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Selected AbstractsThe frequency of polycystic ovary syndrome in females with resistant acne vulgarisJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2010Azar Hadi Maluki MD, CABMS (DV), FICMS (DV), MBCHB Summary Background, Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective, To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods, This case-controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al-Najaf during the period from October 2007 to November 2008. One hundred and twenty-three female patients with resistant acne vulgaris were included in this study. One hundred and twenty-three women, age-matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results, One hundred and twenty-three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty-three control women without acne were enrolled; their ages ranged from 17,40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age-matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion, Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris. [source] Clinical, virological and histopathological features: long-term follow-up in patients with chronic hepatitis C co-infected with S. mansoniLIVER INTERNATIONAL, Issue 4 2000Sanaa Kamal Abstract:Background/Aims: Infection with Schistosoma mansoni is endemic in Egypt leading to hepatic schistosomiasis and eventually portal hypertension. The prevalence of antibodies against hepatitis virus C among Egyptians is 14,51%. The aim of the present study was to investigate the influence of schistosomiasis on chronic hepatitis C with respect to the natural course of the disease, immunology, virology and histology. Patients and Methods: One hundred and twenty-six Egyptian patients classified into three groups: group A: chronic hepatitis C (n=33); group B: chronic schistosomiasis (n=30) and group C: chronic hepatitis C and chronic schistosomiasis (n=63) were enrolled and prospectively followed for 62.7±22 months. Patients infected with other hepatic viruses and/or parasites were excluded. Detailed history, clinical examination, CD4+ and CD8+ lymphocyte counts in blood, hematological and blood chemical values, abdominal ultrasonography, upper endoscopy, HCV RNA titer by RT/PCR, genotype and histological activity index in the liver biopsy were determined. Results: Thirty patients (48%) with HCV and schistosomiasis had liver cirrhosis and Child-Pugh class C vs. five (15%) in HCV patients and none in the schistosomal group. HCV RNA levels ranged between 0.07 and 13×105 copies/ml in group A, and between 1 and 25×105 copies/ml in group C. HCV genotype 4 was detected in 58 patients with co-infection (92%) and 21 patients with HCV alone (64%). Patients with coinfection showed higher grading and staging scores in their liver biopsies. Hepatocellular carcinoma was detected only in patients with coinfection. During follow-up, the mortality rate was 12%, 3% and 48% in group A, B and C, respectively. Conclusions: Patients with concomitant HCV and schistosomiasis infection were characterized by more advanced liver disease, higher HCV RNA titers, predominance of HCV genotype 4, higher histologic activity, higher incidence of cirrhosis and hepatocellular carcinoma as well as a much higher mortality rate. [source] Dwarf elliptical galaxies: structure, star formation and colour,magnitude diagramsMONTHLY NOTICES OF THE ROYAL ASTRONOMICAL SOCIETY, Issue 1 2001Giovanni Carraro The aim of this paper is to cast light on the formation and evolution of elliptical galaxies by means of N -body hydrodynamical simulations that include star formation, feedback and chemical evolution. Particular attention is paid to the case of dwarf spheroidals of the Local Group which, thanks to their proximity and modern ground-based and space instrumentation, can be resolved into single stars so that independent determinations of their age and star formation history can be derived. Indeed, the analysis of the colour,magnitude diagram of their stellar content allows us to infer the past history of star formation and chemical enrichment, thus setting important constraints on galactic models. Dwarf galaxies are known to exhibit complicated histories of star formation ranging from a single very old episode to a series of bursts over most of the Hubble time. By understanding the physical process driving star formation in these objects, we might be able to infer the mechanism governing star formation in more massive elliptical galaxies. Given these premises, we start from virialized haloes of dark matter, and follow the infall of gas into the potential wells and the formation of stars. We find that in objects of the same total mass, different star formation histories are possible, if the collapse phase started at different initial densities. We predict the final structure of dwarf spheroidal galaxies, their kinematics, their large-scale distribution of gas and stars, and their detailed histories of the star formation and metal enrichment. Using a population synthesis technique, star formation and metal enrichment rates are then adopted to generate the present colour,magnitude diagrams of the stellar populations hosted by dwarf spheroidal galaxies. The simulations are made assuming the redshift of galaxy formation and varying the cosmological parameters H0 and q0. The resulting colour,magnitude diagrams are then compared with the observational ones for some dwarf spheroidals of the Local Group. [source] Parkinsonism in patients with a history of amphetamine exposureMOVEMENT DISORDERS, Issue 2 2010Chadwick W. Christine MD Abstract We recently found a