Symptom Combinations Associated with Outcome and Therapeutic Effects in a Cohort of Cases with SARS

2006 ◽  
Vol 34 (06) ◽  
pp. 937-947 ◽  
Author(s):  
Shao Li ◽  
Ruiqin Wang ◽  
Yulong Zhang ◽  
Xuegong Zhang ◽  
A. Joseph Layon ◽  
...  
Keyword(s):  
Combined Treatment ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Adverse Outcomes ◽  
Therapeutic Effects ◽  
Treatment Protocols ◽  
Oxyhemoglobin Saturation ◽  
Treatment Groups ◽  
Lost To Follow Up

Severe acute respiratory syndrome (SARS) is an infectious disease and some of its symptoms were clinically indistinguishable of those from similar diseases. This study aimed to find the symptom combinations associated with adverse outcome and the therapeutic effects in a cohort of patients with probable SARS retrospectively. In 2003, 123 SARS cases in Beijing were subjected to a strictly western medicine (WM) treatment, or a combined treatment (WM plus Herba houttuyniae injection, addition of individualized herbal treatments when necessary), of which 115 were followed till death or discharge; 8 were transferred and lost to follow-up. In both treatment groups, clinical manifestations were evaluated daily; development of signs and symptoms, and their possible relationship with outcome, were assessed. The relationships between these sign/symptom complexes and outcome under two treatment protocols were evaluated and differences were noted. Dynamic symptom combinations, dividing into the early, the medium-term and the durational symptom clusters, were identified as likely being related to the adverse outcomes of SARS ( p < 0.05, p < 0.01). Compared with a strictly WM treatment, the combined treatment resulted in a longer hospital stay ( p = 0.028), a non-statistically significant mortality rate decrease (combined treatment: 9.6% versus WM: 11.1%), and a significant improvement of arthralgia and myalgia ( p < 0.05) in the early symptom cluster. Additionally, the combined protocol improved arterial oxyhemoglobin saturation significantly at day 22 ( p < 0.05). In conclusion, the progress and outcome of SARS may be associated with specific temporal patterns of development in combination of several non-specific signs and symptom complexes, which are also helpful for evaluating the therapeutic effects on SARS patients.

scholarly journals Efficacy of Combined Laparoscopic and Hysteroscopic Repair of Post-Cesarean Section Uterine Diverticulum: A Retrospective Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Cuilan Li ◽  
Shiyan Tang ◽  
Xingcheng Gao ◽  
Wanping Lin ◽  
Dong Han ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Combined Treatment ◽  
Clinical Manifestations ◽  
Abnormal Uterine Bleeding ◽  
Lower Uterine Segment ◽  
Improvement Rate ◽  
Uterine Scar ◽  
Lost To Follow Up

Background. Diverticulum, one of the long-term sequelae of cesarean section, can cause abnormal uterine bleeding and increase the risk of uterine scar rupture. In this study, we aimed to evaluate the efficacy of combined laparoscopic and hysteroscopic repair, a newly occurring method, treating post-cesarean section uterine scar diverticulum.Methods. Data relating to 40 patients with post-cesarean section uterine diverticulum who underwent combined laparoscopic and hysteroscopic repair were retrospectively analyzed. Preoperative clinical manifestations, size of uterine defects, thickness of the lower uterine segment (LUS), and duration of menstruation were compared with follow-up findings at 1, 3, and 6 months after surgery.Results. The average preoperative length and width of uterine diverticula and thickness of the lower uterine segment were recorded and analyzed. The average durations of menstruations at 1, 3, and 6 months after surgery were significantly shorter than the preoperative one (p<0.05), respectively. At 6 months after surgery, the overall success improvement rate of surgery was 90% (36/40). Three patients (3/40 = 7.5%) developed partial improvement, and 1/40 (2.5%) was lost to follow-up.Conclusions. Our findings showed that combined treatment with laparoscopy and hysteroscopy was an effective method for the repair of post-cesarean section uterine diverticulum.

