scholarly journals Mortality among patients with non-affective functional psychoses in a metropolitan area of South-Eastern Brazil

1996 ◽  
Vol 30 (4) ◽  
pp. 304-309 ◽  
Author(s):  
Paulo R. Menezes ◽  
Anthony H. Mann
Keyword(s):  
Confidence Interval ◽  
Psychiatric Hospitals ◽  
First Year ◽  
Eastern Brazil ◽  
Adequate Care ◽  
Functional Psychoses ◽  
Clinical Diagnoses ◽  
Life Threatening ◽  
Standardised Mortality Ratios ◽  
Discharge From Hospital

High mortality rates among those suffering from schizophrenia and related psychoses have been consistently described in developed societies. However, to date there is a lack of data on this matter in Brazil. In order to examine this issue, a prospective 2-year follow-up study was carried out in S. Paulo. The sample consisted of 120 consecutive admissions to psychiatric hospitals in a defined catchment area, aged 18 to 44 years old, with clinical diagnoses of non-affective functional psychoses according to the ICD-9. After 2 years, 116 (96.7%) subjects were traced. During the study period there were 7 deaths (6.0% of those traced), 5 (4.3%) due to suicide. All but one of the suicides occurred in the first year after discharge from hospital. Age and sex Standardised Mortality Ratios (relative to rates for the population of the city of Sao Paulo) were 8.4 for overall mortality (95% confidence interval: 4.0-15.9) and 317.9 for deaths due to suicide (95% confidence interval: 125.2-668.3). These results are in agreement with previous studies, and show that in Brazil non-affective functional psychoses are life-threatening illnesses, which need adequate care, particularly when patients go back to live in the community after hospital discharge.

scholarly journals Stridor in infant caused by subglottic hemangiome: case report

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Raquel Lot ◽  
Caroline Rosa ◽  
Camila Freitas ◽  
Gracinda Adnet ◽  
Luisa Costa ◽  
...  
Keyword(s):  
Beta Agonist ◽  
First Year ◽  
Vascular Neoplasms ◽  
Threatening Condition ◽  
Life Threatening ◽  
Diagnostic Hypothesis ◽  
Therapeutic Measures ◽  
The Right ◽  
First Year Of Life ◽  
Age Range

Subglottic hemagioma is a rare cause of stridor, but it is one of the most common vascular neoplasms of the airways in childhood. If the treatment is not promptly instituted, it becomes a life-threatening condition. The diagnosis should be suspected when infants outside the age range for acute laryngitis present with stridor associated with severe respiratory effort, without viral prodromes, with a condition that is not responsive to initial therapeutic measures considering the main diagnostic hypothesis. Infantile hemangiomas begin to proliferate during the first year of life (between the 1st and 2nd month of life). Involution usually occurs between 6 months and 12 months of life (most involution until 4 years). The case is a 5-month-old female infant, with sudden stridor associated with respiratory distress without viral prodromes or fever, with little response to inhaled short-acting beta-agonist, inhaled adrenaline, as well as corticosteroids inhalation/parenteral. Bronchoscopy showed a bulging of the submucosa to the right of the subglottis with slight vascularization, suggestive of subglottic hemangioma. Treatment with propranolol was initiated orally with the aim of regressing the hemangioma and after clinical stability, the infant was discharged with outpatient follow-up.

scholarly journals Benefits of venom immunotherapy: How soon can they be expected

2017 ◽  
Vol 145 (3-4) ◽  
pp. 173-177
Author(s):  
Sasa Kadivec ◽  
Mitja Kosnik
Keyword(s):  
First Year ◽  
Severe Reaction ◽  
Allergic Reactions ◽  
Venom Immunotherapy ◽  
Emergency Situations ◽  
Sting Reaction ◽  
Life Threatening ◽  
Medical Emergencies ◽  
The Cost ◽  
Patients Experience

Introduction/Objective. Allergic reactions to insect stings are medical emergencies that could be prevented by venom immunotherapy (VIT). The main purpose of VIT is to prevent fatal or life-threatening reactions. We aimed to show the rapidity with which patients experience the benefits of VIT and estimate the number of emergency treatments that are prevented. Methods. We reviewed the medical files of patients who started VIT between 2010 and 2014. We calculated the costs of treatment of the sting reactions, the costs of immunotherapy, and estimated the costs of prevented allergic reactions. Results. In a cohort of 514 patients (40.9% female, age 47.2 ? 14.4 years), the cost of treatment of the index sting reaction was 180.4 ? 166.8 euros. During VIT, 195 patients experienced 446 field stings. In 86.3% of patients, stings were well tolerated, and only one patient experienced a severe reaction (grade III, according to Mueller). A total of 20.4% of VIT treated patients were stung during the first year of VIT and 57% during five years of VIT. The expenditure for five years of VIT was 2,886 euros per patient, which corresponded to an average of 16 emergency treatments for systemic reactions. Conclusion. Emergency situations are prevented in a substantial number of venom-allergic patients and a beneficial effect was already observed during the first year of VIT.