higher rate of prolonged amphetamine exposure in patients diagnosed with Parkinson's disease (PD) than in spouse/caregiver controls. Since distinguishing features have been described in some patients with parkinsonism due to environment exposures (e.g., manganese), we sought to compare the clinical features of patients with PD with prolonged amphetamine exposure with unexposed patients with PD. Prolonged exposure was defined as a minimum of twice a week for ,3 months, or weekly use ,1 year. We reviewed the clinical records of patients with PD who had participated in a telephone survey of drug and environmental exposures and compared the clinical features of patients with a history of prolonged amphetamine exposure to patients who had no such exposure. Records were available for 16 of 17 (94%) patients with prior amphetamine exposure and 127 of 137 (92%) of those unexposed. Age at diagnosis was younger in the amphetamine-exposed group (49.8 ± 8.2 years vs. 53.1 ± 7.4 years; P < 0.05), but other features, including presenting symptoms, initial and later treatments, development of motor fluctuations, and MRI findings were similar between these groups. Because we did not detect clinical features that differentiate parkinsonism in patients with prolonged amphetamine exposure, research to determine whether amphetamine exposure is a risk factor for parkinsonism will require detailed histories of medication and recreational drug use. © 2009 Movement Disorder Society [source] Sharing experience, conveying hope: Egalitarian relations as the essential method of Alcoholics AnonymousNONPROFIT MANAGEMENT & LEADERSHIP, Issue 2 2006Thomasina Borkman The predictions of Max Weber's "iron cage" of bureaucracy and Michels's "iron law of oligarchy" failed to materialize in Alcoholics Anonymous. AA has maintained an alternative form of collectivistic-democratic voluntary organization for more than seventy years. Its organizational form was developed within its first five years and articulated in its foundational text, Alcoholics Anonymous, published in 1939. Based on detailed histories of its early years, an analysis of AA's crucial ingredients suggests that six factors interacted to avoid the temptations of power, money, and professionalization that would have resulted in a bureaucratic form of organization or oligarchic leadership. In order to avoid death and to obtain or maintain abstinence, the desperate cofounders stumbled on the essential method: egalitarian peers share their lived experiences, conveying hope and strength to one another. In the context of the essential method, the two cofounders, from the Midwest and New York City, held similar spiritual beliefs and practiced a self-re?exive mode of social experiential learning gained from the Oxford Group, a nondenominational group that advocated healing through personal spiritual change; they downplayed their charismatic authority in favor of consulting with and abiding by the consensus of the group. [source] The prevalence of depressive symptoms in a white European and South Asian population with impaired glucose regulation and screen-detected Type 2 diabetes mellitus: a comparison of two screening toolsDIABETIC MEDICINE, Issue 8 2010N. Aujla Diabet. Med. 27, 896,905 (2010) Abstract Aims, To compare the identification of prevalent depressive symptoms by the World Health Organization-5 Wellbeing Index (WHO-5) and Centre for Epidemiological Studies Depression Scale (CES-D) for South Asian and white European people, male and female, attending a diabetes screening programme, and to explore the adequacy of the screening tools for this population. An additional aim was to further explore associations of depressive symptoms with impaired glucose regulation (IGR) and Type 2 diabetes mellitus (Type2 DM). Methods, Eight hundred and sixty-four white European (40,75 years old) and 290 South Asian people (25,75 years old) underwent an oral glucose tolerance test (OGTT), detailed history and anthropometric measurements and completed the WHO-5 and CES-D. Depressive symptoms were defined by a WHO-5 score , 13, and CES-D score , 16. Results, Unadjusted prevalence of depressive symptoms with the WHO-5, for people with Type2 DM was 42.3% (47.4% in white European; 28.6% in South Asian) and for IGR 30.7% (26% in white European; 45.8% in South Asian). With the CES-D, the prevalence in Type2 DM was 27.2% (25.4% in white European; 31.8% in South Asian) and for IGR 30.7% (27.8% in white European; 40.7% in South Asian). Statistically significant differences in the prevalence of depressive symptoms for sex or ethnicity were not identified. Odds ratios adjusted for age, sex and ethnicity showed no significant association of depression with Type2 DM or IGR, with either WHO-5 or CES-D. Agreement was moderate (, = 0.48, 95% confidence intervals 0.42,0.54), and reduced when identifying depressive symptoms in people with Type2 DM. For this group, a WHO-5 cut-point of , 10 was optimal. Conclusions, Depressive symptoms, identified by WHO-5 or CES-D, were not significantly more prevalent in people with Type2 DM or IGR. The WHO-5 and CES-D differed in their identification of depressive symptoms in people with Type2 DM, though discrepancies between sex and ethnicity were not identified. [source] Symptomatic Epilepsies Imitating Idiopathic Generalized EpilepsiesEPILEPSIA, Issue 2005Hirokazu Oguni Summary:, The diagnosis of idiopathic generalized epilepsies (IGEs) is not generally difficult if one follows the clinical and electroencephalogram (EEG) definitions of each subsyndrome that constitutes IGEs. In contrast, symptomatic epilepsies develop based