Home About us Contact
|
Home About us Contact | ||
|
|
||
Unrecognized
Terms modified by Unrecognized Selected AbstractsNasolacrimal Duct Orifice Cysts in Adults: A Previously Unrecognized, Easily Treatable Cause of EpiphoraTHE LARYNGOSCOPE, Issue 10 2007John M. DelGaudio MD Abstract Background: Epiphora is a common problem evaluated by ophthalmologists and otolaryngologists. It is typically the result of obstruction at some level of the nasolacrimal system, either the canaliculi, sac, or duct. Multiple etiologies exist, including scarring from infection or trauma, tumors, or masses. Cysts of the nasolacrimal duct orifice (dacryocystoceles) in the inferior meatus have been described in neonates, usually presenting as obstructive nasal masses shortly after birth. Nasolacrimal duct orifice cysts have not been described in the adult population in the medical literature. Patients: Three patients were identified with epiphora as a result of cysts in the inferior meatus at the opening of the nasolacrimal duct. All patients presented with constant epiphora and were referred for dacryocystorhinostomy by an ophthalmologist or an otolaryngologist. None of the patients had a previous history of nasolacrimal duct (NLD) surgery. One patient had previous endoscopic sinus surgery for nasal polyps. Cysts were identified by nasal endoscopy of the inferior meatus in all patients. Results: All patients underwent endoscopic resection of the inferior meatus cyst to relieve the obstruction of the NLD. Two procedures were performed under general anesthesia and one under intravenous sedation. All patients had complete relief of epiphora and have had no evidence of recurrence of the symptoms or the cyst in 4 to 10 months follow-up. Conclusions: NLD orifice cysts are easily correctable causes of epiphora. Routine inferior meatus endoscopy should be routinely performed in patients with epiphora to identify whether on not this pathology is present prior to performing dacryocystorhinostomy. [source] Inadequacies of absolute threshold levels for diagnosing prediabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2010Michael Bergman Abstract Prediabetes comprising Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) represents an intermediate stage of altered glucose metabolism between normal glucose levels and type 2 diabetes mellitus and is associated with an increased risk for the development of diabetes and cardiovascular disease. There is considerable evidence that glucose levels lower than those meeting the current definition of prediabetes may also be associated with similar risks particularly in high-risk individuals. Prediabetes is often unrecognized and therefore constitutes a major public health concern suggesting the need for earlier intervention than is currently recommended. Copyright © 2010 John Wiley & Sons, Ltd. [source] Clinical features, diagnosis and management of maternally inherited diabetes and deafness (MIDD) associated with the 3243A>G mitochondrial point mutationDIABETIC MEDICINE, Issue 4 2008R. Murphy Abstract Maternally inherited diabetes and deafness (MIDD) affects up to 1% of patients with diabetes but is often unrecognized by physicians. It is important to make an accurate genetic diagnosis, as there are implications for clinical investigation, diagnosis, management and genetic counselling. This review summarizes the range of clinical phenotypes associated with MIDD; outlines the advances in genetic diagnosis and pathogenesis of MIDD; summarizes the published prevalence data and provides guidance on the clinical management of these patients and their families. [source] Follicular variant of papillary carcinoma: Cytologic findings on FNAB samples,experience with 16 casesDIAGNOSTIC CYTOPATHOLOGY, Issue 2 2001Franco Fulciniti M.D. Abstract Between January 1, 1992 and December 31, 1997, a cytopathological diagnosis of follicular variant of papillary thyroid carcinoma (FVPC) was made on a series of 16 out of 18 patients with palpable nodules who underwent fine-needle aspiration biopsy (FNAB) in our Department. The results of aspiration biopsy were followed by histopathological examination of the surgically excised tissues. There were three false-negative aspirations (16.6%), of which two were probably bound to fine-needle sampling and one due to a mixture of benign and malignant cells which had originally gone unrecognized. The accuracy of the cytopathologic diagnosis in this variant was 88.8%. An analysis of the diagnostic cytopathological criteria was performed, which demonstrated the importance of both architectural features (monolayered and branching sheets, microacinar structures, and their combinations) and nuclear features (presence of nuclear grooves). Background -bound features were mainly represented by dense, nonfilamentous colloid. The cytopathologic findings in FVPC were compared to those found in a series of 10 usual papillary carcinomas (UPC) and 10 follicular neoplasms (FN). These latter had originally been diagnosed by FNAB and were subsequently classified histologically as follicular adenoma (n = 6), follicular carcinoma (n = 3), or adenomatoid colloid nodule (n = 1). Statistical evaluation was performed on the cytopathological findings in the three classes of lesions (FVPC, UPC, and FN) as to their presence and relative frequency or absence by using a nonparametric one-way ANOVA (Kruskall-Wallis) and, where necessary, a Mann-Whitney U test. Papillary cellular fragments and multinucleated giant cells (P < 0.005), nonfilamentous dense colloid, squamoid cells, and syncytia were significantly more represented in UPC than in FVPC (P < 0.05), while histiocytes were significantly more frequent in FVPC (P < 0.005). Other nuclear and/or background features were significant only in the distinction between papillary carcinomas as a group and FN. The cytological differential diagnosis of the FVPC is briefly discussed with relevance to the possible pitfalls caused by its peculiar cyto- and histomorphology. Diagn. Cytopathol. 