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1
Golubovic, Jagos, Petar Vulekovic, Djula Djilvesi, Mladen Karan, Bojan Jelaca, and Tomislav Cigic. "Semiology of pathological conditions in patients indicated for stereotactic biopsy." Medical review 69, no. 11-12 (2016): 345–50. http://dx.doi.org/10.2298/mpns1612345g.
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Introduction. Brain tumors produce symptoms and signs which are often non-specific, and therefore they may occur for more than a few months prior to diagnosis. The aim of this study was to determine the frequency of referent signs and symptoms among patients referred for stereotactic brain biopsy. Material and Methods. In this study, we retrospectively analyzed medical history of 65 patients (67.7% males and 32.3% females) between the ages of 16 and 81 years. The following symptoms and signs were included in the analysis: organic brain syndrome, lateralization of crossed pyramidal tract, cranial nerve dysfunction, speech disorders, cerebellar-vestibular syndrome, nausea, vomiting, headache, the occurrence of at least one epileptic seizure and respondents? physical weakness. Results. Physical weakness was the most frequent symptom to be recognized (76.9%), whereas pyramidal neurological lateralization was the most commonly recognized sign (58.5%). There was a significant correlation between the course of disease and physical weakness (rho = -0.34, p = 0.005), as well as the course of disease and lateralization of the pyramidal tract (rho = 0.65, p = 0.00). No significant correlation was found between other clinical signs and symptoms. Conclusion. An accurate diagnosis and early recognition of signs and symptoms may be useful in determining indications for stereotactic brain biopsy.
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Sherrard, Jackie, Janet Wilson, Gilbert Donders, Werner Mendling, and Jørgen S. Jensen. "2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge." International Journal of STD & AIDS 29, no. 13 (July 27, 2018): 1258–72. http://dx.doi.org/10.1177/0956462418785451.
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Four common pathological conditions are associated with vaginal discharge: bacterial vaginosis, aerobic vaginitis, candidosis, and the sexually transmitted infection, trichomoniasis. Chlamydial or gonococcal cervical infection may result in vaginal discharge. Vaginal discharge may be caused by a range of other physiological and pathological conditions including atrophic vaginitis, desquamative inflammatory vaginitis, cervicitis, and mucoid ectopy. Psychosexual problems may present with recurrent episodes of vaginal discharge and vulval burning. These need to be considered if tests for specific infections are negative. Many of the symptoms and signs are non-specific and a number of women may have other conditions such as vulval dermatoses or allergic and irritant reactions.
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Ribeiro, Raul Rio, Sydnei Magno da Silva, Gustavo de Oliveira Fulgêncio, Marilene Suzan Marques Michalick, and Frédéric Jean Georges Frézard. "Relationship between clinical and pathological signs and severity of canine leishmaniasis." Revista Brasileira de Parasitologia Veterinária 22, no. 3 (September 2013): 373–78. http://dx.doi.org/10.1590/s1984-29612013000300009.
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Canine visceral leishmaniasis (CVL) is a zoonotic disease that presents variable clinical and laboratory aspects. The aims of this study were to identify the main biochemical/hematological status of dogs naturally infected with Leishmania (Leishmania) infantum and to associate theses parameters with clinical forms of CVL. Blood samples were analyzed from 51 dogs, 15 uninfected (control group) and 36 infected, which were classified clinically in three groups: asymptomatic (n=12), oligosymptomatic (n=12) and symptomatic (n=12). All the infected dogs showed lower albumin/globulin ratios (A-G ratio) than the limit of reference. The mean values of total protein, urea, α-globulin 2, globulin and A-G ratio of infected dogs were outside the reference interval and differed significantly from those of the controls. Anemia was detected only in groups that showed clinical signs of the disease, and a statistical analysis indicated a significantly higher frequency of lower eritrogram in these groups than in the asymptomatic group. In addition, a significant association was observed between anemia and the presence of the symptoms, with dogs displaying higher erythrogram values showing better clinical conditions. These results provide additional evidence that the clinical forms of CVL may reflect on the erythrogram status.
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Dedov, Ivan Ivanovich, Galina Afanas'evna Mel'nichenko, Roman Viktorovich Rozhivanov, and Dmitriy Gennadievich Kurbatov. "The recommendations on diagnostics and treatment of male hypogonadism (deficit of testosterone). The project." Problems of Endocrinology 61, no. 5 (November 12, 2015): 60–71. http://dx.doi.org/10.14341/probl201561560-71.
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Male hypogonadism is a condition in which the body doesn’t produce enough testosterone which results in its low serum level in combination with characteristic clinical symptoms and/or signs (see the description below) that can be observed in the patients presenting with pathological changes in testicles and/or hypophysis, such as Kleinfelter’s syndrome, and in men with idiopathic metabolic or iatrogenic disorders leading to androgen deficiency. The present recommendations does not cover the entire set of pathological conditions responsible for the development of hypogonadism (deficit of testosterone); rather, they are focused on its clinical variants that account for the majority of the cases of male hypogonadism.
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Sukmana, Mayusef, and Falasifah Ani Yuniarti. "The Pathogenesis Characteristics and Symptom of Covid-19 in the Context of Establishing a Nursing Diagnosis." Jurnal Kesehatan Pasak Bumi Kalimantan 3, no. 1 (June 26, 2020): 21. http://dx.doi.org/10.30872/j.kes.pasmi.kal.v3i1.3748.
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Covid-19 is a disease that causes a global health emergency, caused by SAR-CoV2 and transmitted through droplets. Viruses attached to host cells are strongly bound to ACE2 causing excessive inflammatory reactions (Cytokine Storm). The incubation period 1-14 days, causing signs and symptoms of the respiratory syndrome, fever, leukopenia, thrombocytopenia, and in severe conditions multi-organ failure that ends in death. In May 2020 the world mortality rate increased by 15.45%, which previously was March 2020 at 3.4%. The concept of pathogenesis is needed as an effort to provide understanding in handling Covid-19 so that mortality can be controlled. Tracing and understanding the characteristics of Covid-19 pathogenesis that gives rise to various pathological responses of the body becomes an interesting analytical study to establish an appropriate diagnosis, including nursing diagnoses in order to develop a comprehensive nursing plan. This study aims to review the characteristics of covid-19 pathogenesis in the context of establishing a nursing diagnosis according to the Indonesian Nursing Diagnosis Standards. A literature study is done by analyzing the characteristics of COVID-19 signs and symptoms and comparing the major and minor data groupings that exist in the Indonesian Nursing Diagnosis Standard. Characteristic pathogenesis results from mild, moderate and severe symptoms. Grouping results refer to nursing diagnoses including ineffective airway clearance, ventilator weaning disorders, gas exchange disorders, ineffective breathing patterns, the risk of spontaneous circulatory disorders, hyperthermia and anxiety. Keywords: Nursing diagnosis Covid-19, signs anda symptome covid-19, pathogenesis Covid-19, SAR-CoV2
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Lee, O. Danny, and Ken Tillman. "An Overview of Testosterone Therapy." American Journal of Men's Health 10, no. 1 (November 14, 2014): 68–72. http://dx.doi.org/10.1177/1557988314556671.
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Millions of men, as a result of the natural aging process, injury, illness, and medical therapies, experience a decline in testosterone levels that necessitate a need for testosterone supplementation therapy (TST). The signs and symptoms of testosterone decline may occur gradually, and low testosterone levels may be misdiagnosed as other medical conditions. Over the past two decades, there has been an increase in testing of testosterone levels and the use of TST. With so many men now on TST, it is essential for health care professionals to know the signs and symptoms, the causes of testosterone decline, how testosterone deficiency is diagnosed, what pathological changes are associated with testosterone decline, and the benefits and risks of TST. In addition, health care providers need to be aware of the various forms of testosterone available as well as the advantages and disadvantages of each. This article provides a brief overview of testosterone deficiency, TST treatment options and guidelines, and the risks and benefits associated with of TST.
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Botelho, Ricardo Vieira, Matheus Fernandes de Oliveira, and José Marcus Rotta. "Amyloidosis presenting as multiple vertebral fractures." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 33, no. 03 (September 2014): 240–43. http://dx.doi.org/10.1055/s-0038-1626220.
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AbstractAmyloidosis is a plasma cell disorder characterized by the overproduction and tissue deposition of a monoclonal IG light chain or fragments. Musculoskeletal and soft tissue manifestations are arthropathy, myopathy, bone lesions, and lymphadenopathy. It can also present with symptoms and signs that mimic a variety of rheumatic conditions, such as scleroderma, rheumatoid arthritis, Sjögren's syndrome polymyalgia rheumatica, a myeloma or a bone tumour. We describe the case of a 64-year-old white woman with an acute history of fall from own height in whose investigation revealed fractures in T8, T9, T11 and L1. In order to determine the nature of lesion, the patient was submitted to percutaneous biopsy guided by fluoroscopy of T11, without any surgical complications. Pathological findings were compatible with deposition of amyloid protein and amyloidosis. Amyloidosis must be considered in differential diagnosis of pathological fractures together with other osteopenic and lytic conditions, such as bone metastasis, metabolic and infectious diseases.
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Lobanov, Mikhail N., Oleg Y. Bronov, Yuliya A. Abovich, Nataliya V. Ledikhova, Elena V. Turavilova, Sergey P. Morozov, and Natalya N. Kamynina. "Differential Diagnosis of Lungs Lesions in a New Coronavirus Infection COVID-19 and Diseases of Non-Viral Etiology on the Clinical Cases by Computed Tomography Scans in Outpatient CT Centers." Annals of the Russian academy of medical sciences 75, no. 5S (December 4, 2020): 395–405. http://dx.doi.org/10.15690/vramn1429.
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New coronavirus infection (COVID-19) viral pneumonia diagnosed by a complex assessment of the epidemiological history, clinical symptoms, radiological and laboratory tests. Radiologists often play a leading role in diagnosis of viral pneumonia, since they may encounter suspicious changes according to radiological studies before clinicians. However, in a number of diseases, including diseases of non-infectious non-viral etiology with a corresponding similar clinical symptoms, it may be difficult to correctly assess the changes detected by computed tomography. This study uses clinical cases to show the main differential diagnostic criteria for COVID-19 viral pneumonia and non-infectious lesions such as pulmonary edema, pulmonary embolism, acute hypersensitive pneumonitis, drug-induced pneumonitis, non-specific interstitial pneumonia, and adenocarcinoma. All patients were hospitalized based on the results of computed tomography, where a diagnosis of non-infectious non-viral lung injuries was established based on morphological and/or typical clinical symptoms, laboratory or radiological data. We examined clinical cases with radiological signs similar to viral pneumonia, such as areas of ground glass opacities with the presence or absence of areas of consolidation, as well as thickening of the lung interstitium with decreased lung attenuation (crazy paving symptom). In a difficult epidemiological situation, it is important for a radiologist to suspect the above-mentioned pathological conditions in patients who are urgently admitted to outpatient CT centers.
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Hilton-Jones, David. "Myopathies." Reviews in Clinical Gerontology 11, no. 2 (May 2001): 131–47. http://dx.doi.org/10.1017/s0959259801011248.
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Myopathy is a convenient shorthand term meaning muscle disease or dysfunction. In other words, the myopathies are those conditions in which the patient’s symptoms and signs can be attributed to a pathological process affecting either the structure of muscle fibres or their associated interstitial tissues, or to disturbance of the biochemical or electrophysiological function of those fibres. Myopathies are rare in all age ranges. They may be inherited or acquired. Onset of inherited myopathies in the elderly, not surprisingly, is uncommon, but some of these diseases are asymptomatic or cause such minor symptoms that their significance is not appreciated by the patient, and thus they may not be recognized until late on in life. Their recognition may have implications for other, younger, family members. Many of the acquired myopathies afflicting the elderly are treatable, but the commonest, inclusion body myositis, is not, and incorrect diagnosis and inappropriate use of steroids may compound morbidity.
