scholarly journals Outbreak of Foodborne Botulism in Alexandria, Egypt: Modulating Indications for Administration of Heptavalent Botulinum Antitoxin

2021 ◽  
Author(s):  
Sara A Ghitani ◽  
Maha A Ghanem ◽  
Eman A Sultan ◽  
Maram Atef ◽  
Maii F Henaidy
Keyword(s):  
Prospective Study ◽  
Clinical Characteristics ◽  
Personal Data ◽  
Poison Center ◽  
Supportive Treatment ◽  
Past Medical History ◽  
Salted Fish ◽  
History Of ◽  
Foodborne Botulism

Abstract Background: In October 2019, 94 patients were admitted into Alexandria Poison Center (APC) with a history of ingestion of Feseekh (salted fish). As a trial to allocate the resources, not all patients were given Heptavalent botulinum antitoxin (HBAT) immediately.The current study aimed to portray the clinical characteristics of the cases, explore the possible relation between these characteristics and necessity of HBAT administration, explore the reliability of MLT, and to establish a clinical guide for management with preservation of resources.Subject and Method: the current prospective study included 94 patients who were admitted to Alexandria Poison Center (APC) in the period from 29 th September to 27 th October 2019. The patients' data was recorded using a checklist that includes: personal data, past medical history, clinical assessment, investigations, treatment and the outcome. The checklist was carried out to assess and follow up each patient. Hospitalized patients were categorized according to symptoms consistent with botulism. The equine HBAT, made by Emergent BioSolutions Canada Inc. (formerly Can gene Corporation) was used in the treatment.Results: HBAT was given to (36.2%) patients only out of the total admission. However, 87.2% of patients were completely cured, whereas 10.6% of patients were discharged with mild neurological sequelea and death occurred only in two cases (2.2%).Conclusion: 63.8% of cases with suspected foodborne botulism toxicity could be managed by supportive treatment only with no need for HBAT.

Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina

2018 ◽  
Vol 19 (2) ◽  
pp. 173-175
Author(s):  
Jonathan Lazari ◽  
Andrew Money-Kyrle ◽  
Benjamin R Wakerley
Keyword(s):  
Clinical Characteristics ◽  
Troponin I ◽  
Coronary Intervention ◽  
Severe Stenosis ◽  
Exertional Headache ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Cardiac Cephalalgia

Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.

scholarly journals Right lumbar abscess containing a gallstone—an unexpected late complication of laparoscopic cholecystectomy

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
André Marçal ◽  
Ricardo Vaz Pereira ◽  
Ana Monteiro ◽  
José Dias ◽  
António Oliveira ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Late Complication ◽  
Late Complications ◽  
Gallbladder Perforation ◽  
Past Medical History ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Gallstone Spillage ◽  
Saline Lavage

Abstract During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.

scholarly journals A Prospective Study on Changes in Nutritional Status and Growth Following Two Years of Ketogenic Diet (KD) Therapy in Children with Refractory Epilepsy

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1596 ◽  
Author(s):  
Marisa Armeno ◽  
Antonella Verini ◽  
Mariana del Pino ◽  
Maria Beatriz Araujo ◽  
Graciela Mestre ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Prospective Study ◽  
Ketogenic Diet ◽  
Refractory Epilepsy ◽  
Growth Monitoring ◽  
Male Predominance ◽  
History Of ◽  
A Prospective Study ◽  
Growth Deceleration

Introduction: Epilepsy is a neurological disorder characterized by an increased susceptibility to seizures. The ketogenic diet (KD) is currently the most important alternative non-pharmacological treatment. Despite its long history of clinical use, it is not clear how this diet affects longitudinal growth in children. Methods: A prospective study was designed to evaluate growth and nutritional status in 45 children on KD. Growth was assessed by measuring weight, height, and body mass index (BMI). Standard deviation scores (SDS) were calculated for all measurement parameters at KD initiation and at a two-year follow-up. Results: Overall, 45 patients who completed 24 months on KD were enrolled. Median age was 6.6 years (0.8 to 17.3), with a male predominance (n = 23); 74% of the 45 patients were responders on seizure reduction at three months; 26% of patients were non-responders. In our study, using −1 SDS as a cut-off point, growth deceleration was observed in 9% (n: 4) of the patients; however, the nutritional status was maintained or even improved. No correlation with age, sex, or ambulatory status was found. Conclusions: The nutritional follow-up of these patients was helpful to improve overweight and thinness but could not avoid growth deceleration in some of them. These findings confirm that children with refractory epilepsy on KD treatment require careful growth monitoring.

scholarly journals Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION)

2019 ◽  
Vol 15 (5) ◽  
pp. 656-662 ◽  
Author(s):  
E. Yu. Okshina ◽  
M. M. Loukianov ◽  
S. Yu. Martsevich ◽  
S. S. Yakushin ◽  
N. P. Kutishenko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Practice ◽  
Family History ◽  
Drug Treatment ◽  
Clinical Characteristics ◽  
Beta Blockers ◽  
All Cause Mortality ◽  
History Of ◽  
Hospital Registry

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance. 

