scholarly journals Measles outbreak in Gothenburg urban area, Sweden, 2017 to 2018: low viral load in breakthrough infections

2019 ◽  
Vol 24 (17) ◽  
Author(s):  
Nicklas Sundell ◽  
Leif Dotevall ◽  
Martina Sansone ◽  
Maria Andersson ◽  
Magnus Lindh ◽  
...  
Keyword(s):  
Viral Load ◽  
High Risk ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Previous History ◽  
Contact Tracing ◽  
Measles Outbreak ◽  
History Of ◽  
Measles Vaccination

In an outbreak of measles in Gothenburg, Sweden, breakthrough infections (i.e. infections in individuals with a history of vaccination) were common. The objective of this study was to compare measles RNA levels between naïve (i.e. primary) and breakthrough infections. We also propose a fast provisional classification of breakthrough infections. Medical records were reviewed and real-time PCR-positive samples genotyped. Cases were classified as naïve, breakthrough or vaccine infections. We compared clinical symptoms and measles RNA cycle threshold (Ct) values between breakthrough and naïve infections. Sixteen of 28 confirmed cases of measles in this outbreak were breakthrough infections. A fast provisional classification, based on previous history of measles vaccination and detectable levels of measles IgG in acute serum, correctly identified 14 of the 16 breakthrough infections, confirmed by IgG avidity testing. Measles viral load was significantly lower in nasopharyngeal samples from individuals with breakthrough compared with naïve infections (median Ct-values: 32 and 19, respectively, p < 0.0001). No onward transmission from breakthrough infections was identified. Our results indicate that a high risk of onward transmission is limited to naïve infections. We propose a fast provisional classification of breakthrough measles that can guide contact tracing in outbreak settings.

Paroxysmal Stabbing Headache in The Multiple Dermatomes of The Head and Neck: A Variant of Primary Stabbing Headache or Occipital Neuralgia?

Cephalalgia ◽  
2007 ◽  
Vol 27 (10) ◽  
pp. 1101-1108 ◽  
Author(s):  
JH Shin ◽  
HK Song ◽  
JH Lee ◽  
WK Kim ◽  
MK Chu
Keyword(s):  
Medical Center ◽  
Previous History ◽  
Headache Disorder ◽  
Acute Onset ◽  
Occipital Neuralgia ◽  
Cervical Nerve ◽  
Primary Stabbing Headache ◽  
History Of ◽  
Stabbing Headache

A paroxysmal stabbing or icepick-like headache in the multiple nerve dermatomes, especially involving both trigeminal and cervical nerves, has not been fully explained or classified by the International Classification of Headache Disorder, 2nd Edition (ICHD-II). Of patients with acute-onset paroxysmal stabbing headache who had visited the Hallym University Medical Center during the last four years, 28 subjects with a repeated stabbing headache involving multiple dermatomes at the initial presentation or during the course were prospectively enrolled. All patients were neurologically and otologically symptom free. A coincidental involvement of both trigeminal and cervical nerve dermatomes included seven cases. Six cases involved initially the trigeminal and then cervical nerve dermatomes. Five cases showed an involvement of the cervical and then trigeminal nerve dermatomes. The remaining patients involved multiple cervical nerve branches (the lesser occipital, greater occipital and greater auricular). Pain lasted very shortly and a previous history of headache with the same nature was reported in 13 cases. Preceding symptom of an infection and physical and/or mental stress were manifested in seven and six subjects, respectively. All patients showed a self-limited benign course and completely recovered within a few hours to 30 days. Interestingly, a seasonal gradient in occurrence of a stabbing headache was found in this study. A paroxysmal stabbing headache manifested on multiple dermatomes can be explained by the characteristics of pain referral, and may be considered to be a variant of primary stabbing headache or occipital neuralgia.

scholarly journals Unusual dyspnea in a hemodialysis patient: A case report

10.3823/2607 ◽  
2019 ◽  
Vol 12 ◽  
Author(s):  
Ching-Hsiang Wang ◽  
Jenq-Shyong Chan ◽  
Chung-Chi Yang ◽  
Po-Jen Hsiao
Keyword(s):  
Hemodialysis Patient ◽  
Pleural Cavity ◽  
Middle Age ◽  
Clinical Symptoms ◽  
Rapid Development ◽  
Previous History ◽  
Final Diagnosis ◽  
Spontaneous Hemothorax ◽  
Life Threatening ◽  
History Of