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Grosso, Salvatore, Rosa Mostardini, Carlo Venturi, Sandra Bracco, Alfredo Casasco, Rosario Berardi, and Paolo Balestri. "Recurrent Torticollis Caused by Dissecting Vertebral Artery Aneurysm in a Pediatric Patient: Results of Endovascular Treatment by Use of Coil Embolization: Case Report." Neurosurgery 50, no. 1 (January 1, 2002): 204–8. http://dx.doi.org/10.1097/00006123-200201000-00031.
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ABSTRACT OBJECTIVE AND IMPORTANCE Torticollis is a symptom that can be related to different pathological mechanisms ranging from simple to life-threatening conditions. We report a child with recurrent torticollis caused by an intracranial dissecting vertebral artery aneurysm. This is a very rare condition in childhood, and it was resolved successfully with endovascular treatment. CLINICAL PRESENTATION The patient was a 10-year-old boy with a 4-year history of left recurrent torticollis, followed by hemiparesis, dysarthria, dysmetria, and tremor. Brain magnetic resonance imaging and digital angiography detected a dissecting aneurysm involving the fourth segment of the left vertebral artery. INTERVENTION The patient underwent endovascular treatment. Coil embolization, followed by histoacryl injection into the lesion, provided complete obliteration of the aneurysmal sac. CONCLUSION The patient's postoperative course was characterized by a dramatic disappearance of symptoms and signs within a few hours of the intervention. No relapses of symptoms occurred during a follow-up period of 18 months. This is the first report of a child in whom recurrent torticollis was related to a dissecting vertebral artery aneurysm. Although long-term results of vertebral artery coil embolization remain to be elucidated, the method seems reliable and effective in treatment of these vascular lesions in pediatric patients.
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Jovanovic, Ivana, Milorad Tesic, Nebojsa Antonijevic, Nemanja Menkovic, Ivana Paunovic, Arsen Ristic, Vera Vucicevic, and Bosiljka Vujisic-Tesic. "Acute renal failure and hepatocellular damage as presenting symptoms of type II aortic dissection." Srpski arhiv za celokupno lekarstvo 144, no. 5-6 (2016): 320–24. http://dx.doi.org/10.2298/sarh1606320j.
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Introduction. Pericardial effusion can be a consequence of a number of pathological conditions, and as such it can cause impaired left ventricular filling followed by decreased cardiac output and blood pressure. This kind of hemodynamic compromise and its consequences are extremely uncommon unless pericardial effusion causes tamponade. Case Outline. We describe a very rare case of a 30-year old male patient, with an acute aortic dissection type II causing pericardial effusion without clinical nor echocardiographic signs of tamponade, while presenting with an acute renal and hepatic failure. After initial diagnostic uncertainties, and following final diagnosis of an acute aortic dissection, this patient underwent surgical aortic valve replacement with a satisfactory outcome. Conclusion. It is important to underscore the significance of clinical situation of simultaneously existing acute renal and hepatic failures in the setting of a ?non-tamponade? pericardial effusion, following a type II aortic dissection. Although most commonly aortic dissection presents itself with typical clinical symptoms or patient history data, it is not that unusual for it to be hidden in an entirely atypical clinical milieu as the one described in this case.
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Muneer, A., and N. S. Jones. "Unilateral abducens nerve palsy: a presenting sign of sphenoid sinus mucocoeles." Journal of Laryngology & Otology 111, no. 7 (July 1997): 644–46. http://dx.doi.org/10.1017/s0022215100138204.
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AbstractSphenoid sinus mucocoeles can stimulate a variety of pathological conditions and patients can present to a range of specialists. Because of the relative rarity of sphenoid sinus mucocoeles, diagnosis is often delayed and these lesions can progressively expand and cause direct mechanical compression on adjacent structures. We present three cases which presented with an abducens nerve palsy. Early surgical intervention is advocated and these patient's symptoms resolved following surgery. Although several conditions can present with an abducens nerve palsy, it is important to consider a sphenoid sinus mucocoele in the differential diagnosis.
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Nikitina, V., T. Vetlugina, and I. Stoyanova. "Psychoneuroimmunomodulation at various levels of mental adaptation." European Psychiatry 26, S2 (March 2011): 1076. http://dx.doi.org/10.1016/s0924-9338(11)72781-x.
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We have examined 232 healthy persons (mean age 21,7 ± 1,6 years) in a problematic situation - the first temporal period of adaptation (2–3 months) to new conditions of life. We have distinguished three groups of probands characterizing by various level of mental adaptation:group 1 (n = 129) - healthy, characterized by absence of symptoms testifying to presence of pathological disadaptive manifestations;group 2 (n = 64) - persons with signs of psychoadaptive syndrome ((PAS) that is a relatively stable formation, during tension of adaptive mechanisms without signs of their exhaustion;group 3 (n = 39) - persons with signs of psychodisadaptive syndrome (PDAS) characterized by decrease of adaptive abilities, presence of signs of exhaustion and absence of resources for resilience.Diagnosis of clinical manifestations of the secondary immune deficiency has shown increase of incidence rate of allergic and autoimmune syndromes in persons with signs of mental health disturbance as compared with healthy persons. Immune status of persons without disadaptive manifestations and with PAS were compatible; in group with PDAS we have identified reliable decrease of HLADR+-lymphocytes (p < 0,01), trend toward decrease of natural killers (CD16+) and factors of humoral immunity.Study of personal traits has identified significant predominance of personal anxiety as a stable trait formed based on biopsychosocial factors, in group of PDAS as compared with PAS (p < 0,05) and by persons without signs of mental health disturbance (p < 0,01).In result of conducted investigation we have obtained data about contribution of neuroimmune interaction and personal response into mechanisms of mental adaptation-disadaptation in continuum: “norm-pre-morbid-illness”.
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Andres, Lewis A., and Mithilesh J. Mishra. "Angiomyxoma diagnosed in a man presenting for abdominal lipectomy." Canadian Journal of Plastic Surgery 15, no. 3 (September 2007): 163–64. http://dx.doi.org/10.1177/229255030701500301.
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Aggressive angiomyxoma is a rare tumour that is locally infiltrative but nonmetastasizing. It occurs nearly exclusively in adult women of childbearing age and almost always arises in the perineum and pelvic area. A case of angiomyxoma occurring in a middle-aged, morbidly obese man is reported. The clinical presentation was one of progressing scrotal edema and enlargement with subsequent development of scrotal abscesses, requiring several incisions and drainages as well as oral and intravenous antibiotics. His symptoms and body habitus left him in a significantly debilitated state, prompting him to seek treatment for his conditions. He initially presented for abdominal lipectomy. However, due to the chronic scrotal infections and enlargement, scrotectomy was recommended before any other surgical procedures. A scrotectomy was performed by the urology service. Pathological diagnosis of the excised tumour was an aggressive angiomyxoma. Given the rarity of this tumour, especially in males, the proper diagnosis and treatment of angiomyxoma is still being investigated. With this in mind, the physical signs and symptoms that characterize this condition are presented and treatment options are reviewed.
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Cheung, Johnson, Ayham Al Afif, Martin Joseph Bullock, Chad Robertson, Robert Hart, and Reginald Goodday. "An Unusual Case of Mandibular Squamous Cell Carcinoma in Intimacy with an Impacted Wisdom Tooth." Case Reports in Surgery 2019 (April 11, 2019): 1–6. http://dx.doi.org/10.1155/2019/8360357.
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Squamous cell carcinoma is the most common head and neck malignancy. It can occur in the mandible or maxilla without a preexisting oral mucosal lesion. Often, the clinical and radiographic presentation of SCC directs the clinician to favour malignancy over other pathological conditions. However, SCC may also mimic an infectious condition and therefore can pose a diagnostic challenge even for the most experienced clinicians. Herein, we report a case of mandibular squamous cell carcinoma in a 53-year-old male who presented with symptoms of right facial swelling, trismus, pain, and right-sided lip paresthesia. The patient underwent a surgical removal of the presumed infected third molar of the right mandible, but histopathological analysis of the associated soft tissue unexpectedly yielded squamous cell carcinoma. Given the biopsy-proven diagnosis, the patient received a mandibular resection of the tumor followed by primary reconstruction with a fibular free flap. Patients presenting with symptoms mimicking odontogenic infections should receive vigilant attention by clinicians with regard to the disease history, clinical signs, radiographic evidence, and decision for histopathological analysis. This is especially true in the context of impacted dentition, where malignancy must be considered when formulating a differential diagnosis.
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Agarkov, Alexander, Anatoly Dmitriev, N. Agarkov, A. Shulunova, and A. Sidelnikov. "Morphofunctional changes assessment in newborn piglets in early postnatal ontogenesis complicated by isoimmunization symptoms." E3S Web of Conferences 210 (2020): 06025. http://dx.doi.org/10.1051/e3sconf/202021006025.
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It is known that the pathological course of pregnancy is associated with a violation in the mutually dependent complex “mother-fetus” and leads to specific clinical consequences at the molecular-cellular, tissue, organ, organismic and population levels of the organization. Pathogenic action mechanism of the isoimmunization effect is very complex and still remains insufficiently deciphered. However, changes in the system of organs responsible for adaptation and survival play an important role in the pathogenesis of morphofunctional disorders associated with isoimmunization. Therefore, in farms where the fact of isoimmunization state is established, it is necessary to pay special attention to the creation of conditions that contribute to the normalization of the functional systems of adaptation of newborn animals. The material for research was the lungs, intestines, kidneys, and thymus. Only fresh material was examined. Samples up to 0.5 cm thick were taken for histological examination after forced slaughter. Fixation was performed with a neutral aqueous 10% formalin solution. Histological sections 4-6 microns thick were made from the obtained paraffin blocks, which were stained with hematoxylin and eosin for review purposes. When describing the morphofunctional state of organs, the structure, cellular composition, and condition of blood vessels were observed. Isoimmunization of sows during pregnancy is manifested by a characteristic clinical and morphological complex that differs from other infectious and non-infectious diseases. The most characteristic pathomorphological signs are: hypoplasia, delayed differentiation, dystrophic changes in the respiratory, digestive, urinary systems and organs of immunogenesis.
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Deryugina, Ludmila A., and T. V. Otpuschennikova. "Clinical assessment of urination in young children." Russian Journal of Pediatric Surgery 24, no. 3 (July 30, 2020): 167–73. http://dx.doi.org/10.18821/1560-9510-2020-24-3-167-173.
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The aim of the study was to study the formation of urination in young children, taking into account perinatal factors. Material and methods. the pattern of urination was studied in 42 patients at the stages of antenatal observation, after birth during the first year of life and at the age of three. Clinical evaluation of urination was performed in young children using a developed qualimetric table that takes into account the volume of the bladder and frequency of urination, the nature of urination, the presence of urge to urinate and behavioral reactions. At the age of three, a qualimetric table was used to evaluate E. L. Vishnevsky’s urination (2001). The observation group consisted of 42 patients whose urination pattern was studied at the stages of antenatal observation, during the first year of life and at the age of three. The features of the course of the antenatal and postnatal period of children’s development were taken into account: pregnancy complications, fetal pathological conditions, features of the morpho-functional state of infants, and neurological comorbidities. Results. According to the results of clinical evaluation of urination in children at 3 years of age, 3 groups of children were identified: with “Mature”,”delayed formation of “Mature” type of urination”, as well as “dysfunctional type of urination”. Conclusions. the manifestations of “maturity of urination” in infants at the age of 1 year are the compliance of hydrodynamic indicators with age standards, the formation of continuous urination, signs of controlling behavior: behavioral reaction to the urge, the absence of” missing urine “during the day, during daytime and nighttime sleep, “urination on request”. The “delay in the formation of mature urination type”, the formation of “dysfunctional urination type “ revealed the determining influence of the pathological course of the antenatal period of child development, the implementation of signs of pathological fetal urination, the presence of neurological symptoms and signs of morpho-functional immaturity of the postnatal period. “Dysfunctional urination” was manifested by: a decrease in the capacity of the bladder and the discrepancy between the hydrodynamic characteristics of the age parameters; monotony of the volume characteristics of the bladder during the day; imperative contractions of the bladder, that is, the presence of “wet gaps” between urination; urination during sleep; as well as a delay or lack of urge to urinate, behavioral responses and neatness skills.