on organic brain lesions and are easily diagnosed by the presence of developmental delay, neurologic abnormalities, and a characteristic seizure and EEG pattern. However, in clinical practice, it is sometimes difficult to differentiate IGEs from symptomatic epilepsies, especially when the clinical course from the onset of epilepsy is too short to exhibit typical clinical and EEG findings of either epilepsy type, or when patients with symptomatic epilepsies have atypical features that imitate the clinical characteristics of IGEs. The neurodegenerative or metabolic disorders at times start during the clinical course with epileptic seizures and later show typical neurologic abnormalities. The newly recognized metabolic disorder of glucose transporter type 1 deficiency syndrome (Glut-1 DS) may start with myoclonic seizures at an age of less than 1 year and imitate benign myoclonic epilepsy in infancy early in the clinical course. Progressive myoclonus epilepsies (PMEs) that develop at 1,4 years of age at times imitate epilepsy with myoclonic-astatic seizures with respect to the presence of astatic seizures and an epileptic encephalopathic EEG pattern. In addition, young children with focal cortical dysplasia may also have similar clinical and EEG patterns, although the latter may become localized after treatment. Approximately 15% of patients with juvenile myoclonic epilepsy (JME) are resistant to antiepileptic drugs (AEDs) and may require extensive study to make a differential diagnosis from symptomatic epilepsies. PMEs that develop during adolescence may imitate JME early in the clinical course; however, a detailed history and the differentiation between myoclonic seizures and myoclonus would help to distinguish both conditions. The diagnosis of IGEs is very demanding for patients with atypical features with regard to seizure type, EEG findings, and response to appropriate AEDs. [source] Malignant pheochromocytoma with progressive paraparesis in von Hippel,Lindau diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2000R. Mössner Pheochromocytomas are a feature of the von Hippel,Lindau disease spectrum, a multisystem disorder of autosomal dominant inheritance. Pheochromocytomas are, however, observed during life with a lower frequency than other features of this disease, such as retinal angiomas, haemangioblastomas of the CNS, and renal carcinomas. We present the highly unusual case of a patient who required an emergency operation for an intradural extramedullary thoracic tumour which was clinically suggestive initially of neurinoma. We present evidence from NMR, histological and isotope scan investigations of this being a pheochromocytoma metastasis and of an additional right-sided paraganglioma at the same height. A detailed history revealed that this patient had suffered from four other pheochromocytomas and two other paragangliomas, in addition to retinal angiomatosis of von Hippel,Lindau disease. This case is extraordinary due to (i) the unusual site of the metastasis, (ii) the neurological requirement for an emergency operation of pheochromocytoma, (iii) metastasis of pheochromocytoma in von Hippel,Lindau disease (only eight previous cases), and (iv) the number of recurrent pheochromocytomas. It clearly demonstrates the necessity for frequent and life-long follow-up in von Hippel,Lindau disease. [source] Contrasting phylogeographies inferred for the two alpine sister species Cardamine resedifolia and C. alpina (Brassicaceae)JOURNAL OF BIOGEOGRAPHY, Issue 1 2009Judita Lihová Abstract Aim, We use Cardamine alpina and C. resedifolia as models to address the detailed history of disjunctions in the European alpine system. These species grow on siliceous bedrock: C. alpina in the Alps and Pyrenees, and C. resedifolia in several mountain ranges from the Sierra Nevada to the Balkans. We explore differentiation among their disjunct populations as well as within the contiguous Alpine and Pyrenean ranges, and compare the phylogeographical histories of these diploid sister species. We also include samples of the closely related, arctic diploid C. bellidifolia in order to explore its origin and post-glacial establishment. Location, European alpine system, Norway and Iceland. Methods, We employed amplified fragment length polymorphisms (AFLPs). AFLP data were analysed using principal coordinates analysis, neighbour joining and Bayesian clustering, and measures of diversity and differentiation were computed. Results, For the snow-bed species C. alpina (27 populations, 203 plants) we resolved two strongly divergent lineages, corresponding to the Alps and the Pyrenees. Although multiple glacial refugia were invoked in the Pyrenees, we inferred only a single one in the Maritime Alps , from which rapid post-glacial colonization of the entire Alps occurred, accompanied by a strong founder effect. For C. resedifolia (33 populations, 247 plants), which has a broader ecological amplitude and a wider distribution, the genetic structuring was rather weak and did not correspond to the main geographical disjunctions. This species consists of two widespread and largely sympatric main genetic groups (one of them subdivided into four geographically more restricted groups), and frequent secondary contacts exist between them. Main conclusions, The conspicuously different histories of these two sister species are likely to be associated with their different ecologies. The more abundant habitats available for C. resedifolia may have increased the probability of its gradual migration during colder periods and also of successful establishment after long-distance dispersal, whereas