P320Heart failure with mid-range (HFmrEF) or recovered (HFrecEF) ejection fraction: differential determinants of transition

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R De Maria ◽  
F Macera ◽  
M Gorini ◽  
I Battistoni ◽  
M Iacoviello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Nyha Class ◽  
Multivariable Logistic Regression Analysis ◽  
Class Iii ◽  
Mild Disease ◽  
Lower Likelihood ◽  
History Of

Abstract Background Heart failure with mid-range ejection fraction (HFmrEF) has been identified as a multi-faceted phenotype that may encompass both patients with mild disease or those who from previous HFrEF recover EF (HFrecEF) Purpose To describe clinical characteristics and factors associated with phenotype transition at follow-up. Methods From 2009 to 2016, 1194 patients with baseline EF<50% and a second echocardiographic determination during clinically stability at a median of 6 months were enrolled in the IN-CHF Registry. Based on EF at enrollment, 335 (28%) had HFmrEF and 859 (72%) had HFrEF. We compared baseline clinical characteristics and predictors associated with follow-up reclassification to HFmrEF or full EF recovery Results When compared to HFrEF patients, those with HFmrEF had less often an ischemic etiology, advanced symptoms and a HF admission in the previous year. No other differences were found in clinical characteristics and drug therapy (Table). At a median follow-up of 6 months, 30% of HFrEF patients improved EF by 14 (9) units: 21% showed partial EF recovery (transition to HFmrEF) and 9% had full EF recovery. Conversely among HFmrEF patients 22% improved EF, by 9 (5) units, to full recovery, and 18% deteriorated by 1.5 (5.5) units sloping to HFrEF. By multivariable logistic regression analysis, variables associated with EF recovery at 6-month follow-up differed between baseline phenotypes. Within HFrEF, ischemic etiology (OR 0.46, 95% CI 0.33–0.64) and NYHA class III-IV symptoms (OR 0.57, 95% CI 0.38–0.68) were associated with a lower likelihood of EF recovery, while a history of HF<6 month correlated with a higher likelihood of EF recovery (OR 2.44, 95% CI 1.76–3.39). Within HFmrEF, while ischemic etiology (OR 0.66, 95% CI 0.19–0.68) was also associated with a lower likelihood of EF recovery, a history of atrial fibrillation at enrollment correlated with higher likelihood of EF recovery (OR 2.66, 95% CI 1.37–5.17) by 6 month-follow-up. At a median follow-up of 36+28 months mortality was 4.6% vs 6.9% in HFrecEF vs non-recovered patients (log rank p=0.08). Baseline characteristics HFrEF vs HFmrEF Conclusions HFmrEF patients showed a less severe clinical picture than HFrEF patients, but had EF recovery less often. EF improvement is negatively associated with ischemic etiology in both phenotypes, and positively associated with atrial fibrillation in HFmrEF and a short history of HF in HFrEF.

scholarly journals Risk Factors for Early Recurrence of Gallstones in Patients Undergoing Laparoscopy Combined With Choledochoscopic Lithotomy: A Single-Center Prospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Bo Wang ◽  
Anhua Huang ◽  
Min Jiang ◽  
Haidong Li ◽  
Wenqing Bao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Prospective Study ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Gallbladder Wall ◽  
Postoperative Recurrence ◽  
Factors Associated ◽  
History Of

Objective: For patients with gallstones, laparoscopy combined with choledochoscopic lithotomy is a therapeutic surgical option for preservation rather than the removal of the gallbladder. However, postoperative recurrence of gallstones is a key concern for both patients and surgeons. This prospective study was performed to investigate the risk factors for early postoperative recurrence of gallstones.Methods: The clinical data of 466 patients were collected. Each patient was followed up for up to 2 years. The first follow-up visit occurred 4 months after the operation, and a follow-up visit was carried out every 6 months thereafter. The main goal of each visit was to confirm the presence or absence of gallbladder stones. The factors associated with gallstone recurrence were analyzed by univariate analysis and Cox regression.Results: In total, 466 eligible patients were included in the study, and 438 patients (180 men and 258 women) completed the 2-year postoperative follow-up. The follow-up rate was 94.0%. Recurrence of gallstones was detected in 5.71% (25/438) of the patients. Univariate analysis revealed five risk factors for the recurrence of gallstones. Multivariate Cox regression analysis showed that multiple gallstones, a gallbladder wall thickness of ≥4 mm, and a family history of gallbladder stones were the three predictive factors for postoperative recurrence of gallstones (P &lt; 0.05).Conclusion: The overall 2-year recurrence rate of gallstones after the operation was 5.71%. Multiple gallstones, a gallbladder wall thickness of ≥4 mm, and a family history of gallstones were the three risk factors associated with early postoperative recurrence of gallstones.

The Natural History of Subarachnoid Haemorrhage with Negative Angiography: A prospective study and 3-year follow-up

1988 ◽  
Vol 2 (1) ◽  
pp. 33-41 ◽  
Author(s):  
Robert M. Redfern ◽  
Stefan Zygmunt ◽  
John D. Pickard ◽  
Patrick M. Foy ◽  
M. D. M. Shaw
Keyword(s):  
Natural History ◽  
Subarachnoid Haemorrhage ◽  
Prospective Study ◽  
Negative Angiography ◽  
History Of ◽  
A Prospective Study

Clinical profile of acute rheumatic fever in Pakistan

2003 ◽  
Vol 13 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Hasina Suleman Chagani ◽  
Kalimuddin Aziz
Keyword(s):  
Prospective Study ◽  
Rheumatic Fever ◽  
Sore Throat ◽  
Acute Rheumatic Fever ◽  
Clinical Profile ◽  
First Episode ◽  
History Of

We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.

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