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Sbarigia, Enrico, Cesare Battocchio, Maria A. Panico, Davide Zaccagnini, Filippo M. Salvatori, and Corrado Argentino. "Endovascular Management of Acute Carotid Artery Dissection with a Waxing and Waning Neurological Deficit." Journal of Endovascular Therapy 10, no. 1 (February 2003): 45–48. http://dx.doi.org/10.1177/152660280301000110.
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Purpose: To evaluate the feasibility and efficacy of emergent carotid stenting for an acute internal carotid artery (ICA) dissection. Case Report: A 51-year-old man was admitted to our emergency department's stroke unit 1 hour after the onset of left hemiparesis. Computed tomographic and transcranial Doppler scans showed no pathological findings, but the color Doppler study detected a double lumen in the right carotid bifurcation extending to the proximal ICA. Within the first 2 hours after admission, the patient's neurological status began to fluctuate; the NIH Stroke Scale (NIHSS) and Rankin scores evaluated each hour after admission ranged from 0 to 12 and from 0 to 3, respectively. Emergency carotid angiography confirmed the dissection of the bulb and proximal right ICA, which prompted implantation of 2 Wallstents from the internal to common carotid artery. Forty-eight hours later, the patient was almost totally asymptomatic with an NIHSS score of 1 and a Rankin score of 0; he was discharged on postoperative day 3. At 3 months, the patient was free of neurological symptoms and the stented carotid artery was patent. Conclusions: In patients with fluctuating neurological signs and symptoms consistent with carotid artery dissection that are refractory to medical therapy, a stent can be placed to prevent permanent neurological deficits provided that the anatomical conditions are suitable.
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Gromov, I. N. "Noinfectious diseases in industrial poultry farming: histological diagnostics." Agrarian science 344, no. 1 (March 13, 2021): 15–17. http://dx.doi.org/10.32634/0869-8155-2021-344-1-15-17.
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Under conditions of egg and poultry farming noninfectious diseases are widespread and cause significant economic damage. These diseases can be caused by a variety of etiological factors: the deficiency of the necessary chemical elements, substances or their combination, excessive amount of certain classes of organic substances in feed. Diseases of complex etiology are also recorded, which arise from a combination of unfavorable factors and anatomical and physiological properties of individual bird crosses. Under the influence of unfavorable factors in various organ systems, pathological processes of various nature (dystrophic, necrotic, inflammatory) arise. In this case, the symptoms and pathological changes can be either similar or poorly visible macroscopically. In this regard, the results of histological examination of organs and tissues play an important role in making a presumptive diagnosis. The article introduces the original results of researches on pathomorphological diagnosis of the most widespread diseases in industrial poultry farming of noninfectious etiology: chronic feed borne toxicoses (including mycotoxicoses), hypovitaminosis A, hyposelenosis, amyloidosis, necrosis of the femoral head. The results of examination of spontaneous material stuff. The findings are formulated in the form of histological diagnoses. The attention is focused on the main (pathognomonical) signs of a great value for differential diagnostics of this group of diseases. Various variants of pathomorphological course of the diseases running both in a classical way, and in the form of a pathomorphosis (the variated pathoanatomical and histological lesions against application of vaccines and antibiotics) are considered.
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Karakostas, P., R. Dolscheid-Pommerich, M. Hass, P. Brossart, and V. Schäfer. "POS1126 PREVALENCE OF HYPOPHOSPHATASIA IN ADULT RHEUMATOLOGY PATIENTS SCREENED BY LOW LEVELS OF ALKALINE PHOSPHATASE." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 842. http://dx.doi.org/10.1136/annrheumdis-2021-eular.1082.
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Background:Hypophosphatasia (HPP) is a genetic disease caused by one or more mutations in the alkaline phosphatase (ALP) gene, which encodes tissue-specific ALP and affects the mineralization process. Accordingly, arthralgia, fractures, and dental abnormalities have been reported in adults, and fatal courses in children. This metabolic disorder is commonly misdiagnosed with other more prevalent bone diseases due to its low prevalence and lack of recognition (i.e. chrondrocalcinosis). However, no epidemiological studies on the prevalence of HPP in the rheumatological patient population have been available to date.Objectives:To identify the prevalence of HPP in rheumatological patients screened for persistent low levels of ALP and association with mutations in the ALP gene.Methods:All adult rheumatology patients were screened for pathological low levels of ALP (< 35 IU/L) between January 1, 2017 and June 30, 2019 at the Department of Rheumatology, Clinic of Internal Medicine III, University Hospital Bonn, Germany. Medical files of patients with pathological low ALP levels were then reviewed for clinical signs and symptoms as well as results of genetic testing for HPP (full sequencing using Next Generation Sequencing).Results:In total, 2,289 rheumatology patients were screened for low ALP levels. In 60 patients (2.62 %), pathological low ALP levels were identified, while in 30 of these (1.31 %), persistent low ALP levels were detected. In 19 of the 30 patients, genetic tests for ALPL gene mutations were done. Seven out of 19 patients (36.84 %) had HPP-related symptoms (fracture, dental abnormalities) with normal bone densitometry, while four of these patients (21.05 %) had a history of fracture and three patients (15.78 %) showed dental abnormalities. In addition to the typical HPP signs and symptoms, 13 patients (68.42%) showed mutations in the ALPL gene. One of the ALP mutations was found to be a novel genetic variant, classified as pathological. Interestingly, no association with chondrocalcinosis was detected.Conclusion:In summary, it can be concluded that HPP is an under-diagnosed condition with a higher proportion of affected rheumatologic patients than previously thought (at least 0.56 percent of rheumatologic patients vs. 0,01 percent in a spanish healthy population). If we replicate these numbers for the german population (83 million, 5 percent of whom suffer from rheumatic conditions) the yield is approximately 4.15 million. This possibly indicates that 23,240 potential cases of HPP are currently not diagnosed. Therefore, implementation of a protocol in clinical practice to prevent underdiagnosis of HPP and to treat this disease appropriately is essential.References:[1]García-Fontana C, Villa-Suárez JM, Andújar-Vera F et al (2019) Epidemiological, Clinical and Genetic Study of Hypophosphatasia in A Spanish Population: Identification of Two Novel Mutations in The Alpl Gene. Sci Rep. https://doi.org/10.1038/s41598-019-46004-2[2]Mornet E, Yvard A, Taillandier A et al (2011) A molecular-based estimation of the prevalence of hypophosphatasia in the European population. Ann Hum Genet 75:439–445. https://doi.org/10.1111/j.1469-1809.2011.00642.xFigure 1.Flow chart of identification of potential hypophosphatasia (HPP) patients from an adult rheumatology population. Threshold alkaline phosphatase < 35 IU/L at 37`C. ALP: alkaline phosphataseDisclosure of Interests:Pantelis Karakostas: None declared, Ramona Dolscheid-Pommerich: None declared, Moritz Hass: None declared, Peter Brossart: None declared, Valentin Schäfer Speakers bureau: AbbVie, Novartis, BMS, Chugai, Celgene, Medac, Sanofi, Lilly, Hexal, Pfizer, Janssen, Roche, Schire, Onkowissen, Royal College London, Consultant of: Novartis, Chugai, AbbVie, Celgene, Sanofi, Lilly, Hexal, Pfizer, Amgen, BMS, Roche, Gilead, Medac, Grant/research support from: Novartis, Hexal, Lilly, Roche, Celgene, Universität Bonn.
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Beniuk, S. V., and T. V. Kovaliuk. "Cholestatic hepatosis of pregnant women: issues of etiopathogenesis, diagnosis, management." HEALTH OF WOMAN, no. 7(153) (September 29, 2020): 8–13. http://dx.doi.org/10.15574/hw.2020.153.8.
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Cholestatic hepatosis of pregnant women complicates approximately 0.2% to 2% of pregnancies and may increase the risk of pregnancy and fetal pathology. The article provides information on diagnosis, treatment methods and possible risks to pregnant women and the fetus associated with cholestatic hepatosis of pregnancy. The diagnosis of cholestatic hepatosis of pregnant women is usually based on clinical (itching) and laboratory (elevated bile acid levels) signs. Other markers that reflect liver function, such as alanine aminotransferase and aspartate aminotransferase, are also often elevated, and this requires a differential diagnosis with other pathological conditions leading to liver dysfunction. Cholestatic hepatosis of pregnant women causes an increased risk of premature birth, fetal distress, respiratory distress syndrome of the newborn and stillbirth. There is evidence that with increasing levels of bile acids increases the risk of adverse effects for newborns. Ursodeoxycholic acid therapy reduces maternal symptoms, but this therapy has not been shown to reduce risks to the fetus. Women diagnosed with cholestatic hepatosis in pregnant women have a high risk of recurrence during subsequent pregnancies and hepatobiliary disease later in life. Keywords: cholestatic hepatosis of pregnant women, intrahepatic cholestasis of pregnant women, obstetric cholestasis.
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D’Arrigo, Stefano, Carmela Loiacono, Claudia Ciaccio, Chiara Pantaleoni, Flavia Faccio, Matilde Taddei, and Sara Bulgheroni. "Clinical, Cognitive and Behavioural Assessment in Children with Cerebellar Disorder." Applied Sciences 11, no. 2 (January 8, 2021): 544. http://dx.doi.org/10.3390/app11020544.
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Cerebellar disorders are characterised clinically by specific signs and symptoms, often associated with neurodevelopmental disorder. While the clinical signs of cerebellar disorders are clearly recognisable in adults and have a precise anatomo-functional correlation, in children the semiotics are less clear and vary with age because of the particular nature of the cerebellum’s maturation. Unlike other structures of the central nervous system, this begins at a later stage of foetal development and extends over a longer period of time, even after birth. As a result, the typical signs of cerebellar dysfunction will only become evident when the cerebellar functions have become integrated into the complex circuits of the central nervous system. This means that poor motor coordination in the very early years of life may not necessarily correlate with cerebellar dysfunction, and this may also be encountered in healthy children. The cerebellum’s role in cognitive and emotional functions relies on its structure and the complexity of its connections. Cognitive and behavioral impairment in cerebellar disorders can be the results of acquired lesions or the action of genetic and environmental risk factors, to which the cerebellum is particularly vulnerable considering its pattern of development. In the pathological setting, early evidence of cerebellar damage may be very vague, due, partly, to spontaneous compensation phenomena and the vicarious role of the connecting structures (an expression of the brain’s plasticity). Careful clinical assessment will nonetheless enable appropriate instrumental procedures to be arranged. It is common knowledge that the contribution of neuroimaging is crucial for diagnosis of cerebellar conditions, and neurophysiological investigations can also have a significant role. The ultimate goal of clinicians is to combine clinical data and instrumental findings to formulate a precise diagnostic hypothesis, and thus request a specific genetic test in order to confirm their findings, wherever possible.
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D’Arrigo, Stefano, Carmela Loiacono, Claudia Ciaccio, Chiara Pantaleoni, Flavia Faccio, Matilde Taddei, and Sara Bulgheroni. "Clinical, Cognitive and Behavioural Assessment in Children with Cerebellar Disorder." Applied Sciences 11, no. 2 (January 8, 2021): 544. http://dx.doi.org/10.3390/app11020544.