2001;25:86,93. © 2001 Wiley-Liss, Inc. [source] Emergency Physician,Verified Out-of-hospital Intubation: Miss Rates by ParamedicsACADEMIC EMERGENCY MEDICINE, Issue 6 2004James H. Jones MD Abstract Objectives: To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods:The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO2), and physical examination. Results: During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department. [source] Unrecognized Misplacement of Endotracheal Tubes in a Mixed Urban to Rural Emergency Medical Services SettingACADEMIC EMERGENCY MEDICINE, Issue 9 2003Michael E. Jemmett MD Abstract Objective: To determine the rate of unrecognized endotracheal tube misplacement when performed by emergency medical services (EMS) personnel in a mixed urban and rural setting. Methods: The authors conducted a prospective, observational analysis of out-of-hospital endotracheal intubations (EIs) performed by EMS personnel serving a mixed urban, suburban, and rural population. From July 1, 1998, to August 30, 1999, emergency physicians assessed and recorded the position of out-of-hospital EIs using auscultation, direct laryngoscopy, infrared CO 2 detectors, esophageal detector devices, and chest x-ray. The state EMS database also was reviewed to determine the number of EIs involving patients transported to the authors' medical center and paramedic assessment of success for these encounters. Results: A total of 167 out-of-hospital EIs were recorded, of which 136 (81%) were deemed successful by EMS personnel. Observational forms were completed for 109 of the 136 patients who arrived intubated to the emergency department. Of the studied patients, 12% (13 of 109) were found to have misplaced endotracheal tubes. For the patients with unrecognized improperly placed tubes, 9% (10 of 109) were in the esophagus, 2% (2 of 109) were in the right main stem, and 1% (1 of 109) were above the cords. Paramedics serving urban and suburban areas did not perform significantly better (p < 0.05) than intermediate-level providers serving areas that are more rural. Conclusions: The incidence of unrecognized misplacement of endotracheal tubes by EMS personnel may be higher than most previous studies, making regular EMS evaluation and the out-of-hospital use of devices to confirm placement imperative. The authors were unable to show a difference in misplacement rates based on provider experience or level of training. [source] Proteomic profiling reveals a catalogue of new candidate proteins for human skin agingEXPERIMENTAL DERMATOLOGY, Issue 10 2010Martin Laimer Abstract:, Studies of skin aging are usually performed at the genomic level by investigating differentially regulated genes identified through subtractive hybridization or microarray analyses. In contrast, relatively few studies have investigated changes in protein expression of aged skin using proteomic profiling by two-dimensional (2-D) gel electrophoresis and mass spectrometry, although this approach at the protein level is suggested to reflect more accurately the aging phenotype. We undertook such a proteomic analysis of intrinsic human skin aging by quantifying proteins extracted and fluorescently labeled from sun-protected human foreskin samples pooled from ,young' and ,old' men. In addition, we analyzed these candidate gene products by 1-D and 2-D western blotting to obtain corroborative protein expression data, and by both real-time PCR (RT-PCR) and microarray analyses to confirm expression at the mRNA level. We discovered 30 putative proteins for skin aging, including previously unrecognized, post-translationally regulated candidates such as phosphatidyl-ethanolamine binding protein (PEBP) and carbonic anhydrase 1 (CA1). [source] PAX5/IGH rearrangement is a recurrent finding in a subset of aggressive B-NHL with complex chromosomal rearrangements,GENES, CHROMOSOMES AND CANCER, Issue 2 2005Bruce Poppe We present an extensive characterization of 10 B-cell lymphomas with a t(9;14)(p13;q32). The presence of the PAX5/IGH gene rearrangement was demonstrated by fluorescence in situ hybridization (FISH) using a validated probe set, whereas complex karyotypic changes were reassessed by multiplex-FISH (M-FISH). Pathologic and clinical review revealed the presence of this rearrangement in 4 histiocyte-rich, T-cell-rich B-cell lymphomas (HRTR-BCLs) and 2 posttransplantation diffuse large B-cell lymphomas (PTLD-DLBCLs). In contrast to initial observations describing this translocation in lymphoplasmacytic lymphoma (LPL) and LPL-derived large B-cell lymphoma, our data showed a wide morphologic and clinical spectrum associated with the PAX5/IGH