ribavirin for chronic hepatitis C%聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎期间中性粒细胞减少症与临床感染风险的相关性

    Institute of Scientific and Technical Information of China (English)

    孙丽杰; 于建武; 康鹏; 赵勇华; 颜炳柱

    2012-01-01

    Objective To investigate the corelation between neutropenia (ANC) incidence and infection during treatment with peginterferon alfa and ribavirin for chronic hepatitis C.Methods A retrospective cohort study of 399 patients treated with peginterferon and ribavirin derived from database of Department of Infectious Diseases, the Second Affiliated Hospital, Harbin Medical University was conducted.The incidence of infections and their relation with ANC were investigated.Potential risk factors for infection were identified by multivariate analysis.Results During treatment,neutropenia (ANC < 1.50 ×109/L) occurred in 251 patients.Among which,mild neutropenia [ANC: ( > 0.75-< 1.50) x 109/L],moderate neutropenia [ANC: ( 0.50-0.75 ) × 109/L]and severe neutropenia ( ANC < 0.50 × 109/L)occurred in 132 patients,103 patients and 16 patients,respectively.A total of 80 infections (20.1% )occurred,among which,14 infections were defined as severe.There was no significant difference in infection rate between patients with and without neutropenia ( 19.9%,50/251 vs 20.3%,50/251 ; x2 =0.007,P =0.933).There was no significant difference in infection rate between patients with and without peginterferon dose reduction ( 21.5%,31/144 vs 19.2%,49/255 ; x2 =0.307,P =0.580 ).In multivariate logistic regression analysis,the independent factors associated with infection were age (P =0.021),diabetes (P =0.004) and cirrhosis (P =0.012).Conclusions Infections during treatment with peginterferon alfa and ribavirin for chronic hepatitis C are irrelevant to neutropenia.The independent factors associated with infection are age,diabetes and cirrhosis.%目的 研究聚乙二醇干扰素(PEG-IFN) α-2a联合利巴韦林治疗慢性丙型肝炎(CHC)期间中性粒细胞(ANC)减少症发生率及其与临床感染发生之间的关系.方法 对哈尔滨医科大学附属第二医院进行PEG-IFNα-2a联合利巴韦林治疗的399例CHC患者进行回顾性分析,研究ANC减少症、

  19. 化疗后粒细胞缺乏与患者特异性危险因素的相关探讨%Research on the Correlation of Neutropenia after Chemotherapy and Patients’ Specific Risk Factors

    Institute of Scientific and Technical Information of China (English)

    彭群英

    2015-01-01

    目的:探讨白血病患者化疗后出现粒细胞缺乏的相关特异性危险因素。方法:随机抽选2014年1-12月本院收治的138例急性白血病患者作为研究对象。对其两次化疗后的粒细胞缺乏情况以及相应的特异性危险因素情况进行统计、分析和比较。结果:138例患者共276次化疗,粒细胞缺乏总发生率明显高于粒细胞缺乏总未发生率。年龄≥60岁、首次化疗有粒细胞缺乏、肿瘤分期Ⅲ~Ⅳ期以及食欲下降患者的粒细胞缺乏发生率均明显高于年龄<60岁、首次化疗无粒细胞缺乏、肿瘤分期Ⅰ~Ⅱ期以及食欲良好患者的粒细胞缺乏发生率,比较差异均有统计学意义(P<0.05)。结论:白血病患者经过化疗后出现粒细胞缺乏症与年龄、既往史、肿瘤分期及食欲下降有关。%Objective:To explore the specific risk factors related to neutropenia in leukemic patients after chemotherapy.Method:138 patients with acute leukemia in our hospital from January to December 2014 were randomly selected as the research objects.The situation of neutropenia and its related specific risk factors after chemotherapy were analyzed and compared.Result:138 patients finished 276 times of chemotherapy totally.The total occurrence rate of neutropenia was higher than the non-occurrence rate of neutropenia.The incidence rates of neutropenia in patients who were 60 years or more,with neutropenia for the first time,with tumor of Ⅲ to Ⅳ stage and with decreased appetite were higher than those in patients who were less than 60 years,without neutropenia for the first time,with tumor of Ⅰto Ⅱ stage and without decreased appetite,the differences were statistically significant(P<0.05).Conclusion:The occurrence of neutropenia in leukemic patients after chemotherapy has a correlation with patients’ age,previous history, tumor staging and loss of appetite.

  20. Severe hyperkalaemia: demographics and outcome

    OpenAIRE

    Phillips, B. M.; Milner, S.; Zouwail, S.; Roberts, G.; Cowan, M; Riley, S.G.; Phillips, A.O.

    2014-01-01

    Background Few studies have evaluated the prevalence of severe hyperkalaemia in unselected patient populations. We identified all episodes of severe hyperkalaemia occurring in 1 year, and described patient demographics, clinical response and outcome. We also assessed junior doctor knowledge of its causes and significance. Materials and methods A retrospective interrogation of the database of the regional biochemical laboratory identified all episodes of severe hyperkalaemia (K≥ 6.5 mmol/L) oc...

  1. 万古霉素致儿童中性粒细胞减少不良反应/不良事件分析%Analysis of Vancomycin-induced Neutropenia Adverse Reactions/Adverse Events in Children

    Institute of Scientific and Technical Information of China (English)

    季欢欢; 罗健; 宋林; 周波; 田晓颖; 贾运涛

    2016-01-01

    OBJECTIVE:To provide reference for vancomycin-induced neutropenia adverse reactions/adverse events in clinical diagnosis. METHODS:With a case of children with neutropenia treated by long-course and large-dose vancomycin,PubMed and CNKI were retrieved to collect related literature and the literature was analyzed. RESULTS:Neutropenia may be associated with vancomycin,based on causality criterion of adverse reaction in China. CONCLUSIONS:Vancomycin-induced neutropenia in chil-dren is most likely associated with prolonged exposure induced by infusion,vancomycin dosage should be reduced or stopped,and routine blood and plasma concentration should be closely monitored.%目的:为临床判断万古霉素致中性粒细胞减少不良反应/不良事件提供参考。方法:以1例骨髓炎患儿长疗程、大剂量使用万古霉素后致中性粒细胞减少为例,同时检索PubMed、中国知网数据库中的相关文献,并结合文献进行分析。结果:根据中国国家药品不良反应因果关系准则,该患儿中性粒细胞减少可能与输注万古霉素有关。结论:万古霉素致儿童中性粒细胞减少与输注该药后引起的药物蓄积有关,一旦发生不良反应/不良事件应减少万古霉素剂量或停药,同时密切监测血常规及血药浓度。

  2. Risk Factors for Neutropenia in Extremely Low Birth Weight Infants%极低出生体重儿中性粒细胞减少症的危险因素

    Institute of Scientific and Technical Information of China (English)

    王晨; 王丹华

    2014-01-01

    目的:研究极低出生体重儿中性粒细胞减少症的危险因素。方法回顾性纳入2011年1月至2013年12月在北京协和医院新生儿重症监护室住院治疗的极低出生体重儿。根据生后第一周内有无中性粒细胞减少症,分为早发中性粒细胞减少症和无早发中性粒细胞减少症病例;同时根据第一周后有无中性粒细胞减少症,分为晚发中性粒细胞减少症和无晚发中性粒细胞减少症病例。分别对其临床情况进行比较,对中性粒细胞减少症的危险因素进行分析。结果共108例患儿纳入本研究,平均胎龄(30.1±2.2)周,平均出生体重(1188±216) g。其中32例发生早发中性粒细胞减少症,53例发生晚发中性粒细胞减少症。早发中性粒细胞减少症患儿孕母妊娠期患高血压疾病发生率高于未发生早发中性粒细胞减少症患儿(59.4%比31.6%, P=0.007)。晚发中性粒细胞减少症患儿胎龄小于未发生晚发中性粒细胞减少症患儿[(29.5±2.3)周比(30.6±2.0)周, P=0.009];出生体重低于未发生晚发中性粒细胞减少症患儿[(1123±212) g比(1251±201) g, P=0.002];早发感染、晚发感染的发生率均高于未发生晚发中性粒细胞减少症患儿(50.9%比30.9%, P=0.034;100%比43.6%, P<0.001)。早发感染患儿中血小板减少症发生率高于中性粒细胞减少症发生率(45.5%比25.0%, P=0.045)。结论早发中性粒细胞减少症与晚发中性粒细胞减少症的危险因素不同。孕母妊娠期高血压疾病可能是早发中性粒细胞减少症的危险因素;小胎龄、低出生体重、早发感染和晚发感染可能是晚发中性粒细胞减少症的危险因素。%Objective To investigate the risk factors for neutropenia in extremely low birth weight ( EL-BW) infants.Methods We retrospectively studied the clinical data of ELBW infants treated in Neonatal

  3. Tackling antibiotic resistance in febrile neutropenia: current challenges with and recommendations for managing infections with resistant Gram-negative organisms.

    Science.gov (United States)

    Nouér, Simone A; Nucci, Marcio; Anaissie, Elias

    2015-10-01

    Multidrug resistant (MDR) Gram-negative bacteria (GNB) have emerged as important pathogens and a serious challenge in the management of neutropenic patients worldwide. The great majority of infections are caused by the Enterobacteriaceae (especially Escherichia coli and Klebsiella spp.) and Pseudomonas aeruginosa, and less frequently Acinetobacter spp. and Stenotrophomonas maltophilia. A broader-spectrum empiric antibiotic regimen is usually recommended in patients with a history of prior bloodstream infection caused by a MDR GNB, in those colonized by a MDR GNB, and if MDR GNBs are frequently isolated in the initial blood cultures. In any situation, de-escalation to standard empiric regimen is advised if infection with MDR GNB is not documented. PMID:26115679

  4. Initial Management of Low-Risk Pediatric Fever and Neutropenia: Efficacy and Safety, Costs, Quality-of-Life Considerations, and Preferences.