Sight-threatening progressive corneo-scleral involvement in porphyria cutanea tarda

2021 ◽  
Vol 14 (10) ◽  
pp. e245160
Author(s):  
Sonali Prasad ◽  
Vidhata Vidhata ◽  
Subhash Prasad
Keyword(s):  
Porphyria Cutanea Tarda ◽  
Clinical Manifestations ◽  
Ocular Involvement ◽  
Slit Lamp ◽  
Uroporphyrinogen Decarboxylase ◽  
Progressive Loss ◽  
The Right ◽  
Lost To Follow Up ◽  
Test Serum

Porphyria cutanea tarda is the most common type of porphyria. It is associated with a deficiency of uroporphyrinogen decarboxylase enzyme responsible for heme synthesis. Clinical manifestations are predominantly dermatological and very rarely present with ocular involvement. Although scleral thinning in the interpalpebral area is a well-documented entity, sight-threatening corneal involvement is rarely described. We, herein report a case of a 58-year-old man who presented with ocular surface dryness, photophobia and mild redness. Slit-lamp biomicroscopy revealed corneo-scleral thinning in both eyes. The diagnosis was confirmed with a urine porphyrin test, serum iron and serum ferritin levels. We started him on conservative management after which he was lost to follow-up. He presented again after 6 years with total corneal opacification and progressive loss of vision in the right eye.

High Skp2 Expression Is an Independent Predictor of Unfavorable Outcome in 333 Patients with Diffuse Large B Cell Lymphoma (DLBCL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 1560-1560
Author(s):  
Ritsuko Seki ◽  
Koichi Ohshima ◽  
Fumio Kawano ◽  
Toshihiko Murayama ◽  
Yukiyoshi Moriuchi ◽  
...  
Keyword(s):  
Clinical Stage ◽  
Combined Treatment ◽  
B Cell Lymphoma ◽  
Similar Distribution ◽  
Prognostic Impact ◽  
Advanced Clinical Stage ◽  
Treatment Groups ◽  
Skp2 Expression ◽  
New Treatment

Abstract The addition of rituximab to CHOP (CHOP-R) chemotherapy has resulted in an improved outcome for patients with DLBCL and has recently been shown to diminish the prognostic impact of several recognized biomarkers. S-phase kinase-associated protein 2 (Skp2) is a proto-oncogene that has been shown to be expressed in a number of tumors. We have reported that Skp2 expression in tumor cells is an unfavorable prognostic factor in DLBCL. In the present study, we investigated the significance of Skp2 expression in the patients with DLBCL treated with CHOP or CHOP-R. DLBCL patients (333 cases) were entered into this study, based on the availability of paraffin blocks for interpretable immunohistochemistry for all antigens (CD10, Bcl-6, MUM1, Bcl-2, Skp2). All patients were treated with either CHOP (201) or CHOP-R (132) from 1996 to 2005, and were diagnosed as having DLBCL at the twenty different hospitals. All specimens were histopathologically reviewed before entering into this study. Their clinical characteristics, including either the IPI or R-IPI factors, were evenly matched. The median follow-up of living patients was 3.7 and 2.1 y for CHOP vs CHOP-R, respectively. DLBCL were assigned to GCB subtype (40.8%: 136/333) or non-GCB subtype (59.2%: 197/333) based on the method of Hans et al., Blood 103: 275–82 (2004), with similar distribution in both treatment groups. Expression of bcl-6 (p&lt;0.05) or GCB subtypes (p&lt;0.05) was associated with better overall survival (OS), whereas expression of bcl-2 (p&lt;0.05) was associated with worse OS in CHOP treatment group. The addition of R was associated with an improved survival in the non-GCB subtype and resulted in same as that of GCB subtype. The survival benefit of both low Bcl-2 and high Bcl-6 expressions diminished in combined treatment with R to CHOP. There were 97 patients with high Skp2 expression (&gt;60% positive cells) (97/333: 29.1%). High Skp2 expression was found in both GCB subtype (28.6%) and non-GCB subtype (30.3%). In advanced clinical stage or extranodal involvement (&gt;2), the patients with high Skp2 expression had worse survival than those with low Skp2 expression (p&lt;0.05). Interestingly, in CHOP-R group, high Skp2 expression was the strong biomarker of worse prognosis (p&lt;0.05). DLBCL patients with high Skp2 expression did not benefit from the addition of R to CHOP. Therefore, Skp2 may be a useful prognostic marker in recent rituximab era. The new treatment strategy is necessary for the DLBCL patients with high Skp2 expression. Figure Figure

Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia

1993 ◽  
Vol 162 (6) ◽  
pp. 776-787 ◽  
Author(s):  
Isaac M. Marks ◽  
Richard P. Swinson ◽  
Metin Başoǧlu ◽  
Klaus Kuch ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Combined Treatment ◽  
Randomised Trial ◽  
Treatment Groups ◽  
End Of Treatment ◽  
Group A ◽  
Contrast Group ◽  
Drop Outs ◽  
Cross National

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (‘non-evaluables’). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.

scholarly journals Effect of Butoconazole Nitrate 2% Vaginal Cream and Miconazole Nitrate 2% Vaginal Cream Treatments in Patients with Vulvovaginal Candidiasis

1996 ◽  
Vol 4 (6) ◽  
pp. 323-328
Author(s):  
Myra A. Lappin ◽  
Doris C. Brooker ◽  
Carol A. Francisco ◽  
Joan Dorfman
Keyword(s):  
Potassium Hydroxide ◽  
Signs And Symptoms ◽  
Vulvovaginal Candidiasis ◽  
Vaginal Cream ◽  
Miconazole Nitrate ◽  
Symptom Scores ◽  
Cure Rates ◽  
Lost To Follow Up ◽  
Butoconazole Nitrate

In a multicenter, randomized, invesgtigator-blind, parallel study, 398 patients were dispensed topical butoconazole nitrate 2% cream for 3 days (n = 199) or miconazole nitrate 2% cream for 7 days (n = 199) for vaginal use. Efficacy analyses included 254 patients with culture-confirmedCandida(119 butoconazole and 135 miconazole users). Of the 398 patients issued study medication, 9 were lost to follow-up. Therefore, safety analyses included 389 patients (197 butoconazole and 192 miconazole users). Evaluations upon admission and approximately 8 and 30 days post-treatment includedCandidacultures, potassium hydroxide (KOH) wet mounts, and vulvovaginal examinations, with rating of vulvovaginal signs and symptoms using a 4-point scale. Rates of clinical cure (based on sign/symptom scores), microbiologic cure (based on cultures and wet mounts), and therapeutic cure (both clinical and microbiologic cures) were assessed and were to be similar between the regimens. Therapeutic cure rates were 57.8% and 61.4% for butoconazole and miconazole, respectively. Three-day butoconazole treatment was as safe and effective as 7-day miconazole therapy in treating vulvovaginal candidiasis.

Intra-uterine Methylmercury Poisoning in Iraq

PEDIATRICS ◽  
1974 ◽  
Vol 54 (5) ◽  
pp. 587-595 ◽  
Author(s):  
Laman Amin-Zaki ◽  
Sami Elhassani ◽  
Mohamed A. Majeed ◽  
Thomas W. Clarkson ◽  
Richard A. Doherty ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Laboratory Evaluation ◽  
Marked Contrast ◽  
Milk Samples ◽  
Blood Mercury ◽  
Methylmercury Poisoning ◽  
Neonatal Blood

A disastrous epidemic of methylmercury poisoning occurred in rural Iraq early in 1972, due to the ingestion of home-made bread prepared from wheat treated with a methylmercury fungicide. We report the clinical and laboratory evaluation of 15 infant-mother pairs exposed to methylmercury during pregnancy, including mercury determinations in blood samples of mothers and infants, and in milk samples from mothers, during the first seven months following the epidemic. In all cases except one, the infants' blood mercury levels were higher than their mothers' during the first four months after birth. Our results indicate that methylmercury passes readily from mother to fetus and that neonatal blood mercury levels are maintained through ingestion of mercury in mothers' milk. Clinical manifestations of methylmercury poisoning were evident in six of 15 mothers and in at least six of 15 infants. In five severely affected infants there was gross impairment of motor and mental development. However, in only one infant-mother pair was the infant affected and the mother free of signs and symptoms–a marked contrast to the reports of Japanese mother-infant pairs from Minamata. Careful follow-up studies of these and other Iraqi infants will determined where signs and symptoms of methylmercury poisoning will appear as these children continue to develop. Studies of these and additional infant-mother pairs may allow determination of the prenatal period of greatest fetal sensitivity to methylmercury poisoning.