Full textAbstract:
Cerebellar disorders are characterised clinically by specific signs and symptoms, often associated with neurodevelopmental disorder. While the clinical signs of cerebellar disorders are clearly recognisable in adults and have a precise anatomo-functional correlation, in children the semiotics are less clear and vary with age because of the particular nature of the cerebellum’s maturation. Unlike other structures of the central nervous system, this begins at a later stage of foetal development and extends over a longer period of time, even after birth. As a result, the typical signs of cerebellar dysfunction will only become evident when the cerebellar functions have become integrated into the complex circuits of the central nervous system. This means that poor motor coordination in the very early years of life may not necessarily correlate with cerebellar dysfunction, and this may also be encountered in healthy children. The cerebellum’s role in cognitive and emotional functions relies on its structure and the complexity of its connections. Cognitive and behavioral impairment in cerebellar disorders can be the results of acquired lesions or the action of genetic and environmental risk factors, to which the cerebellum is particularly vulnerable considering its pattern of development. In the pathological setting, early evidence of cerebellar damage may be very vague, due, partly, to spontaneous compensation phenomena and the vicarious role of the connecting structures (an expression of the brain’s plasticity). Careful clinical assessment will nonetheless enable appropriate instrumental procedures to be arranged. It is common knowledge that the contribution of neuroimaging is crucial for diagnosis of cerebellar conditions, and neurophysiological investigations can also have a significant role. The ultimate goal of clinicians is to combine clinical data and instrumental findings to formulate a precise diagnostic hypothesis, and thus request a specific genetic test in order to confirm their findings, wherever possible.
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Orsini, Marco, Flavio R. Sztajnbok, Acary Bulle Oliveira, Marco Antonio Araújo Leite, Peter Salem Júnior, Marcos R. G. De Freitas, Osvaldo J. M. Nascimento, et al. "Benign fasciculations and Corticosteroid use: possible association? An update." Neurology International 3, no. 2 (September 20, 2011): 11. http://dx.doi.org/10.4081/ni.2011.e11.
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Fasciculations are characterized by visible subtle and fast contractions of muscle, even wormlike in movement, by the contraction of a fascicle of muscle fibers. The authors present the case study of a 28-year-old patient with the appearance of migratory and diffuse fasciculations with an onset after partial tapering off of oral corticosteroides (60 mg total dose) indicated for treatment of Minimal change Glomerulopathy. Clinical Neurological physical exam allied with an ENMG, besides other complementary laboratory exams were used for screening the above-mentioned patient. Afterwards, current research relating to the topic at hand was made in order to update the data available in the Bireme, Scielo and PubMed Data Banks using the following key words: Fasciculation’s, motor neuron disease, and benign fasciculations in the Portuguese, English as well as Spanish language. Although fasciculation’s are most commonly associated with Motor neuron disease as well as with certain metabolic disorders, they may also be present in individuals with absolutely no underlying pathological disorders. In our case, fasciculation potentials that have been present for six months, with no other signs of a neurogenic disorder as well as absence of laboratory findings, the patient received a diagnosis of Benign Fasciculation Syndrome (BFS).We believe that the use of corticosteroides in high doses with subsequent tapering contributed to the fasciculation’s, especially due to the changes that this causes on the ionic channels. Fasciculation’s are symptoms seen in a large range of conditions, and also being the main symptom of the so-called Benign Fasciculation Syndrome. We have presented an example of this clinical syndrome in a patient whose complaint was fasciculation’s, with complete clinical remission of symptoms following complete tapering off of corticosteroid six months previously.
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Defabjanis, Patrizia. "Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes." Journal of Clinical Pediatric Dentistry 27, no. 2 (January 1, 2004): 95–100. http://dx.doi.org/10.17796/jcpd.27.2.27934221l1846711.
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Respiratory disorders in the upper respiratory tract during sleep are most often part of a continuous pathological process of long standing. Schematically, three clinical syndromes with increasing severity are described: breathing with the mouth open, snoring and sleep apneal hypopnea syndrome. Obstructive sleep apnea syndrome (OSAS) is a subtle, but severe sleep disorder of early childhood. It is often difficult to detect and may have long-term consequences, including failure to thrive, behavioral disturbances, developmental delay, and cor pulmonale.1 These conditions always include a functional maxillofacial perturbation, which may be associated with a constitutional or acquired morphological disorder. Pediatric dentists must be aware of the problems connected with mouth breathing and OSAS (obstructive sleep apnea syndrome) in children as any delay in diagnosis and treatment may cause prolonged morbidity. They also have a role in the diagnosis and co-management of these patients because the signs and symptoms may be recognizable in the dental practice. Besides the medical approach itself, the treatment sometimes is surgical, always orthopedic: the earlier it is initiated, the more effective, simple and unrestraining it is. The aim of this work is to focus attention on the early diagnosis and prevention of these pathologies. Diagnostic guidelines will be illustrated.
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Pilipovich, A. A. "Early stages of Parkinson’s disease: aspects of the diagnosis and therapy." Medical Council, no. 18 (December 1, 2019): 61–70. http://dx.doi.org/10.21518/2079-701x-2019-18-61-70.
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Parkinson’s disease (PD) is the second most common neurodegenerative disease that is characterized by steady progression and results into persistent disability. It has been known that more than 10 years may elapse between the onset of cell death in certain structures of the nervous system and the onset of clinical symptoms of the disease, and most of the dopaminergic neurons are lost during this period. The identification of patients in the period between the expected onset of dopaminergic cell loss and the onset of clinical parkinsonism may be crucial for the development of effective neuroprotective treatment strategies. The scientists around the world are currently paying special attention to the search for reliable clinical, neuroimaging and molecular markers that could help diagnose PD in the early stages, distinguish it from other pathological conditions, track progression, and detect a positive response to therapy. The article provides an overview of the status update on the problem of early diagnosis and search for early clinical signs, preclinical biochemical, genetic and neuroimaging markers of PD, the main modern directions of PD therapy. Symptomatic pharmacotherapy, which compensates for dopaminergic deficiency and is able to alleviate motor and some nonmotor symptoms of parkinsonism, as well as some neuroprotective treatment options, have been analysed. Among other factors, the role of amantidines is described in detail. The foreign and domestic experience of their use as monotherapy and complex treatment of PD is presented. The author provides an analysis of the clinical case of PK-Merz therapy of the initial stage of PD.
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Hossain, Md Amzad, Tahmina Akther, Md Amran Sarker, Arunava Paul, Tanzina Zannat, Seikh Mohammad Rifat, and GKM Shahiduzzaman. "Haemophagocytic Lymphohistiocytosis: A Case Report and Short Overview." Journal of Shaheed Suhrawardy Medical College 10, no. 1 (November 22, 2018): 51–58. http://dx.doi.org/10.3329/jssmc.v10i1.38905.
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Haemophogocyticlymphohistiocytosis (HLH) is a rare but potentially fatal disease, which describes a clinical syndrome of hyper-inflammation resulting in uncontrolled and ineffective immune response. It appears commonly in infancy, although it has been seen in all age groups. A vast majority of cases are acquired due to secondary causes (infections, autoimmune, malignancy, metabolic disorders) but primary HLH (genetic) is also not uncommon which also gets triggered by infection as suggested by recent studies. “Hypercytokinemia” which is the hallmark of HLH can result in end organ damage and even death in some cases if there is delay in diagnosis. The pathological hallmark of this syndrome is uncontrolled activation of T lymphocytes and macrophages, together with an impaired cytotoxic function of NK cells and CD8+T lymphocytes resulting into massive cytokine release (e.g. interferon-ã, TNF-á, Interleukin-6, 8, 10, 12, 18) from this cells and overwhelming inflammation. Lymphocytes and macrophages sometimes with haemophagocytic activity accumulate in bone marrow, spleen, liver or lymph nodes. This disorder is characterized by fever, hepatosplenomegaly, lymphadenopathy, skin rash, cytopenias, hepatitis, coagulopathy, and neurological symptoms. We report a case of 55 yr. old male presenting with fever and high colored urine who developed clinical and laboratory findings consistent with diagnosis of HLH according to HLH-2004 guidelines. Unfortunately the patient died despite receiving chemotherapy. HLH has multifaceted clinical presentations with often non-specific signs and symptoms that are often found in other clinical conditions. Early recognition of HLH is critical in initiating therapy early and preventing high mortality resulting from multi-organ failure.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 51-58
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Usyukina, M., and S. Kornilova. "Risk Factors for Criminal Offending of Patients Suffered from Epilepsy." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71081-8.
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Study material: 148 male offenders with the proved diagnosis of epilepsy, stayed for inpatient forensic psychiatric evaluation.Risk factors could be relevant to clinical psychopathological (mechanisms of aggressive actions, primary syndrome, a course of the disorder) and different social and psychological factors such as social maladjustment (unemployed person, absence of the trade, not qualified physical work), poor living conditions, family disturbances with aggressive attitudes of patients in family and susceptibility to antisocial influence from others; alcohol abuse, repeated committing of criminal offences both before and after the onset of the disease, breach of a hospital regimen, particularly - a violent behavior. The syndromal description of the patient's condition has provided us with key data that allowed to make an opinion of the probability of committing a new crime and of its potential severity. Social dangerousness of patients with psychotic conditions (delirium, hallucinations, impairment of coinsciousness, paroxysmal states) could be found at the periods of psychotic manifestations. The social dangerousness of patients with negative symptoms (personality changes, dementia signs) is relatively stable. There has been a prevalence of situation driven negative and personality mechanisms such as affective control loss and intellectual incapacity. Assessing the dangerousness of the patients with positive psychotic mechanisms of an offence the content of delirious experience should be discovered as well and the place and the role of real persons who might be involved into the pathological delirious plot have to be found. Assessment of the dangerousness of positive psychotic mechanisms without delirious motivation requires to focus on stability on probability of the recurrence of the syndrome that produced this psychopathological mechanism.
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Ahn, Jeonghyun, Ara Ko, Eun Jung Jun, Minah Won, Yoo Kyum Kim, Eun-Seon Ju, Eun Seok Jeon, and Heuiran Lee. "Antiviral Effects of Small Interfering RNA Simultaneously Inducing RNA Interference and Type 1 Interferon in Coxsackievirus Myocarditis." Antimicrobial Agents and Chemotherapy 56, no. 7 (April 16, 2012): 3516–23. http://dx.doi.org/10.1128/aac.06050-12.
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ABSTRACTAntiviral therapeutics are currently unavailable for treatment of coxsackievirus B3, which can cause life-threatening myocarditis. A modified small interfering RNA (siRNA) containing 5′-triphosphate, 3p-siRNA, was shown to induce RNA interference and interferon activation. We aimed to develop a potent antiviral treatment using CVB3-specific 3p-siRNA and to understand its underlying mechanisms. Virus-specific 3p-siRNA was superior to both conventional virus-specific siRNA with an empty hydroxyl group at the 5′ end (OH-siRNA) and nonspecific 3p-siRNA in decreasing viral replication and subsequent cytotoxicity. A single administration of 3p-siRNA dramatically attenuated virus-associated pathological symptoms in mice with no signs of toxicity, and their body weights eventually reached the normal range. Myocardial inflammation and fibrosis were rare, and virus production was greatly reduced. A nonspecific 3p-siRNA showed relatively less protective effect under identical conditions, and a virus-specific OH-siRNA showed no protective effects. We confirmed that virus-specific 3p-siRNA simultaneously activated target-specific gene silencing and type I interferon signaling. We provide a clear proof of concept that coxsackievirus B3-specific 3p-siRNA has 2 distinct modes of action, which significantly enhance antiviral activities with minimal organ damage. This is the first direct demonstration of improved antiviral effects with an immunostimulatory virus-specific siRNA in coxsackievirus myocarditis, and this method could be applied to many virus-related diseases.
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You, Sooseong, Byoung-Kab Kang, Jihyun Kim, Hoyoung Lee, Eun Hyoung Shim, Mi Mi Ko, Jiae Choi, et al. "Four Subgroups of Blood Stasis Syndrome Are Identified by Manifestation Cluster Analysis in Males." Evidence-Based Complementary and Alternative Medicine 2019 (July 8, 2019): 1–7. http://dx.doi.org/10.1155/2019/2647525.