    Science.gov (United States)

    Sung, Lillian

    2012-01-01

    Initial management options for pediatric low-risk fever and neutropenia (FN) include outpatient compared with inpatient management and oral compared with intravenous therapy. Single-arm and randomized trials have been conducted in children. Meta-analyses provide support for the equivalence of outpatient and inpatient approaches. Outpatient oral management may be associated with a higher risk of readmission compared with outpatient intravenous management in children with FN, although other outcomes such as treatment failure and discontinuation of the regimen because of adverse effects were similar. Importantly, there have been no reported deaths among low-risk children treated as outpatients or with oral antibiotics. Costs, whether derived directly or through cost-effectiveness analysis, are consistently reduced when an outpatient approach is used. Quality of life (QoL) and preferences should be considered in order to evaluate different strategies, plan programs, and anticipate uptake of outpatient programs. Using parent-proxy report, child QoL is consistently higher with outpatient approaches, although research evaluating child self-report is limited. Preferences incorporate estimated QoL, but, in addition, factor in issues such as costs, fear, anxiety, and logistical issues. Only approximately 50% of parents prefer outpatient management. Future research should develop tools to facilitate outpatient care and to measure caregiver burden associated with this strategy. Additional work should also focus on eliciting child preferences for outpatient management. Finally, studies of effectiveness of an ambulatory approach in the real-world setting outside of clinical trials are important. PMID:24451798

  5. Oxaliplatin-based chemotherapy combined with traditional medicines for neutropenia in colorectal cancer: A meta-analysis of the contributions of specific plants.

    Science.gov (United States)

    Chen, Menghua; May, Brian H; Zhou, Iris W; Sze, Daniel Man-Yuen; Xue, Charlie C; Zhang, Anthony L

    2016-09-01

    This review assessed the effects on chemotherapy induced neutropenia (CIN) of combining oxaliplatin regimens with traditional plant-based medicines (TMs) in the management of colorectal cancer (CRC). 32 RCTs (2224 participants) were included. Meta-analysis showed reduced incidence of grade 3/4 CIN (RR 0.45[0.31, 0.65], I(2)=0%). No studies reported serious adverse events or reduction in tumour response rates associated with concurrent use of oxaliplatin and TM. Due to small sample sizes and risk of bias, these results should be interpreted with caution. Analyses of sub-groups of studies that used similar TM interventions assessed the relative contributions of individual plant-based ingredients to the results. Astragalus, Codonopsis, Atractylodes, Poria and Coix, in various combinations were consistently associated with reduced CIN incidence when administered orally. Experimental studies of these plants have reported reduced myelosuppression and/or enhanced immune response. Further studies of these plants may lead to the development of interventions to supplement conventional CIN treatment. PMID:27497028

  6. Mpn1, Mutated in Poikiloderma with Neutropenia Protein 1, Is a Conserved 3′-to-5′ RNA Exonuclease Processing U6 Small Nuclear RNA

    Directory of Open Access Journals (Sweden)

    Vadim Shchepachev

    2012-10-01

    Full Text Available Clericuzio-type poikiloderma with neutropenia (PN is a rare genodermatosis associated with mutations in the C16orf57 gene, which codes for the uncharacterized protein hMpn1. We show here that, in both fission yeasts and humans, Mpn1 processes the spliceosomal U6 small nuclear RNA (snRNA posttranscriptionally. In Mpn1-deficient cells, U6 molecules carry 3′ end polyuridine tails that are longer than those in normal cells and lack a terminal 2′,3′ cyclic phosphate group. In mpn1Δ yeast cells, U6 snRNA and U4/U6 di-small nuclear RNA protein complex levels are diminished, leading to precursor messenger RNA splicing defects, which are reverted by expression of either yeast or human Mpn1 and by overexpression of U6. Recombinant hMpn1 is a 3′-to-5′ RNA exonuclease that removes uridines from U6 3′ ends, generating terminal 2′,3′ cyclic phosphates in vitro. Finally, U6 degradation rates increase in mpn1Δ yeasts and in lymphoblasts established from individuals affected by PN. Our data indicate that Mpn1 promotes U6 stability through 3′ end posttranscriptional processing and implicate altered U6 metabolism as a potential mechanism for PN pathogenesis.

  7. History of chronic comorbidity and risk of chemotherapy-induced febrile neutropenia in patients with non-Hodgkin lymphoma not receiving granulocyte colony-stimulating factor prophylaxis.

    Science.gov (United States)

    Chao, Chun; Rodriguez, Roberto; Page, John H; Yang, Su-Jau; Huynh, Julie; Chia, Victoria M

    2015-01-01

    We conducted a cohort study to examine the association between a wide variety of chronic comorbidities and risk of febrile neutropenia (FN) in patients with non-Hodgkin lymphoma (NHL) from 2000 to 2009 treated with chemotherapy at Kaiser Permanente Southern California. History of comorbidities and FN events were identified using electronic medical records. Cox model adjusting for propensity score was used to determine the association between a comorbid condition and FN. Models that additionally adjusted for cancer stage, baseline absolute neutrophil count, chemotherapy regimen and dose reduction were also evaluated. A total of 2480 patients with NHL were included, and 60% received CHOP/R-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone, with or without rituximab). In total, 236 (9.5%) patients developed FN in the first chemotherapy cycle. Anemia (adjusted hazard ratio [HR] = 1.6, 95% confidence interval [1.2-2.2]), HIV infection (HR = 3.8 [2.0-6.7]) and rheumatoid diseases (HR = 2.4 [1.3-4.0]) were associated with significantly increased risk of FN. These results provide evidence that chronic comorbidity increases the risk of FN. PMID:24684228

  8. Reduction of Invasive Fungal Infections Among Cancer Patients With Chemotherapy-Induced Neutropenia After Protective Environment Implementation May Save Costs in a Developing Country: A Quasi-Experimental Study

    Directory of Open Access Journals (Sweden)

    Stoll

    2015-11-01

    Full Text Available Background Invasive fungal infections (IFI represent a serious threat for severely immunocompromised patients. Infection control interventions, including protective environment (PE implementation, are essential to reduce IFI incidence, mortality and burden of hospitalization, among high-risk patients. Information about the impact of these strategies in cancer patients with chemotherapy-induced neutropenia (CIN, in developing countries, is insufficient. Objectives To assess the impact of PE implementation on IFI incidence, consumption and cost of antifungal treatment, in a general, tertiary teaching hospital, in Southern Brazil. Patients and Methods We conducted a quasi-experimental study to evaluate an institutional intervention, in a hospital ward, for patients with CIN, which consisted in renovation of the ward and measures involving air-quality technologies installation, the main one being high efficiency particulate air (HEPA filters. Simultaneously, infection control routines were implemented. Neutropenic patients, admitted to any other hospital ward, prior to the renovation, were included in the historical control group. The IFI incidence was defined, according to the criteria proposed by the European Organization for Research and Treatment of Cancer. Direct costs of antifungal drugs were recorded, for all neutropenic patients. Results A total of 190 and 181 hospital admissions were included in the intervention and control groups, respectively. Total IFI incidence was reduced in the PE group (7.4% vs. 18.2%; P = 0.002 and the same was observed when considering only proven and probable IFI (1.6% vs. 8.3%; P = 0.003. This benefit persisted even after adjusting for antifungal prophylaxis (OR = 0.17; 95% CI = 0.05 ‒ 0.60. We observed a decreasing trend in molds and yeasts IFI incidence, in the intervention group. Although the final cost of antifungal agents was lower, after intervention (78347.37 USD vs. 154176.60 USD, the median cost per

  9. Ecthyma gangrenosum: A rare cutaneous manifestation caused by pseudomonas aeruginosa without bacteraemia in a leukaemic patient- A case report

    Directory of Open Access Journals (Sweden)

    Singh T

    2005-01-01

    Full Text Available Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by Pseudomonas aeruginosa in the majority of cases, typically affecting immunocompromised patients, particularly those with neutropenia. We report a rare case of ecthyma gangrenosum in the absence of bacteraemia presenting as a solitary necrotic ulcer in a female patient with acute lymphoblastic leukaemia. A culture from the ecthyma lesion revealed the presence of Pesudomonas aeruginosa , but the results of repeated blood cultures were negative. The patient responded well to amikacin to which the isolate was susceptible in vitro . Considering high rate of mortality, early diagnosis and prompt effective treatment is mandatory.