rearrangement, pointing to an association between this aberration and a subset of de novo DLBCLs presenting with advanced disease and adverse prognosis. In addition, the recurrent incidence of this rearrangement in both HRTR-BCL (4 cases) and PTLD-DLBCL (2 cases) was previously unrecognized and is intriguing. © 2005 Wiley-Liss, Inc. [source] Huntington's disease with onset ages greater than 60 yearsGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1 2007Kunihiro Yoshida We examined five patients with late-onset Huntington's disease (HD), who developed chorea as an initial symptom at age 60 or later. The mean disease duration from the onset of chorea was approximately 8 years (range, 2,16 years). All carried expanded HD alleles with 39 or 40 CAG repeats. Cognitive or psychiatric decline was observed in four patients, the mean duration of the disease being approximately 10 years. One of them had been institutionalized in a nursing home undiagnosed for a long time. Late-onset HD patients with shorter repeat expansions may be overlooked in Japan. Non-disabling chorea, mild cognitive or psychiatric decline in such patients are sometimes unrecognized or misunderstood as aging-related phenomena, and do not come to medical attention. Considering the potential genetic risk to younger generations, however, genetic testing on such late-onset HD patients should be conducted with careful genetic counseling and psychological support for their family members. [source] Chylous effusions complicating lymphoma: a serious event with octreotide as a treatment optionHEMATOLOGICAL ONCOLOGY, Issue 2 2003J. Evans Abstract Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. Drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30,kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. Literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72,h leading to the resumption of a normal diet and discharge within 2 weeks. Copyright © 2003 John Wiley & Sons, Ltd. [source] Increased expression of mRNA encoding interleukin (IL)-4 and its splice variant IL-4,2 in cells from contacts of Mycobacterium tuberculosis, in the absence of in vitro stimulationIMMUNOLOGY, Issue 4 2004Helen A. Fletcher Summary Expression of interleukin (IL)-4 is increased in tuberculosis and thought to be detrimental. We show here that in healthy contacts there is increased expression of its naturally occurring antagonist, IL-4delta2 (IL-4,2). We identified contacts by showing that their peripheral blood mononuclear cells (PBMC) released interferon (IFN)-, in response to the Mycobacterium tuberculosis -specific antigen 6 kDa early secretory antigenic target (ESAT-6). Fresh unstimulated PBMC from these contacts contained higher levels of mRNA encoding IL-4,2 (P=0·002) than did cells from ESAT-6 negative donors (noncontacts). These data indicate that contact with M. tuberculosis induces unusual, previously unrecognized, immunological events. We tentatively hypothesize that progression to active disease might depend upon the underlying ratio of IL-4 to IL-4,2. [source] Studies of scleroderma at The Alfred Hospital, MelbourneINTERNAL MEDICINE JOURNAL, Issue 8 2006A. J. Barnett Abstract Scleroderma had been virtually unrecognized in this country before this study. Our interest in this condition was raised by the discovery that certain patients being investigated for ischaemic disease of the hand had scleroderma. Although uncommon, it is not excessively rare and we have been able to study an increasingly large number of patients, eventually resulting in 177 patients over a period of 35 years. The clinical features in these patients have been delineated. At first, the patients were subdivided into types: type 1, skin changes obvious only in the hands; type 2, skin changes extending beyond the hands but excluding the trunk; type 3, skin changes diffuse and involving the trunk. All types have similar visceral changes, but these are more severe and there is a worse prognosis in type 3 patients. Types 1 and 2 can conveniently be combined as acrosclerosis. Types 1 and 2 have a similar and good prognosis with survival at 30 years of 40%. Type 3 patients have a much worse prognosis, with no type 3 patients living more than 20 years. All types have a high incidence of autoantibodies, but these are generally not related to the severity of the disease and do not occur in relatives or spouses, this being the evidence of the absence of hereditary and environmental factors in their presence. Although patients may receive much relief from symptomatic measures, no treatment had lessened the skin stiffness and there is no specific treatment for the visceral lesions. The cause of the condition remains unknown. [source] Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of AfricaINTERNAL MEDICINE JOURNAL, Issue 1-2 2003S. A. Skull Abstract The prevalence of and risk factors for vitamin D deficiency were examined for recent adult immigrants from East Africa living in Melbourne. Demographic data were collected via a face-to-face questionnaire and risk factors predicting deficiency were examined. Suboptimal levels <25 nmol/L were found in 61 patients (53%; 74% of women; 20% of men). Lower levels were more likely in: (i) patients with a longer duration of residence in Australia, (ii) patients who were mostly covered when outdoors and (iii) women. Routine