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Signs
Kinds of Signs Terms modified by Signs Selected AbstractsThe management of dyslipidaemias in antiretroviral-treated HIV infection: a systematic reviewHIV MEDICINE, Issue 6 2007C McGoldrick Objectives The aim of the study was to assess the currently available evidence concerning the management of dyslipidaemias in HIV-infected individuals treated with antiretroviral therapy. Methods Randomized trials, published within the 5 years preceding 5 October 2005, were identified in PubMed Medline, Embase, and The Cochrane Central Register of Controlled Trials. Studies were then included or excluded, dependent on their meeting inclusion/exclusion criteria. The evidence obtained in the studies that were included was assessed using methods employed by the Scottish Intercollegiate Guidelines Network (SIGN). Results Thirteen relevant trials were identified, concerning the use of statins, fibrates, antiretroviral drug switches and insulin-sensitizing drugs. Most contained small numbers of trial participants. Conclusions Most studies suggested beneficial effects and satisfactory safety profiles for the interventions studied. However, the insulin-sensitizing drug rosiglitazone appeared to have some detrimental effects on lipid profiles. With the small numbers of participants in the majority of studies, these studies were likely to have been inadequately powered to assess the effects of the interventions examined. Larger trials are therefore necessary. [source] Metastatic spinal cord compression: a review of practice and careJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Lynn Kilbride Aim and objectives., The aim of this review was to address: (1) How is spinal stability assessed? (2) What is the role of bracing/should braces be used? (3) When is it safe to mobilise the patient? (4) What position should the patient be nursed in? Background., Controversy surrounds the care for patients with metastatic spinal cord compression (MSCC). There is some evidence to indicate that care for patients with MSCC is based on individual clinician preference rather than evidence-based guidelines which has been shown to cause delays and discrepancies in patient treatment. Design., A structured literature review to synthesise the available evidence about the management of MSCC. Methods., The following databases were searched: Medline, EMBASE, Cochrane Systematic Reviews Database, SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for Clinical Excellence), AMED (Allied and Complementary Medicine), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and BNI (British Nursing Index). Publications were selected from the past 10 years. The search yielded a total of 1057 hits, 755 abstracts were screened, and 73 articles were retrieved and examined. Thirty-five articles were included. Results., The findings identified a gap and evidence relating to spinal stability, bracing, patient mobilisation, and positioning is limited and may be inconclusive. It is important for patients with a poor prognosis that their preferences and quality of life are considered. Conclusion., Currently, the evidence base to underpin care is limited, and further research in this area is necessary for patients and healthcare professionals alike. Relevance to clinical practice., Patients who suffer from MSCC suffer numerous physical, psychological and social issues. Because of lack of consensus, the current guidelines to inform clinical decision-making of professional staff are of limited benefit. [source] Risk of malnutrition in a sample of acute and long-stay NHS Fife in-patients: an auditJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 1 2008C. H. S. Ruxton Abstract Background, Hospital malnutrition (undernutrition) continues to attract concern. The implementation of standards for food and fluids in Scotland provided the stimulus for an audit of current practices in NHS Fife hospitals in order to provide baseline data with which to evaluate progress. Methods, One hundred and fifty in-patients were recruited from wards likely to yield those with a high risk of malnutrition. Using patient records and anthropometry, data were collected on weight, weight change, body mass index (BMI), mid-upper-arm circumference (MUAC), dietetic referral, therapeutic diets and patients' perceptions of nutritional status. Malnutrition was estimated by comparing BMI, weight change and MUAC with the Malnutrition Universal Screening Tool (MUST) and standards published by the Scottish Intercollegiate Guidelines Network (SIGN). Results, Depending upon the standard used, the minimum risk of malnutrition varied from 14 to 25%. The prevalence was lower than that reported previously, although methods were not directly comparable. Obesity was also evident with 42% of patients having a BMI > 25. Mean weight