  10. Severe anaphylaxis: the secret ingredient.

    Science.gov (United States)

    Buergi, Andreas; Jung, Barbara; Padevit, Christian; John, Hubert; Ganter, Michael T

    2014-02-01

    In this case report, we describe a healthy urological patient who suffered severe intraoperative anaphylaxis to chlorhexidine, an ingredient contained in frequently used lubricants (Instillagel, Endosgel). Chlorhexidine is a well-known skin disinfectant and antiseptic component in mouthwash or other over the counter antiseptic pharmaceuticals. There is little awareness that commonly used lubricants may contain hidden chlorhexidine. After severe intraoperative anaphylaxis, it is important to investigate all potential (including hidden) agents that might have caused this life-threatening reaction. PMID:25611155

  11. Economic costs of chemotherapy-induced febrile neutropenia among patients with non-Hodgkin’s lymphoma in European and Australian clinical practice

    Directory of Open Access Journals (Sweden)

    Weycker Derek

    2012-08-01

    Full Text Available Abstract Background Economic implications of chemotherapy-induced febrile neutropenia (FN in European and Australian clinical practice are largely unknown. Methods Data were obtained from a European (97% and Australian (3% observational study of patients with non-Hodgkin’s lymphoma (NHL receiving CHOP (±rituximab chemotherapy. For each patient, each cycle of chemotherapy within the course, and each occurrence of FN within cycles, was identified. Patients developing FN in a given cycle (“FN patients”, starting with the first, were matched to those who did not develop FN in that cycle (“comparison patients”, irrespective of subsequent FN events. FN-related healthcare costs (£2010 were tallied for the initial FN event as well as follow-on care and FN events in subsequent cycles. Results Mean total cost was £5776 (95%CI £4928-£6713 higher for FN patients (n = 295 versus comparison patients, comprising £4051 (£3633-£4485 for the initial event and a difference of £1725 (£978-£2498 in subsequent cycles. Among FN patients requiring inpatient care (76% of all FN patients, mean total cost was higher by £7259 (£6327-£8205, comprising £5281 (£4810-£5774 for the initial hospitalization and a difference of £1978 (£1262-£2801 in subsequent cycles. Conclusions Cost of chemotherapy-induced FN among NHL patients in European and Australian clinical practice is substantial; a sizable percentage is attributable to follow-on care and subsequent FN events.

  12. Monitoring procalcitonin in febrile neutropenia: what is its utility for initial diagnosis of infection and reassessment in persistent fever?

    Directory of Open Access Journals (Sweden)

    James Owen Robinson

    Full Text Available BACKGROUND: Management of febrile neutropenic episodes (FE is challenged by lacking microbiological and clinical documentation of infection. We aimed at evaluating the utility of monitoring blood procalcitonin (PCT in FE for initial diagnosis of infection and reassessment in persistent fever. METHODS: PCT kinetics was prospectively monitored in 194 consecutive FE (1771 blood samples: 65 microbiologically documented infections (MDI, 33.5%; 49 due to non-coagulase-negative staphylococci, non-CNS, 68 clinically documented infections (CDI, 35%; 39 deep-seated, and 61 fever of unexplained origin (FUO, 31.5%. RESULTS: At fever onset median PCT was 190 pg/mL (range 30-26'800, without significant difference among MDI, CDI and FUO. PCT peak occurred on day 2 after onset of fever: non-CNS-MDI/deep-seated-CDI (656, 80-86350 vs. FUO (205, 33-771; p500 pg/mL distinguished non-CNS-MDI/deep-seated-CDI from FUO with 56% sensitivity and 90% specificity. PCT was >500 pg/ml in only 10% of FUO (688, 570-771. A PCT peak >500 pg/mL (1196, 524-11950 occurred beyond 3 days of persistent fever in 17/21 (81% invasive fungal diseases (IFD. This late PCT peak identified IFD with 81% sensitivity and 57% specificity and preceded diagnosis according to EORTC-MSG criteria in 41% of cases. In IFD responding to therapy, median days to PCT <500 pg/mL and defervescence were 5 (1-23 vs. 10 (3-22; p = 0.026, respectively. CONCLUSION: While procalcitonin is not useful for diagnosis of infection at onset of neutropenic fever, it may help to distinguish a minority of potentially severe infections among FUOs on day 2 after onset of fever. In persistent fever monitoring procalcitonin contributes to early diagnosis and follow-up of invasive mycoses.

  13. Severe Malnutrition: A Global Approach.

    Science.gov (United States)

    Pelletier, Jean-Gerard

    1993-01-01

    This report examines the immediate and underlying causes of malnutrition in the developing world. The first section discusses the effects of malnutrition on childhood development and examines the efficacy of nutritional rehabilitation. The second section addresses the medical effects of severe malnutrition, including the onset of ponderostatural…

  14. Polyhydramnios: Causes, Diagnosis and Therapy

    OpenAIRE

    Hamza, A.; Herr, D.; Solomayer, E. F.; Meyberg-Solomayer, G.

    2013-01-01

    Polyhydramnios is defined as a pathological increase of amniotic fluid volume in pregnancy and is associated with increased perinatal morbidity and mortality. Common causes of polyhydramnios include gestational diabetes, fetal anomalies with disturbed fetal swallowing of amniotic fluid, fetal infections and other, rarer causes. The diagnosis is obtained by ultrasound. The prognosis of polyhydramnios depends on its cause and severity. Typical symptoms of polyhydramnios includ...

  15. Determinación de la profundidad y duración de la neutropenia inducida por ciclofosfamida en ratones hembras MPF de la cepa Udea: ICR(cd-1

    Directory of Open Access Journals (Sweden)

    Omar Vesga

    2004-02-01

    Full Text Available

    El modelo murino de infección del muslo emplea animales neutropénicos para poder determinar la eficacia intrínseca de los antibióticos in vivo. Sin embargo, no se ha definido el número de neutrófilos y la duración de la neutropenia inducida por ciclofosfamida (CFM intraperitoneal (IP, información fundamental
    para valorar la reproducibilidad y confiabilidad del modelo.

     

     

  16. Determinación de la profundidad y duración de la neutropenia inducida por ciclofosfamida en ratones hembras MPF de la cepa Udea: ICR(cd-1)

    OpenAIRE

    Omar Vesga; María Agudelo; Carlos Rodriguez; Andrés Zuluaga; Beatriz Salazar

    2004-01-01

    El modelo murino de infección del muslo emplea animales neutropénicos para poder determinar la eficacia intrínseca de los antibióticos in vivo. Sin embargo, no se ha definido el número de neutrófilos y la duración de la neutropenia inducida por ciclofosfamida (CFM) intraperitoneal (IP), información fundamental
    para valorar la reproducibilidad y confiabilidad del modelo.

     

     

  17. 中性粒细胞缺乏伴发热与感染鉴别诊断及治疗%Differentiation between neutropenia complicated by fever and infections and the treatment

    Institute of Scientific and Technical Information of China (English)

    盖绿华; 冯其梅; 左大鹏; 翟红岩

    2013-01-01

    OBJECTIVE To differentiate the three types of neutropenia complicated with fever so as to provide evidence for the clinical treatment. METHODS The clinical data of 166 neutropenia patients complicated by fever, collected in the hospital from Jan to Aug 2012, were retrospectively analyzed. RESULTS Of totally 166 cases of neutropenia patients complicated by fever, the imaging examination was done in 46 cases, blood culture examination was done in 126 cases and only 23 cases was done for 3 times. Dynamic changes on pulmonary imaging were found in 21 cases, positive blood cultures were showed in 4 cases; urine routine examination was performed in 9 cases,the result showed all positive; after the treatment there were 153 cases improved, 9 cases exacerbated,and 4 cases died. CONCLUSION For the patients with neutropenia complicated with fever, it's a suitable approach to seek for focal infections and pathogens, if the focal infections or pathogens are found, definite diagnosis should be done according to diagnostic criteria for hospital infection of the Ministry of Health, otherwise, the antimicrobial therapy should be given .%目的 将中性粒细胞缺乏伴发热的3种类型进行鉴别,为临床诊治提供参考依据.方法 对医院2012年1-8月166例中性粒细胞缺乏伴发热患者进行回顾性分析.结果 166例中性粒细胞缺乏伴发热患者中,仅46例进行了影像学检查,21例肺部影像学有动态变化;126例进行了血培养检查,送检3次的病例仅23例,4例血培养呈阳性;9例进行了尿常规检查,结果均呈阴性;经治疗,病情好转153例,恶化9例,死亡4例.结论 对于粒细胞缺乏伴发热的病例,应及时寻找感染灶和病原体,能明确诊断的应按照卫生部医院感染诊断标准进行诊断,中性粒细胞缺乏伴发热确实查不到感染灶和病原菌时,给予抗感染治疗.

  18. Severe Aplastic Anemia (SAA)

    Science.gov (United States)

    ... Email this page Print this page Severe aplastic anemia (SAA) Severe aplastic anemia (SAA) is a disease in which the bone ... blood cells for the body. Tweet Severe aplastic anemia Symptoms of SAA How transplant can treat SAA ...

  19. Statistics of severe tornadoes and severe tornado outbreaks

    OpenAIRE

    B. D. Malamud; Turcotte, D.L.

    2012-01-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L≥10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database). We find that for the period 1982–2011...

  20. Statistics of severe tornadoes and severe tornado outbreaks

    OpenAIRE

    B. D. Malamud; Turcotte, D.L.

    2012-01-01

    The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider 4061 severe tornadoes (defined as L≥10 km) in the continental USA for the time period 1981–2010 (USA Storm Prediction Center Severe Weather Database). We find fo...

  1. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    OpenAIRE

    Natasha Gupta; Seema Ahmed; Lemuel Shaffer; Paula Cavens; Josef Blankstein

    2014-01-01

    Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term an...

  2. [Treatment of severe scoliosis].