assessment for vitamin D deficiency should be considered for male and female immigrants from East Africa. (Intern Med J 2003; 33: 47,51) [source] Localized cutaneous leishmaniasis imported into Paris: a review of 39 casesINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2004Lise El Hajj MD Background, Localized cutaneous leishmaniasis (LCL) is a common cause of dermatosis in travelers returning from the tropics. We describe the epidemiological, clinical, and biological aspects and therapeutic outcome of imported LCL. Methods, A retrospective study of all cases of LCL observed from 1992 to 2000 in our tropical disease unit. Diagnosis was based on direct examination of skin smear and/or culture with identification of subsequent subspecies. Results, Thirty-nine cases (25 males, 14 females; median age: 38 years) were included: 35 French travelers and four foreign immigrants; 15 cases were acquired in the Old World and 24 cases in the New World. The patients presented to our department with a median of 60 days after return. Thirteen patients had already consulted general practitioners, and the diagnosis was missed in five cases (38%). Five clusters were identified. The median number of skin lesions was two per patient. Diagnosis was established by direct microscopic examination in 36 cases (92%). Thirty-five patients were assessable for first-line treatment with antimonials (intramuscularly in 18, intralesionally in nine), intramuscular pentamidine isethionate or oral ketoconazole (four patients each). Twenty-five patients (71.4%) were cured. The remaining 10 patients were cured after one to three courses of other treatments. Overall adverse events occurred in 60% of the patients treated with antimonials and 37% of those treated with pentamidine. Conclusion, Imported LCL is still unrecognized by Western physicians. Clusters may be observed in groups of travelers. The therapeutic outcome is impaired by numerous but minor side-effects. [source] Correlates of knowledge and beliefs about depression among long-term care staffINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 4 2008Liat Ayalon Abstract Context Despite the high prevalence of depression in long-term care (LTC), it often is unrecognized and inadequately treated. Thus, the goals of the present study were to evaluate LTC staff characteristics that are associated with knowledge and beliefs about depression. Methods A cross sectional study of 371 LTC staff members completed a knowledge and beliefs about depression questionnaire, a short demographic questionnaire, a burden measure, and a questionnaire about attitudes associated with working with depressed residents. Results Relative to nurses, social workers, and activity staff, paraprofessional caregivers had a lower score on the depression measure and a higher score on the burden measure. Paraprofessional caregivers were more likely to view depression as a normal phenomenon, held less accurate beliefs about signs and symptoms of depression, and were less familiar with the effectiveness of specific treatments of depression. Conclusions Educational interventions about depression should be specifically geared to meet the needs of paraprofessional caregivers who provide the majority of care to LTC residents, yet possess less knowledge about depression and its treatments. Copyright © 2007 John Wiley & Sons, Ltd. [source] Performance of the XE-2100 leucocyte differentialINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2002G. Stamminger Summary The XE-2100Ō was evaluated in a multicentre study following a previously established protocol. In this paper, we demonstrate the results of analytical performance studies, including comparison of the leucocyte differential with the NCCLS H20-A method and evaluation of flagging sensitivity. Linearity of the leucocyte count over a wide clinical range, low imprecision in clinically important ranges and no measurable carry over were confirmed. For comparability studies, 4 × 200 cell microscopic differential leucocyte counts were correlated with the automated five-part-differential counts. No significant differences were detected in (1) a group without morphological abnormality and in (2) a leukopenic group. The sensitivity of flags for the detection of immature granulocytes and myeloid blasts was very good. Only few samples containing blast cells remained unrecognized but these would have been examined microscopically in any event because of other abnormalities indicated by the instrument. Atypical/abnormal lymphocytes/and lymphoblasts were detected very reliably when the total lymphocyte count and the flags were evaluated in combination. A similiar procedure is recommended for the detection of left shift. When the neutrophil count is elevated, the sensitivity of the left shift flag is improved. The absolute immature granulocyte (IG) count by the instrument correlates well with that of myeloid precursor cells by microscopy. [source] Nutritional status and health outcomes for older people with dementia living in institutionsJOURNAL OF ADVANCED NURSING, Issue 5 2007Meei-Fang Lou Abstract Title.,Nutritional status and health outcomes for older people with dementia living in institutions Aim., This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. Background., Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. Method., A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. Results., Eighteen