C. alpina has been restricted by its dependence on snow-beds. Surprisingly, the arctic C. bellidifolia formed a very divergent lineage with little variation, contradicting a scenario of recent, post-glacial migration from the Alps or Pyrenees. [source] The BreathmobileÔ: A Novel Comprehensive School-Based Mobile Asthma Care Clinic for Urban Underprivileged ChildrenJOURNAL OF SCHOOL HEALTH, Issue 6 2006Otto Liao Many school-based programs have been funded to improve asthma management, especially for these "high-risk" inner-city children with asthma. Here we report the outcomes of the Children's Hospital of Orange County Breathmobile program, which is a school-based asthma program that combines the use of a mobile clinic and a pediatric asthma specialist. Baseline evaluations included a detailed history and physical, skin prick test to common allergens, spirometry measurements, and asthma severity classification based on the current National Asthma Education and Prevention Program guidelines. From April 2002 to September 2005, a total of 1321 children were evaluated for asthma. Analysis of the 1112 (84%) children diagnosed with asthma showed a population mean age of 7.8 years, 81% Latino ethnicity, and 73% with persistent disease. At baseline, only 24% of children with persistent asthma were on daily anti-inflammatory medications, which increased to 78% by the first follow-up visit. In the year prior to entry into the program, 64% had school absenteeism related to asthma (38% >10 days), 45% had emergency room (ER) visits (28% >1), and 19% had hospitalizations (9% >1). There was a significant reduction (p < .001) in the annual rates of ER visits, hospitalizations, and school absenteeism when comparing pre- and postentry into the program. These data suggest that a mobile asthma van clinic at the school site with an asthma specialist could be an effective model in reducing morbidity in the underserved child with asthma. Further studies are necessary to determine whether this model is applicable to other inner-city settings. (J Sch Health. 2006;76(6):313-319) [source] Acute liver failure induced by green tea extracts: Case report and review of the literatureLIVER TRANSPLANTATION, Issue 12 2006Michele Molinari In industrialized countries, over-the-counter dietary supplements have become popular in preventing and treating an expanding list of medical conditions. Although most commercially available supplements have not been rigorously tested for safety and efficacy, they have found an enlarging market because they are considered natural. Oral supplements containing green tea extract have been marketed as effective for weight loss and to prevent and cure some solid tumors. Although there is little scientific evidence of the effectiveness of green tea extracts to improve the quality of health of regular consumers, there is an increasing body of medical literature supporting the hypothesis that they can cause serious side effects. Our experience adds to previous reports of acute liver toxicity observed in individuals consuming supplements containing green tea extract. We highlight the importance of obtaining a detailed history of dietary supplement consumption when evaluating a patient presenting with acute liver dysfunction. Liver Transpl 12:1892,1895, 2006. © 2006 AASLD. [source] Consistent geographic structure among multiple nuclear sequences and cpDNA polymorphisms of Cardamine nipponica Franch. et Savat. (Brassicaceae)MOLECULAR ECOLOGY, Issue 13 2008HAJIME IKEDA Abstract Molecular phylogeography has inferred the history of differentiation between regions and/or among populations following the Pleistocene climatic oscillations, mostly based on the genetic structure of organelle DNA. However, such genetic structure only reflects the history of a single gene, and studies based on single-copy genes of nuclear DNA (nDNA) are required for phylogeography, although their efficiency remains unclear. To examine the utility of nDNA loci, the genetic structures of three genes from Cardamine nipponica, which is closely related to the model species Arabidopsis thaliana, were elucidated: the nDNA genes DET1, PHYA, PHYE, as well as chloroplast DNA (cpDNA). In 279 individuals collected from throughout the range of the species, strong genetic differentiation between northern and central Japan was found for all loci. This result suggested that populations in central Japan experienced a different history from those in northern Japan during the Pleistocene climatic oscillations. In addition, the evidence of refugia at the edges of the distribution, where the genetic structure was less influenced by colonization following range expansion, was shown for several loci. The specific genetic structure within the southernmost populations of northern Japan suggested that this region was also isolated during range expansion. Hence, the consistent history among loci and a more detailed history from several loci indicated that cpDNA can represent the history of vicariance and demonstrated the efficiency of single-copy nuclear genes in phylogeography. [source] The Etiology of Different Forms of Urticaria in ChildhoodPEDIATRIC DERMATOLOGY, Issue 2 2004Cansin Sackesen M.D. In contrast to the ease of its diagnosis, etiologic factors are often difficult to determine. In order to study whether differences exist among various forms of urticaria in childhood and whether the patterns of different types of urticaria differ between adults and children, we extensively studied the possible causes of urticaria in children. Fifty-four children (23 girls and 31 boys; ages 1,19 years) with various forms