    Science.gov (United States)

    Helenius, Ilkka; Pajulo, Olli

    2015-01-01

    Untreated severe scoliosis results in a serious malposition of the back, restrictive lung disease and increases mortality compared with the normal population. Idiopathic scoliosis rarely reaches a severe degree. In the treatment of severe scoliosis, preoperative head traction of several weeks' duration has proven a safe and effective method of correcting the malposition, and will also make scoliosis surgery technically easier. Most cases of severe scoliosis can be treated with anterior pedicle screw instrumentation, and vertebrectomy is only seldom required. PMID:26638663

  3. Morbidity of severe obesity.

    Science.gov (United States)

    Kral, J G

    2001-10-01

    Although obesity is an easy diagnosis to make, its etiologies, pathophysiology, and symptomatology are extraordinarily complex. Progress in surgical technique and anesthesiological management has substantially improved the safety of performing operations on the severely obese in the last 20 years. These improvements have occurred more or less empirically, without a full understanding of etiology or pathophysiology, although this has advanced concomitantly with improvements in practice. This review has attempted to provide a framework to facilitate progress in the neglected areas of patient selection and choice of operation, in an effort to improve long-term outcome. Despite the disparate etiologies of obesity and its diverse comorbidities and complications, there are unifying interdependent pathogenetic mechanisms of great relevance to the practice of antiobesity surgery. The rate of eating, whether driven by HPA dysfunction, ambient stress, or related hereditary susceptibility factors including the increased energy demands of an expanded body fat mass, participates in a cycle that results in disordered satiety (see Fig. 3). This leads to substrate overload, causing extensive metabolic abnormalities such as atherogenesis, insulin resistance, thrombogenesis, and carcinogenesis. This interpretation of the pathophysiology of obesity ironically accords with the original meaning of the word obesity: "to overeat." The ultimate solution to the problem of obesity--preventing it--will not be forthcoming until the food industry is forced to lower production and change its marketing strategies, as the liquor and tobacco industries in the United States were compelled to do. This cannot occur until the large and fast-growing populations of industrialized nations become educated in the personal implications of the energy principle. Regardless of whether school curricula are modified to prioritize health education, the larger problems of cultural and economic change remain for

  4. Evaluación del desenlace y características clínicas de una serie de niños con neutropenia febril sin foco en el Hospital Universitario San Vicente de Paúl, Medellín, Colombia, 2000-2005

    OpenAIRE

    María Adelaida Aristizábal Gil; Isabel Cristina Valencia Montoya; Carolina Jaramillo Arango

    2008-01-01

    Introducción: la neutropenia febril (NF) se asocia a infección en 48-60% de los casos y es la segunda causa de ingreso hospitalario al servicio de oncología pediátrica. El objetivo del estudio fue evaluar el desenlace de una serie de niños, que recibían tratamiento para neutropenia febril sin foco aparente, según un protocolo preestablecido en el Servicio de Hematooncología infantil del Hospital Universitario San Vicente de Paúl. MATERIALES Y MÉTODOS: se incluyeron retrospectivamente historia...

  5. Palmer Drought Severity Index

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — PDSI from the Dai dataset. The Palmer Drought Severity Index (PDSI) is devised by Palmer (1965) to represent the severity of dry and wet spells over the U.S. based...

  6. Dengue and Severe Dengue

    Science.gov (United States)

    ... 2014 Fact sheets Features Commentaries 2014 Multimedia Contacts Dengue and severe dengue Fact sheet Updated July 2016 Key facts Dengue ... risk of developing severe dengue. Global burden of dengue The incidence of dengue has grown dramatically around ...

  7. Severe Burn Patients Complicated with Acute Respiratory Distress Syndrome (Root Cause Analysis and Prevention Measures%严重烧伤患者并发急性呼吸窘迫综合征的原因分析及防治措施

    Institute of Scientific and Technical Information of China (English)

    刘卫华; 李俊

    2014-01-01

    Objective To study the cause of severe burn patients complicated with ARDS , clinical characteristic and the prevention and control measures.Methods The serious burn patients complicated with ARDS the clinical data of 31 cases, according to the clinical manifestation and laboratory examination , put forward the possible causes and choose suitable treatment according to the results of the diagnosis.Results The patients in the combined inhalation injury com-plicated with ARDS in 13, 4 cases occurred in shock stage , 12 cases occurred in patients , 2 cases occurred in operation the latter.This group of patients after treatment , except 2 cases died of MODS , all healing discharged from hospi-tal.Conclusions Patients with severe burn complicated with ARDS is high , causes a merger with burn area and depth , whether inhalation injury , also with shock, infection, length of surgery and intraoperative transfusion volume , nutritional support and wound treatment.For patients with severe burn complicated by early diagnosis and treatment of ARDS , can effectively reduce the patients complicated with MODS , promote wound healing early is important.%目的:探讨严重烧伤患者并发ARDS的原因、发病特点和防治措施。方法收集2005-01~2012-01间收治并发ARDS的严重烧伤患者31例的临床资料,根据临床表现和实验室检查,提出可能的致病原因并根据诊断结果选择适合的治疗方案。结果本组患者中合并吸入性损伤者并发ARDS 13例,发生于休克期者4例,发生于感染者12例,发生于手术后者2例。本组患者经过治疗,除2例死于MODS外,其余全部愈合出院。结论严重烧伤患者并发ARDS发生率很高,发病原因与烧伤面积、深度、是否合并吸入性损伤有关,也与休克、感染、手术时间长短及术中输液量、营养支持及创面处理有关。对严重烧伤患者并发ARDS的早期诊断和治疗,能有效减少此类患者

  8. What Causes Angina?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Angina? Underlying Causes Angina usually is a symptom of coronary heart ... and cause angina or a heart attack . Immediate Causes Many factors can trigger angina pain, depending on ...

  9. What Causes Lymphocytopenia?

    Science.gov (United States)

    ... low lymphocyte counts with no underlying cause. Acquired Causes Many acquired diseases, conditions, and factors can cause ... anemia . Radiation and chemotherapy (treatments for cancer). Inherited Causes Certain inherited diseases and conditions can lead to ...

  10. What Causes Cardiogenic Shock?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Cardiogenic Shock? Immediate Causes Cardiogenic shock occurs if the heart suddenly can' ... reason why emergency treatment is so important. Underlying Causes The underlying causes of cardiogenic shock are conditions ...

  11. Hobo transposons causing chromosomal breakpoints.

    OpenAIRE

    Ladevèze, V; Aulard, S.; Chaminade, N; Périquet, G; Lemeunier, F

    1998-01-01

    Several laboratory surveys have shown that transposable elements (TEs) can cause chromosomal breaks and lead to inversions, as in dysgenic crosses involving P-elements. However, it is not presently clear what causes inversions in natural populations of Drosophila. The only direct molecular studies must be taken as evidence against the involvement of mobile elements. Here, in Drosophila lines transformed with the hobo transposable element, and followed for 100 generations, we show the appearan...

  12. Pharmacotherapy of severe asthma

    OpenAIRE

    Firszt, Rafael; Kraft, Monica

    2010-01-01

    Severe asthma is a complex and heterogeneous phenotype where management can be challenging. While many patients with severe asthma respond to high-dose inhaled corticosteroids in combination with a long-acting β-agonist, there remains a significant subset of patients that require oral corticosteroids to control symptoms. Alternative therapies are needed to help reduce the need for continuous oral corticosteroids; however, there are currently very few effective options. Several new alternative...

  13. Severe asthma in children

    OpenAIRE

    Guilbert, TW; Bacharier, LB; Fitzpatrick, AM

    2014-01-01

    Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of ICS or oral corticosteroids. Children with severe asthma may fall into two categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, poor adherence due to adverse psychological or environmental factors. In contrast, treatment-resistant is defined as difficult asthma despite man...

  14. Severe accident phenomena

    International Nuclear Information System (INIS)

    Severe accidents are nuclear reactor accidents in which the reactor core is substantially damaged. The report describes severe reactor accident phenomena and their significance for the safety of nuclear power plants. A comprehensive set of phenomena ranging from accident initiation to containment behaviour and containment integrity questions are covered. The report is based on expertise gained in the severe accident assessment projects conducted at the Technical Research Centre of Finland (VTT). (49 refs., 32 figs., 12 tabs.)

  15. Statistics of severe tornadoes and severe tornado outbreaks

    Directory of Open Access Journals (Sweden)

    B. D. Malamud

    2012-09-01

    Full Text Available The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L≥10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database. We find that for the period 1982–2011, for individual severe tornadoes (L≥10 km: (i There is a strong linear scaling between the number of severe tornadoes in a year and their total path length in that year. (ii The cumulative frequency path length data suggests that, not taking into account any changing trends over time, we would expect in a given year (on average one severe tornado with a path length L≥115 km and in a decade (on average one severe tornado with a path length L≥215 km. (iii The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20<L<200 km, is well approximated by an inverse power-law relationship with exponent near 3. We then take the total path length of severe tornadoes in a convective day (12:00–12:00 UTC, LD, as a measure of the strength of a 24-h USA tornado outbreak. We find that: (i For 1982–2011, the number of severe tornadoes in a USA convective day outbreak has a strong power-law relationship (exponent 0.80 on the convective day total path length, LD. (ii For 1952–2011, the cumulative frequency path length data for severe tornado outbreaks suggests that we would expect in a given year (on average one daily severe tornado outbreak with total path length LD≥480 km and in a decade (on average one daily severe tornado outbreak with a total path length LD≥1200 km. (iii For 1982–2011, the noncumulative frequency-length statistics of tornado

  16. Taking Hydrochloric Acid after Clopidogrel Neutropenia Correlation Analysis%服用盐酸氯吡格雷后中性粒细胞减少的相关性分析

    Institute of Scientific and Technical Information of China (English)

    王泽; 杜莉

    2013-01-01

    Objective:to study the coronary heart disease patients take hydrochloric acid after clopidogrel neutropenia related factors. Methods:to Inner Mongolia baotou hospital in January 2010-12 month in hospitalized patients with coronary heart disease and taking hydrochloric acid clopidogrel person as the research object, check before and after medication neutrophils change, divided into reduce group and normal group comparison. Results: 242 cases of the research object of neutropenia group and an example, 11.15%incidence of single factor analysis results show that the resistance to diabetes drugs, smoking, drinking three aspects, neutropenia group and normal group compared with the statistical significance (P < 0.05). Conclusion:Diabetes, drinking and smoking is leucopenia correlation factors.%  目的:研究冠心病患者服用盐酸氯吡格雷后中性粒细胞减少的相关因素.方法:以内蒙古包钢医院2010年1月~12月间住院患者中患冠心病并服用盐酸氯吡格雷者为研究对象,检查服药前后中性粒细胞变化,分为减少组和正常组进行比较.结果:其242例研究对象中中性粒细胞减少组27例,发生率11.15%单因素分析结果显示抗糖尿病药物、吸烟、饮酒3个方面,中性粒细胞减少组和正常组比较具有统计学意义,(P<0.05).结论:糖尿病、饮酒和吸烟是白细胞减少的相关性因素.