Clinical presentation and treatment of melioidosis in the head and neck region

2018 ◽  
Vol 132 (9) ◽  
pp. 827-831 ◽  
Author(s):  
K Mahawerawat ◽  
P Kasemsiri
Keyword(s):  
Early Diagnosis ◽  
Confidence Interval ◽  
Head And Neck ◽  
Clinical Presentation ◽  
Neck Region ◽  
Oral Antibiotic ◽  
Head And Neck Region ◽  
Indirect Haemagglutination ◽  
Appropriate Treatment ◽  
Life Threatening

AbstractBackgroundAlthough melioidosis in the head and neck region is uncommon, it is a potentially life-threatening infection. Thus, early diagnosis and proper management are very important.ObjectivesTo report the clinical presentation and management of melioidosis in the head and neck.MethodA retrospective study was conducted from 1 January 2013 to 31 October 2016 in Mukdahan Hospital, Thailand. Case records of patients who had presented with culture-positive melioidosis were analysed.ResultsMedical records of 49 patients (23 males and 26 females) were analysed. Patients ranged in age from 1 to 75 years. Clinical presentations included 22 parotid abscesses, 16 neck abscesses and 11 suppurative lymphadenitis cases. Only 35 patients (71 per cent) had high indirect haemagglutination assay titres of ≥ 1:160 (95 per cent confidence interval = 45.35–88.28). Almost half of the patients received intravenous ceftazidime and subsequently oral co-trimoxazole. Oral antibiotic regimens were prescribed for mild localised melioidosis. Overall, 95.65 per cent of patients were in remission and no relapses were observed (95 per cent confidence interval = 85.47–98.80).ConclusionCareful clinical correlation and proper investigation are required to establish an early diagnosis of melioidosis and to initiate appropriate treatment.

scholarly journals Association of Urinary Biomarkers of Kidney Injury with Estimated GFR Decline in HIV-Infected Individuals following Tenofovir Disoproxil Fumarate Initiation

2018 ◽  
Vol 13 (9) ◽  
pp. 1321-1329 ◽  
Author(s):  
Simon B. Ascher ◽  
Rebecca Scherzer ◽  
Michelle M. Estrella ◽  
William R. Zhang ◽  
Anthony N. Muiru ◽  
...  
Keyword(s):  
Risk Factors ◽  
Confidence Interval ◽  
Cystatin C ◽  
Tenofovir Disoproxil Fumarate ◽  
Disease Risk ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
First Year ◽  
Mixed Effect ◽  
Monocyte Chemoattractant Protein 1

Background and objectivesTenofovir disoproxil fumarate (tenofovir) is associated with elevated concentrations of biomarkers of kidney damage and dysfunction in individuals with HIV. The relationship of these kidney biomarkers with longitudinal kidney function decline is unknown.Design, setting, participants, & measurementsWe evaluated associations of 14 urinary biomarkers of kidney injury with changes in eGFR among 198 men and women with HIV who initiated tenofovir between 2009 and 2015 in the Multicenter AIDS Cohort Study and Women’s Interagency HIV Study. Urinary biomarkers included albumin-to-creatinine ratio, α-1-microglobulin, β-2-microglobulin, cystatin C, kidney injury molecule-1 (KIM-1), IL-18, neutrophil gelatinase–associated lipocalin (NGAL), clusterin, osteopontin, uromodulin, monocyte chemoattractant protein-1, EGF, trefoil factor 3, and chitinase 3-like protein 1. We used multivariable linear mixed-effect models controlling for demographics, traditional kidney disease risk factors, and HIV-related risk factors to evaluate associations of baseline biomarkers with first-year changes in eGFR, and associations of year 1 and first-year change in biomarkers with changes in eGFR from year 1 to year 3. We used the least absolute shrinkage and selection operator method to identify a parsimonious set of biomarkers jointly associated with changes in eGFR.ResultsMedian eGFR before tenofovir initiation was 103 (interquartile range, 88–116) ml/min per 1.73 m2. During the first year of tenofovir use, eGFR decreased on average by 9.2 (95% confidence interval, 6.5 to 11.9) ml/min per 1.73 m2 and was stable afterward (decrease of 0.62; 95% confidence interval, −0.85 to 2.1 ml/min per 1.73 m2 per year). After multivariable adjustment, higher baseline β-2-microglobulin, KIM-1, and clusterin were associated with larger first-year eGFR declines, whereas higher baseline uromodulin was associated with a smaller eGFR decline. First-year increase in urinary cystatin C and higher year 1 IL-18 were associated with larger annual eGFR declines from year 1 to year 3. The parsimonious models identified higher pre-tenofovir clusterin and KIM-1, lower pre-tenofovir uromodulin, and higher year 1 IL-18 as jointly associated with larger eGFR declines.ConclusionsUrinary biomarkers of kidney injury measured before and after tenofovir initiation are associated with subsequent changes in eGFR in individuals with HIV.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_08_28_CJASNPodcast_18_9_S.mp3