percent of the residents were under-nourished (body mass index <18·5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. Conclusion., Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia. [source] Empirical tests of the recognition heuristicJOURNAL OF BEHAVIORAL DECISION MAKING, Issue 3 2006Rüdiger F. Pohl Abstract The recognition heuristic postulates that individuals should choose a recognized object more often than an unrecognized one whenever recognition is related to the criterion. This behavior has been described as a one-cue, noncompensatory decision-making strategy. This claim and other assumptions were tested in four experiments using paired-comparison tasks with cities and other geographical objects. The main results were (1) that the recognized object was chosen more often than the unrecognized one when the recognition cue was valid; (2) that participants' behavior did not reflect the recognition validity of their own knowledge; (3) that a less-is-more effect (i.e., better performance with less knowledge) was either absent or of only small size; and (4) that judgments were influenced by further knowledge, which could even compensate for the recognition cue. In sum, the recognition cue represents an important piece of knowledge in paired comparisons, but apparently not the only one. Copyright © 2006 John Wiley & Sons, Ltd. [source] After Dark and Out in the Cold: Part-time Law Students and the Myth of ,Equivalency'JOURNAL OF LAW AND SOCIETY, Issue 2 2009Andrew Francis This paper presents the findings of the first major research study of part-time law students. It argues that many face multiple disadvantages, largely unrecognized by universities, whose emphasis on the formal equivalency of part-time and full-time law degrees ignores the distinctive backgrounds and needs of part-time students. As a result, many are marginalized, impacting on their retention, overall performance, and work prospects. It is also argued that the context within which part-time law students experience legal education contributes to a collective habitus which may structure what is ,thinkable' for their futures. Such concerns are of particular importance given the strong vocational drive amongst part-time law students. An effective response requires action by both universities and the legal profession. Without this, part-time legal education will remain a fundamentally paradoxical experience, offering broader access to legal practice for non-traditional entrants, while continuing to inhibit their chances of success by entrenching their difference in the eyes of the profession. [source] Occult hepatitis B infection in patients infected with HIV: Report of two cases of hepatitis B reactivation and prevalence in a hospital cohortJOURNAL OF MEDICAL VIROLOGY, Issue 2 2010B. Bloquel Abstract Patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are particularly at risk of hepatitis B reactivation. Two cases of patients infected with HIV with isolated anti-HBc antibodies who had experienced an HBV reactivation are described. In the two cases HBV reactivation occurred after withdrawal of anti-retroviral treatment with anti-HBV activity from the patients' highly active antiretroviral therapy (HAART), in accordance with HIV genotypic resistance profiles. Consequently, plasma samples from 383 patients infected with HIV were tested to assess the prevalence of occult HBV infection in the Infectious Diseases Department Unit of Nancy Hospital by investigating serological patterns and HBV replication. Forty-five percent (172/383) of patients had had previous contact with HBV. Isolated anti-HBc antibodies were observed in 48 patients (48/383, 12%) and, among these, 2 were HBV-DNA positive. Since 75% (288/383) of the patients were treated with HAART, including at least one drug active against HBV, occult HBV infection was perhaps unrecognized. In cases of HIV infection, all patients should be screened for HBV infection and the knowledge of HBV status as well as the monitoring of HBV viral load are essential in preventing HBV reactivation. Consideration should be given to the continuation of drugs with anti-HBV activity in co-infected patients receiving HAART, as cessation of therapy is associated with a risk of HBV reactivation. At least, close monitoring of the HBV viral load is warranted in such situations. J. Med. Virol. 82:206,212, 2010. © 2009 Wiley-Liss, Inc. [source] Neuroimaging in Posterior Reversible Encephalopathy SyndromeJOURNAL OF NEUROIMAGING, Issue 2 2004C. Lamy ABSTRACT The terms posterior reversible leukoencephalopathy, reversibleposterior cerebral edema syndrome, and posterior reversibleencephalopathy syndrome(PRES) all refer to a clinicoradiologic entity characterized by headaches, confusion, visual disturbances, seizures, and posterior transient changes on neuroimaging. Clinical findings are not sufficiently specific to readily establish the diagnosis; in contrast, magnetic resonance imaging pattern is often characteristic and represents an essential component of the diagnosis of PRES. Typical lesions predominate in the posterior white matter, with some involvement of the overlying cortex; are hyperintense on T2-weighted images; and are usually hypointense or isointense on diffusion-weighted