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Blood stasis syndrome (BSS) is an important pathological condition in traditional East Asian medicine and is associated with ischemic heart disease, cerebral vascular accident, diabetes mellitus, chronic renal failure, severe traumatic injury, and dysmenorrhea. However, previous studies have been unable to reveal the clinical and biological characteristics or biological markers of BSS. We hypothesized that the heterogeneity among the manifestations of BSS or non-BSS could interfere with an analysis to describe the characteristics of BSS. In this study, male participants based on the severity of BSS-associated symptoms and signs were clustered and classified into four subgroups: BSS subgroups (1), (2), (3), and (4). Non-BSS core subgroup was redefined using manifestation cluster analysis. Biological characteristics of subgroups BSS(1) and BSS(2) belong to the range of the non-BSS core subgroup (1), whereas that of subgroups BSS(3) and BSS(4) are characterized by different biological parameters such as systemic inflammatory conditions and elevated D-dimer level. Our results suggested that patients in subgroups of BSS(3) and BSS(4) are more likely to be exposed in an inflammatory state than other BSS subgroups. We found the heterogeneity among the manifestations which could mask the characteristics of BSS and identified the clinical and biological profiles of the four BSS subgroups through comparisons of the redefined non-BSS and BSS subgroups. This finding could provide accurate diagnostic criteria and new approaches for BSS treatments in different subgroups.
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Md Arifuzzaman, Shaikh Nurul Fattah, Mohammad Nazrul Islam, Md Mehedi Hasan, Md Monirul Islam, Chowdhury Tamanna Tabassum, Shirajum Monira, Sardar Mohammad Tanvir, and Mohammad Farhad. "Clinicopathological Study of Change of Voice." Journal of Dhaka Medical College 29, no. 2 (January 5, 2021): 116–25. http://dx.doi.org/10.3329/jdmc.v29i2.51185.
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Background: Change of voice is one of the common complaints in ENT practice and hoarseness of voice is the commonest symptom of changed voice quality. Hoarseness is invariably the earliest manifestation of conditions directly or indirectly affecting the voice apparatus. Though most common causes of hoarseness are benign and vocal abuse is the commonest among them, but we should always investigate for more sinister pathology like malignancy.
Objectives: To find out the symptoms, signs and pathological incidence, leading to change of voice for early diagnosis and interventional purpose.
Methods: Total 87 patients of change of voice, studied in 06 months duration from 1st January 2016 to 30th June 2016 in the Department of ENT & Head-Neck Surgery, Dhaka Medical College Hospital, Dhaka. The cases were selected according to the eligibility criteria by purposive sampling. Then the data were collected by the active participation of the patients interviewed by the preformed proforma of data collection sheet.
Results: Maximum number of cases of change of voice were due to carcinoma larynx (37.93%), then chronic laryngitis (20.99%), followed by vocal cord nodules (19.54%) and vocal cord polyps (8.05%.). Laryngopharyngeal reflux was found in 45.95% patients of chronic laryngitis. Males were affected more than females (1.81:1). Most of the patients were in the age group of 21 to 50 years. Peak incidence was in the 4th decade. Labourers/ daily wage earners formed the predominant group. Majority of patients were from low socioeconomic class. Smoking, vocal abuse, smoking and infections were the common predisposing factors.
Conclusion: Hoarseness of voice is just a symptom with a very diverse etiology. The etiological data varies in different geographical location and from one center to other, so every case should be carefully and thoroughly evaluated to know the diagnosis and underlying pathology for early and prompt management.
J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 116-125
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McSweeney, Sean E., Ali Naraghi, David Salonen, John Theodoropoulos, and Lawrence M. White. "Hip and Groin Pain in the Professional Athlete." Canadian Association of Radiologists Journal 63, no. 2 (May 2012): 87–99. http://dx.doi.org/10.1016/j.carj.2010.11.001.
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Hip and groin pain is a common condition in professional athletes and may result from an acute injury or from chronic, repetitive trauma. It is responsible for significant morbidity, which leads to time away from training and competition, and may result in a career-ending injury. The anatomic and biomechanical causes for hip and groin injuries are among the most complex and controversial in the musculoskeletal system. This makes clinical differentiation and subsequent management difficult because of the considerable overlap of symptoms and signs. This review article will evaluate several pathologic conditions of the hip and groin in athletes, divided into acute (secondary to single event) and chronic (secondary to altered biomechanical load or repetitive microtrauma) injuries, with an emphasis on imaging in the diagnosis of these injuries. Appropriate use of imaging along with clinical findings can allow accurate diagnosis and subsequent appropriate management of these patients to ultimately allow return to athletic activity.
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Manno, M., M. Rezzadore, M. Grossi, and C. Sbrana. "Potentiation of occupational carbon tetrachloride toxicity by ethanol abuse." Human & Experimental Toxicology 15, no. 4 (April 1996): 294–300. http://dx.doi.org/10.1177/096032719601500404.
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1 Two separate cases of acute occupational poisoning following exposure to vapours of a fire extinguishing liquid are described. Analytical, clinical, pathological and toxicological data leave little doubt that toxicity was due, in both cases, to inhalation of carbon tetrachloride present at high concentrations (>15% and 78% by weight, respectively) in the fire extinguishing liquid. 2 Both subjects were admitted to hospital, 4 and 8 days after exposure, respectively, and developed severe hepato-nephrotoxicity with hepatomegaly, increased va lues of serum transaminases, blood urea nitrogen (BUN), creatinine, γ-glutamyl-transpeptidase (γ-GT), bilirubin and uric acid and, finally, anuria. They recovered in about three to four weeks, after several haemodialytic sessions. 3 Interestingly, in both cases the other workers exposed under the same conditions and for the same period of time as the two patients showed no signs or symptoms of toxicity. The reason for the observed different suscept ibility to CCl4 is attributable to an abnormally high ethanol abuse by the two workers, as reported in the clinical records and confirmed by their relatives and collegues (120 and 250 g per day, respectively). Daily ethanol intake by the coworkers was less than 50 g for all subjects. 4 Although the potentiating effect of ethanol on the toxicity of CCl4 is well known in experimental animals, as a result of cytochrome P-450 induction, direct evidence in humans reported in the literature so far was limited by the lack of information, in all published reports, on the presence or absence of effects in non-alcoholic exposed 'controls', when these were present.
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Y. B., Ramaswami, Prakash H. S., Raghavendra Prabhu T. C., and Faiyaz Abdul Jabbar. "Hyperbilirubinemia: a new diagnostic marker for perpendicular perforation." International Surgery Journal 4, no. 9 (August 24, 2017): 3024. http://dx.doi.org/10.18203/2349-2902.isj20173880.
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Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.
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Yatsenko, Anna, Lidiya Trankovskaya, and Olga Artyulova. "DIAGNOSIS OF ORAL MUCOSAL PATHOLOGY IN PATIENTS WITH VARIOUS MANIFESTATIONS OF GROUP B VITAMIN IMBALANCE." Actual problems in dentistry 16, no. 4 (February 9, 2021): 77–83. http://dx.doi.org/10.18481/2077-7566-20-16-4-77-83.
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Subject. The scientific works of recent years show an increase in the degree of negative impact of vitamin deficiency and vitamin-like substances on the state of health of the population. With the deficiency of most vitamins, synthetic processes and regeneration of oral tissues are reduced, so often the initial signs of hypovitaminosis are stomatitis, gingivitis, glossitis, and therefore, it is dentists who are the first to diagnose deviations in the body associated with vitamin deficiency. This justifies the relevance and practical value of studying and describing clinical cases of manifestations of deficient vitamin conditions in the oral cavity.
The object – is to study the effect of B vitamins on the oral mucosa in order to increase the effectiveness of diagnosis of vitamin-deficient conditions of the human body.
Methodology. These clinical examples illustrate the management experience of patients with manifestations of deficient vitamin conditions on the oral mucosa. Clinical and laboratory methods of diagnosing the analysed conditions of the organism were applied. Statistical processing of materials was carried out using the STATISTICA 10 software (StatSoft, Inc., USA).
Results. The deficient condition of the organism in relation to vitamins B2, B6, B12 in patients 18-75 years old has been studied. Characteristic clinical changes on the oral mucosa of the examined patients were established. So, in most patients with vitamin B2 deficiency, the classic Sebrel triad was found: dermatitis, glossitis, cheilitis. In those examined with a lack of vitamin B6, language desquamations (smoothed, polished language) were determined in the 83.6%, often combined with glossodinia. Patients with vitamin B12 deficiency were characterized by a lesion in the form of Meller-Gunter glossitis in 74.9% of cases, moreover, 67.6% of patients showed paresthesia in the area of tongue and oral mucosa.
Conclusions. The study found that the first clinical symptoms of deficient conditions of the presented vitamins of group B were found from the oral cavity. Thus, it is the dentist who is the first to diagnose the pathological states of lack of group B vitamins in the human body, which emphasizes the importance and relevance of continuing to study these states of the body.
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Eicken, John J., and Dustin Morrow. "Limb threatening thigh hematoma diagnosis accelerated by emergency physician bedside ultrasound." SAGE Open Medical Case Reports 7 (January 2019): 2050313X1984858. http://dx.doi.org/10.1177/2050313x19848589.
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Introduction: Compartment syndrome is a serious condition that requires prompt diagnosis, specialty consultation, and definitive management to prevent significant morbidity. Traditionally, compartment syndrome is identified by physical exam findings including the presence of pain, pallor, paresthesia, pulselessness, and paralysis involving the affected limb. Identifying the presence of compartment syndrome prior to the onset of signs that portend a poor outcome (i.e. pallor, pulselessness, and paralysis) can be challenging since many other less serious traumatic conditions can lead to paresthesia and pain in a limb. Bedside ultrasound is increasingly being utilized by emergency providers to expedite identification of various emergent diagnoses and guide care for patients who present to emergency departments. Bedside ultrasound allows emergency providers to visualize pathologic processes occurring that may be difficult to identify through traditional physical exam findings. This case report highlights the use of bedside ultrasound to promptly identify the presence of a traumatic thigh hematoma, which led to expedited advanced imaging and specialty consultation for compartment syndrome prior to the onset of physical exam findings consistent with compartment syndrome. Conclusion: The identification of compartment syndrome in the early stages is challenging given the overlap of signs and symptoms with other less emergent conditions. Early diagnosis of compartment syndrome is important to decrease morbidity, which can result from a delayed diagnosis of compartment syndrome. To our knowledge, this is the first case report to describe the use of bedside ultrasound to aid in the diagnosis of compartment syndrome and accelerate the care for a patient who presented with a traumatic thigh hematoma, which rapidly progressed to compartment syndrome and required emergent operative intervention.
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Westers, Theresia M., Eline MP Cremers, Uta Oelschlaegel, Ulrika Johansson, Peter Bettelheim, Birgit Witte, Matteo G. Della Porta, Wolfgang Kern, and Arjan van de Loosdrecht. "Diagnostic Application of Immunophenotypic Analysis of Erythroid Dysplasia in Myelodysplastic Syndromes. a Report on Behalf of the European Leukemianet-IMDS-Flow Cytometry Working Group." Blood 124, no. 21 (December 6, 2014): 1914. http://dx.doi.org/10.1182/blood.v124.21.1914.1914.