scholarly journals Clinical and hepatic evaluation in adult dengue patients: a prospective two-month cohort study

2012 ◽  
Vol 45 (6) ◽  
pp. 675-681 ◽  
Author(s):  
Ricardo Tristão-Sá ◽  
Claire Fernandes Kubelka ◽  
Eliana Zandonade ◽  
Sônia Maria Oliveira Zagne ◽  
Natally de Souza Maciel Rocha ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Denv Infection ◽  
Duration Of Symptoms ◽  
Persistent Symptoms ◽  
Study Results ◽  
Taste Alteration

INTRODUCTION: To analyze the liver dysfunction and evolution of signs and symptoms in adult dengue patients during a two-month follow-up period. METHODS: A prospective cohort study was conducted in Campos dos Goytacazes, Rio de Janeiro, Brazil, from January to July, 2008. The evolution of laboratory and clinical manifestations of 90 adult dengue patients was evaluated in five scheduled visits within a two-month follow-up period. Twenty controls were enrolled for the analysis of liver function. Patients with hepatitis B, hepatitis C, those known to be human immunodeficiency virus (HIV) seropositive and pregnant women were excluded from the study. RESULTS: At the end of the second month following diagnosis, we observed that symptoms persisted in 33.3% (30/90) of dengue patients. We also observed that, 57.7% (15/26) of the symptoms persisted at the end of the second month. The most persistent symptoms were arthralgia, fatigue, weakness, adynamia, anorexia, taste alteration, and hair loss. Prior dengue virus (DENV) infection did not predispose patients to a longer duration of symptoms. Among hepatic functions, transaminases had the most remarkable elevation and in some cases remained elevated up to the second month after the disease onset. Alanine aminotransferase (ALT) levels overcame aspartate aminotransferase (AST) during the convalescent period. Male patients were more severely affected than females. CONCLUSIONS: Dengue fever may present a wide number of symptoms and elevated liver transaminases at the end of the second month.

Cranialization of the frontal sinus—the final remedy for refractory chronic frontal sinusitis

2012 ◽  
Vol 116 (3) ◽  
pp. 531-535 ◽  
Author(s):  
J. Marc C. van Dijk ◽  
Michiel Wagemakers ◽  
Astrid G. W. Korsten-Meijer ◽  
C. T. Kees Buiter ◽  
Bernard F. A. M. van der Laan ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Signs And Symptoms ◽  
Anatomical Location ◽  
Frontal Sinusitis ◽  
Long Term Effects ◽  
Assess Patient Satisfaction ◽  
Long Term Follow Up ◽  
Lost To Follow Up

Object Chronic sinusitis can be a debilitating disease with significant impact on quality of life. Frontal sinusitis has a relatively low prevalence, but complications can be severe due to its anatomical location. After failure of conservative measures, typically endoscopic procedures are performed to improve the drainage of the frontal sinus. The cranialization of the frontal sinus is the final surgical measure, in which the affected frontal sinus is truly removed. In this study the authors describe the surgical technique of cranialization of the frontal sinus for refractory chronic frontal sinusitis, systematically search the literature for its application, and assess patient satisfaction in a cohort of consecutively treated patients after long-term follow-up. Methods A consecutive cohort of 15 patients with refractory chronic frontal sinusitis was treated by cranialization of the frontal sinus and followed over a 20-year period (1989–2008) for the direct results and complications of the surgery. Long-term follow-up (mean 6.5 years) was obtained to assess the long-term effects of the cranialization. Results In all patients the signs and symptoms of chronic frontal sinusitis responded very well to the cranialization. Five patients had surgical complications, of which 2 were serious. One patient died of an unrelated cause and 1 patient was lost to follow-up. The remaining 13 patients had a long-term follow-up, which revealed that 12 of them thought that their life was better after the surgical procedure. Conclusions Cranialization of the frontal sinus deserves consideration as the final remedy for refractory chronic frontal sinusitis after definite failure of other options.