images, with an increase of the apparent diffusion coefficient, indicating vasogenic edema. The pathogenesis is incompletely understood, although it seems to be related to the breakthrough of autoregulation and endothelial dysfunction. Since its initial description, this syndrome has been subsequently described in an increasing number of medical conditions, including hypertensive encephalopathy, eclampsia, and the use of cytotoxic and immunosuppressive drugs. The diagnosis has important therapeutic and prognostic implications because the reversibility of the clinical and radiologic abnormalities is contingent on the prompt control of blood pressure and/or discontinuing the offending drug. On the contrary, when unrecognized, conversion to irreversible cytotoxic edema may occur. [source] Detection of Maternal Alcohol Use Problems in the Pediatric Emergency DepartmentALCOHOLISM, Issue 7 2006Heather A. Flynn Background: Maternal alcohol use problems may impact the health and well-being of children, but often remain unrecognized. Mothers of young children seldom seek outpatient care for themselves; thus, pediatric settings may present an opportunity for the detection of maternal alcohol use problems. This study examines the feasibility of screening for and prevalence of alcohol use problems in mothers of young children in the context of seeking pediatric emergency care. We also examined the relationship of maternal alcohol use problems with use of pediatric emergency care. Methods: A total of 361 English-speaking mothers of children aged 7 and younger completed screening measures during their child's emergency care visit. TWEAK was used to screen for alcohol use problems. The screening survey also included information on children's health status and health care use, demographics, and the Center for Epidemiological Studies Depression Scale. Results: Of the women approached, 90% agreed to complete the screening measure. On the basis of cutoff score of 2 or more, 7% of women had elevated TWEAK scores. Those women with a TWEAK score >2 reported greater use of the pediatric emergency department (PED) than women scoring below the cutoff. On the basis of multivariate analyses, significant predictors of recent PED use included the presence of child chronic illness, younger maternal age, and TWEAK score. Conclusions: Screening for alcohol use problems among mothers of young children using the TWEAK appears to be feasible in a busy PED setting. The PED setting is promising for identifying risk drinking among women who may be less likely to be otherwise detected and for whom alcohol use may be impacting child outcomes. [source] Vitamin and trace metal levels in recessive dystrophic epidermolysis bullosaJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2004S Ingen-Housz-Oro ABSTRACT Background, In recessive dystrophic epidermolysis bullosa (RDEB), a good nutritional balance is necessary to obtain healing of the chronic wounds. However, involvement of the oral mucosa and oesophagus stenosis may be responsible for severe nutritional deficiencies. Objective, In order to propose an adapted nutritional management, we studied the vitamin and trace metal status of 14 RDEB patients. Methods, Height and weight were measured. Plasma levels of albumin, iron, ferritin, calcium, parathyroid hormone (PTH), folates, vitamins C, D, B12, A, E, B1, B6, PP and B2, zinc, selenium, carnitine and copper were measured. Results, Most patients had a significant growth retardation. We found iron, vitamin D, C, B6, PP, zinc and selenium deficiencies in 36,70% of the patients, without clinical expression, except in one case. Vitamin B1, 12, B2, A/RBP, E/lipids and carnitine were normal. The three patients with gastrostomy feeding had better growth but still a protein deficiency and sometimes vitamin C, B6, PP, zinc and carnitine deficiencies. Conclusion, Vitamin and trace metal deficiencies are frequent in RDEB, even in patients receiving gastrostomy feeding, and often go unrecognized. Regular nutritional evaluation is necessary. Dietary advice and supplements should be given. Enteral feeding by gastrostomy should be discussed in early childhood. [source] Nature of the Martian uplands: Effect on Martian meteorite age distribution and secondary crateringMETEORITICS & PLANETARY SCIENCE, Issue 10 2006William K. Hartmann Some 80,89% of these launch sites sampled igneous rock formations from only the last 29% of Martian time. We hypothesize that this imbalance arises not merely from poor statistics, but because the launch processes are dominated by two main phenomena: first, much of the older Martian surface is inefficient in launching rocks during impacts, and second, the volumetrically enormous reservoir of original cumulate crust enhances launch probability for 4.5 Gyr old rocks. There are four lines of evidence for the first point, not all of equal strength. First, impact theory implies that MM launch is favored by surface exposures of near-surface coherent rock (,102 m deep), whereas Noachian surfaces generally should have ,102 m of loose or weakly cemented regolith with high ice content, reducing efficiency of rock launch. Second, similarly, both Mars Exploration Rovers found sedimentary strata, 1,2 orders of magnitude weaker than Martian igneous rocks, favoring low launch efficiency among some