change from admission to audit was +0.4 kg, with a wide range (,11 kg to +13 kg). Most patients identified as malnourished were referred to the dietitian or given nutritional support. Conclusions, Fewer patients were at risk of malnutrition than expected. However, improving the provision of food and fluids remains a priority in Fife as malnutrition and eating problems can occur across the entire BMI spectrum. [source] TO IMAGINE SPINOZA: DELEUZE AND THE MATERIALITY OF THE SIGNPHILOSOPHICAL FORUM, Issue 3 2010CHRISTOPHER M. DROHAN First page of article [source] RE: RESUSCITATION BEYOND 10 MINUTES OF TERM BABIES BORN WITHOUT SIGNS OF LIFEJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 8 2004JR Tompkins Dr No abstract is available for this article. [source] FOLLOWING THE SIGNS: APPLYING URBAN REGIME ANALYSIS TO A UK CASE STUDYJOURNAL OF URBAN AFFAIRS, Issue 5 2007NANCY HOLMAN ABSTRACT:,As the debate continues regarding the applicability of urban regime analysis in a UK context, three aspects stand out as highly significant: the target for analysis, the mode of scrutiny, and the context of local governing arrangements with its implications for interdependence as an impetus for co-operation. This article will examine urban regime analysis and the move from government to governance in order to answer why and how the private, voluntary and public sectors might be inclined to collaborate in regimes. In addition, the regime analysis will provide the parameters for examination whilst the issue of governance will afford context for local governing arrangements. Although some issues require slight reframing to reflect the UK context, the article will follow a rigorous framework for examination utilizing the full weight of regime analysis as articulated by Stone such that it could not be accused of "concept stretching." Far from it: Through the examination of an informal partnership, a coalition of actors from the public, private, and voluntary sectors that has been in existence for more than 13 years, the article focuses, specifically, on the long-term, less visible aspects of local governance. As such, it is able to demonstrate how economic and political change can have a tangible effect on the manifestation of interdependence as an impetus for co-operation, not only for this specific locale but also for other cities facing similar challenges. [source] Solitary Cutaneous Metastasis as the First Sign of Relapse of Thyroid Carcinoma: A Clinical, Dermoscopic-Pathologic Case StudyDERMATOLOGIC SURGERY, Issue 3 2009VINCENZO DE GIORGI MD First page of article [source] Antral Red Streaking is a Negative Endoscopic Sign for Helicobacter Pylori InfectionDIGESTIVE ENDOSCOPY, Issue 3 2002Takao Kawabe Background: ,One of the most important endoscopic findings for the diagnosis of chronic gastritis is erythema. Erythema is classified into two groups: spotted or scattered erythema and linear erythema. We feel that red streaking has a tendency to be found on the apparently normal gastric mucosa without inflammation. Methods: ,To evaluate this association prospectively, we conducted the present study in 1513 consecutive patients undergoing endoscopy. Helicobacter pylori infection was assessed by rapid urease test, culture, pathological test, serological test and urea breath test using 13C. Results: ,Of these patients, red streaking was recognized in 94 patients (6.2%). All of the tests showed very low prevalence (0,3.5%) of H. pylori infection in patients with red streaking whereas positive results were obtained recognized in 42,49% of 94 age-sex-matched patients without red streaking. Additionally, no peptic-ulcer diseases, such as gastric ulcer/ulcer scar and duodenal ulcer/ulcer scar, were found in the patients with red streaks. In conclusion, red streaking is a negative sign for H. pylori infection and peptic-ulcer diseases. Conclusions: ,The understanding of these results might also improve the effort and cost-effectiveness of endoscopic examinations by avoiding unnecessary further testing. [source] Heart Rate Changes and ECG Abnormalities During Epileptic Seizures: Prevalence and Definition of an Objective Clinical SignEPILEPSIA, Issue 8 2002Maeike Zijlmans Summary: ,Purpose: To determine the prevalence of heart rate changes and ECG abnormalities during epileptic seizures and to determine the timing of heart rate changes compared to the first electrographic and clinical signs. To assess the risk factors for the occurrence of ECG abnormalities. Methods: We analyzed retrospectively 281 seizures in 81 patients with intractable epilepsy who had prolonged video-EEG and two-channel ECG. The nature and timing of heart rate changes compared to the electrographic and clinical seizure onset was determined. The ictal period (including one minute preictally and three minutes postictally) was analyzed for