  17. Statistics of severe tornadoes and severe tornado outbreaks

    Directory of Open Access Journals (Sweden)

    B. D. Malamud

    2012-03-01

    Full Text Available The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider 4061 severe tornadoes (defined as L≥10 km in the continental USA for the time period 1981–2010 (USA Storm Prediction Center Severe Weather Database. We find for individual severe tornadoes: (i The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20 < L < 200 km, is well approximated by an inverse power-law relationship with exponent near 3. (ii There is a strong linear scaling between the number of severe tornadoes in a year and their total path lengths in that year. We then take the total path length of severe tornadoes in a day, LD, as a measure of the strength of a 24-hour USA tornado outbreak. We find that: (i On average, the number of days per year with at least one continental USA severe tornado (path length L≥10 km has increased 16% in the 30-year period 1981–2010. (ii The daily numbers of severe tornadoes in a USA outbreak have a strong power-law relationship (exponent 0.87 on their daily total path lengths, LD, over the range 20 < LD < 1000 km dy−1. (iii The noncumulative frequency-length statistics of tornado outbreaks, 10 < LD < 1000 km dy−1, is well approximated by an inverse power-law relationship with exponent near 1.7. We believe that our robust scaling results provide evidence that touchdown path lengths can be used as quantitative measures of the systematic properties of severe tornadoes and severe tornado outbreaks.

  18. 2009年秋至2010年春我国西南地区严重干旱的成因分析%Analyses of the Causes of Severe Drought Occurring in Southwest China from the Fall of 2009 to the Spring of 2010

    Institute of Scientific and Technical Information of China (English)

    黄荣辉; 刘永; 王林; 王磊

    2012-01-01

    A severe drought occurred in Southwest China from the fall of 2009 to the spring of 2010. Either its persistent time and area or decreased amount of rainfall were less observed during the last 50 years. Thus, in this paper, the occurring causes of this drought are analyzed by using the ERA-40 reanalysis data and SST data from the impacts of thermal anomalies in the tropical western Pacific (TWP) and the tropical Indian Ocean (TIO) on the atmospheric circulation over the TWP and South Asia. The results show that during the period from the fall of 2009 to the spring of 2010, both the TWP and the TIO were in a warming state. Under the common thermal effect of both oceans, a strong anticyclonic anomalous circulation appeared in the lower troposphere over the TWP and the South China Sea, which caused not only the strengthening of the southwest flow anomaly, but also the appearance of a low trough anomaly over South China and Central China. In this case, the northwest flow anomaly and descending flow anomaly behind the trough controlled the eastern part of the Tibetan Plateau, and water vapor was difficultly transported from the Bay of Bengal into the Yunnan-Guizhou Plateau (Yun Gui Plateau in short). Thus, less rainfall for a long time was caused in this region. Moreover, the analysis results also show that the circulation anomaly over the mid- and high latitudes had an important impact on the severe drought Since the polar wave guide of quasi-stationary planetary wave propagations over the high latitudes was stronger, but the low-latitude wave guide was weaker from the fall of 2009 to the spring of 2010, which led to convergence and divergence of the wave E-P fluxes for quasi-stationary planetary waves in the upper troposphere and the stratosphere over the region about 60° N and in the middle and upper troposphere over the region about 35°N, respectively. Thus, the zonal mean wind was weakened in the upper troposphere and the stratosphere over the region about 60

  19. Antifungals in severe asthma

    NARCIS (Netherlands)

    Parulekar, Amit D.; Diamant, Zuzana; Hanania, Nicola A.

    2015-01-01

    Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes

  20. Transfusion Related Acute Lung Injury: A severe case triggered with anti-HLA class II antibodies in the recipient

    Directory of Open Access Journals (Sweden)

    Hale Borazan

    2012-04-01

    Full Text Available Transfusion-related acute lung injury (TRALI is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. The classic TRALI syndrome is characterized by the suddenly onset of respiratory failure within 2-6 hrs of the transfusion of a blood product, generally transient, resolves within 48-96 hrs spontaneously, and has a better prognosis. Nonetheless there is an expanded definition of TRALI syndrome up to 72 hrs, which is called delayed TRALI. The potential causes of TRALI can be explained by two distinct mechanism including the anti-leukocyte antibodies in donor plasma or in recipient plasma with the reverse mechanism, and biological response modifiers in susceptible individuals. This report highlights the succesful management of a classic TRALI case that was seen approximately two hours after the transfusion of a packed red blood cell and triggered with anti-HLA class II antibodies in the recipient with reverse mechanism accompanied by neutropenia together.

  1. 湿润烧伤膏在ICU重症腹泻所致肛周皮肤损伤患者中的应用与观察%Application and observation of moist exposed burn ointment in perianal skin lesions caused by severe diarrhea in ICU

    Institute of Scientific and Technical Information of China (English)

    吴小飞

    2012-01-01

    目的 探索湿润烧伤膏在ICU患者腹泻所致皮肤损伤中的临床应用,解决ICU腹泻患者肛周皮肤护理困难问题.方法 将入住ICU的患者按人院先后顺序分为对照组和观察组,两组患者均在每次腹泻后,用温开水清洗肛门、会阴,皮肤有破溃者用生理盐水棉球清洗,PVP碘棉球擦拭.对照组采用传统的红外线照射,观察组采用湿润烧伤膏外涂,观察比较两组疗效.结果 观察组在治疗中愈合率明显高于对照组,两组对比有显著性差异.结论 湿润烧伤膏局部外涂治疗ICU重症腹泻患者肛周皮肤损伤效果较好,且使用方便,值得临床推广使用.%Objective To explore the application of moist burn ointment in skin injury caused by diarrhea in patients of ICU and solve the problems of perianal skin care in ICU diarrhea patients. Method According to the admission sequence, ICU patients was divided into observation group and control group, The anus, perineum of each patient were cleaned by warm boiling water after diarrhe-a. The patients with skin ulceration were cleaned with saline cotton and PVP iodine cotton ball. The control group was used the traditional infrared irradiation, the observation group was treated with moist burn ointment. Result The healing rate of the observation group was significantly higher than the control group. Conclusion The effect of MEBO in treatment of perianal skin injury patients caused by severe diarrhea was good and convenient, which was worth promoting in clinic.

  2. 多黏菌素E治疗严重烧伤后多药耐药革兰阴性杆菌感染的临床评估%Clinical assessment of colistin in treating infections caused by multidrug-resistant gram-negative bacillus in patients with severe burn

    Institute of Scientific and Technical Information of China (English)

    张家平; 杨小顺; 陈建; 彭毅志; 黄跃生

    2009-01-01

    Objective To investigate the therapeutic effect and side effects of eolistin in treating in-fections caused by multidrug-resistant (MDR) gram-negative bacillus in patients with severe burn in order to provide the basis for reasonable application of this antibiotic in clinic. Methods Nine burn patients suf-fered from infections caused by MDR gram-negative bacillus admitted to our institute from August 2005 to January 2009 were involved in this study. On the premises that isolated bacteria were only sensitive to colistin or not sensitive to other antibiotics, patients were treated with intravenous drip of colistin (100×10~4-150× 10~4U/d), or intravenous drip combined with administration of the drug into respiratory tract by atomization or instillation (50×10~4-100×10~4 U/d). The bacteriologic and therapeutic effects and side effects (inclu-ding neurotoxicity and nephrotoxicity, rise in serum levels of creatinine, urea nitrogen and cystatin C were detected and compared before and after administration) of colistin were observed. Results Out of 9 pa-tients, 7 patients were with bloodstream and pulmonary infections, 1 patient was with bloodstream, pulmona-ry, and invasive wound infections, and 1 patient was with bloodstream and urinary tract infections. The path-ogenic bacteria were proved to be Pseudomonas aeruginosa , Acinetobacter baumannii and Pseudomonas maltophilia. After the administration of colistin, bacteria clearance rate of blood reached 92.3% in 9 pa-tients;isolation rate of MDR gram-negative bacillus of sputum was significantly decreased in 7 patients with pulmonary infection (before treatment 58.2% v.s. After treatment 14.6% , P 0.05),1例患者明显升高但停药1个月后回降.用药期间和停药5 d内患者均未见神经毒性反应或其他不良反应.结论 在未出现更有效药物的前提下,合理应用多黏菌素E是目前治疗严重烧伤MDR革兰阴性杆菌感染的良好选择.