fluvial-derived Hesperian and Noachian rocks. Even if launched, such rocks may be unrecognized as meteorites on Earth. Third, statistics of MM formation age versus cosmic-ray exposure (CRE) age weakly suggest that older surfaces may need larger, deeper craters to launch rocks. Fourth, in direct confirmation, one of us (N. G. B.) has found that older surfaces need larger craters to produce secondary impact crater fields (cf. Barlow and Block 2004). In a survey of 200 craters, the smallest Noachian, Hesperian, and Amazonian craters with prominent fields of secondaries have diameters of ,45 km, ,19 km, and ,10 km, respectively. Because 40% of Mars is Noachian, and 74% is either Noachian or Hesperian, the subsurface geologic characteristics of the older areas probably affect statistics of recognized MMs and production rates of secondary crater populations, and the MM and secondary crater statistics may give us clues to those properties. [source] Eosinophilic oesophagitis in adultsNEUROGASTROENTEROLOGY & MOTILITY, Issue 10 2009N. Gonsalves Abstract, Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) ,15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis. [source] Intravenous glycerol therapy should not be used in patients with unrecognized fructose-1,6-bisphosphatase deficiencyPEDIATRICS INTERNATIONAL, Issue 1 2003YUKIHIRO HASEGAWA AbstractBackground: In Asian countries, glycerol solution that contains fructose (5%) is often used for management of brain edema. However, glycerol and fructose may cause severe hypoglycemia and metabolic acidosis in patients with fructose-1,6-bisphosphatase (FBPase) deficiency, even under stable conditions. The aim of the present study was to determine whether glycerol solution was used for brain edema during acute metabolic decompensation of hypoglycemia and metabolic acidosis in patients with unrecognized FBPase deficiency in Japan and to examine a long-term prognosis of the patients who had this kind of severe metabolic decompensation with or without glycerol therapy. Methods: A retrospective study of 20 children with FBPase deficiency was conducted, based on their medical records. Results: Six of the 20 children were given glycerol solution for the presence or possibility of brain edema during acute metabolic decompensation of hypoglycemia and metabolic acidosis; two of the six patients administered with glycerol were given dialysis. In four patients treated with glycerol alone without dialysis, two had no brain edema before glycerol administration but it developed later after the administration. These four patients treated with glycerol alone died or developed severe neurological complications. Fourteen patients who were not treated with glycerol solution had no brain edema and showed good prognosis. Conclusion: Glycerol solution, which contains fructose in Asian countries including Japan, should not be used as an osmotic agent for treatment of brain edema in patients who have hypoglycemia and retention-type metabolic acidosis, until FBPase deficiency is ruled out by measuring blood concentration of lactate. [source] The Art of PrescribingPERSPECTIVES IN PSYCHIATRIC CARE, Issue 2 2006Antidepressants in Late-Life Depression: Prescribing Principles QUESTION. , Ms. Antai-Otong, I am a psychiatric nurse practitioner currently employed in a large primary care clinic. My greatest challenge with older adults suspected of being depressed is their hesitancy to admit they are depressed or unwillingness to take antidepressants. I have started some of these patients on antidepressants and had mixed results. Please provide some guidelines for treating depression in older adults with coexisting medical conditions. ANSWER., Depression is a common companion of chronic medical illnesses and frequently goes unrecognized and untreated, resulting in high morbidity and mortality. Depression is unrecognized and underdiagnosed in approximately 16% of older patients seen in primary care settings (Unutzer, 2002). Typically, older adults deny being depressed, minimize symptom severity, fail to recognize common subjective experiences, such as anhedonia, fatigue, and concentration difficulties associated with this disorder, and hesitate to accept their illness due to social stigma and effects of stoicism. Cultural and generational influences also impact how older adults perceive mental health services. Due to the growing number of individuals 65 and older with coexisting medical and psychiatric conditions, particularly depression, seeking health care in vast practice settings, advanced practice psychiatric nurses must collaborate with primary care providers and develop holistic care that addresses coexisting chronic medical and psychiatric conditions. [source] Structural Effects on the Electronic Absorption Properties of 5,6-Dihydroxyindole Oligomers: The Potential of an Integrated Experimental and DFT Approach to Model Eumelanin Optical Properties,PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 3 2008Marco D'Ischia Elucidation of the relationships between structural features and UV,visible absorption properties of 5,6-dihydroxyindole oligomers is an essential step towards an understanding of the unique optical properties of eumelanins. Herein, we report the first combined experimental and density functional theory (DFT) investigation of the 5,6-dihydroxyindole oligomers so far isolated. 