cardiac arrhythmias, conduction and repolarization abnormalities. Risk factors for cardiac abnormalities were investigated using parametric and non-parametric statistics. Results: There was an increase in heart rate of at least 10 beats/minute in 73% of seizures (93% of patients) and this occurred most often around seizure onset. In 23% of seizures (49% of patients) the rate increase preceded both the electrographic and the clinical onset. ECG abnormalities were found in 26% of seizures (44% of patients). One patient had an asystole for 30 seconds. Long seizure duration increased the occurrence of ECG abnormalities. No other risk factor was found. Conclusions: Heart rate changes occur frequently and occur around the time or even before the earliest electrographic or clinical change. The change can clarify the timing of seizure onset and the specific rate pattern may be useful for seizure diagnosis and for automatic seizure detection. ECG abnormalities occur often and repeatedly in several seizures of the same patient. [source] Sign of Eye Irritation in Female Hospital Workers and the Indoor EnvironmentINDOOR AIR, Issue 4 2001HANS THORE SMEDBOLD First page of article [source] Level-Sets fields, placement and velocity based formulations of contact-impact problemsINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 13 2007Hachmi Ben Dhia Abstract By introducing unknown Sign -like fields of Level-Sets type, the Signorini-Moreau dynamic contact conditions are set merely as boundary equations. From this setting, a continuous hybrid weak,strong formulation for dynamic contact between deformable solids is derived and a new Lagrangian formulation (we call stabilized) generalizing both the classical and augmented ones is obtained. Friction phenomena are treated similarly. In the global problem, the irregular Sign -like fields stand for the intrinsic contact unknown ones. This problem is discretized by means of time, space and collocation schemes. Some numerical experimentations are carried out, showing the potential of our developments. Copyright © 2006 John Wiley & Sons, Ltd. [source] Crying as a Sign, a Symptom and a SignalJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 1 2002Pippa Mundy [source] Organizational Differentiation through Badging: Investors in People and the Value of the SignJOURNAL OF MANAGEMENT STUDIES, Issue 8 2002Emma Bell This paper explores the meaning of the state,sponsored initiative for people management, Investors in People (IiP), through deconstruction of the signifiers that represent its articulation. Semiotic analysis is employed in order to consider the sign,value that is associated with IiP and to explore the symbolic meaning of cultural artefacts, such as ,the badge' and ,the flag', which feature in the experience of managers and employees in six case study organizations. This post,structuralist approach enables us to focus on the discursive construction of textual meaning surrounding IiP as a ,readerly' as well as a writerly project. It is suggested that organizations are subject to a process of image production and consumption. This process requires them to seek differentiation from other organizations by acquiring quality initiatives that constitute a system of objects. In particular, the meaning of IiP signifiers as emblems of achievement is explored and the extent to which these become simulacra is considered. It is argued that there is a significant gap between writerly intentions as to what quality initiatives ought to signify and their organizational, context,bound, indeterminate meanings. By elucidating the conditions of IiP's signification it is shown that this discourse has the potential to undermine the very philosophy it asserts. Finally, drawing on this analysis, we outline the way that badge acquisition develops over time through processes of accumulation and adaptation. [source] Sign Up to Receive 2003 Every WomanNURSING FOR WOMENS HEALTH, Issue 1 2003Award-Winning Health Guide Written for 40-Something Women No abstract is available for this article. [source] Inadequate ICD Discharges Due to Diaphragmatic Electromyopotential Oversensing as the First Sign of Right Ventricular Lead PerforationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2006UWE K. H. WIEGAND M.D. Right ventricular lead perforation, when acute, is a rare but potentially life-threatening complication of implantable cardioverter defibrillator (ICD) therapy. We report about a patient with early lead perforation presenting with repetitive ICD discharges due to oversensing of diaphragmatic electromyopotentials and describe the management of this complication. [source] Atrial Tachycardia as the Presenting Sign of a Left Atrial Appendage AneurysmPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2000ALAN B. WAGSHAL A patient presented with atrial tachycardia. The