INFECTIOUS CROUP. II. "VIRUS" CROUP

PEDIATRICS ◽  
1948 ◽  
Vol 2 (4) ◽  
pp. 415-427
Author(s):  
EDWARD F. RABE
Keyword(s):  
Respiratory Tract ◽  
Cause Of Death ◽  
Progressive Disease ◽  
Specific Treatment ◽  
Severe Complication ◽  
Type B ◽  
Common Cause ◽  
Clinical Forms ◽  
Viral Influenza ◽  
Respiratory Embarrassment

Of the three etiologic types of infections croup the most frequently occurring type in this study was so-called "virus" croup. The pathology of so-called "virus" croup is distinct from that of croup due to H. influenzae type B and C. diphtheriae. It is similar to viral influenza in man and viral laryngotracheitis in chickens. Clinically "virus" croup is a progressive disease with downward spread of the infection in the respiratory tract. The inflammation can extend to various regions resulting in the clinical forms of the disease known as laryngitis, laryngotracheitis, or laryngotracheopneumonitis. The mortality increases as the disease spreads down the respiratory tract. There is no well-founded specific treatment for "virus" croup. However, sulfadiazine should be given to all infectious croup patients until cultures of the rhinopharynx and blood assure the absence of H. influenzae type B. Continued chemotherapy should be given all patients severely ill with the disease. The most frequent and severe complication of "virus" croup is some form of extraalveolar thoracic air. The most common cause of death is respiratory embarrassment.

scholarly journals Early Mortality and Aggressive Presentation Lead to Poor Outcomes in Patients with Newly Diagnosed Double Hit and Triple Hit Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3762-3762
Author(s):  
Charanpreet Singh ◽  
Sreejesh Sreedharanunni ◽  
Vandana Panakkal ◽  
Aditya Jandial ◽  
Arihant Jain ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
High Risk ◽  
Cause Of Death ◽  
Progressive Disease ◽  
Plasma Cells ◽  
Hazard Ratio ◽  
Newly Diagnosed ◽  
Common Cause ◽  
Double Hit

Abstract INTRODUCTION mSMART classifies high-risk Multiple Myeloma patients into Double Hit and Triple Hit Myeloma (DH/THM) on the basis of the number of high-risk cytogenetic abnormalities detected. The outcome of these patients with the use of proteasome inhibitors and IMiDs with upfront Auto HSCT is not known in the real-world setting. We retrospectively studied the outcome of these patients in a resource constrained setting. METHODS The case records of all newly diagnosed multiple myeloma patients who fulfilled the criteria for active myeloma between January 2018 and December 2020 were identified. The diagnosis of double hit and triple hit myeloma was based on mSMART classification (Presence of two or more of the following: IgH-FGFR3 translocation, IgH-MAF translocation, TP53 deletion, gain of chromosome 1q). Their case records were retrieved and information regarding baseline characteristics, therapy and outcomes was noted. RESULTS A total of 55 patients with newly diagnosed DH/THM were treated at our center during the study period. Median age of the cohort was 60 years with almost an equal number of male and female patients (M= 26; F= 29). Renal failure (serum creatinine >2.0mg/dl) was present in 33 patients (60%) while bone lesions, anemia (Hemoglobin <10 gm/dl) and hypercalcemia (serum calcium >12mg/dl) were present in 44 (80%), 51 (92.7%) and 24 (43.6%) patients respectively. Six patients (10.9%) fulfilled the criteria for plasma cell leukemia. All but 2 patients had gain of 1q with at least 3 copies. The most common cytogenetic combination was IgH-FGFR3 translocation with gain of 1q, which was seen in 28 patients (50.9%). This was followed by co-occurrence of TP53 deletion with gain of chromosome 1q in 11 patients (20%). Nine patients (16.4%) had triple hit myeloma. Bortezomib was used in the initial therapy of 43 patients (78.2%) and IMiDs (lenalidomide, thalidomide and pomalidomide) were used in the initial therapy of 32 patients (58.2%). Most patients received triplet therapy (N=32; 58.2%) with the most common regimen being RVd. Nine patients (16.4%) died within the first month of diagnosis and another 7 died in next month [15 patients in 2 months (29.1%)]. The most common cause of death within 2 months was progressive disease (N=13; 81.3%). Twenty-two patients (40%) achieved VGPR or better with anti-myeloma therapy and 7 patients (12.7%) underwent autologous HCT. Of the 39 evaluable patients, 21 patients (53.8%) relapsed during follow up with a median EFS of 8 months. Of the 7 patients who underwent transplant, 5 patients have had a follow-up of more than 1 year, of whom 3 have relapsed. One patient with post-transplant relapse died with progressive disease and CMV colitis. Median follow up of the entire cohort was 11 months (Range- 0 to 35 months). After excluding patients who died within the first 2 months of diagnosis, the median follow up was 14 months (Range- 3 to 35 months). Thirty-three patients (60%) patients died during follow-up. The most common cause of death was active or progressive disease (25 patients, 78.1%). Median OS for the cohort was 13 months. On univariate analysis, survival was better for patients without renal injury at presentation (29 months vs 6 months; p=0.007) and patients with <5% circulating plasma cells (14 months vs 2 months; p=0.045). Patients who achieved VGPR had a better OS than patients who did not (Not reached vs 3 months; p=0.000) as did patients who underwent auto transplant (Not reached vs 10 months; p=0.023). OS did not significantly differ with TP53 deletion status, or number of copies of 1q (3 or greater than 3). In the multi-variate analysis, presence of renal failure (Hazard ratio- 2.663; p-0.017) and >5% circulating plasma cells (Hazard ratio- 3.082; p-0.020) were significantly associated with increased risk of mortality, while achievement of VGPR or better with therapy was associated with longer survival (Hazard ratio- 0.174; p-0.001). DISCUSSION The outcome of DH/THM remains poor in the real-world setting. The outcome was not affected by specific high-risk cytogenetic abnormalities or their combination in our study. Progressive disease within the first two months of diagnosis was the most common cause of death in more than 1/3 rd of the patients. Novel therapies and protocols are required to improve outcomes for this group of multiple myeloma patients. Disclosures No relevant conflicts of interest to declare.