of urticaria were included in the study. In all cases, questions about food allergies, food additive intolerance, drug intake, signs of infection, causes of physical urticaria, insect bites, and personal and family history of atopy were asked. Clinical characteristics of the disease, such as duration, recurrence, and associated angioedema and symptoms of anaphylaxis were also investigated. Detailed laboratory tests, including serologic, autoimmune, and allergic analyses, were conducted to reveal the probable etiologies of urticaria. Of the study patients, 68.5% and 31.5% were diagnosed as having acute and chronic urticaria, respectively. The patient group with chronic urticaria was older and included more boys than the acute group. In the acute urticaria group, infection was the most frequently documented cause (48.6%), followed by drugs (5.4%), and food allergies (2.7%), whereas in chronic urticaria, physical factors were the leading cause (52.94%). The most frequently documented infection was urinary tract infection, followed by serologically determined infections of Chlamydia pneumoniae and Helicobacter pylori. In this study we found indications that infections were frequently associated with urticaria, which suggests that urticaria management should include a survey of certain infectious agents in addition to a detailed history. [source] Temporal relationship of asthma to acute chest syndrome in sickle cell diseasePEDIATRIC PULMONOLOGY, Issue 2 2007Karl P. Sylvester PhD Abstract Acute chest syndrome (ACS) is an important cause of mortality and morbidity in children with sickle cell disease (SCD). An association between asthma and ACS has been reported. Our aims were to determine whether asthma was more common in SCD children than controls and the relationship of the timing of the SCD children's first ACS episode to a diagnosis of asthma. One hundred and sixty-five SCD children median age 8.2 (range 0.3,17.3) years and 151 similar ethnic origin and aged controls were prospectively recruited into the study and a detailed history was taken from all of the children to determine if they were taking anti-asthma medication. The medical records of the SCD children were examined to assess whether they had an ACS episode, the age this episode occurred and when any diagnosis of asthma had been made. A similar proportion of the SCD children and controls were taking anti-asthma medication (7% and 9%). Thirty-three SCD children had at least one ACS episode. More of the children who had an ACS compared to those who had not were taking anti-asthma medication (P,=,0.02). The ACS children had been diagnosed as asthmatic at a median of 3.5 (range 0.5,7) years prior to their first ACS episode. In conclusion, these results suggest asthma exacerbations may predispose to ACS episodes. Pediatr Pulmonol. 2007; 42:103,106. © 2006 Wiley-Liss, Inc. [source] Enuresis: Prevalence, risk factors and urinary pathology among school children in Istanbul, TurkeyPEDIATRICS INTERNATIONAL, Issue 1 2004Emel Gür AbstractBackground: Enuresis is a common problem among children and adolescents, and can lead to important social and psychological disturbances. The aim of the present study was to establish the prevalence of enuresis among school children and determine the risk factors associated with this disorder. Methods: A cross sectional population-based study was conducted in 1576 children. The pupils enrolled in the study were chosen randomly from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire completed by parents. Enuretic children were invited to the pediatric nephrology outpatient clinic of Cerrahpasa Medical School, Istanbul, Turkey. A detailed history was taken, physical and ultrasonographic examinations, urinalysis and urine culture were performed. The relationship between the prevalence of enuresis and the patients' age, gender, region, the parental educational level and employment status, number of family members, and the family's monthly income were tested by means of ,2 and logistic regression analysis. The comparison between the two enuretic groups (monosymptomatic nocturnal enuresis group vs diurnal enuresis only and diurnal,nocturnal enuresis group) regarding the sociodemographic factors were tested with the ,2 test and P < 0.05 was accepted as statistically significant. Results: The study group was composed of 1576 school children aged between 6 and 16 years. The overall prevalence of enuresis was 12.4%. When the ,2 test was used, a significant relationship was found between the prevalence of enuresis and age, educational level of the father, the family's monthly income, and number of family members. However, when logistic regression analysis was applied, there was a statistically significant relationship only between enuresis, and age and number of family members. In the whole group, monosymptomatic enuresis nocturna was found to be more common in boys. When the two enuretic children groups (monosymptomatic nocturnal, diurnal only and nocturnal,diurnal enuretics) were compared with each other regarding gender, parental educational and employment status, and number of family members, statistically significant differences were found. Both maternal and the paternal low educational status were found to be associated with monosymptomatic enuresis nocturna. Likewise, monosymptomatic enuresis nocturna was found to be more common in the children of the unemployed mothers, while diurnal enuresis was more common in the children of unemployed fathers. Nocturnal enuresis was found to be associated with large families. No statistically significant difference was demonstrated