Delayed diagnosis of bilateral subdural effusions complicating intracranial hypotension in a patient presenting with post lumbar puncture headache

2021 ◽  
Vol 14 (2) ◽  
pp. e239559
Author(s):  
Saleheen Huq ◽  
Menaka G Iyer ◽  
Samson O Oyibo
Keyword(s):  
Lumbar Puncture ◽  
Delayed Diagnosis ◽  
Bed Rest ◽  
Viral Meningitis ◽  
Magnetic Imaging ◽  
Intracranial Complications ◽  
Life Threatening ◽  
History Of ◽  
Discharge From Hospital ◽  
Subdural Effusions

A 34-year-old woman presented with an unrelenting headache which had been ongoing since discharge from hospital 4 days before. She initially presented 2 weeks earlier with a 7 days history of severe headache, for which she had a CT scan, lumbar puncture and treatment for possible viral meningitis. The headache got worse 4 days after the lumbar puncture. Despite analgesics and bed rest, the headache persisted. A subsequent magnetic imaging scan demonstrated bilateral subdural effusions. She was given supportive treatment, which included advice concerning strict bed rest and analgesia. The headache took several months to abate. A third of patients suffer from post lumbar puncture headaches and this should be explained during informed consenting and post procedure. Not all post lumbar puncture headaches are simple headaches. A post lumbar puncture headache continuing for more than 7–14 days after the procedure requires further investigation to exclude life-threatening intracranial complications.

scholarly journals Lemierre Syndrome: A Meta-analysis

2020 ◽  
Vol 24 (03) ◽  
pp. e379-e385
Author(s):  
Mitchell R. Gore
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Sufficient Data ◽  
Lemierre Syndrome ◽  
Patient Demographics ◽  
Treatment Type ◽  
Pubmed Database ◽  
Life Threatening ◽  
Cranial Neuropathies

Abstract Introduction Lemierre syndrome, or postpharyngitis anaerobic sepsis, is an infrequent but life-threatening infection that often involves thrombosis of the internal jugular vein. The role of anticoagulation in addition to antibiotics and surgical treatment remains uncertain. Objectives 1) To perform a meta-analysis on outcomes and treatment of Lemierre syndrome; and 2) to evaluate the effect of anticoagulation in Lemierre syndrome on vessel recanalization and on mortality. Data Synthesis A Pubmed database search was conducted using the keywords Lemierre syndrome. A total of 427 studies were identified and reviewed. Data were extracted on patient demographics, treatment type including use and type of anticoagulation, type of antibiotics, presence and location of vessel thrombosis, presence of cranial neuropathies, recanalization of thrombosed vessels on follow-up imaging, organisms isolated on wound or blood cultures, and mortality. The primary outcome variables examined were the effect of anticoagulation on vessel recanalization and mortality. After the review, 359 studies totaling 394 patients between 1990 and 2017 had partial or complete data that could be analyzed. In total, 50 patients had sufficient data on the effect of anticoagulation on vessel recanalization, and 194 had sufficient data on the effect of anticoagulation on mortality. The odds ratio for anticoagulation and vessel recanalization was 1.6 (95% confidence interval = 0.3 to 9.4; p = 0.6). The odds ratio for anticoagulation and death was 0.6 (95% confidence interval = 0.1 to 2.9; p = 0.5). Conclusion The present meta-analysis did not demonstrate a statistically significant effect on vessel recanalization or mortality for patients treated with anticoagulation versus patients not anticoagulated in the Lemierre syndrome literature.

scholarly journals Association of Continuation of Loop Diuretics at Hemodialysis Initiation with Clinical Outcomes

