Clinical Reasoning: A Middle-Aged Man With a History of Muscle Pain Presenting With Progressive Leukoencephalopathy and Subsequent Coma

Abstract Background PM 2.5 pollution has become a major public health concern in urban China. Understanding the residents’ individual perceptions toward haze pollution is critical for policymaking and risk communication. However, the perceptions of middle-aged and elderly residents, who particularly vulnerable to haze pollution, are poorly understood. Methods A cross-sectional study of 400 randomly sampled individuals (aged 40 to 90 years) was conducted in Wuxi, a typical PM 2.5 -polluted city. Each participant’s demographic and health information, individual perception and pulmonary function outcomes were collected to explore the relationship between personal characteristics and pulmonary function parameters and perception factors. Results We found that the mean values for controllability (4.99 ± 2.78) and dread of self-risk (6.90 ± 2.45) were the lowest and the highest values, respectively, in our study. Education and average family income were positively related with all individual perception factors, while age was negatively associated. A history of respiratory disease was positively associated with all individual perception factors except controllability . Significant positive associations were observed between PEF (coefficients ranged from 0.18 to 0.22) and FEF75% (coefficients ranged from 0.18 to 0.29) with a variety of individual perception factors. Conclusions There was a lack of concern and knowledge, weak self-protection consciousness and a strong dread of PM 2.5 pollution among the middle-aged and elderly residents in Wuxi. Their individual perceptions were associated with age, education levels, average family income, history of respiratory disease and pulmonary function outcomes. Our findings may help policymakers develop effective policies and communication strategies to mitigate the hazards of haze among older residents.

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Clinical features and outcome of Covid-19 in individuals without Comorbidities. Do children have the advantage?

Pediatric Review International Journal of Pediatric Research ◽

10.17511/ijpr.2021.i02.04 ◽

2021 ◽

Vol 8 (2) ◽

pp. 88-93

Author(s):

Dr. Abhishek Kumar ◽

◽

Dr. Nilu Kumari ◽

Dr. Ranjeet Kumar Singh ◽

Dr. Alok Kumar ◽

...

Keyword(s):

Severe Disease ◽

Age Groups ◽

Asymptomatic Infection ◽

Healthy Individuals ◽

Adult Group ◽

Middle Aged ◽

History Of ◽

Adults And Children ◽

The Mean ◽

Respiratory Complaints

Objective: Information regarding clinical characteristics and the natural course of COVID-19amongst individuals without comorbidities is scarce. We therefore conducted a retrospectiveobservational study to decipher the disease profile in two different age groups, middle-aged (40-59years) and children (up to 12 years). Method: Study was conducted by reviewing the medicalrecords of all patients in the desired age groups and excluding all those with preexisting illness(called comorbidities). Result: A total of 154 and 27 patients were enrolled and studied in themiddle-aged adults and children group respectively. Males dominated in both groups with a sex ratioof 2.9 in adults and 1.7 in children. Most of the children (92.5%) had a history of exposure from aninfected family member, while in the adult group history of contact was present in 71.4% ofpatients.62.9% of children had an asymptomatic infection which was significantly higher than 22.8%in adults. Cough and fever were the most common symptoms in both age groups, but adults weremore likely to have respiratory complaints when compared with children.11 (7.1%) patients in theadult group had severe disease while in the children group none had severe disease. Similarly in theadult group 11 patients required ICU admission, but none in the children group. The mean durationof RTPCR positivity was similar in both groups. There was 1 (0.6%) expiry in the adult groupwhereas none in children. Conclusion: Healthy individuals in both middle-aged and children grouptend to have milder disease and both harbour the virus for the almost same duration but adults aremore symptomatic in comparison to children and hence children are more likely to be potentialasymptomatic carrier and transmitter of infection.

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Overdosing the Overdosed

The Cognitive Autopsy ◽

10.1093/med/9780190088743.003.0032 ◽

2020 ◽

pp. 211-218

Author(s):

Pat Croskerry

Keyword(s):

Emergency Department ◽

Head Injury ◽

Medication Error ◽

General Hospital ◽

Middle Aged ◽

Fundamental Attribution Error ◽

Inappropriate Use ◽

Laboratory Error ◽

Toxic Drug ◽

History Of

In this case, a middle-aged male presents to the emergency department (ED) of a general hospital with dizziness and weakness and a history of falling the previous day associated with seizures. There is also a possibility of head injury. He is well known to the department and has been seen previously by the head of the department regarding inappropriate use of the ED. Some difficulty ensues in terms of whether he has been having seizures or not, which, combined with a medication error and a laboratory error, results in him being overdosed with a significantly toxic drug. The case is an example of groupthink as well as fundamental attribution error.

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A Middle-Aged Man With a History of Asthma Presenting With Recurrent Episodes of Respiratory Distress

CHEST Journal ◽

10.1016/j.chest.2019.11.059 ◽

2020 ◽

Vol 158 (4) ◽

pp. e205-e208

Author(s):

Dale Jun ◽

Laura W. Glassman ◽

Allison Ariniello ◽

Guy W. Soo Hoo

Keyword(s):

Respiratory Distress ◽

Middle Aged ◽

History Of

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Role of Blood Pressure in Mediating Carotid Artery Dilation in Response to Sympathetic Stimulation in Healthy, Middle-Aged Individuals

American Journal of Hypertension ◽

10.1093/ajh/hpz159 ◽

2019 ◽

Author(s):

Arron Peace ◽

Virginia Pinna ◽

Friso Timmen ◽

Guillherme Speretta ◽

Helen Jones ◽

...

Keyword(s):

Blood Pressure ◽

Carotid Artery ◽

Cold Pressor Test ◽

Cold Pressor ◽

Sympathetic Stimulation ◽

Middle Aged ◽

Cvd Risk ◽

Significant Difference ◽

History Of ◽

Relative Change

Abstract Objectives Carotid artery diameter responses to sympathetic stimulation, i.e., carotid artery reactivity (CAR), represent a novel test of vascular health and relates to cardiovascular disease (CVD)/risk. This study aims to understand the relationship between the increase in blood pressure and carotid artery diameter response during the CAR-test in healthy, middle-aged men. Methods Sample consisted of 40 normotensive men (aged 31–59 years) with no history of CVD of currently taking medication. Noninvasive ultrasound was used to measure carotid artery diameter during the cold pressor test (CPT), with CAR% being calculated as the relative change from baseline (%). Mean arterial pressure (MAP) was measured with beat-to-beat blood pressure recording. Results CAR% was 4.4 ± 5.4%, peaking at 92 ± 43 seconds. MAP increased from 88 ± 9 mmHg to 110 ± 15 mmHg, peaked at 112 ± 38 seconds, which was significantly later than the diameter peak (P = 0.04). The correlation between resting MAP and CAR% was weak (r = 0.209 P = 0.197). Tertiles based on resting MAP or MAP-increase revealed no significant differences between groups in subject characteristics including age, body mass index, or CAR% (all P > 0.05). Subgroup analysis of individuals with carotid constriction (n = 6) vs. dilation (n = 34), revealed no significant difference in resting MAP or increase in MAP (P = 0.209 and 0.272, respectively). Conclusion Our data suggest that the characteristic increase in MAP during the CPT does not mediate carotid artery vasomotion.

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