  3. Relationship between plant nutrition and severity of damage caused by white rot desease on onion (Allium cepa Relación entre la nutrición mineral y la severidad del daño ocasionado por pudrición blanca en cebolla de bulbo

    Directory of Open Access Journals (Sweden)

    Piraneque G Nelson Virgilio

    2006-12-01

    Full Text Available

    In a comercial onion crop (Allium cepa located in Tibasosa, Boyacá, Colombia, the relationship between plant nutrition and severity of damage caused by white rot disease was studied. The soil was classified as sulfic endoamept. At 20 days before sowing (DAS and at 45, 90 and 120 days after sowing soil samples and esclerotium were taken plant tissue analysis at 45, 90 and 120 DAS was carried out. Also association among soil chemical parameters and plant percentage of damage was estudied. Results showed direct relationship among cooper content in soil (r=0.71, nitrogen in leaves (r=0.46 and magnesium in leaves (r=0.66 with percentage o damage caused by S. cepivorum. Calcium content in leaves (r=0.52, boron in leaves (r=-0.49 and esclerocios in soil Elg (r=0.56 were inversely proportional to percentage of damage. The treatment with the highest percentage of damage had higher contents of N, P and S in leaves and lower K, Ca, Mg, B, Mn, Cu and Zn.

    Key words: Allium cepa; Sclerotium cepivorum; plant nutrition.

    En un cultivo comercial de cebolla de bulbo (Allium cepa situado en el municipio de Tibasosa, Boyacá-Colombia, se recolectaron muestras de suelos (sulfic endoaquepts yesclerocios 20 días antes de la siembra, 45, 90 y 120 días después de la siembra (DDS; los análisis de tejidos se realizaron a los 45, 90 y 120 DDS. Se determinó la asociación entre parámetros químicos del suelo y de la planta con el porcentaje de daño. Se estableció asociación directa entre las variables, contenido de cobre en suelo Cu (r=0.71, nitrógeno foliar Nf(r=0.46 y magnesio foliar Mgf (r=0.66 con el porcentaje de daño causado por S. cepivorum. El contenido de calcio foliar Caf (r=-0.52, boro foliar Bf (r=-0.49 y esclerocios por gramo de suelo ES/g (r=-0.56 fueron inversamente proporcionales con el porcentaje de daño. El tratamiento con mayor porcentaje de daño presentó contenidos altos de N, P y S en tejidos y menores

  4. Severe Sensorineural Hearing Loss in Children with Cochlear Implants Causes of the Failure before the ECG and Nursing%重度感音聋患儿人工耳蜗植入术前心电图检查失败原因分析及护理对策

    Institute of Scientific and Technical Information of China (English)

    于莉; 刘伟萍; 李爱军

    2013-01-01

    Objective:To investigate severe sensorineural hearing loss in children with cochlear implants before ECG failure and develop appropriate nursing measures. Methods:A retrospective analysis of our hospital in February 2011~February 2012 period 428 cases (236males, 192females) with severe sensorineural hearing loss in children with cochlear implants preoperative clinical and ECG data, statistics, analysis and classification severe sensorineural hearing loss in children with preoperative ECG failure cases causes of the failure to develop nursing measures. Results:Preoperative ECG successful children with 188 cases, accounting for 44%;quadratic successful children with 232 cases, accounting for 54.2%;three successful children with eight cases, accounting for 1.87%;6 cases in 428 cases diagnosed with long QT syndrome, inoperable. Failure:(1) children with parents and children on a larger preoperative ECG lack of understanding of the necessity and importance. (2) ECG before taking on the role of drugs and side effects do not. (3) environmental factors and children with their own factors.Conclusion:Compliance behavior of parents of children with poor children is not fully implemented by your doctor right preoperative ECG preparation before;severe sensorineural hearing loss in children with cochlear implants before ECG targeted for parents of children and children with nursing intervention is necessary.%目的:探讨重度感音聋患儿人工耳蜗植入术前心电图检查失败的原因和制定相应的护理对策的措施。方法:回顾性分析我院2011年2月~2012年2月期间收治行人工耳蜗植入术重度感音聋患儿428例(男236例,女192例)术前的临床资料和心电图,统计、分类及分析重度感音聋患儿术前心电图检查失败病例的失败原因,制定相应的护理对策。结果:术前心电图检查一次成功的患儿有188例,占44%;二次成功的患儿有232例,占54.2%;三次成功的患儿有8

  5. Severe Urticaria Following Erythromycin Therapy

    Directory of Open Access Journals (Sweden)

    Anada S. Prasad

    1960-01-01

    Full Text Available Enythromycin is believed to cause no serlous reactions after large doses, nausea, rarely vomiting and occasionally abdominal pain and diarrhea may occur, (Herrell, 1954. According to' Kagan and Faller (1955 no allergic reaction to' erythromycin has been reported. Phlebitis and thrombosis have been observed, (Shoe maker & Yow, 1954. In a report by Solomon and Johnson, (1955 toxic reactions were recorded as being uncommon. In a large series of cases, only one patient had a rash, another had fever possibly due to the drug, nne had nausea and vomiting and 4 had loose bowel movements while under therapy. Among the 122 patients treated with erythromcin, therapy was stopped owing to side effects in only one. My patient had severe urticaria within 24 hours of beginning therapy with erythromycin and a positive skin test was observed. It was believed to be an allergic reaction caused by the drug.

  6. S1415CD, Prophylactic Colony Stimulating Factor Management in Patients With Breast, Colorectal or Non-Small Cell Lung Cancer Receiving Chemotherapy and With Risk of Developing Febrile Neutropenia

    Science.gov (United States)

    2016-04-08

    Febrile Neutropenia; Stage 0 Breast Cancer; Stage 0 Colorectal Cancer; Stage 0 Non-Small Cell Lung Cancer; Stage I Colorectal Cancer; Stage IA Breast Cancer; Stage IA Non-Small Cell Lung Carcinoma; Stage IB Breast Cancer; Stage IB Non-Small Cell Lung Carcinoma; Stage IIA Breast Cancer; Stage IIA Colorectal Cancer; Stage IIA Non-Small Cell Lung Carcinoma; Stage IIB Breast Cancer; Stage IIB Colorectal Cancer; Stage IIB Non-Small Cell Lung Carcinoma; Stage IIC Colorectal Cancer; Stage IIIA Breast Cancer; Stage IIIA Colorectal Cancer; Stage IIIA Non-Small Cell Lung Cancer; Stage IIIB Breast Cancer; Stage IIIB Colorectal Cancer; Stage IIIB Non-Small Cell Lung Cancer; Stage IIIC Breast Cancer; Stage IIIC Colorectal Cancer; Stage IV Breast Cancer; Stage IV Non-Small Cell Lung Cancer; Stage IVA Colorectal Cancer; Stage IVB Colorectal Cancer

  7. 扶中升白方对大肠癌化疗所致白细胞减少的治疗作用%Curative effect of Fuzhong Shengbai decoction on neutropenia induced by colorectal cancer chemotherapy

    Institute of Scientific and Technical Information of China (English)

    郑岚; 沈小珩; 周东亮

    2011-01-01

    Objective It is to observe the efficacy of little compound preparation Fuzhong Shengbai ( FZSB ) decoction in treatment of neutropenia induced by colorectal cancer chemotherapy. Methods 60 patients wiih malignancies confirmed by pathology or cytology were randomly divided into two groups, there were 30 cases in each group. The cases in control group were given chemotherapy regimen based on Oxaliplatin plus Leucovorin plus Fluorouracil. The cases in treatment group were given FZSB decoction combined with chemotherapy regimen, and FZSB decoction was given between two periods of chemotherapy.All six periods of chemotherapy treatmenL and the countercheck one month after the whole periods were observed. The change of leucocyte counts , the dosage of using granulocyte colony stimulating factor, the erythrocyte and hemoglobin and thrombocyte counts, the score of traditional Chinese medicine symptom, Karnofsky performance status were observed, also the function of the liver and kidney were observed as safety index. Results Compared with control group, the time of chemotherapy induced neutropenia was delayed, the degree of neutropenia was reduced, the resume of leucocyte and hemoglobin were improved after the whole periods of chemotherapy, the dosage of using Granulocyte-colony stimulating factor was decreased, the degree of hypoglobulia was reduced, the score of traditional Chinese medicine symptom was increased, and the damnification on the body taken by chemotherapy was reliefed in treatment group. Conclusion FZSB decoction is a little compound safety preparation which is effective on treating chemotherapy induced neutropenia.%目的 观察扶中升白方对大肠癌化疗所致白细胞减少的治疗作用.方法 选择有明确病理学诊断的大肠癌患者60例并随机分为2组,对照组30例以草酸铂、氟尿嘧啶和亚叶酸钙为基础的化疗方案治疗;治疗组30例在对照组治疗的同时,化疗间歇期给予扶中升白方.6个疗程及全

  8. [Gastroduodenal intussusception causing gastric retention.

    DEFF Research Database (Denmark)

    Alamili, M.; Berg, J.O.; Lindstrom, C.; Jensen, C.V.; Wettergren, A.

    2008-01-01

    A case of gastroduodenal intussusception caused by a duodenal lipoma is presented. The condition was characterized by severe upper gastrointestinal retention, epigastric pain and weight loss. The mass was diagnosed by CT scan. The diagnosis was confirmed by operation. The patient was treated...

  9. What Causes Raynaud's?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Raynaud's? There are two main types of Raynaud’s— ... type of Raynaud's is often called Raynaud's phenomenon. Causes of Secondary Raynaud's Many things can cause secondary ...

  10. What Causes Thrombocytopenia?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Thrombocytopenia? Many factors can cause thrombocytopenia (a low ... known for sure. Rare and Serious Conditions That Cause Blood Clots Some rare and serious conditions can ...

