scholarly journals Interaction of concurrent infection pathogens in complex comorbidity (theoretical and practical issues)

2021 ◽  
Vol 5 (11) ◽  
pp. 737-743
Author(s):  
V.V. Shkarin ◽  
◽  
N.V. Saperkin ◽  
Keyword(s):  
Human Body ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Biological Properties ◽  
Immune Defense ◽  
Concurrent Infection ◽  
Infectious Process ◽  
Antagonistic Microorganisms ◽  
Severe Clinical Picture ◽  
Parasitic System

In case of co-infections, the human body and the pathogen form a complex parasitic system. Also, the development of the infectious process is possible according to the following scenarios: infectious process activation caused by all pathogens; predominant activation of one of the infectious processes; absence of the infectious process activation; absence of combined infection interaction. Infectious pathogens affect the human body in different ways both at the site of permeation, launching a cascade of pathological processes, and at the site of the main localization. The formation of complex comorbidity depends on the non-specific immune defense, the biological properties of pathogens, the simultaneity or sequence of infection, the intervals between infection with various pathogens, etc. This article discusses the reasons for the predominance of one of the disease clinical manifestations in concurrent infections: synergism, antagonistic microorganisms, the chain of infection, the incubation period duration. The following variants of the co-infection course and their influence on complex comorbidity are considered: the dominance of one infection clinical manifestations; the same severity of symptoms of all infections, or the formation of a more severe clinical picture compared to single infections; the aggravating effect of one infection on another; the clinical picture overlap of one infection on another. KEYWORDS: mixed infection, concurrent infection, complex comorbidity, etiology, interaction of pathogens, parasitic system, infectious process, epidemic process. FOR CITATION: Shkarin V.V., Saperkin N.V. Interaction of concurrent infection pathogens in complex comorbidity (theoretical and practical issues). Russian Medical Inquiry. 2021;5(11):737–743 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-737-743.

Clinical manifestations, diagnosis and treatment of HIV infection of stage 4 (severely symptomatic stage) in the practice of a health professional

2020 ◽  
pp. 27-34
Author(s):  
A. Nikitina ◽  
A. Rusanova ◽  
A. Zhilenkova
Keyword(s):  
Hiv Infection ◽  
Health Professional ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Significant Problem ◽  
Diagnosis And Treatment ◽  
Modern World ◽  
Infected People ◽  
Stage 4 ◽  
Future Practice

HIV infection is a significant problem in the modern world, because there are more and more infected people every year. This article will consider: the clinical picture, diagnosis and treatment of this disease in different countries. Based on these data, the following conclusions will be made to help doctors in their future practice correctly approach the diagnosis and treatment of patients with this disease.

scholarly journals Automatic Evaluation of the Lung Condition of COVID-19 Patients Using X-ray Images and Convolutional Neural Networks

2021 ◽  
Vol 11 (1) ◽  
pp. 28
Author(s):  
Ivan Lorencin ◽  
Sandi Baressi Šegota ◽  
Nikola Anđelić ◽  
Anđela Blagojević ◽  
Tijana Šušteršić ◽  
...  
Keyword(s):  
Neural Networks ◽  
Convolutional Neural Networks ◽  
Clinical Picture ◽  
Data Augmentation ◽  
Lower Amount ◽  
Training Procedure ◽  
X Ray ◽  
Severe Clinical Picture ◽  
Lung Condition

COVID-19 represents one of the greatest challenges in modern history. Its impact is most noticeable in the health care system, mostly due to the accelerated and increased influx of patients with a more severe clinical picture. These facts are increasing the pressure on health systems. For this reason, the aim is to automate the process of diagnosis and treatment. The research presented in this article conducted an examination of the possibility of classifying the clinical picture of a patient using X-ray images and convolutional neural networks. The research was conducted on the dataset of 185 images that consists of four classes. Due to a lower amount of images, a data augmentation procedure was performed. In order to define the CNN architecture with highest classification performances, multiple CNNs were designed. Results show that the best classification performances can be achieved if ResNet152 is used. This CNN has achieved AUCmacro¯ and AUCmicro¯ up to 0.94, suggesting the possibility of applying CNN to the classification of the clinical picture of COVID-19 patients using an X-ray image of the lungs. When higher layers are frozen during the training procedure, higher AUCmacro¯ and AUCmicro¯ values are achieved. If ResNet152 is utilized, AUCmacro¯ and AUCmicro¯ values up to 0.96 are achieved if all layers except the last 12 are frozen during the training procedure.