between the two groups of enuretics regarding age and family income levels. The rate of urinary abnormalities in the whole group was 7.1%. Conclusions: Enuresis is a common problem among school children and associated urinary abnormalities are not uncommon. Identification of children at risk is an essential first step before choosing the individualized management for each enuretic child. [source] Late hemorrhagic disease of the newbornPEDIATRICS INTERNATIONAL, Issue 1 2000Özcan Bör Abstract Background: Late hemorrhagic disease of the newborn (HDN) may occur without an underlying disorder or as a secondary manifestation of an underlying disorder. It may be seen in fully breast-fed infants without a routine supplementation of vitamin K. In contrast, idiopathic late HDN is defined as HDN without the presence of any risk factor, such as gastroenteritis or use of antibiotics. Severe hemorrhagic symptoms frequently occur. Methods: Between March 1987 and May 1997, we evaluated 15 infants with idiopathic late HDN, who were diagnosed by detailed history, physical examination and laboratory findings. Results: The age (mean~SD) at onset of symptoms was 62.4~33.9 days. All children were breast-fed infants and were born at term from healthy mothers. The delivery histories were uneventful. There was no history of vitamin K administration at birth. Signs and symptoms of the patients were convulsions (47%), feeding intolerance and poor sucking (47%), irritability (33%) and pallor (20%). In physical examination; there was bulging or full fontanel in 10 patients (67%), diminished or absent neonatal reflexes in nine patients (60%) and ecchymosis in three patients (20%). Before administration of vitamin K, prothrombin time (PT) was 76.1~43.0 s and partial thromboplastin time (PTT) was 123.4~68.8 s. Six to 12 h after administration of vitamin K, PT was 15.6~1.8 s and PTT was 33.4~1.0 s. Neurologic, gastrointestinal and skin hemorrhagic findings were found in 11 (73%), three (20%) and three patients (20%), respectively. There were both neurologic and skin bleeding symptoms in two patients. The mortality in the present study was 33%. Conclusions: Late HDN results in severe hemorrhage, especially hemorrhage in the central nervous system. Administration of vitamin K (1 mg, i.m.) at the birth can reduce these severe complications. [source] The association between physical activity and hot flash severity, frequency, and duration in mid-life womenAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 1 2009William A. Romani The value of physical activity to reduce vasomotor symptoms has yet to be determined conclusively. As a result, we used a cross-sectional population-based design to examine the association between self reported physical activity level and hot flash symptoms in 45,54-year-old women. Participants (n = 603) completed a detailed survey to report physical activity level at work, home, and leisure as well as a detailed history of the frequency and severity of hot flash symptoms. Results showed that higher levels of physical activity were significantly associated with increasing odds of moderate or severe hot flashes (P for trend = 0.02). These findings suggest that there is a positive relation between physical activity and moderate or severe hot flash symptoms but no relation between physical activity and the reporting of any hot flashes, daily hot flashes, or hot flashes experienced for greater than 1 year. Am. J. Hum. Biol., 2009. © 2008 Wiley-Liss, Inc. [source] Etiologic yield of autistic spectrum disorders: A prospective studyAMERICAN JOURNAL OF MEDICAL GENETICS, Issue 1 2006Agatino Battaglia Abstract Studies addressing etiologic yield in childhood developmental disabilities have mainly looked at individuals with developmental delay/mental retardation. The few studies addressing the question of etiologic yield in patients with pervasive developmental disorders (PDDs) had a major drawback, in that the enrolled subjects were diagnosed as having the autistic spectrum disorders based only on history and clinical examination, and/or on unspecified instruments. In addition, only some of these patients underwent a complete laboratory evaluation. To investigate the etiologic yield of PDDs, we undertook a large prospective study on subjects selected according to very strict criteria and diagnosed as having PDD based on the present "gold standard" (ADI-R and ADOS-G), and a clinical diagnosis made by a child psychiatrist. Eighty-five (85) patients with PDD and their first degree relatives participated in this study. These patients were selected from a sample of 236 subjects who had received a clinical diagnosis of PDD at the Stella Maris Institute between March 2002 and 2005. Selection criteria for entering the study were: (1) a diagnosis of PDD (with exclusion of the Rett syndrome) confirmed after the administration of the ADI-R (autism diagnostic interview-revised) and the ADOS-G (autism diagnostic observation schedule-generic). In addition, a clinical diagnosis was made by the child psychiatrist, on the basis of presence or absence of DSM-IV symptoms of autism; (2) chronological age between 4 and 18 years; (3) IQ>30; (4) availability of both biologic parents. Patients, 65/85 (76.5%), had autism, 18/85 (21.2%) had PDD-NOS, and the remaining 2/85 (2.3%) had Asperger syndrome. Ages varied between 4 years 2 months and 12 years 5 months (mean 7.6 years), and there was a marked male preponderance (68/85). All subjects underwent various laboratory studies and neuroimaging. With respect to possible etiologic determination, a detailed history and physical examination in this