work-up, guided by the tachycardia morphology, led to the diagnosis of left atrial appendage aneurysm. Surgical removal of the atrial appendage resulted in cure of the tachycardia and associated symptoms. [source] Harlequin Sign (Hemifacial Flushing and Contralateral Hypohidrosis) in a 4-year-old Girl with Horner SyndromePEDIATRIC DERMATOLOGY, Issue 4 2006Masatoshi Abe M.D., Ph.D. A 4-year-old Japanese girl had an acquired right ocular ptosis and unequal pupils presenting shortly after birth. She also exhibited left hemifacial flushing and loss of sweating on the contralateral side (harlequin sign). Physical examination demonstrated 2.0 mm of ptosis of the right upper lid with normal elevator function. The diameters of the pupils were 4 mm on the left and 2.5 mm on the right. No sweating was induced in the right frontal region at 40°C for 15 minutes of sweat challenge test. Otherwise, no abnormalities were found by the neurophysiologic examinations or magnetic resonance imaging of the brain. Based on the clinical examination, we speculated that the responsible lesion might be in the preganglionic areas. Harlequin sign was informative for making the diagnosis of Horner syndrome. [source] An Unusual Cutaneous Lesion as the Presenting Sign of Spinal Dysraphism in a Preterm InfantPEDIATRIC DERMATOLOGY, Issue 6 2004M. Mansur Tatli M.D. Our clinical diagnosis was probable twin nevus, with a blanched nevus adjacent to a telangiectatic nevus, later complicated by ulceration. Ultrasonography and magnetic resonance imaging of the lumbosacral region revealed that her conus medullaris level was at L4 and the spinal cord was tethered by an intraspinal lipoma, without evidence of a hemangioma. We could not find any literature reporting the association of twin nevus with spinal dysraphism. [source] Source of Renewal or Sign of Stagnation?THE ECUMENICAL REVIEW, Issue 4 2007A Brief Look at the Week of Prayer First page of article [source] Opacity and Lucency Sign of the Seventh Lumbar Vertebra in DogsANATOMIA, HISTOLOGIA, EMBRYOLOGIA, Issue 5 2010S. Kneissl With 2 figures Summary A curvilinear opacity of the seventh vertebral arch and an adjacent focal lucency of the seventh lumbar vertebral body were incidentally noted in routine radiographs. The aim of this study was to analyze this radiographic absorption pattern using a sample of 51 dogs. Images of the bony surface of three macerated lumbosacral junctions were compared to their laterolateral radiographs and computed tomographic (CT) scans. Additional 48 lateral radiographic projections were reviewed for presence or absence of L7 opacity and lucency, length of the L6 and L7 vertebral bodies, vertebral disc disease, osteochondrosis, or spondylosis. Retrieved data were compiled and statistically analyzed. Radiographs and CT scans of the macerated bones revealed that the L7 pedicle had thickened layers of compact bone and the adjacent vertebral notch varying depth and extension. Superimposition of the pedicle on the vertebral body resulted in a curvilinear opacity (L7 opacity), the vertebral notch caused the focal lucency (L7 lucency). These findings were present in 69% of the reviewed radiographs and were found to be significantly associated with L6,L7 length ratios of less than 0.86 (P = 0.003). It is hypothesized that the changes correspond with normal anatomic morphology of the seventh lumbar vertebra plus adaptive bone remodelling. The importance of this study is that it could help avoid misinterpretation of this appearance as a pathologic condition. [source] Bedside Ultrasound of a Painful Finger: Kanavel's Fifth Sign?ACADEMIC EMERGENCY MEDICINE, Issue 10 2009J. Scott Bomann DO No abstract is available for this article. [source] Inferolateral ST Elevation as a First Sign of Left Anterior Descending Artery OcclusionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Po-Chao Hsu M.D. Combined anterior and inferior ST elevation due to occlusion of wrapped left anterior descending artery (LAD) is well reported in the literature. However, there is rare literature mentioned about inferolateral ST elevation in this patient group. Herein, we report a case of acute proximal wrapped LAD occlusion with initial electrocardiographic sign of inferolateral ST elevation. The most likely mechanism of this electrocardiographic finding might be related to old anteroseptal myocardial infarction, combination with other coronary abnormality, such as chronic total occlusion of left circumflex artery that caused larger injury current in inferolateral than anteroseptal myocardium, and made anteroseptal leads reveal isoelectric pattern. Ann Noninvasive Electrocardiol 2010;15(1):90,93 [source] ECG Manifestations of Multiple Electrolyte Imbalance: Peaked T Wave to P Wave ("Tee-Pee Sign")ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2009Amer M. Johri M.D. The