The typical clinical symptoms of hemothorax include a rapid development of chest pain or dyspnea, which may be life-threatening without immediate management. As we know, spontaneous hemothorax, a collection of blood within the pleural cavity without previous history of trauma or other cause, which usually onsets suddenly. The early and accurate diagnosis of spontaneous hemothorax is imperative in clinical practice. We reported a middle-age male undergoing regular hemodialysis was referred to our emergency department due to unknown cause of dyspnea and acute respiratory failure. Chest radiography revealed bilateral patchy infiltration of lung. Pleural tap analysis showed exudative pleural effusion with numerous red blood cells. Video-assisted thoracic surgery (VATS) were performed and confirmed the final diagnosis of spontaneous hemothorax. He was then successfully treated with the surgery of VATS combined chest tube thoracostomy.

scholarly journals Occult Foreign Body Aspirations in Pediatric Patients: 20-years of Experience

2020 ◽  
Author(s):  
Bo Liu ◽  
Fengxia Ding ◽  
Yong An ◽  
Yonggang Li ◽  
Zhengxia Pan ◽  
...  
Keyword(s):  
Foreign Body ◽  
Medical Records ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Previous History ◽  
Rigid Bronchoscopy ◽  
Diagnostic Difficulties ◽  
History Of ◽  
Male Patients ◽  
Symptoms And Signs

Abstract Background: The purpose of our study was to assess the frequency of occult foreign body aspiration (FBA) and to evaluate the diagnostic difficulties and therapeutic methods for these patients. Methods: Between May 2000 and May 2020, 3557 patients with the diagnosis of FBA were treated in our department. Thirty-five patients with occult FBA were included in this study. A retrospective analysis of medical records was performed. Results: Twenty-three male patients (65.7%) and 12 female patients (34.3%) were hospitalized due to occult FBA. The average age was 3.60 years (range 9 months-12 years). Most of the patients were younger than 3 years old (n=25, 71.4%). Coughing (n=35, 100%) and wheezing (n=18, 51.4%) were the main symptoms and signs. All the patients were found to have a FBA under the fiberoptic bronchoscope. The most common organic foreign bodies were peanuts (n=10) and the most common inorganic foreign bodies were pen caps (n=5). The extraction of foreign bodies under rigid bronchoscopy was applied successfully in 34 patients. Only one patient needed a surgical intervention. Conclusions: Occult FBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases that are poorly explained, even in the absence of a previous history of aspiration.

scholarly journals Orbital Schwannoma: Case Report and Review

2019 ◽  
Vol 38 (03) ◽  
pp. 199-202 ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Mário José Goes ◽  
Feres Chaddad ◽  
Lucas Crociati Meguins ◽  
Dionei Freitas de Moraes ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Previous History ◽  
Mass Effect ◽  
Complete Resection ◽  
High Signal ◽  
Resonance Imaging ◽  
History Of Disease ◽  
Orbital Pain ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

Quality of Life and Functional Outcomes after Multiligament Knee Reconstruction

2018 ◽  
Vol 31 (10) ◽  
pp. 970-978 ◽  
Author(s):  
George Hatch ◽  
Diego Villacis ◽  
Dhanur Damodar ◽  
Michael Dacey ◽  
Anthony Yi
Keyword(s):  
Quality Of Life ◽  
Linear Regression Analysis ◽  
Previous History ◽  
Life Questionnaire ◽  
Knee Ligament ◽  
Management Protocol ◽  
Knee Ligament Surgery ◽  
History Of

AbstractWe aimed to determine factors that affect the quality of life of patients undergoing a standardized surgical and postoperative management protocol for knee dislocations. A total of 31 patients (33 knees) were included in this study. We contacted patients at a minimum of 12 months postoperatively (mean: 38 months; range, 12–111 months) and administered the previously validated Multiligament Quality of Life questionnaire (ML-QOL), 2000 International Knee Documentation Committee Subjective Knee Form (IKDC), and Lysholm Knee Scoring Scale. We performed independent two-sample t-tests and age-adjusted multivariable linear regression analysis to examine the difference in these scores. Patients who underwent previous knee ligament surgery had significantly worse mean ML-QOL scores relative to patients who did not undergo previous knee ligament surgery (114.3 versus 80.4; p = 0.004) (higher score indicates worse quality of life). All other differences in the ML-QOL scores were not statistically significant. IKDC and Lysholm scores did not differ significantly with regards to the studied variables. Among patients with no previous knee ligament surgery, patients undergoing surgery within 3 weeks of injury had significantly worse mean ML-QOL scores relative to patients undergoing surgery greater than 3 weeks after their injury (98.7 versus 74.7; p = 0.042) and patients with Schenck classification of III or IV had significantly worse mean ML-QOL scores relative to patient with a Schenck classification of I or II (88.7 versus 62.9; p = 0.015). We found that patients with a previous history of knee ligament surgery had a significantly worse quality of life relative to those with no history of knee ligament surgery. This is a level III, retrospective cohort study.