group of patients with PDD was informative in 10.5% (9/85). HRB karyotype was diagnostic in one, and molecular fragile X studies in one child. Brain MRI was informative in two children (2.3%) with relative macrocrania but no neurological features; and EEG was helpful in one child, identifying a Landau,Kleffner disorder. Audiometry and brainstem auditory evoked potentials (BAEPs) showed a bilateral sensorineural loss in another child. Metabolic evaluation gave normal results in all subjects. The results suggest an evaluation paradigm with reference to etiologic determination for individuals with PDDs that does not presently justify metabolic or neuroimaging on a screening basis. Recurrence risk, treatment implications, and significant and long-lasting emotional relief for the parents suggest that serious consideration be given to clinical genetic examination, genetic testing, EEG study (during wakefulness and sleep), and audiometry, despite a relatively low yield. © 2006 Wiley-Liss, Inc. [source] Autism and other neuropsychiatric symptoms are prevalent in individuals with MeCP2 duplication syndrome,ANNALS OF NEUROLOGY, Issue 6 2009Melissa B. Ramocki MD Objective There have been no objective assessments to determine whether boys with MECP2 duplication have autism or whether female carriers manifest phenotypes. This study characterizes the clinical and neuropsychiatric phenotypes of affected boys and carrier females. Methods Eight families (9 males and 9 females) with MECP2 duplication participated. A detailed history, physical examination, electroencephalogram, developmental evaluation, Autism Diagnostic Observation Schedule, and Autism Diagnostic Interview,Revised were performed for each boy. Carrier females completed the Symptom Checklist-90-R, Wechsler Abbreviated Scale of Intelligence, Broad Autism Phenotype Questionnaire, and detailed medical and mental health histories. Size and gene content of each duplication were determined by array comparative genome hybridization. X-chromosome inactivation patterns were analyzed using leukocyte DNA. MECP2 and IRAK1 RNA levels were quantified from lymphoblast cell lines, and western blots were performed to assess MeCP2 protein levels. Results All of the boys demonstrated mental retardation and autism. Poor expressive language, gaze avoidance, repetitive behaviors, anxiety, and atypical socialization were prevalent. Female carriers had psychiatric symptoms, including generalized anxiety, depression, and compulsions that preceded the birth of their children. The majority exhibited features of the broad autism phenotype and had higher nonverbal compared to verbal reasoning skills. Interpretation Autism is a defining feature of the MECP2 duplication syndrome in boys. Females manifest phenotypes despite 100% skewing of X-inactivation and normal MECP2 RNA levels in peripheral blood. Analysis of the duplication size, MECP2 and IRAK1 RNA levels, and MeCP2 protein levels revealed that most of the traits in affected boys are likely due to the genomic region spanning of MECP2 and IRAK1. The phenotypes observed in carrier females may be secondary to tissue-specific dosage alterations and require further study. Ann Neurol 2009;66:771,782 [source] "All Gone Now": The Material, Discursive and Political Erasure of Bank and Building Society Branches in BritainANTIPODE, Issue 1 2008Shaun French Abstract:, This paper examines an apparent anomaly that lies at the heart of processes of financial exclusion within Britain. Given that the branch networks of banks and building societies have shrunk in size by about one-third since 1989, a period during which the Government has launched a wide-ranging set of policies to tackle financial exclusion, why is it that the issue of branch closure has been neutralised as a political issue? After providing evidence to show the extent of branch closure in Britain and illustrating the ways in which geographical research in particular has drawn attention to the nature of this problem, we look at the way the issue of physical access to financial services has been discursively and politically marginalised. We undertake a detailed history of public policy in the area, and the ways in which research funded by industry bodies and Government departments has been used and framed to build a pro-market, neoliberal policy programme that constructs branch closures as natural and inevitable. [source] Developing a strategy to reduce the high morbidity of patients with long-term urinary catheters: the BioMed catheter research clinicBJU INTERNATIONAL, Issue 6 2007Azhar A. Khan OBJECTIVE To assess the idea of managing patients having problems with long-term catheterization (LTC, normally used when all other methods of bladder management have failed or are unsuitable) in a dedicated clinic, to present a prospective analysis of consecutive new patients attending between February 2002 and October 2006, and to establish the incidence of bladder stones in patients who have recurrent catheter encrustation and blockage. PATIENTS AND METHODS Patients treated with LTC are a large heterogeneous group, mainly consisting of elderly people who have chronic disabilities, and catheter-associated complications occur in > 70% of them. In all, 260 consecutive new patients having problems with LTC were assessed; the evaluation consisted of basic demographics, a detailed history, clinical examination, urine analysis and flexible cystoscopy (FC) via the catheterization route. Patients with bladder stones were screened with FC for recurrence of stones at 3, 6 and 12 months after treatment. RESULTS In all, 117 men and 143 women (mean