Energy-Sensing Pathways in Ischemia: The Counterbalance Between AMPK and mTORC

2020 ◽  
Vol 25 (45) ◽  
pp. 4763-4770
Author(s):  
Angel Cespedes ◽  
Mario Villa ◽  
Irene Benito-Cuesta ◽  
Maria J. Perez-Alvarez ◽  
Lara Ordoñez ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cause Of Death ◽  
Artery Occlusion ◽  
Brain Pathology ◽  
Common Cause ◽  
Specific Analysis ◽  
Energy Sensing ◽  
Cerebral Artery Occlusion

: Stroke is an important cause of death and disability, and it is the second leading cause of death worldwide. In humans, middle cerebral artery occlusion (MCAO) is the most common cause of ischemic stroke. The damage occurs due to the lack of nutrients and oxygen contributed by the blood flow. : The present review aims to analyze to what extent the lack of each of the elements of the system leads to damage and which mechanisms are unaffected by this deficiency. We believe that the specific analysis of the effect of lack of each component could lead to the emergence of new therapeutic targets for this important brain pathology.

scholarly journals The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mohammad Amin Abazari ◽  
Deniz Rafieianzab ◽  
M. Soltani ◽  
Mona Alimohammadi
Keyword(s):  
Aortic Dissection ◽  
Clinical Decision Making ◽  
Beta Blockers ◽  
False Lumen ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Patient Specific ◽  
Type B ◽  
Windkessel Model ◽  
Computed Tomography Images

AbstractAortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

scholarly journals EXPRESS: Retrospective study of clinical characteristics and viral etiologies of patients with viral pneumonia in Beijing

2021 ◽  
pp. 204589402110110
Author(s):  
Xiang Zhao ◽  
Yao Meng ◽  
Duo Li ◽  
Zhaomin Feng ◽  
Weijuan Huang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Influenza A ◽  
Clinical Characteristics ◽  
Ebola Virus ◽  
Treatment Strategies ◽  
Lavage Fluid ◽  
Viral Pneumonia ◽  
Chip Technology ◽  
Viral Influenza ◽  
Simplex Virus