Severe Chronic Neutropenia in Korean Children.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4513-4513
Author(s):  
Mee Jeong Lee ◽  
Hyeon Jin Park ◽  
Hee Young Shin ◽  
Hyoung Jin Kang ◽  
Hong Hoe Koo ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Conflicts Of Interest ◽  
Clinical Manifestations ◽  
Bone Marrow Examination ◽  
Korean Children ◽  
Hematologic Disorder ◽  
Lost To Follow Up ◽  
Chronic Neutropenia ◽  
Main Clinical Manifestation

Abstract Abstract 4513 Introduction Severe chronic neutropenia (SCN) is a rare hematologic disorder defined by an absolute neutrophil count less than 0.5×109/L for several months or years. They usually suffer from recurrent infections. Principal subtypes of SCN are congenital, cyclic, idiopathic and primary autoimmune neutropenia (AIN). Patients and Methods Medical records collected from a national survey were retrospectively analyzed on newly diagnosed SCN patients in Korea between January, 1999 and December, 2008 in respect to the diagnosis, clinical manifestations, treatments and prognosis of the patients. Results There were 64 patients (Male, 20; Female 44) reported from 16 hospitals: congenital, 19; cyclic, 16; idiopathic, 25; and immune in origin, 4. The main clinical manifestation was various types of bacterial infections. Two cases (1 congenital, 1 cyclic) were diagnosed by family histories. The median age at diagnosis was 12 months (11 days-158 months). A bone marrow examination was done in 45 patients (70.3 %) at the median age of 26 months (1 day-158 months), with the interval between the initial CBC and BM study being 7.3 months (9 days-138 months). The ELA2 mutation, done in 6 patients, was not detected. Only one patient with congenital SCN evolved to AML at 54 months after diagnosis, who is under chemotherapy. Most patients were treated with G-CSF (5-10 μg/kg/day) during infection episodes. The median follow up duration was 23 months (11 days – 176 months). Two patients of congenital SCN died of infection (pneumonia, meningitis) and 8 patients were lost to follow up, and the remaining are alive. Conclusions SCN is a rare hematologic disease with inherent vulnerability to infections, thus early detection with proper management should be important for survival of SCN patients. We propose a nation-wide, prospective study to delineate the prevalence, molecular diagnosis, natural history, the optimal use of G-CSF, and prognostic factors in Korean patients with SCN. Disclosures: No relevant conflicts of interest to declare.

A Partial Component Analysis of Beck’s Cognitive Therapy for the Treatment of General Anger

2000 ◽  
Vol 14 (1) ◽  
pp. 77-95 ◽  
Author(s):  
Eric R. Dahlen ◽  
Jerry L. Deffenbacher
Keyword(s):  
Cognitive Therapy ◽  
Behavioral Change ◽  
Cognitive Change ◽  
Reliable Change Index ◽  
Trait Anger ◽  
Anxiety And Depression ◽  
Treatment Protocols ◽  
Treatment Groups ◽  
Anger Reduction

Eighty-six high-anger undergraduates were assigned to eight group sessions of Beck’s full cognitive therapy (FCT) focusing on both cognitive and behavioral change, cognitive restructuring only (CRO) focusing only on cognitive change, or a no-treatment control. Analyses suggested treatments were delivered in an equivalent, high-quality manner and that therapists adhered to treatment protocols. By 5-week follow-up, treatment groups, while not differing from each other, showed reductions in trait anger, cognitive, emotional, and behavioral components of anger, the individual’s greatest ongoing source of anger, and anger-related physiological arousal. Treatments lowered anger suppression and outward negative expression and enhanced controlled expression. Compared to controls, CRO also reduced trait anxiety and depression. Treatment effect sizes were medium (η2 = .06 to .13) to large (η2 > .13), and more treatment participants met a clinically reliable change index on trait anger. Findings support FCT and CRO for general anger reduction.

Sign in / Sign up

Export Citation Format

Share Document