age 67.7 years, range 23,97) were assessed; 147 (55.5%) had catheter encrustation. FC showed that 66 of the 147 patients (45%) had bladder stones. Forty-eight patients (73%) were successfully treated at the same clinic appointment and their stones were removed with the help of a tip-less stone basket. Eighteen patients (27%) were referred for inpatient treatment of bladder stones under general anaesthesia. Twenty of 66 patients with bladder stones (30%) formed recurrent bladder stones at a mean (range) follow-up of 8.1 (3,18 months). In addition, 36 patients had successful insertion of suprapubic catheter (SPC) under local anaesthetic in the clinic, and 11 were referred for SPC insertion under general anaesthesia. Two patients were diagnosed with bladder transitional cell carcinoma. CONCLUSION The introduction of a dedicated catheter clinic, equipped with facilities such as FC and a hoist, enables patients to be treated in an environment that meets their needs and potentially reduces the risk of more complex stone removal and catheter problems at a later date. It can also act as a potential source of data for use in research and development. A significant proportion (45%) of patients with catheter encrustation and blockage had formed bladder stones. Our study provides a rationale for FC of all such patients to detect and remove stones. [source] The role of imaging in urinary incontinenceBJU INTERNATIONAL, Issue 5 2005Walter Artibani A detailed history, physical examination, symptom and quality-of-life assessment, and urine analysis are unanimously considered essential components of the initial evaluation of urinary incontinence. Beyond these assessments, there are no universally accepted recommendations and, to date, imaging is not recommended in the initial management of urinary incontinence. In selected patients, urodynamics and/or a radiographic evaluation may be indicated. According to International Continence Society guidelines, imaging of the upper and lower urinary tract is indicated only if renal damage or pelvic pathology are suspected; video-urodynamics and voiding cysto-urethrography are considered optional diagnostic tests and continue to be refined; magnetic resonance imaging is considered an important research tool in evaluating lower urinary tract disorders, but at present its clinical role remains investigational. [source] Cystometric evaluation of reconstructed classical bladder exstrophyBJU INTERNATIONAL, Issue 4 2001S. Dave Objective To evaluate the association of urodynamic variables with continence and upper tract status after reconstruction in patients with classical bladder exstrophy. Patients and methods Thirty-one patients with bladder exstrophy were assessed 1 year after a modified bladder neck reconstruction. The evaluation included a detailed history, radioisotope renography, voiding cysto-urethrography, ultrasonography and artificial slow-filling cystometry. Results Fifteen of the 31 patients were satisfactorily continent; their maximum cystometric capacity was higher than that of the incontinent patients. The compliance, assessed as the maximum bladder capacity at a detrusor pressure of < 20 cmH2O, was significantly higher in the continent patients. There was a 45% incidence of unstable contractions in the 31 patients. Persistent sphincteric activity was detected on electromyography in 10 patients during voiding. Twenty-one patients could initiate a detrusor contraction during voiding. The residual volume was significant in nine of the 21 patients who attempted to void. Patients with a high end-fill pressure (> 40 cmH2O) had a significantly higher incidence of unobstructive hydronephrosis than had patients who had an end-fill pressure of < 40 cmH2O. Conclusions Bladder abnormalities are common after reconstruction of bladder exstrophy, with poor compliance, small capacity and unstable contractions. These factors hinder any increase in capacity and cause persistent incontinence. Hypocompliance and high end-fill pressure can lead to upper tract damage even in continent patients. Detailed urodynamic evaluation is vital to assess the results and to plan subsequent treatment. [source] Jesus and the eye: New Testament miracles of visionACTA OPHTHALMOLOGICA, Issue 6 2005Ahmad M. Mansour Abstract. Purpose:,To compile and appraise the accounts of the miracles of vision in the New Testament. Methods:,We carried out a critical analysis of the compilation of ocular miracles using past medical knowledge and historical reconstruction based on the accounts of the apostles and of various historians living in the first three centuries ad. Results:,Three blind adult male beggars residing on three different street locations were described. Two had previously had good vision that had declined over a long time and the third had been born blind. The manifestations of the ocular diseases in these cases were meagre, precluding any precise diagnosis. The healing methodology did not rely on physical examination, detailed history, or the use of medicines. Jesus' tools consisted of spitting, touching, praying and the use of words. Visual outcome reported as a complete cure was realized in all three incidents. Conclusions:,The accounts of miracles in the Gospels appear to be historically reliable, yet subject to different interpretations: faith in the miracle (the Christian perspective); sorcery (the Jewish perspective); mythology (the atheist perspective), and scientifically possible human action by a charismatic, compassionate, knowledgeable man (the scientific perspective: psychotherapy or suggestion). [source] | |||||||||||||||||||||||||||||||