2018 ◽  
Vol 14 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Scott Sibbel ◽  
Adam G. Walker ◽  
Carey Colson ◽  
Francesca Tentori ◽  
Steven M. Brunelli ◽  
...  
Keyword(s):  
Weight Gain ◽  
Confidence Interval ◽  
Loop Diuretic ◽  
Loop Diuretics ◽  
Dialysis Initiation ◽  
First Year ◽  
Intradialytic Hypotension ◽  
Interdialytic Weight Gain ◽  
Adjusted Incidence Rate ◽  
Adjusted Incidence

Background and objectivesLoop diuretics are commonly used to manage nondialysis-dependent CKD. Despite benefits of augmented urine output, loop diuretics are often discontinued after dialysis initiation. Here, we assessed the association of the early decision to continue loop diuretics at hemodialysis start with clinical outcomes during the first year of dialysis.Design, setting, participants, & measurementsWe considered all patients on in-center hemodialysis at a large dialysis organization (2006–2013) with Medicare Part A and D benefits who had an active supply of a loop diuretic at dialysis initiation (n=11,297). Active therapy was determined on the basis of whether loop diuretic prescription was refilled after dialysis initiation and within 30 days of exhaustion of prior supply. Patients were followed under an intention-to-treat paradigm for up to 12 months for rates of death, hospitalization, and intradialytic hypotension and mean monthly values of interdialytic weight gain, serum potassium, predialysis systolic BP, and ultrafiltration rates.ResultsWe identified 5219 patients who refilled a loop diuretic and 6078 eligible controls who did not. After adjustments for patient mix and clinical differences, continuation of loop diuretics was associated with lower hospitalization (adjusted incidence rate ratio, 0.93; 95% confidence interval, 0.89 to 0.98) and intradialytic hypotension (adjusted incidence rate ratio, 0.95; 95% confidence interval, 0.92 to 0.99) rates, no difference in death rate (adjusted hazard ratio, 0.92; 95% confidence interval, 0.84 to 1.01), and lower interdialytic weight gain (P=0.03).ConclusionsContinuation of loop diuretics after hemodialysis initiation was associated with lower rates of hospitalization and intradialytic hypotension as well as lower interdialytic weight gain, but there was no difference in mortality over the first year of dialysis.

Prospective Randomised Open-label Comparison of Danaparoid with Dextran 70 in the Treatment of Heparin-induced Thrombocytopaenia with Thrombosis

2001 ◽  
Vol 86 (11) ◽  
pp. 1170-1175 ◽  
Author(s):  
B. H. Chong ◽  
J. F. Cade ◽  
H. Magnani ◽  
A. Manoharan ◽  
M. Oldmeadow ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Clinical Effectiveness ◽  
Serotonin Release ◽  
Thromboembolic Events ◽  
Open Label ◽  
Danaparoid Sodium ◽  
Clinical Recovery ◽  
Dextran 70 ◽  
Discharge From Hospital

Summary Aim: To compare clinical outcomes in a randomised comparison of treatment with danaparoid sodium (a heparinoid), or dextran 70, for heparin-induced thrombocytopaenia (HIT) plus thrombosis. Methods: Forty-two patients with recent thrombosis and a clinical diagnosis of probable HIT who presented at ten Australian hospitals during a study period of six and one half years were randomly assigned to open-label treatment with intravenous danaparoid or dextran 70, each combined with oral warfarin. Thirty-four patients (83%) had a positive platelet aggregation or 14C-serotonin release test for HIT antibody. Twenty-five received danaparoid as a bolus injection of 2400 anti-Xa units followed by 400 units per hour for 2 h, 300 units per hour for 2 h, and then 200 units per hour for five days. Seventeen received 1000 mL dextran 70 on day one and then 500 mL on days 2-5. Patients were reviewed daily for clinical evidence of thrombus progression or resolution, fresh thrombosis or embolism, bleeding or other complications. The primary trial endpoint was the proportion of thromboembolic events with complete clinical resolution by the time of discharge from hospital. Results: With danaparoid, there was complete clinical recovery from 56% of thromboembolic events compared to 14% after dextran 70 (Odds Ratio 10.53, 95% Confidence Interval 1.6–71.4; p = 0.02). Clinical recovery with danaparoid was complete or partial in 86% of thromboembolic events compared with 53% after dextran 70 (Odds Ratio 4.55, 95% Confidence Interval 1.2–16.7; p = 0.03). Overall clinical effectiveness of danaparoid was rated as high or moderate in 88% of patients compared with 47% for dextran 70 (p = 0.01). One patient given danaparoid died of thrombosis compared with three patients given dextran 70. The platelet count returned to normal after a mean of 6.7 days with danaparoid and 7.3 days with dextran 70. There was no major bleeding with either treatment. Conclusion: danaparoid plus warfarin treatment for HIT with thrombosis is effective, safe, and superior to dextran 70 plus warfarin.