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Abstract Discriminating between cytopenia(s) due to myelodysplastic syndromes (MDS) and due to other (non-clonal) causes can be challenging, especially when dysplasia as assessed by cytomorphology is minimal, and when other MDS-specific features (such as ring sideroblasts or cytogenetic aberrations) are absent. Current recommendations for diagnosing MDS endorse flow cytometry (FC) as a valuable and informative diagnostic tool. Most FC protocols focus on analyzing the progenitor cells and the maturing myelomonocytic lineage. However, one of the most frequently observed symptoms in MDS is anemia, which is often associated with erythrodysplasia. Therefore, flow cytometric features of nucleated erythroid cells may complement current validated FC tools. The international, multicenter study within the European LeukemiaNet MDS-FC working group (ELNet-IMDS-Flow) reported herein focused on defining those erythroid parameters that enable discrimination of dyserythropoiesis associated with MDS from erythropoiesis in non-clonal cytopenias. This analysis was based on ELNet iMDS-flow guidelines for studying nucleated erythroid cells and their expression of CD117, CD71, CD36, CD235a and CD105. [Westers et al., Leukemia 2012] Nineteen centers (members of the ELNet-iMDS-flow) collected FC data on the erythroid lineage in mainly low grade MDS cases and pathological and normal controls. Bone marrow aspirates were taken after informed consent in accordance with the Declaration of Helsinki and local ethics committee approval. Data from a learning cohort were compared among MDS patients and controls; the results were validated in a separate cohort. The learning cohort comprised 685 cases and the validation cohort 352 cases; in total 191 normal controls, 443 pathological controls, and 403 MDS cases were included. The data revealed that the analysis of the expression pattern of CD71 and that of CD36 on erythroid cells in combination with the percentage of CD117+ erythroid progenitors provides the best discrimination between MDS and non-clonal cytopenia. The selected markers were used to build an FC erythroid dysplasia score which displayed a sensitivity of 59% (95% CI: 49-68%) and a specificity of 84% (95% CI: 77-89%). Of note, not every MDS case shows signs of erythrodysplasia by cytomorphology whereas some non-clonal conditions do. Evaluation of the results in the validation cohort displayed a specificity of 77% (95% CI: 29-50%) and a sensitivity of 39% (95% CI: 66-85%) for separating pathologic controls and MDS cases based on FC erythroid dysplasia. Most “FC-dysplastic” cases in the pathological control group involved reactive conditions and cytopenia associated with infections. The majority of the “FC-dysplastic” controls demonstrated abnormal CD71 expression, which argues against the application of single aberrancies to indicate dysplasia. Considering only the presence of multiple erythroid aberrancies as erythroid dysplasia by FC increased the specificity to 96% and 95% in the learning and validation cohorts, respectively; however, at the cost of a markedly reduced sensitivity (37% and 21%, respectively). Ultimately, analysis of the erythroid and myeloid lineages should be combined to increase both sensitivity and specificity. In summary, the defined erythroid marker combination may aid the diagnostic work-up of cytopenic cases with suspected MDS, particularly in combination with flow cytometric evaluation of the progenitor cells and maturing myelomonocytic lineage. This will be implemented in an upcoming multicenter data collection exercise within ELNet iMDS-flow. Disclosures Kern: MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Loosdrecht:Celgene: Consultancy.
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Vafaee-Shahi, Mohammad, Roghayeh Saeedi, Neda Pak, Aina Riahi, and Saeide Ghasemi. "Snake Eye Appearance; A Rare Radiology Presentation in Acute Flaccid Paralysis: A Case Report." Open Neurology Journal 15, no. 1 (July 7, 2021): 43–47. http://dx.doi.org/10.2174/1874205x02115010043.
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Background: Acute flaccid paralysis (AFP) is defined by the acute onset of weakness or paralysis with reduced muscle tone in children. There are many non-infectious and infectious causes. Snake eye appearance (SEA) is a rare radiologic appearance and helps narrow down differential diagnoses in flaccid paralysis. Case Presentation: Here, we reported a 6 months-old girl who was admitted with sudden onset flaccid paralysis. She was lethargic and ill without any detectable deep tendon reflexes. She had a high fever that had started 3 days earlier with malaise, poor feeding and coryza. The first child of the family was a boy who expired with similar symptoms; however, the reason is still unknown. Her parents were relatives (cousins). The laboratory and cerebrospinal fluid tests analysis were normal. The brain MRI analysis revealed T1 dim Hypo intensity and T2 hyperintensity along with obvious ADC map hyperintensity in the brain stem. At first, the PCR tests analysis of stool samples for poliovirus and enterovirus were normal. Spinal MRI showed snake eye appearance and helped us narrow our differential diagnosis. We repeated the PCR tests of stool because of snake eye appearance in cervical MRI that was positive for poliovirus and indicated vaccine-associated Paralytic Poliomyelitis (VAPP). Unfortunately, she expired from vaccine associated poliomyelitis. Conclusion: Snake eye appearance is a rare radiologic appearance that can be seen in several pathological conditions; however, it is very rare in patients with acute flaccid paralysis. Radiology signs, especially in spinal cord MRI, can help recognizing abnormalities in images, and narrow the list of differential diagnosis in acute flaccid paralysis. Therefore, spinal cord MRI has an important role in the evaluation of patient with brain stem involvement in acute flaccid paralysis.
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Min, Evelyn Tai Li, Lakana Kumar Thavaratnam, Raja Azmi Mohd Noor, Win Mar Salmah, and Wan Hazabbah Wan Hitam. "A review of optic perineuritis." International Eye Research 1, no. 1 (March 28, 2020): 58–61. http://dx.doi.org/10.18240/ier.2020.01.11.
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Optic perineuritis (OPN) refers to a spectrum of conditions involving pathologic inflammation of the optic nerve sheath. The classic triad of OPN consists of unilateral optic neuropathy associated with pain and/or disc oedema, but the condition often mimics other optic neuropathies, resulting in delayed diagnosis and suboptimal treatment. We performed a database search of Medline and Ovid in January 2016 for articles published in any language with the keywords ‘optic perineuritis’. Sixty articles were found, published from 1956 to 2015. Two reviewers (Tai ELM and Tevaraj JMP) performed an independent screening of abstracts. Articles of interest were subsequently examined. In this review, we highlight the salient features of OPN, with particular emphasis on the clinical differences between OPN and optic neuritis. Although the majority of cases of OPN are idiopathic, investigations are required to rule out specific infectious and inflammatory causes of secondary OPN. MRI is an invaluable component of the workup, as radiographic demonstration of peri-neural inflammation is diagnostic of OPN. Corticosteroid therapy results in dramatic and rapid reversal of the signs and symptoms, but prolonged therapy with slow tapering of oral corticosteroids may be necessary to reduce the risk of relapses.
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Spuziak, R. M., R. V. Ulko, O. V. Maksimishyn, and E. P. Stepanov. "Study of the role of digital radiological examination in the diagnosis of lung changes in Coronavirus disease." Український радіологічний та онкологічний журнал 29, no. 2 (June 9, 2021): 76–90. http://dx.doi.org/10.46879/ukroj.2.2021.76-90.
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Introduction. World Health Organization announced that COVID-19 was a “public health emergency”. Тhe number of patients with COVID-19 and deaths from this disease are increasing every day, so the issue of diagnosis and treatment of this serious pathology remains relevant.
Goal. To identify the key lung lesion patterns in patients with SARS-CoV-2 infection during digital radiological examination. To identify its capabilities in assessing the prevalence and dynamics of radiological manifestations of lung damage.
Material and methods. The analysis of data of radiological examination of 1,075 patients with SARS-CoV-2 infection in moderate and severe conditions, who were treated in MNPE KRC “Regional Clinical Specialized Dispensary for Radiation Protection” in the period from June to November 2020 has been carried out.
All the patients were given digital radiography at the time of treatment. To assess the dynamics the control examination depending on the clinical manifestations was held. The images were evaluated by two independent radio- logists. Pathological changes manifested in the form of matte, consolidation of parenchyma and reticular pattern.
Results. The majority of the total number of the surveyed patients falls on the age group between 50 and 75 years old – 789 patients (73.4%). The most common pattern of lung lesion on the primary radiograph is a GGO symptom (82.7%), and in control examination there was an increase in the frequency of consolidation (53.4%), and then – fibrous changes of varying severity (62.5%). Bilateral lesion was detected in 74.8% of cases. Middle-lower and lower lobes of the lungs were more often affected.
Conclusions. OCC CT should be used to detect pathological changes in COVID-19 in the early stages, and digital radiography can identify characteristic signs of lung lesion in inpatients with moderate to severe Coronavirus disease and is sufficient to assess the dynamics of the patholo- gical process. Digital radiography method should be included in the examination protocol of patients in moderate and severe conditions in the hospital due to the impossibility or difficulty of their transportation. If repeated examination in such patients is necessary much higher dose load on CT compared to digital radiography should be taken into account.
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Rajwani, Aakash, and Luma Ghalib. "Pituitary Hyperplasia: To Operate or Not to Operate, That Is the Question." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A599. http://dx.doi.org/10.1210/jendso/bvab048.1221.
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Abstract Pituitary hyperplasia is defined as an absolute increase in the number of one or more adenohypophyseal cell subtypes, manifesting radiologically as pituitary enlargement beyond what is considered normal. It has been noted in certain physiological conditions like pregnancy however can also be seen in pathological conditions with end organ insufficiency like severe hypothyroidism. 21- year old female with a past medical history of Primary Hypothyroidism secondary to Hashimoto’s thyroiditis presented initially for evaluation of worsening headache and blurry vision. She was diagnosed with hypothyroidism at 10 years of age and had an extensive family history of hypothyroidism. At the time of presentation, she was 11 months post- partum and had been on and off her levothyroxine supplementation, having stopped it completely for a few months after delivery. MRI brain showed an 18 mm homogeneously enhancing intrasellar mass with suprasellar extension. She was referred to Neurosurgery for further evaluation. Workup revealed a TSH >100 (0.27 - 4.2 mIU/L) and FT4 <0.4 (0.8 - 2 ng/dL). In the context of severe untreated hypothyroidism and MRI findings consistent with pituitary hyperplasia with abutment but no mass effect on the optic apparatus, initial plan was to treat the hypothyroidism medically and observe closely. Patient was started on levothyroxine supplementation. Her TSH improved to 3.367 (0.550 - 4.780 uIU/mL) and FT4 to 2.00 (0.89 - 1.76 ng/dL), ηοωεϖερ she continued to have worsening of visual symptoms. Surgery was considered to decompress the optic nerve, but pre-operative MRI showed a significant decrease in size of the pituitary gland with decreased suprasellar bulging and no mass effect on the optic chiasm. Surgery was subsequently cancelled. Prolonged primary hypothyroidism leads to pituitary hyperplasia due to loss of negative feedback from lack of circulating T4 and T3, leading to excessive TRH secretion from the hypothalamus. The high TRH can lead to thyrotroph as well as lactotroph hyperplasia. Subsequently patients can present with headache, vision changes along with signs and symptoms of hypothyroidism and increased prolactin secretion. It is important to differentiate hyperplasia from other sellar lesions like pituitary macroadenoma or hypophysitis. Patients with hypothyroidism, who have pituitary enlargement diagnosed on brain imaging, should be promptly diagnosed and treated with thyroid hormone replacement. With a higher frequency and improved quality of imaging techniques, we are increasingly coming across scenarios of abnormal findings on imaging. Correlation of radiographic imaging results with a thorough history and biochemical testing is essential prior to proceeding with surgical intervention.
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Volosivska, Yuliia, Yuliia Hodovanets, and Lilia Yurieva. "SIGNIFICANCE OF CLINICAL AND LABORATORY MARKERS IN DISORDERS OF THE FUNCTIONAL CONDITION OF THE HEPATOBILIARY SYSTEM IN NEONATAL JAUNDICE." Proceedings of CBU in Medicine and Pharmacy 1 (November 16, 2020): 116–22. http://dx.doi.org/10.12955/pmp.v1.108.
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INTRODUCTION: The liver is the central organ of metabolic activity in the body.