Aims: The virus is common in patients with viral pneumonia. However, the viral etiology and clinical features of patients with viral pneumonia in China remain unclear. The main purpose of this study was to analyze the viral causes and epidemiology of patients with viral pneumonia in Beijing, which can significantly improve the pertinence and accuracy of clinical treatment of the disease. Methods: Firstly, 1,539 respiratory specimens of pneumonia (oropharyngeal swabs, nasopharyngeal swabs, saliva samples and bronchoalveolar lavage fluid) were collected from 19 hospitals in Beijing from September 2015 to August 2018. Then, TaqMan low-density microfluidic chip technology was used to detect viral pneumonia specimens in 1,539 respiratory tract specimens of pneumonia, and determine the types of viral bacteria in them. Lastly, the analysis of demographic, clinical and etiological data of patients with viral pneumonia was performed. Results: The results showed that among the 1,539 respiratory tract specimens with pneumonia, 760 were detected as viral pneumonia specimens, with a positive rate of 49.4%. Among which, 467 were infected with mono-viral and 293 were infected with multi-viral. Influenza A virus (Flu A), mycoplasma pneumoniae (MPn), ebola virus (EBV) and herpes simplex virus type 1 (HSV-1) were the major viral components in the samples of these patients. Furthermore, these viral species were significantly associated with sample sources, onset season and certain clinical characteristics. Discussion: Our findings may provide corresponding treatment strategies for viral pneumonia patients infected with specific viruses.

scholarly journals Suicide prevention in low- and middle-income countries: part perceptions, partial solutions

2017 ◽  
Vol 211 (5) ◽  
pp. 264-265 ◽  
Author(s):  
K. S. Jacob
Keyword(s):  
Public Health ◽  
Suicide Prevention ◽  
Cause Of Death ◽  
Population Based ◽  
Personal Distress ◽  
Public Health Perspective ◽  
Middle Income ◽  
Common Cause ◽  
Middle Income Countries ◽  
Low And Middle Income

SummarySuicide, a common cause of death in many low- and middle-income countries, has often been viewed through a medical/psychiatric lens. Such perspectives medicalise social and personal distress and suggest individual and medication-based treatments. This editorial argues for the need to examine suicide from a public health perspective and suggests the need for population-based social and economic interventions.

SUDDEN AND UNEXPECTED DEATH IN INFANCY AND CHILDHOOD

PEDIATRICS ◽  
1956 ◽  
Vol 17 (5) ◽  
pp. 663-699 ◽  
Author(s):  
Lester Adelson ◽  
Eleanor Roberts Kinney
Keyword(s):  
Sudden Death ◽  
Respiratory Tract ◽  
Pulmonary Edema ◽  
Cause Of Death ◽  
Respiratory Infections ◽  
Past History ◽  
Prognostic Significance ◽  
Control Group ◽  
Unexpected Death ◽  
History Of

One hundred twenty-six consecutive cases of sudden and unexpected death in children between the ages of 10 days and 2 years were studied. Anatomic and microbiologic studies were carried out and an investigation was made at the home in each case. Both sexes were equally vulnerable. Eighty-five per cent of the children were less than 6 months old. The peak incidence was at 2 months. Ninety-nine children were found dead and 27 were observed to die. The same variety and severity of anatomic lesions were found in both categories. Sixteen children in the same age range who died rapidly following known lethal voilence were studied as a control group. Of the nontraumatic sudden death ("unexplained") series 106 (84 per cent) revealed microscopic inflammatory changes in 1 or more sites of the respiratory tract, and histologic evidence of inflammatory disease in other organs was seen in many cases. Acute hemorrhagic pulmonary edema was a common anatomic finding (82 per cent). It was usually accompanied by visceral and cerebral congestion and hemorrhages. Special investigative procedures including staining of the liver for glycogen, determination of the glucose level of the cerebrospinal fluid and study of the adrenals for sudanophilia and birefringence indicated that these factors are without significance in sudden death in early life. A variety of congenital and acquired abnormalities, the presence of which had been unsuspected, was demonstrated at necropsy. Eleven per cent of the 126 cases showed no anatomic abnormalities other than the circulatory phenomena. No single bacterial organism or group of organisms was isolated with any degree of consistency from any site. All attempts to isolate viruses were negative. Ante-mortem symptomatology, circumstances of death, history of contact with infectious disease, and past history of repeated respiratory infection were without prognostic significance and were not pathognomic as to the cause of death. Eighty children had histories of mild illness for 48 hours or less prior to death. Fifty-three children had received some form of treatment during this interval. Sixty-nine children had histories of contact with infectious diseases. Forty-one children had past histories of repeated respiratory infections. The cases came from every social level. Sixty-five per cent had received good care while 35 per cent had received poor care. Many of the control cases showed inflamatory disease in the respiratory tract similar to that seen in the natural death group as well as anatomic evidence of lethal trauma. The inflammatory lesions are thus not incompatible with life. Several hypotheses are offered in an effort to link microscopic inflammatory respiratory tract changes with hemorrhagic pulmonary edema and sudden death. Anatomic and anamnestic evidence exclude mechanical suffocation by bedding. No statement as to the cause of death of an infant who has died suddenly and unexpectedly should be made without complete gross and microscopic studies and thorough investigation of the scene and circumstances of death.