scholarly journals Invasiveness of Serotypes and Clones of Streptococcus pneumoniae among Children in Finland

2005 ◽  
Vol 73 (1) ◽  
pp. 431-435 ◽  
Author(s):  
William P. Hanage ◽  
Tarja H. Kaijalainen ◽  
Ritva K. Syrjänen ◽  
Kari Auranen ◽  
Maija Leinonen ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Confidence Interval ◽  
Multilocus Sequence Typing ◽  
Invasive Disease ◽  
Invasive Infection ◽  
Data Set ◽  
Dramatic Effect ◽  
Life Threatening ◽  
The Difference ◽  
Sequence Types

ABSTRACT Streptococcus pneumoniae (the pneumococcus) causes diseases from otitis media to life-threatening invasive infection. The species is extremely antigenically and clonally diverse. We wished to determine odds ratios (ORs) for serotypes and clones of S. pneumoniae that cause invasive disease in Finland. A total of 224 isolates of S. pneumoniae from cases of invasive disease in children <2 years of age in Finland between 1995 and 1999 were serotyped, and sequence types (STs) were determined by multilocus sequence typing. These STs were compared with a previously published carriage data set. STs from invasive disease were significantly less diverse than those from carriage (invasive disease, 0.038 ± 0.01; carriage, 0.019 ± 0.005). The ORs of serotypes 14, 18C, 19A, and 6B were significantly greater than 1, indicating association with invasive disease. The ORs of 6A and 11A were significantly less than 1. The difference between 6A and 6B is significant, which suggests that relatively subtle changes in the capsule may have a dramatic effect upon disease potential. We found that ST 156, the Spain9V-3 clone which mainly expressed serotype 14 in Finland, is strongly associated with invasive disease (OR, 10.1; 95% confidence interval, 1.3 to 79.5). Significant associations with invasive disease were also detected for STs 482, 191, 124, and 138, and associations with carriage were detected for STs 485 and 62. These results demonstrate the invasive phenotype of the serotype 14 variant of the Spain9V-3 clone and differences between members of the same serogroup in invasive disease potential.

The Risk of Seizure Following Surgery for Brain Arteriovenous Malformation: A Prospective Cohort Study

Neurosurgery ◽  
2017 ◽  
Vol 81 (6) ◽  
pp. 935-948 ◽  
Author(s):  
Joan Margaret O’Donnell ◽  
Michael Kerin Morgan ◽  
Gillian Z Heller
Keyword(s):  
Confidence Interval ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Continuous Variable ◽  
Receiver Operator Characteristic Curve ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Maximum Diameter ◽  
Discharge From Hospital

Abstract BACKGROUND The evidence for the risk of seizures following surgery for brain arteriovenous malformations (bAVM) is limited. OBJECTIVE To determine the risk of seizures after discharge from surgery for supratentorial bAVM. METHODS A prospectively collected cohort database of 559 supratentorial bAVM patients (excluding patients where surgery was not performed with the primary intention of treating the bAVM) was analyzed. Cox proportional hazards regression models (Cox regression) were generated assessing risk factors, a Receiver Operator Characteristic curve was generated to identify a cut-point for size and Kaplan–Meier life table curves created to identify the cumulative freedom from postoperative seizure. RESULTS Preoperative histories of more than 2 seizures and increasing maximum diameter (size, cm) of bAVM were found to be significantly (P &lt; .01) associated with the development of postoperative seizures and remained significant in the Cox regression (size as continuous variable: P = .01; hazard ratio: 1.2; 95% confidence interval: 1.0-1.3; more than 2 seizures: P = .02; hazard ratio: 2.1; 95% confidence interval: 1.1-3.8). The cumulative risk of first seizure after discharge from hospital following resection surgery for all patients with bAVM was 5.8% and 18% at 12 mo and 7 yr, respectively. The 7-yr risk of developing postoperative seizures ranged from 11% for patients with bAVM ≤4 cm and with 0 to 2 preoperative seizures, to 59% for patients with bAVM &gt;4 cm and with &gt;2 preoperative. CONCLUSION The risk of seizures after discharge from hospital following surgery for bAVM increases with the maximum diameter of the bAVM and a patient history of more than 2 preoperative seizures.

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