OBJECTIVES: The purpose of this study was to determine predictors, major clinical features, and laboratory criteria for the severity of disorders of the functional state of the hepatobiliary system in newborns with neonatal jaundice (NJ). The study included 164 full-term infants. The main group - 92 children, with manifestations of pathological jaundice, was divided into two subgroups, depending on the severity of the pathology, considering concomitant perinatal pathology. IA group (46 children) includes children, condition of which was defined as moderate, IB (46 children) – children, condition of which was defined as severe, the control group consisted of 72 healthy term infants.
METHODS: The complex of examination methods includes: collection of anamnesis of antenatal and perinatal periods in the mother, clinical examination of the newborn and laboratory methods of examination: blood biochemical analysis (TSB blood, bilirubin fractions, activity of ALT enzymes, AST, ALP , γ-GT, glucose level of blood serum, cholesterol, triglycerides) ultrasound examination of infants' liver.
RESULTS: Clinical symptoms that confirmed the functional impairment of the hepatobiliary system (HBS) in newborns who had signs of NJ in perinatal pathology are: hepatosplenomegaly, impaired bowel function, hypoglycemia, anemic syndrome, hemorrhagic disorders. The results of biochemical studies of the blood showed an increase in the severity of the pathology, an increase in the level of TSB and the fraction of indirect bilirubin, activation of the cytolysis markers of ALT and AST, increase of LDH activity, decrease in the activity of g-GT and ALP, as well as decrease in the level of total protein, albumin, glucose, increase in the level of urea, cholesterol and triglycerides. The most explicit manifestations of HBS dysfunction were found in newborns with a severe condition at birth and in the early neonatal period caused both by the NJ and other comorbidities. Taking into account the revealed deepening of biochemical changes in indicators of blood serum in correlation with the increase of clinical manifestations of pathology, the diagnosis of changes in the early stages will allow to diagnose in time the disorders of the functional state of HBS in NJ for the purpose of appropriate therapeutic correction.
CONCLUSION: The results of the analysis of anamnestic and clinical-laboratory parameters in newborns with NJ showed on the background of a clinical signs of dysfunction of the hepatobiliary system, the presence of significant biochemical changes, especially enzymatic activity, including, ALT, AST, LDH, ALP, and g-GT and, also an increase in TBS levels and an indirect bilirubin fraction, a decrease in total protein and albumin, glucose, a rise in urea, cholesterol and triglycerides.
The use of a biochemical markers in newborns with clinical manifestations of neonatal jaundice, especially in cases of significant severity of the condition with concomitant perinatal pathology, requires more detailed analysis in order to determine the main pathogenesis of disorders of the functional state of the hepatobiliary system for the purpose of timely correction and improvement of the outcome of treatment.
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Hur, Joon Young, Kang Kook Lee, Jun Ho Jang, Kihyun Kim, Chul Won Jung, Won Seog Kim, and Seok Jin Kim. "Clinical Relevance of Diagnostic Criteria for Hemophagocytic Lymphohistiocytosis (HLH) and Survival Outcome of Adult HLH Patients: A Single-Center Prospective Cohort Study." Blood 132, Supplement 1 (November 29, 2018): 3718. http://dx.doi.org/10.1182/blood-2018-99-114858.
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Abstract Introduction Hemophagocytic lymphohistiocytosis (HLH) is an immune-mediated life-threatening condition in which activated macrophages phagocytize hematopoietic cells in various clinical situations from physiologic reactions to pathologic conditions such as malignancy. The diagnosis of HLH is currently done according to the HLH-2004 criteria which were mainly based on pediatric experiences even though underlying causes and clinical features of adult patients with HLH are different from pediatric patients. However, there is little information about the value of each item and its clinical relevance in the diagnosis of adult patients. Thus, we analyzed the diagnostic value of HLH-2004 criteria in adult patients who had symptoms or signs suspicious of hemophagocytosis. Methods We have conducted a prospective cohort study for adult HLH since January of 2017 (Prospective cohort for adult hemophagocytosis: NCT03117010). Adult patients older than 18 years having at least one of the following problems could be enrolled onto this prospective cohort: 1) Pathologically confirmed hemophagocytosis in bone marrow or lymph nodes; 2) Presence of at least 3 conditions among 8 items of HLH-2004 diagnostic criteria. After obtaining written informed consent, we performed laboratory tests for the diagnosis of HLH including natural killer (NK)-cell activity and soluble CD25 in blood. The primary objective of this study was to explore the feasibility and clinical usefulness of HLH-2004 criteria in adult patients, and secondary objective was to analyze underlying causes and outcomes of adult HLH. Results At the time of analysis, 44 patients were enrolled in the cohort, and their median age was 51.5 years (range, 19-85 years). Male (n=27) was more common than female (n=17). All patients had fever (body temperature ≥ 38.5°C) and splenomegaly was found in 29 patients (66%, Figure 1). Although cytopenia such as neutropenia and thrombocytopenia was commonly found, only 20 patients had bi-lineage cytopenia (45%). Hypofibrinogenemia and/or hypertriglyceridemia were also less common findings (n=18, 41%). Hemophagocytosis in bone marrow or lymph nodes was pathologically confirmed in 27 patients (61%). Elevated serum level of ferritin (≥ 500 mg/L) and soluble CD25 (≥ 2400 U/mL) were 42 (95%) and 35 patients (80%), respectively. Among 33 patients whose NK-cell activity was evaluated, 22 patients had low or absent NK-cell activity (67%). According to diagnostic criteria, 28 patients having at least five conditions were diagnosed with HLH, and the remaining patients including 7 patients with bone marrow hemophagocytosis could not be diagnosed. Among 28 patients with HLH, T/NK-cell (n=8) and B-cell lymphomas (n=7) were the most common underlying disorders (n=15, 54%). Infection including EBV (n=6) and rheumatologic disorders (n=3) accounted for non-malignancy associated HLH whereas the remaining four patients' cause was not identified. At the time of analysis, 14 patients died due to uncontrolled HLH or underlying disorders or infectious complications during treatment. The median overall survival of all patients was 13.9 months (95% CI: 10.9 - 16.9), and patients with HLH was not significantly different from patients without HLH (p=0.655). The survival outcome of patients with lymphoma was significantly worse than patients without it regardless of HLH diagnosis (p<0.001). Conclusions Fever and elevated level of serum ferritin were the most frequent condition in patients having suspicious symptoms of HLH. Low or absent NK-cell activity and increased level of soluble CD25 could have additional diagnostic value for timely diagnosis of adult HLH. Considering lymphoma is frequently associated with adult HLH, immediate evaluation for lymphoma should be done in adult patients suspicious of HLH. Figure. Figure. Disclosures No relevant conflicts of interest to declare.
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Volosivska, Y., and O. Hodovanets. "CLINICAL AND PARACLINICAL ASPECTS OF FORECASTING OF SEVERE FORMS OF HYPERBILIRUBINEMIA OF NEONATAL PERIOD." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 19, no. 4 (November 13, 2019): 8–15. http://dx.doi.org/10.31718/2077-1096.19.4.8.
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Modern clinical guidelines in neonatology consist list of risk groups of severe form of neonatal jaundice in newborns, but there is a lack of authenticityof clinical and paraclinical criteria’s, which could have allowed to forecast the severity ofpathological course and to define the predictors and early signs of dysfunction of hepatobiliary system for timely conducting of medical correction in neonatal period.
Objective.To conduct the analysis of risk factors of somatic pathology, course of pregnancy andchildbirthof pregnant, clinical and paraclinical peculiarities of early neonatal adaptation of kids considering gestational age in time of birth for defining of risk groups of newborns with severe form ofhyperbilirubinemia.
Materials and methods.Researched peculiarities of somatic anamnesis, gestational periods course and childbirth of 141 women, whose kids had clinical signs of neonatal jaundice. Main researched groups of newborns: I group includes mature newborns, whowere divided on two subgroups: subgroup IA (46 kids) – kids that had middle condition severity and subgroup IB (23 kids) – kids with severe condition. II (control) group consist of 72 healthy mature newborns. III group includes premature newborns with gestation period 34 – 37 weeks. Consequently, IIIA group consist of 28 newborns with middle condition severity, IIIB group – kids with severe general condition in neonatal period. IV group includes conditionally healthy newborns with defined gestation period. Criteria of excluding from research were: premature childbirth (gestation period < 34 weeks), infectious genesis jaundice (P36), confirmed congenital organic pathology of hepatobiliary system, in particular: anomaly of development of gallbladder, atresia of bile duct (Q44), congenital viral hepatitis (P53.3)
Result and discussions. Maternity factors that complicate the pregnancy course and had an importance for severity of pathological course in kids, who had a clinical sign of hyperbilirubinemia in perinatal pathology: age of pregnant, especially in premature childbirth, infertility and uncontrolled misbirthof anamnesis, placental dysfunction,threat of premature birth in this pregnancy by rhesus factor. According to scale “Risk Score for Neonatal Hyperbilirubinemia” (2004), was distinguished some tendency of increasing of severity risk of hyperbilirubinemia in perinatal pathology of mature newborns, but that tendency didn’t exist in premature newborns. The most frequent clinical symptoms in newborns with hyperbilirubinemia in perinatal pathology were: hepatosplenomegaly, bowels dysfunction, hypoglycemia, anemic syndrome, combined hemorrhagic disorders. Indicators of biochemical blood’s spectrum of newborns showed increased level of general bilirubinserum, mainly for non-conjugate fraction, decreased level of general protein,albumin and glucose, possible increasing of AsAT activity in middle severity of condition, that tells about its activation, decreasing of indicator in severe condition; AsAT activity of premature newborns had a tendency of increasing in both middle and severe condition of newborns. AlAT indicator had a possible increasing of activity in correlation with increasing of conditions severity of mature newborns and decreased ferment reaction – in premature newborns. Сonclusions. 1. Estimation of probability of severe hyperbilirubinemia development in newbornshas to be complex, considering risk factors of pregnant and her somatic, obstetric and gynecological anamnesis, course of pregnancy and of childbirth and with conducting of marks estimation of factors according recommendations of «Risk Score for Neonatal Hyperbilirubinemia» (2004). 2. Important role for prevention of development of severe form of hyperbilirubinemia has estimation of risks in newborns, considering nature of perinatal pathology course, timely detectionof clinical symptoms, existentin disorders of metabolism and transport of bilirubin.
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Ferri, C., D. Giuggioli, V. Raimondo, L. Dagna, V. Riccieri, E. Zanatta, S. Guiducci, et al. "POS1246 COVID-19 IN ITALIAN PATIENTS WITH RHEUMATIC AUTOIMMUNE SYSTEMIC DISEASES: RESULTS OF A NATIONWIDE SURVEY STUDY." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 906–7. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3493.