  11. What Causes Atherosclerosis?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Atherosclerosis? The exact cause of atherosclerosis isn't known. However, studies show ... blood clots can worsen angina (chest pain) or cause a heart attack or stroke . Researchers continue to ...

  12. What Causes Hemochromatosis?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Hemochromatosis? The two types of hemochromatosis are primary and secondary. Each type has a different cause. Primary Hemochromatosis Primary hemochromatosis is caused by a ...

  13. What Causes Aplastic Anemia?

    Science.gov (United States)

    ... this page from the NHLBI on Twitter. What Causes Aplastic Anemia? Damage to the bone marrow's stem ... system attacks its own cells by mistake. Acquired Causes Many diseases, conditions, and factors can cause aplastic ...

  14. Causes of Diabetes

    Science.gov (United States)

    ... Help for Diabetes Care Diabetes Statistics Causes of Diabetes What is diabetes? Diabetes is a complex group of diseases with ... and type 2 diabetes. What causes type 1 diabetes? Type 1 diabetes is caused by a lack ...

  15. What Causes Respiratory Failure?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Causes Respiratory Failure? Diseases and conditions that impair breathing can cause ... injure your lungs. Normal Lungs and Conditions Causing Respiratory Failure Figure A shows the location of the lungs, ...

  16. About Alzheimer's Disease: Causes

    Science.gov (United States)

    ... Project Act (NAPA) About ADEAR About Alzheimer's Disease: Causes Age-related changes in the brain Genetics Health, ... for the Causes of AD" NIA Information on Causes Alzheimer’s Disease in People with Down Syndrome Understanding ...

  17. Biomarkers in Severe Asthma.

    Science.gov (United States)

    Wan, Xiao Chloe; Woodruff, Prescott G

    2016-08-01

    Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma. PMID:27401625

  18. Case analysis of the of clinical pharmacists participating in the treatment of severe hypoglycemia caused by xiaokewan%临床药师参与消渴丸所致重度低血糖治疗的病例分析

    Institute of Scientific and Technical Information of China (English)

    郭燕波; 付登聪

    2015-01-01

    目的:探讨临床药师参与患者药物治疗的作用。方法对1例消渴丸所致重度低血糖的病例进行分析,临床药师从专业角度识别药物不良反应,协助医生制订合理、有效的治疗方案。结果经治疗患者低血糖症状消失,血糖稳定在5~9mmol/ L。结论在临床实践中,临床药师参与不良反应因果关系的判断,对患者进行药学监护,充分发挥了临床药师的价值。%Objective To investigate the effect of clinical pharmacists participating in drug treatment of patients. Methods By analyzing one case of severe hypoglycemia caused by xiaokewan,the clinical pharmacists identify adverse reaction from the professional point of view,and assist doctors in formulating a reasonable and effective treatment plan. Results After the treatment,the symptoms of hypoglycemia disappeared for patients,blood glucose maintained at 5 ~ 9mmol/ L. Conclusion In clinical practice,clinical pharmacists judge the causality of the adverse reactions and provided pharmaceutical care for pa-tient,which played a role in the clinical practice.

  19. Clinical observation on treating postoperative chemotherapy-induced neutropenia with caffeic acid tablets%咖啡酸片治疗食管癌术后化疗引起白细胞减少的临床观察

    Institute of Scientific and Technical Information of China (English)

    陆军

    2013-01-01

    Objective:To investigate the effect of caffeic acid tablets on treating postoperative chemotherapy-induced neutropenia. Methods: 64 cases were divided into two groups, the treated group was given caffeic acid tablets, the control group was given batilol, vitamin B4, Li Ke-jun. Reviewed blood routine once a week before treatment, in treatment and after treatment, observed rise in white blood cells. Results: The difference between the two groups was statistically significant (P<0.01). Conclusion: Caffeic acid tablets have good efficacy on treating postoperative chemotherapy-induced neutropenia.%目的:探讨咖啡酸片治疗食管癌术后白细胞减少的疗效及作用。方法:将食管癌术后白细胞减少患者64例随机分成两组,治疗组给予咖啡酸片;对照组给予鲨肝醇、维生素B4、利可君。两组在治疗前、治疗中、治疗后每周复查1次血常规,观察白细胞上升情况。结果:两组疗效间差异有统计学意义(P<0.01)。结论:咖啡酸片对食管癌术后化疗白细胞减少有很好的疗效。

  20. Causes of Infertility

    Science.gov (United States)

    Infertility Causes of male infertility Causes of female infertility Infertility is clinically defined as the inability to conceive naturally after one year of frequent, unprotected intercourse. Approximately 7. ...

  1. Severe Combined Immunodeficiency (SCID)

    Science.gov (United States)

    ... Content Marketing Share this: Main Content Area Severe Combined Immunodeficiency (SCID) SCID is a group of rare ... prompt treatment and high survival rates. SCID was added in 2010 to the U.S. Department of Health ...

  2. Several inequalities regarding sdepth

    OpenAIRE

    Cimpoeas, Mircea

    2011-01-01

    We give several bounds for $sdepth_S(I+J)$, $sdepth_S(I\\cap J)$, $sdepth_S(S/(I+J))$, $sdepth_S(S/(I\\cap J))$, $sdepth_S(I:J)$ and $sdepth_S(S/(I:J))$ where $I,J\\subset S=K[x_1,...,x_n]$ are monomial ideals. Also, we give several equivalent forms of Stanley Conjecture for $I$ and $S/I$, where $I\\subset S$ is a monomial ideal.

  3. Human errors - human caused, environment caused

    International Nuclear Information System (INIS)

    The importance of human error in the safe operation of Nuclear Plants has been well recognised. The human error could be due to a large number of reasons. Eg. coming from factors like sensing, perceiving, predicting, familiarity, skills, rules, individual performance and environmental factors such as ergonomics, work organisation, procedure, time and duration of work, training, physical environment etc. Two incidents highlighting human caused and environmental caused errors are described. Also a distribution of causes of failure and affected systems of Safety Related Unusual Occurrences is presented on the basis of the reports received by the regulatory body. A system to analyse human errors with respect to human caused and environment caused is being developed. The input data for this analysis is obtained from Safety Related Unusual Occurrence reports received by the regulatory body. The regulatory requirement for submission of these reports include first information report (by telex, telephone etc) within 24 hours of the incident and detailed report within 20 days. The detailed report amongst other information also contains information with respect to the cause of the incident. These reports are discussed at various levels and an attempt is made to identify the root cause. (author). 3 figs, 1 tab

  4. Asthma severity and exposure to occupational asthmogens

    OpenAIRE

    Le Moual, Nicole; Siroux, Valérie; Pin, Isabelle; Kauffmann, Francine; Kennedy, Susan,

    2005-01-01

    RATIONALE: Severe asthma is a public health problem with limited information regarding preventable causes. Although occupational exposures have been implicated as important risk factors for asthma and asthma exacerbations, associations between occupational exposures and asthma severity have not been reported. OBJECTIVE: To examine associations between occupational exposures and asthma severity. METHODS: The Epidemiological Study on the Genetics and Environment of Asthma combines a case-contro...

  5. Exchange Transfusion in Severe Falciparum Malaria

    OpenAIRE

    Dongare, Harshad Chandrakant; Khatib, Khalid Ismail

    2016-01-01

    Malaria is endemic in India with the incidence of P. falciparum Malaria increasing gradually over the last decade. Severe malaria is an acute disease, caused by P. falciparum, but increasingly also by P. vivax with major signs of organ dysfunction and/or high levels of parasitaemia (>10%) in blood smear. Use of exchange transfusion with antimalarial drug therapy as an additional modality of treatment in severe Falciparum malaria is controversial and is unclear. We report a case of severe mala...

  6. Mobilization in Severe Sepsis: An Integrative Review

    OpenAIRE

    Govindan, Sushant; Iwashyna, Theodore J.; Odden, Andrew; Flanders, Scott A; Chopra, Vineet

    2015-01-01

    Severe sepsis is a leading cause of long-term morbidity in the United States. Up to half of severe sepsis is treated in non-intensive care unit (ICU) settings, making it applicable to hospitalist practice. Evidence has demonstrated benefits from physical therapy (PT) in myriad conditions; whether PT may benefit severe sepsis patients either within or outside the ICU is unknown. Therefore, we conduct a review of the literature to understand whether early mobilization improves outcomes in patie...

  7. Severe Traumatic Brain Injury

    Science.gov (United States)

    ... inflicted traumatic brain injury (ITBI), is a leading cause of child maltreatment deaths in the United States. Meeting the ... Awareness Additional Prevention Resources Childhood Injuries Concussion in Children and Teens Injuries from Violence Injuries from Motor Vehicle Crashes Teen Driver Safety ...

  8. [Severe depression : psychoanalysis].

    Science.gov (United States)

    Bouvet de la Maisonneuve, O

    2009-12-01

    The indication for psychoanalysis in severe depression is not clear. And yet, demands for this type of intervention are increasing, despite the absence of any form of consensus on the subject. Freud considered depression as a failure of analytical efforts and, based on this observation, revised his theory, in particular to include the notions of narcissism and the death drive. Many analysts have been reluctant to follow his teachings on this last point and provide depressed patients with analytical-type therapies aimed at restoring narcissism. Melanie Klein pushed Freud's ideas about depression even further and brought such therapies back to the heart of analytical practice. Jacques Lacan took the debate to another level by proposing an overhaul of the principles on which analysis has been based. Today, while following certain precautionary rules, true psychoanalyses can be proposed to patients with severe depression, whether of the bipolar, recurring or even neurotic type that can reach this level of severity. PMID:20141799

  9. [Surgery for severe aspirations].