scholarly journals Two cases of imported respiratory diphtheria in Edinburgh, Scotland, October 2019

2020 ◽  
Vol 148 ◽  
Author(s):  
Lucy Li ◽  
Daniella Ross ◽  
Katherine Hill ◽  
Sarah Clifford ◽  
Louise Wellington ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Corynebacterium Diphtheriae ◽  
High Index ◽  
Contact Tracing ◽  
Emerging Infections ◽  
Diphtheria Antitoxin ◽  
History Of ◽  
Risk Areas ◽  
High Index Of Suspicion

Abstract We report two cases of respiratory toxigenic Corynebacterium diphtheriae infection in fully vaccinated UK born adults following travel to Tunisia in October 2019. Both patients were successfully treated with antibiotics and neither received diphtheria antitoxin. Contact tracing was performed following a risk assessment but no additional cases were identified. This report highlights the importance of maintaining a high index of suspicion for re-emerging infections in patients with a history of travel to high-risk areas outside Europe.

scholarly journals Viral load and short-term natural history of type-specific oncogenic human papillomavirus infections in a high-risk cohort of midadult women

2013 ◽  
Vol 134 (8) ◽  
pp. 1889-1898 ◽  
Author(s):  
Rachel L. Winer ◽  
Long Fu Xi ◽  
Zhenping Shen ◽  
Joshua E. Stern ◽  
Laura Newman ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Viral Load ◽  
High Risk ◽  
Natural History ◽  
Papillomavirus Infections ◽  
Short Term ◽  
History Of ◽  
High Risk Cohort

scholarly journals Quantifying infective endocarditis risk in patients with predisposing cardiac conditions

2017 ◽  
Vol 39 (7) ◽  
pp. 586-595 ◽  
Author(s):  
Martin H Thornhill ◽  
Simon Jones ◽  
Bernard Prendergast ◽  
Larry M Baddour ◽  
John B Chambers ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
High Risk ◽  
Hospital Admissions ◽  
Previous History ◽  
Prosthetic Material ◽  
Moderate Risk ◽  
Prosthetic Valves ◽  
English Population ◽  
Risk Patients ◽  
History Of

Abstract Aims There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions. Methods and results English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions—even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices. Conclusion These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

scholarly journals Sero-epidemiology of human immunodeficiency virus (HIV) in Plateau State, Nigeria

2012 ◽  
Vol 6 (12) ◽  
pp. 860-869 ◽  
Author(s):  
Nenfort Edward Gomwalk ◽  
Lohya Nimzing ◽  
John Danjuma Mawak ◽  
Nimzing G. Ladep ◽  
Stephen B. Dapiap ◽  
...  
Keyword(s):  
High Risk ◽  
Local Government ◽  
Antenatal Care ◽  
Previous History ◽  
Risk Groups ◽  
Multiple Sexual Partners ◽  
Men 2 ◽  
History Of ◽  
Plateau State ◽  
Sex With Men

Introduction: Previous sentinel surveys of HIV in Nigeria studied pregnant women attending antenatal care, thereby omitting other important high-risk groups. We therefore investigated the prevalence of HIV/AIDS in low- and high-risk populations in the state of Plateau, Nigeria. Methodology: Blood samples were collected by venepuncture from 5,021 adults aged ≥15 years between August and October 2008. At least one major town and one rural community were selected in each Local Government Area (LGA). Samples were initially screened with a rapid HIV testing kit; reactive samples were further tested using Stat Pak.  Discordant samples were confirmed using Genie-II. Results: Of 5,021 subjects screened, 245 (4.88%) were seropositive. Local Government prevalence ranged from 0.68% in Bassa to 16.07% in Jos North. On average, LGAs in the Southern Senatorial Zone had higher rates. Most (over 80%) positive cases were younger than 40 years. Females had a significantly higher (6.85%) prevalence than males (2.72%). Age-specific prevalence was higher among females aged 25 to 29 years (2.09%). Risk factors identified  for acquisition of HIV infection were previous history of STDs (6, 16.28%); men having sex with men (2, 11.76%); having multiple sexual partners (97; 10.49%); intravenous drug use (10, 7.58%); sharing of sharp objects (20, 4.82%); and history of blood transfusion (21, 3.65%). Conclusion: The seemingly higher prevalence recorded in this survey could be attributed to the  inclusion of high- and low-risk groups in the general population, unlike previous reports which studied only antenatal care attendees. This survey provides useful baseline information for further studies.