surface electrocardiogram (ECG) is a useful instrument in the detection of metabolic disturbances. The accurate characterization of these disturbances, however, may be considerably more difficult when more than one metabolic abnormality is present in the same individual. While "classic" ECG presentations of common electrolyte disturbances are well described, multiple electrolyte disturbances occurring simultaneously may generate ECG abnormalities that are not as readily recognizable. We report a case of hyperkalemia, with concurrent hypocalcemia and hypomagnesemia resulting in (1) peaking of the T wave, (2) a prominent U wave, and (3) prolongation of the descending limb of the T wave such that it overlapped with the next P wave. In this particular ECG from a patient with combined electrolyte imbalance, we have dubbed the unusual appearance of the segment between the peak of the T wave to the next P wave as the "tee-pee" sign. [source] Left Bundle Branch Block in Type 2 Diabetes Mellitus: A Sign of Advanced Cardiovascular InvolvementANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2004Eliscer Guzman M.D., F.A.C.C. Objective: To evaluate left bundle branch block (LBBB) as an indicator of advanced cardiovascular involvement in diabetic (DM) patients by examining left ventricular systolic function and proteinurea. Methods: Data of 26 diabetic patients with left bundle branch block (DM with LBBB) were compared with data of 31 diabetic patients without left bundle branch block (DM without LBBB) and 18 nondiabetic patients with left bundle branch block (non-DM with LBBB). The inclusion criteria were age >45 years, and diabetes mellitus type 2 of >5 years. Results: Mean ages of patients in DM with LBBB, DM without LBBB, and non-DM with LBBB groups were 67 ± 8, 68 ± 10, and 65 ± 10 years, respectively (P = NS). Females were 65%, 61%, and 61%, respectively (P = NS). Left ventricular ejection fraction in DM with LBBB was significantly lower than in DM without LBBB and non-DM with LBBB (30 ± 10% vs 49 ± 12% and 47 ± 8%, P < 0.01). Left ventricular end-diastolic volume was significantly higher in DM with LBBB than in DM without LBBB and non-DM with LBBB (188.6 ± 16.4 mL vs 147.5 ± 22.3 mL and 165.3 ± 15.2 mL, P < 0.03). Similarly, left ventricular end-systolic volume was significantly higher in DM with LBBB than in DM without LBBB and non-DM with LBBB (135.4 ± 14.7 mL vs 83.7 ± 9.5 mL and 96.6 ± 18.4 mL, P < 0.02). No statistically significant difference was seen in left atrial size. Proteinurea in DM with LBBB (79.4 ± 18.9 mg/dL) was significantly higher than in DM without LBBB (35.6 ± 8.5 mg/dL, P < 0.05) and non-DM with LBBB (12 ± 3.5 mg/dL, P < 0.05); however, there was no significant difference in Hb A1c levels in DM with LBBB and DM without LBBB (9.01% vs 7.81%, P = NS). Conclusions: Left bundle branch block in diabetic patients indicates advanced cardiovascular involvement manifesting with more severe left ventricular systolic dysfunction and proteinurea compared to both diabetic patients without left bundle branch block and nondiabetic patients with left bundle branch block. [source] Emergency Department Echocardiogram of Right Ventricle Thrombus and McConnell's Sign in a Patient with DyspneaACADEMIC EMERGENCY MEDICINE, Issue 5 2009J. Scott Bomann DO No abstract is available for this article. [source] Inside Cover: (Chem. Eur.CHEMISTRY - A EUROPEAN JOURNAL, Issue 31 2010ChemistryViews.org is a comprehensive free-to-view news and information site with an associated magazine, ChemViews, provided by ChemPubSoc Europe and its publisher, Wiley-VCH. The new site enhances ChemPubSoc Europe's and Wiley-VCH's suite of market-leading peer-reviewed journals like Chemistry,A European Journal. ChemViews offers news, commentary, opinion, and additional feature material from leading authors to the global chemistry community. Sign in for a free newsletter at www.ChemViews.org (cover by Heulwen M.,M. Price). [source] Intraperitoneal Hematoma Manifest as Cullen's Sign after Femoral Cardiac CatheterizationCLINICAL CARDIOLOGY, Issue 7 2007Saurabh S. Dhawan M.D. No abstract is available for this article. [source] Persistent Orthopnea and the Prognosis of Patients in the Heart Failure ClinicCONGESTIVE HEART FAILURE, Issue 4 2004Luís Beck Da Silva MD Heart failure (HF) is a public health problem with ever-growing costs. Signs such as jugular venous pressure and third heart sound have been associated with disease prognosis. Symptoms of heart failure are frequently subjective, and their real value is often overlooked. The authors aimed to assess the relationship between orthopnea and left ventricular ejection fraction (LVEF) and hospitalization rate in patients referred to the HF clinic. One hundred fifty-three new consecutive patients referred to the HF clinic from September 2001 to July 2002 were