    Science.gov (United States)

    Von Wihl, S; Bouayed, S; Kohler, R; Dulguerov, P

    2012-10-01

    Severe dysphagia resulting in repeated aspirations and pneumonia are difficult to treat with swallowing therapy and surgical treatment is often required. Our study retrospectively reviews our experience with 19 such cases operated by laryngeal suspension and laryngotracheal separation. Restoration of oral nutrition was possible in 45% of laryngeal suspension cases and in 75% of laryngotracheal separation operations. These surgical techniques prevent severe aspirations while conserving phonation, contrarily to total laryngectomy. Tracheocutaneous fistulas were frequent, especially after radiation, implying that the surgical technique should be modified in the future. PMID:23133886

  10. 足月儿重度高胆红素血症不同治疗方法的预后及常见病因分析%Analysis of the Main Cause of Severe Hyperbilirubinemia in Full-Term Infants and Prognosis of Different Therapies

    Institute of Scientific and Technical Information of China (English)

    刘芳; 刘田田; 任常军; 李英梅; 郭志梅; 暴丽莎; 吕少广

    2015-01-01

    Objective To study the main cause of severe hyperbilibrubinemia in full-term infants and prognosis. Methods During June 2011 and June 2013, 113 full term infants with the serum total bilirubin level ≥342. 2 μmol/L in newborn service of tertiary hospitals were included, 44 cases (38. 94%) received exchange transfusion, 69 cases (61. 06%) received only phototherapy ( routine therapy group); the common causes, treatment and clinical outcomes were analyzed. Results There were no significant differences of gestational weeks, birth weight, birth approach and the TSB before admis-sion to hospital between the two groups with comparability (P>0. 05). In 113 cases, 51 cases (45. 13%) were iso-immune hemolytic diseases;There was 52. 94% (27/51) of the infants with iso-immune hemolytic diseases in exchange transfusion group, 43. 63% (24/51) in routine therapy group, and no breast-feeding jaundice and physiological jaundice in exchange transfusion group was found. There were no significant differences of infection-related jaundice and perinatal related jaundice between the two groups ( P >0. 05 ); The average age in exchange transfusion group and in routine therapy group showed difference with statistical significance (P0.05),具有可比性。病因以同族免疫性溶血占首位(51例,45.13%),其中换血组27例(52.94%),常规组24例(43.63%),差异有统计学意义(P0.05)。平均日龄换血组与常规组比较差异有统计学意义(P<0.05);对母乳喂养、健康足月无明显原因的重度黄疸儿予常规治疗并不增加胆红素脑病的发生率,而对溶血、感染等病因导致的重度高胆红素血症患儿积极的换血治疗则可防止或减少胆红素脑病的发生。结论接诊重度高胆红素血症患儿应尽早明确病因并积极对因治疗,对溶血、日龄<7d的患儿行换血治疗可减少胆红素脑病的发生,相反对母乳喂养及无明显病理因素的重度高胆红素血症患儿予常规治疗预后良好。

  11. Severidade da mela da soja causada por Rhizoctonia solani AG-1 IA em função de doses de potássio Severity of hte foliar blight of the soylean caused by Rhizoctonia solani AG-1 IA infunction of doses of potassium

    Directory of Open Access Journals (Sweden)

    Marco Antonio Basseto

    2007-03-01

    Full Text Available O fungo Rhizoctonia solani pertencente ao grupo de anastomose 1 IA (AG-1 IA é um dos patógenos mais importantes afetando a cultura da soja no Brasil. Este fungo causa queima da folha e/ou mela em soja, para a qual medidas de manejo cultural são consideradas alternativas importantes para controle antes do estabelecimento da doença. Há evidências de que a adubação potássica diminui substancialmente a severidade dos sintomas de várias doenças da soja como a queima foliar (Cercospora kikuchii, a seca da haste e da vagem (Phomopsis phaseoli var. sojae e o cancro da haste (Diaporthe phaseolorum f. sp. meridionalis. Apesar das evidências do efeito do potássio no controle de várias doenças da soja, não há informação na literatura sobre o efeito desse nutriente no controle da mela. A hipótese testada foi que a mela da soja pode ser controlada através de incrementos na adubação potássica. De maneira geral, concluiu-se que, sob condições de casa de vegetação, o incremento de K no solo não resultou no controle da mela da soja. É necessário, entretanto, confirmar esta observação conduzindo-se experimentos sob condições de campo, podendo-se incluir a avaliação do efeito da doença sob aspectos da produção.The fungus Rhizoctonia solani, belonging to anastomosis group 1IA (AG-1 IA is one of the most important pathogens affecting soybean in Brazil. This fungus causes aerial or foliar blight of soybean, and cultural measures are thought as important choices for the control before the establishment of the disease. Based on evidences that potassium amendments can substantially reduce the severity of several soybean diseases such as Cercospora leaf blight (Cercospora kikuchii, pod and stem blight (Phomopsis phaseoli var. sojae and stem canker (Diaporthe phaseolorum f. sp. meridionalis. Despite all evidence, there is no information in the literature about the effect of potassium controlling the soybean foliar blight. The

  12. Severe Strep Infections

    Science.gov (United States)

    ... studies on ClinicalTrials.gov . Related Links Group A Streptococcal Infections National Library of Medicine, MedlinePlus ​​ Javascript Error Your ... the greatest risk of getting a severe strep infection are Children with chickenpox People with suppressed immune systems Burn ...

  13. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Natasha Gupta

    2014-01-01

    Full Text Available Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.

  14. SEVERE ACCIDENT MANAGEMENT TRAINING

    International Nuclear Information System (INIS)

    The purpose of this paper is (a) to define the International Atomic Energy Agency's role in the area of severe accident management training, (b) to briefly describe the status of representative severe accident analysis tools designed to support development and validation of accident management guidelines, and more recently, simulate the accident with sufficient accuracy to support the training of technical support and reactor operator staff, and (c) provide an overview of representative design-specific accident management guidelines and training. Since accident management and the development of accident management validation and training software is a rapidly evolving area, this paper is also intended to evolve as accident management guidelines and training programs are developed to meet different reactor design requirements and individual national requirements

  15. Severe iatrogenic nostril stenosis

    Directory of Open Access Journals (Sweden)

    Ali Ebrahimi

    2015-01-01

    Full Text Available Nostril stenosis (narrowing of the nasal inlet is an uncommon deformity which results in aesthetic and breathing discomfort in patients. The literature review shows that trauma, infection, iatrogenic insults and congenital lesions are major causes of stenosis. Nowadays, rhinoplasty is one of most popular aesthetic surgeries which may have complications such as bleeding, swelling, bruising, asymmetry, obstruction of nasal airways. We present a 30-year-old female patient, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity. Past medical history showed that the patient had undergone three unsuccessful rhinoplasty surgeries with aesthetic goals.

  16. Severe Measles Infection

    OpenAIRE

    Rafat, Cédric; Klouche, Kada; Ricard, Jean-Damien; Messika, Jonathan; Roch, Antoine; Machado, Sonia; Sonneville, Romain; Guisset, Olivier; Pujol, Wilfried; Guérin, Claude; Teboul, Jean-Louis; Mrozek, Natacha; Darmon, Michaël; Chemouni, Frank; Schmidt, Matthieu

    2013-01-01

    Abstract France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases ...

  17. Artemether for severe malaria

    OpenAIRE

    Esu, Ekpereonne; Effa, Emmanuel E; Opie, Oko N; Uwaoma, Amirahobu; Meremikwu, Martin M

    2014-01-01

    Background In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation, many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This review evaluates intramuscular artemether compared with both quinine and artesunate. Objectives To assess the efficacy and safety of intramuscular artemether versus any other parentera...

  18. One reason, several logics

    OpenAIRE

    Evandro Agazzi

    2011-01-01

    Humans have used arguments for defending or refuting statements long before the creation of logic as a specialized discipline. This can be interpreted as the fact that an intuitive notion of "logical consequence" or a psychic disposition to articulate reasoning according to this pattern is present in common sense, and logic simply aims at describing and codifying the features of this spontaneous capacity of human reason. It is well known, however, that several arguments easily accepted by com...

  19. Treatment of severe malaria.

    OpenAIRE

    Warrell, D. A.

    1989-01-01

    In the treatment of severe Plasmodium falciparum infection antimalarial drugs should, ideally, be given by controlled rate intravenous infusion until the patient is able to swallow tablets. In cases where infection has been acquired in a chloroquine resistant area, and where it has broken through chloroquine prophylaxis or where the geographical origin or species are uncertain, quinine is the treatment of choice. When access to parenteral quinine is likely to be delayed, parenteral quinidine ...

  20. Several real variables

    CERN Document Server

    Kantorovitz, Shmuel

    2016-01-01

    This undergraduate textbook is based on lectures given by the author on the differential and integral calculus of functions of several real variables. The book has a modern approach and includes topics such as: •The p-norms on vector space and their equivalence •The Weierstrass and Stone-Weierstrass approximation theorems •The differential as a linear functional; Jacobians, Hessians, and Taylor's theorem in several variables •The Implicit Function Theorem for a system of equations, proved via Banach’s Fixed Point Theorem •Applications to Ordinary Differential Equations •Line integrals and an introduction to surface integrals This book features numerous examples, detailed proofs, as well as exercises at the end of sections. Many of the exercises have detailed solutions, making the book suitable for self-study. Several Real Variables will be useful for undergraduate students in mathematics who have completed first courses in linear algebra and analysis of one real variable.