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Background:SARS-CoV-2 infection poses a serious challenge for patients with rheumatic autoimmune systemic diseases (ASD), characterized by marked immune-system dysregulation and frequent visceral organ involvement.Objectives:To evaluate the impact of Covid-19 pandemic in a large series of Italian patients with ASD.Methods:Our multicenter telephone survey (8-week period, March-April 2020) included a large series of 2,994 patients (584 M, 2,410 F, mean age 58.9±13.4SD years) with ASD followed at 34 tertiary referral centers of 14 regions of northern, central, and southern Italian macro areas, characterized by different prevalence of SARS-CoV-2 infection. According to currently used criteria, Covid-19 was classified as definite Covid-19 (signs or symptoms of Covid-19 confirmed by positive oral/nasopharyngeal swabs at PCR testing) or highly suspected Covid-19 (signs or symptoms highly suggestive of Covid-19, but not confirmed by PCR testing due to limited availability of virological tests in that period). The results were analyzed performing the Odds Ratio by Java-Stat 2-way Contingency Table Analysis.Results:The main findings of the survey study revealed a significantly increased prevalence of Covid-19 in:a.the whole series of ASD patients (definite Covid-19: 22/2994, 0.73%; p=0.0007;definite Covid-19 plus highly suspected Covid-19: 74/2,994, 2.47%; p<0.0001) when compared to Italian general population of Covid-19 infected individuals (349/100000 = 0.34%; data from Italian Superior Institute of Health;https://www.epicentro.iss.it/en/coronavirus/sars-cov-2-national-surveillance-system).b.the subgroup of patients with connective tissue diseases or systemic vasculitis (n = 1,901) compared to the subgroup of inflammatory arthritis (n = 1,093), namely rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (definite Covid-19: 19/1,901, 0.99%, vs 3/1,093, 0.27%; p=0.036; definite Covid-19 plus highly suspected Covid-19: 69/1,901, 3.6%, vs 5/1,093, 0.45%; p<0.0001)c.the subgroup of patients with pre-existing interstitial lung involvement (n = 526) compared to those without (n = 2,468) (definite Covid-19: 10/526, 1.90%, vs 12/2,468, 0.48%; p=0.0015; definite Covid-19 plus highly suspected Covid-19: 33/526, 6.27%, vs 41/2,468, 1.66%; p<0.0001).Of interest, the prevalence of Covid-19 did not correlate with presence/absence of different comorbidities, mainly diabetes, cardio-vascular and/or renal disorders, as well as of ongoing treatments with biological DMARDs; while patients treated with conventional DMARDs showed a significantly lower prevalence of Covid-19 compared to those without. Covid-19 was more frequently observed in the patients’ populations from northern and central compared to southern Italian macro area with lower diffusion of pandemic. Clinical manifestations of Covid-19, observed in 74 patients, were generally mild or moderate; 4/9 individuals requiring hospital admission died for severe pneumonia.Conclusion:The prevalence of Covid-19 observed in ASD patients during the first wave of pandemic was significantly higher than that observed in Italian general population; moreover, the actual prevalence of Covid-19 might be underestimated due to the high number of mild variants as well as the possible clinical overlapping between these two conditions. Patients with ASD should be invariably regarded as ‘frail patients’ during the pandemic course, considering the risk of worse outcome in the acute phase of Covid-19, as well as the potential long-term effects of viral infection.The statistically significant association of Covid-19 with connective tissue diseases/systemic vasculitis, as well as with pre-existing interstitial lung involvement, suggests the presence of distinct clinico-pathological ASD subsets, characterized by markedly different patients’ vulnerability to SARS-CoV-2 infection.Disclosure of Interests:None declared
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Iacob, G., and Angela Olarescu. "Spinal intramedullary cavernomas. Personal experience reffering to six cases." Romanian Neurosurgery 21, no. 4 (December 1, 2014): 407–15. http://dx.doi.org/10.2478/romneu-2014-0056.
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Abstract Despite cavernous malformations of the CNS are pathologically similar, intramedullary cavernous malformations are very rare lesions, increasingly recognized after introduction of magnetic resonance image, generating gradual neurological decline, with severe deficits or acute loss of spinal function. We report our experience on six patients with intramedullary cavernomas defining the spectrum of presenting symptoms and signs analyzing the role of surgery as a treatment for these lesions. We present our experience with 2 cervical and 4 thoracal spinal intramedullary cavernoma from 2010 to 2014 searching history, onset of clinical manifestation, neurological status, radiological findings, operation, and clinical outcome. Among 6 patients male were 2 cases; female 4 cases; mean age was 42 years (range 25-72 years); mean duration of symptoms were 1,5 years (range 5 days and 2 years) with slowly progressive neurological decline. In two cases there was acute onset of neurological compromise. In all cases diagnosis was made on MRI and lesions were possible to be radically excised and gently extracted from the hemosiderin-stained bed inside of the spinal cord via a laminectomy and midline myelotomy with microsurgical techniques. The surgical outcome on a mean duration of follow up of 12 months were: for 4 cases - the patients neurological conditions remarkably improved 1 month later, for 2 cases no improvement were remarked. No recurrent hemorrhages were recorded. A follow-up MRI examination was made in all cases to confirm complete removal of the cavernous angioma. Spinal intramedullary cavernoma should be early recognized by MRI, can be positioned in a precarious position and generate significant neurologic deficits than cranial cavernomas. For symptomatic intramedullary cavernous malformations extended to the dorsal surface of the spinal cord, total resection with microsurgical techniques can offer good or excellent outcome, restoring neurological status and to stop chronic deterioration and acute rebleeding. To asymptomatic patients with deeper lesions which entail a higher operative risk, but also a surgically manageable cause of myelopathy a closed observation is mandatory.
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Jauho, Mikko, and Ilpo Helén. "Symptoms, signs, and risk factors." History of the Human Sciences 31, no. 1 (February 2018): 56–73. http://dx.doi.org/10.1177/0952695117741055.
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In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of chronic somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression.
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Humphreys, Melanie. "Pericardial conditions: signs, symptoms and electrocardiogram changes." Emergency Nurse 14, no. 1 (April 2006): 30–36. http://dx.doi.org/10.7748/en2006.04.14.1.30.c1223.
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Rusinova, Dina S., Evgeniy L. Nikonov, Leyla S. Namazova-Baranova, Galina P. Glazkova, Elena A. Vishneva, Elena V. Kaytukova, and Tatyana E. Privalova. "Primary Observational Results on Children Who Have Been Exposed to COVID-19 in Moscow." Pediatric pharmacology 17, no. 2 (June 10, 2020): 95–102. http://dx.doi.org/10.15690/pf.v17i2.2095.
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Background. The number of people infected with SARS-CoV-2 causing COVID-19 is growing worldwide. It is necessary to study features of prevalence and clinical signs in pediatric population considering the fact that this disease is rather new.The aim of the study is to analyze the features of prevalence and clinical signs of pathologic process of COVID-19 in pediatric patients according to the results of practical experience of primary care medical facility (Children’s City Outpatients Clinic № 133) under the conditions of pandemia.Methods. Pediatricians of Children’s City Outpatient’s Clinic № 133 have examined certain categories of pediatric patients (especially who came from abroad or contacted with infection) for the presence of a new coronaviral infection in February 2020. Doctors have been examining children with catarrhal symptoms and hyperthermia since March 2020. The survey of children in February and March was carried out in accordance with algorithms (uniform for adults and children) approved by the Moscow City Health Department. Later, the survey was carried out in accordance with the guidelines for children prepared by the Ministry of Health of the Russian Federation. The throat and nose swabs on SARS-CoV-2 were performed for all patients on the 1st, 11th and 13th day of the disease.Results. 1,900 children (or 3.1% of total attached pediatric population) have been examined in our outpatient’s clinic with the polymerase chain reaction (PCR) method on the presence of the new coronavirus RNA since the beginning of the COVID-19 pandemic in Russia. The course of disease was analyzed in first 100 patients with the confirmed COVID-19 diagnosis: 58 (58%) boys and 42 (42%) girls. In 81% of cases we revealed the source of infection, in 19% – we did not. The disease was asymptomatic in 11 (11%) children examined after the contact with ill relatives; 89% had mild COVID-19 disease with light catarrhal signs. The most numerous group of patients who had COVID-19 consisted of children over 10 years of age (42%); in 20% of cases it was pupils from 7 to 10 years old. Smell disorders were reported in children over the age of 10 in 50% of all cases.Conclusion. New coronaviral infection COVID-19 in children is taking mild course, without complications, under the «mask» of common viral infection. Thus, it is unknown either those who have undergone COVID-19 asymptomatically remain healthy or they need special rehabilitation. The timely development of clear algorithm with step-by-step instructions for various situations for every health professional is crucial during these difficult times.
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Kocaer, S. B., M. Kaya, S. Guven, Z. Ayhan, A. O. Saatci, F. Onen, and İ. Sari. "FRI0491 IS THERE A RELATIONSHIP BETWEEN VOGT-KOYANAGI-HARADA AND INFLAMMATORY RHEUMATOLOGICAL DISEASES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 844.2–844. http://dx.doi.org/10.1136/annrheumdis-2020-eular.3872.
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Background:Vogt-Koyanagi-Harada Disease (VKHD) is a systemic autoimmune disease characterized by bilateral granulomatous panuveitis associated with systemic symptoms, including neurological, dermatological and audiovestibular systems. Due to its systemic nature, it may accompany with other autoimmune conditions. However, there is a considerably limited number of reports on the association of VKHD and rheumatologic diseases.Objectives:To investigate the relationship between VKHD and inflammatory rheumatological diseases.Methods:Patients who had bilateral granulomatous uveitis and fulfilled the 2001 revised diagnostic criteria for VKHD were included in our study. All patients were systematically reviewed in terms of the presence of any rheumatological manifestations including connective tissue diseases, spondyloarthritis (SpA), vasculitis, Behcet’s disease and sarcoidosis.Results:Demographic findings: There were fifteen patients in the study (86,7%,female), the mean age at diagnosis was 31,2 ± 11,1 years.Comorbidities: Six patients (4 hashimoto thyroiditis, 2 diabetes mellitus) had comorbid diseases.Rheumatological findings: Mechanical back pain in 4 patients, 1 patient had morning stiffness without any other SpA related features; 2 patients had inflammatory arthralgias in small joints, 4 patients had sicca symptoms, 1 patient had arthritis in knee joint, 3 patients had oral aphthae and 1 patient had photosensitivity.Laboratory tests and autoantibodies: The acute phase reactants were within normal ranges. The mean CRP value at the time of diagnosis was 2,7 ± 3,2 mg/L and ESR was 14,4 ± 9,2 mm/h. Two (15,3%) out of 13 patients had high serum ACE levels. RF, anti-CCP and anti-dsDNA were negative in all patients. ANA was positive (>1/160 titers) in 4 patients (28,6%) and 3 patients had a titer above 1/320. Anti-ENA profile was positive in 2 patients with anti-SS-B and anti-histone components. MPO-ANCA was positive in one patient.HLA test: HLA-B27 was negative in all patients. HLA-B51 and B18 were positive in 2 patients.Radiographic findings: One patient had heel enthesitis on X-ray, 4 patients had bilateral grade 1 and one patient had unilateral grade 2 sacroiliitis. None of them fulfilled the Modified New York criteria for radiographic sacroiliitis. Hand X-rays of all patients were normal. One patient had reticular density on chest X-ray.Pathergy: The pathergy test was negative in all patients.Capilleroscopy: Four patients had pathological capilleroscopy findings (3 patient tortuous loops, 1 patient tortuous loops and microhemorrhages).Conclusion:This study suggests that; 1) inflammatory arthralgias and sicca symptoms were the most common rheumatological findings, 2) the frequency of SpA related features were not increased in VKHD, 3) increased autoantibody frequency, particularly in high titers of ANA could be seen in VKHD possibly reflecting the autoimmune nature of the disease, 4) even though there were signs of rheumatic diseases, none of the patients were grouped into any rheumatologic diagnostic classification.Demographic findings and rheumatological manifestations in VKHD patientsVKHD patients (n=15)Females,n (%)13 (86,7)Age,yrs (mean ± std)34,6 ± 12,6Age of diagnosis, yrs (mean±std)31,2 ± 11,1CRP baseline (mean±std)2,7 ± 3,2 mg/LESR baseline (mean±std)14,4 ± 9,2 mm/HHigh ACE levels,n(%)2/13 (15,3)RF positivity,n(%)0/14 (0)Anti-CCP positivity,n (%)0/6 (0)ANA positivity,n(%)4/14 (28,6)ANA pattern,(n)Homogeneous (2)Nuclear (1)Homogeneous speckled (1)Anti-dsDNA positivity,n(%)0/11 (0)Anti-ENA profile positivity,n(%)2/14 (14,2)ANCA positivity,n(%)1/12 (8,3)Pelvis X-Ray abnormality,n(%)Sacroiliitis (n)5/12 (41,7)Bilateral grade 1 (4)Unilateral grade 2 (1)Capilleroscopy abnormality,n(%)4/9 (44,5)Pathergy,n (%)0/12 (0)Disclosure of Interests:None declared