scholarly journals Choroidal Tubercles, an Ocular Presentation in Tuberculosis- a Retrospective Observational Hospital-based Study

2021 ◽  
pp. 1-6
Author(s):  
Rohit Raina ◽  
Neha Chhabra
Keyword(s):  
Cause Of Death ◽  
Primary Infection ◽  
Visual Loss ◽  
The Body ◽  
Infection Site ◽  
Hospital Record ◽  
Record System ◽  
Ocular Tuberculosis ◽  
Common Cause ◽  
Tuberculosis Patients

Aim: To find the prevalence of choroidal tubercles in tuberculosis patients. Introduction: Tuberculosis is the most common cause of infectious cause of death especially in endemic countries. Tuberculosis infection spreads hematogenously from primary infection site to rest of the body. Ocular presentation manifests in the form of choroidal tubercles being the most common fundus change. Materials and Methods: It was a retrospective, observational hospital-based study. Total 100 tuberculosis patients were studied and their data were collected from Hospital record system from February 2020 to March 2021. Fundus examinations were reviewed and most common ocular presentation was found to be choroidal tubercles. Observations and Results: During the study period, out of 100 patients, 60% were females and 40% were males. Fundus changes were present in 14% patients and these were choroidal tubercles in 12% patients and papillitis in 2%. Choroidal tubercles were present in 7 females and 5 males. Conclusion: We concluded that choroidal tubercles is one of the most common form of ocular tuberculosis. Detection of choroidal inflammation can prevent visual loss as the ocular lesion resolves fully with timely management.

scholarly journals Trueperella (Arcanobacterium pyogenes) in Farmed White-Tailed Deer

EDIS ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 3
Author(s):  
Samantha M. Wisely ◽  
Katherin A. Sayler ◽  
Kathryn D. Pothier
Keyword(s):  
Cause Of Death ◽  
Common Cause ◽  
Wildlife Ecology ◽  
Fact Sheet ◽  
Arcanobacterium Pyogenes

Trueperella is a harmless bacterium in intestinal tracts of ruminants like deer, cattle, and pigs, but if it migrates out of the intestine to other areas of an animal’s body and proliferates, it can make the animal sick. Trueperella causes many problems in deer, including lesions, abscesses, and pneumonia, and it is one of the types of bacteria that is known to contribute to the disease lumpy jaw. In young fawns, it is a common cause of death. This 3-page fact sheet written by Kathryn D. Pothier, Katherine A. Sayler, and Samantha M. Wisely and published by the Department of Wildlife Ecology and Conservation explains how to spot and treat trueperella, or, better yet, prevent it in the first place.­http://edis.ifas.ufl.edu/uw427

Stroke

2020 ◽  
pp. 383-388
Author(s):  
Perry Elliott ◽  
Pier D. Lambiase ◽  
Dhavendra Kumar
Keyword(s):  
Sickle Cell Disease ◽  
Fabry Disease ◽  
Cause Of Death ◽  
Sickle Cell ◽  
Single Gene ◽  
Cerebral Haemorrhage ◽  
Developed Countries ◽  
Common Cause ◽  
The Third ◽  
Moya Moya Disease

Stroke is the third most common cause of death, and the most common cause of disability in developed countries. This chapter examines the genetics of stroke, and single gene causes (although stroke is often just one component of the phenotype). It then describes Anderson—Fabry disease, CADASIL, RVCL, autosomal-dominant porencephaly and infantile hemiparesis, hereditary cerebral haemorrhage with amyloidosis, Moya-Moya disease, sickle cell disease, and MELAS.

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