2,2,-Biindolyl 2 and the 2,4,-biindolyl 3 absorb at longer wavelengths relative to 2,7,-biindolyl 4 and their spectra were well predicted by DFT analysis. The absorption bands of 2,4,:2,,4,,- and 2,4,:2,,7,,-triindolyls 5 and 6 also fall at different wavelengths and can be interpreted by DFT simulations as being due to a combination of two main separate transitions. Tetramer 7, in which two 2,4,-biindolyl units are linked through a 2,3,-connection, exhibits a broad chromophore extending over the entire UV range without well defined absorption maxima. Within the dimer,tetramer range examined, three key points emerge: (1) an increase in oligomer chain length does not result in any regular and predictable bathochromic shift; (2) a marked broadening of the absorption bands occurs when going from the monomer to the tetramer structure; and (3) the mode of coupling of the indole units is a crucial, hitherto unrecognized, structural parameter affecting the electronic absorption properties of 5,6-dihydroxyindole oligomers. It is concluded that use of experimentally characterized oligomeric scaffolds as a basis for DFT calculations is a most promising approach to building reliable structural models for studies of eumelanins optical properties. [source] The identification of conserved interactions within the SH3 domain by alignment of sequences and structuresPROTEIN SCIENCE, Issue 11 2000Stefan M. Larson Abstract The SH3 domain, comprised of approximately 60 residues, is found within a wide variety of proteins, and is a mediator of protein,protein interactions. Due to the large number of SH3 domain sequences and structures in the databases, this domain provides one of the best available systems for the examination of sequence and structural conservation within a protein family. In this study, a large and diverse alignment of SH3 domain sequences was constructed, and the pattern of conservation within this alignment was compared to conserved structural features, as deduced from analysis of eighteen different SH3 domain structures. Seventeen SH3 domain structures solved in the presence of bound peptide were also examined to identify positions that are consistently most important in mediating the peptide-binding function of this domain. Although residues at the two most conserved positions in the alignment are directly involved in peptide binding, residues at most other conserved positions play structural roles, such as stabilizing turns or comprising the hydrophobic core. Surprisingly, several highly conserved side-chain to main-chain hydrogen bonds were observed in the functionally crucial RT-Src loop between residues with little direct involvement in peptide binding. These hydrogen bonds may be important for maintaining this region in the precise conformation necessary for specific peptide recognition. In addition, a previously unrecognized yet highly conserved ,-bulge was identified in the second ,-strand of the domain, which appears to provide a necessary kink in this strand, allowing it to hydrogen bond to both sheets comprising the fold. [source] Intraspinally mediated state-dependent enhancement of motoneurone excitability during fictive scratch in the adult decerebrate catTHE JOURNAL OF PHYSIOLOGY, Issue 15 2010Kevin E. Power This is the first study to report on the increase in motoneurone excitability during fictive scratch in adult decerebrate cats. Intracellular recordings from antidromically identified motoneurones revealed a decrease in the voltage threshold for spike initiation (Vth), a suppression of motoneurone afterhyperpolarization and activation of voltage-dependent excitation at the onset of scratch. These state-dependent changes recovered within 10,20 s after scratch and could be evoked after acute transection of the spinal cord at C1. Thus, there is a powerful intraspinal system that can quickly and reversibly re-configure neuronal excitability during spinal network activation. Fictive scratch was evoked in spinal intact and transected decerebrate preparations by stroking the pinnae following topical curare application to the dorsal cervical spinal cord and neuromuscular block. Hyperpolarization of Vth occurred (mean ,5.8 mV) in about 80% of ipsilateral flexor, extensor or bifunctional motoneurones during fictive scratch. The decrease in Vth began before any scratch-evoked motoneurone activity as well as during the initial phase in which extensors are tonically hyperpolarized. The Vth of contralateral extensors depolarized by a mean of +3.7 mV during the tonic contralateral extensor activity accompanying ipsilateral scratch. There was a consistent and substantial reduction of afterhyperpolarization amplitude without large increases in motoneurone conductance in both spinal intact and transected preparations. Depolarizing current injection increased, and hyperpolarization decreased the amplitude of rhythmic scratch drive potentials in acute spinal preparations indicating that the spinal scratch-generating network can activate voltage-dependent conductances in motoneurones. The enhanced excitability in spinal preparations associated with fictive scratch indicates the existence of previously unrecognized, intraspinal mechanisms increasing motoneurone excitability. [source] | |||||||||||||||||||||||||||||||||||||