reviewed. Information about orthopnea was available at baseline and at a 6-month to 1-year follow-up. One hundred thirty-one patients had a baseline multigated radionuclide ventriculogram scan, and 68 patients had a follow-up multigated radionuclide ventriculogram scan available. The patients were divided into groups by presence of orthopnea and compared with respect to LVEF and hospitalization rate. Patients with or without orthopnea had similar LVEFs at baseline (32%±17% vs. 33%±15%, respectively; p=NS). However, patients who were orthopnea-free at the follow-up visit had a significant LVEF improvement whereas patients with ongoing orthopnea at follow-up had no LVEF improvement (11%±13% vs. ,1%±6%; p<0.001). Patients who presented with persistent orthopnea had a significantly higher rate of hospitalization (64% vs. 15.3%; p=0.0001). Persistent orthopnea in HF patients is associated with a significantly higher rate of hospitalization and with worsening or no improvement in LVEF. Patients with persistent orthopnea may require a more aggressive approach to improve their outcome. This result may help centers with limited access to LVEF measurements to better stratify HF patients' risk. [source] Use of a Living Dermal Equivalent for a Refractory Abdominal Defect after Pediatric Multivisceral TransplantationDERMATOLOGIC SURGERY, Issue 9 2004Carlos A. Charles MD Background. Primary closure is not always possible after pediatric multivisceral transplantation. Reepithelialization may require extended periods of postoperative time, which can be associated with significant morbidity Objective. The objective was to accelerate secondary wound closure thereby minimizing infection or further complications in a pediatric multivisceral transplant patient. Methods. Five applications of human fibroblast-derived dermis (Dermagraft, Smith and Nephew) were applied to the postsurgical defect of a pediatric multivisceral transplant patient over the course of 8 months. Routine wound care and observation was performed between human fibroblast-derived dermis applications. Results. Human fibroblast-derived dermis stimulated healing and accelerated reepithelialization. Signs of clinical rejection or infection were not observed. Conclusion. Reepithelialization can be aided in the postoperative period in pediatric multivisceral transplant patients with human fibroblast-derived dermis, thereby helping to deter complications associated with secondary wound closure. We have illustrated the successful use of a human fibroblast-derived dermis as an adjunct for wound healing in a complicated surgical defect. [source] Signs and symptoms at diagnosis of amyotrophic lateral sclerosis: a population-based study in southern ItalyEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2006S. Zoccolella Amyotrophic lateral sclerosis (ALS) diagnostic criteria are used to select patients for clinical trials based on different levels of diagnostic certainty, according to the spread of upper (UMN) and lower motoneuron (LMN) signs in different anatomic regions. However, the clinical presentation of ALS patients is extremely variable and this can delay the time to diagnosis and decrease the likelihood for trial entry. The aims of the study were to describe the signs and symptoms of diagnosis in a population-based incident cohort of ALS cases, using the El Escorial (EEC) and the Revised Airlie Diagnostic Criteria (AHC). The source of the study was a prospective population-based registry established in Puglia, southern Italy, in 1997. The diagnosis and the classification of the cases were based on EEC and AHC. All incident ALS cases during the period 1998,1999 were enrolled and followed up. During the surveillance period, we identified 130 ALS incident cases, and bulbar-ALS represented 20% of our cohort. The highest risk for bulbar onset was among subjects aged >75 years [RR: 20.1, 95% confidence interval (CI) 3.4,118.0] compared with subjects aged <55 years and among females compared with males (Relative risk (RR): 2.75, 95% CI: 1,7.3). The vast majority of patients (72%) referred progressive muscle weakness in the limbs as the presenting symptom. Eighty percent of cases presented contemporary bulbar or spinal involvement; UMN signs in the bulbar region were present in 24% of cases and any motoneuronal sign in thoracic region in only 15% of the cases. In this population-based series, progressive muscle weakness was the most common presenting sign; bulbar onset was associated with advanced age and female sex. UMN signs in the bulbar region and any motoneuronal sign in the thoracic region were observed in 20% of our case series. This may represent the main limitation to show the spread of signs during diagnostic assessment for inclusion in epidemiological studies and clinical trials. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||