scholarly journals IgG Anti-Toxoplasma pada Cairan Otak Pasien Terinfeksi HIV dan AIDS dengan Meningitis

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Yunilda Andriyani ◽  
Agnes Kurniawan ◽  
Ika Puspa Sari ◽  
Retno Wahyuningsih
Keyword(s):  
Clinical Diagnosis ◽  
Predictive Value ◽  
Medical Records ◽  
Clinical Symptoms ◽  
Aids Patients ◽  
Significant Difference ◽  
Life Threatening ◽  
History Of ◽  
Weak Negative Correlation ◽  
End Stage

Toksoplasmosis diperkirakan telah menginfeksi sepertiga populasi dunia dan dapat mengancam jiwa pasien dengan imunokompromi. Ensefalitis toksoplasma (ET) terjadi akibat reaktivasi infeksi laten T. gondii yang sering terjadi pada pasien AIDS, terutama stadium akhir. Untuk menegakkan diagnosis pasti pada pasien AIDS dengan kelainan SSP sangatlah sulit. Diagnosis ET ditegakkan hanya berdasarkan asumsi dari gejala klinis, gambaran radiologi, dan respon terhadap terapi yang diberikan. Pemeriksaan kadar IgG dari cairan organ masih jarang dilakukan. Sampel cairan otak diperoleh dari 50 pasien HIV dan AIDS yang dikumpulkan sejak Januari 2013 hingga 2014 di Laboratorium Parasitologi FKUI. Kadar CD4+, gejala klinis, hasil radiologi, diagnosis klinis, riwayat terapi profilaksis ko-trimoksazol, dan analisis cairan otak, diperoleh dari rekam medik.Dari 50 sampel, diperoleh hasil 24 (48%) positif dan 26 (52%) negatif IgG anti-Toxoplasma. Dari IgG positif, terdapat 5 (20,83%) dengan kadar tinggi, dan 19 (79,17%) dengan kadar IgG rendah. Tidak ada perbedaan bermakna antara kadar IgG antiToxoplasma dengan hasil radiologi, diagnosis klinis, maupun riwayat terapi profilaksis ko-trimoksazol. Diperoleh korelasi negatif antara kadar CD4+ dan IgG anti-Toxoplasma, walaupun kekuatannya sangat lemah. Berdasarkan hasil radiologi, diperoleh sensitivitas 56%, spesifisitas 57%, nilai duga positif 41%, dan nilai duga negatif 71%. Toxoplasmosis is estimated to infect a third of the world's population and can be life-threatening to human immunocompromised system . Toxoplasma Encephalitis (TE) is caused by reactivation of latent T. gondii infection that often occurs in AIDS patients especially those with end-stage . To establish a definite diagnosis in AIDS patients with Central Nervous System (CNS)disorders is very difficult. The diagnosis of TE is only based on the assumptions of clinical symptoms, radiological features, and responses to the therapy given. Examination of IgG levels from organ fluids is still rare. CSF samples were taken from 50 HIV/AIDS patients collected from January 2013 to 2014 at the Parasitology Laboratory at FKUI (Medical Departement of University of Indonesia). CD4 levels, clinical symptoms, radiological results, clinical diagnosis, history of co-trimoxazole prophylaxis, and SCF analysis were obtained from medical records. The results showed that IgG-anti Toxoplasma was positive in 24 patients (48%) and negative in 26 patients (52%). From the positive IgG, there were 5 patients(20.83%) with high IgG levels, and 19 patients(79.17%) with low IgG levels. There was no significant difference between the levels of IgG anti-toxoplasma and the results of radiology, clinical diagnosis, and a history of co-trimoxazole prophylactic therapy. There was a weak negative correlation between CD4 + and IgG anti-Toxoplasma levels, The results of radiology showed values of sensitivity 56%, specificity 57%, positive predictive value 41%, and negative predictive value 71%.

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