scholarly journals SAT0651-HPR BARRIERS IN DIAGNOSING RHEUMATOID ARTHRITIS – A FOCUS GROUP STUDY ON THE GENERAL PRACTITIONERS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1284.1-1285
Author(s):  
A. S. Lundberg ◽  
B. A. Esbensen ◽  
E. M. Hauge ◽  
A. De Thurah
Keyword(s):  
Rheumatoid Arthritis ◽  
General Practice ◽  
Focus Group ◽  
General Practitioners ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
University Hospital ◽  
Text Book ◽  
Clear Cut ◽  
Initial Symptoms

Background:Early treatment, before three months from symptom onset of rheumatoid arthritis (RA), is essential to increase the likelihood of remission and to prevent permanent joint damage (1). However, it has been shown that only 20% of the patients are seen within the first three months, and the median delay in general practice has been estimated to 4 months (range 2–9) (2).Objectives:To explore the barriers in diagnosing RA from the general practitioners’ (GPs) perspective.Methods:We conducted a qualitative study based on focus group interviews. We recorded the interviews digitally and transcribed verbatim. The transcribed interviews were analyzed based on content analysis (3), by using Nivo 12. Sample size was determined by thematic saturation.Results:In total ten GPs participated in three different focus groups. 40 % were female, mean age was 53 years (range 37-64), and mean year since specialist authorization as GP was 16 years (range 5-23). 60 % of the GPs worked in a practice located within the referral area of a university hospital; the remaining within the referral area of a regional hospital.Four themes emerged in the analysis: 1) When the patient is not a text book example, referring to the difficulty of identifying relevant symptoms among all clinical manifestations from the joints as described by the patients, 2)The importance of maintaining the gatekeeper function, referring to the societal perspective, and the GPs responsibility to refer the right patients to secondary care, 3)Difficulties in referral of patients to the rheumatologist,referring to perceived differences in the collaboration with rheumatologists. The GPs experienced that it was sometimes difficult to be assisted by rheumatologists, especially when the clinical picture was not ‘clear cut’. Finally, (4)Para-clinical testing, can it be trusted?referring to challenges on the evaluation of especially biomarkers.The overarching theme was:Like finding a needle in a haystack, covering the GPs difficulties in detecting RA among the many patients in general practice who appear to be well and at the same time have symptoms very similar to RA.Conclusion:The GPs experienced that RA was a difficult diagnosis to make. The immediate challenge was that RA patient’s initial symptoms often resembled those of more common and less serious conditions, and that investigative findings such as biomarkers can be negative at the early state of the disease. At the same time, the collaboration with rheumatologists was sometimes seen as a hurdle, when the clinical picture was not ‘clear cut’.In order to facilitate earlier diagnosis of RA in general practice, the GPs and rheumatologists need to focus on these barriers by strengthening mutual information and collaboration.Physicians should remain vigilant to patients who have conditions that do not resolve as expected with treatment, who have symptoms that persist, or who do not look well despite negative investigative findings.References:[1]Aletaha D, et al. JAMA, Oct 2018.[2]Kiely P, et al. Rheumatology, Jan 2009.[3]Braun V. Qualitative research in psychology. 2006, 3(2), 77-101Disclosure of Interests:Anne Sofie Lundberg: None declared, Bente Appel Esbensen: None declared, Ellen-Margrethe Hauge Speakers bureau: Fees for speaking/consulting: MSD, AbbVie, UCB and Sobi; research funding to Aarhus University Hospital: Roche and Novartis (not related to the submitted work)., Annette de Thurah Grant/research support from: Novartis (not relevant for the present study)., Speakers bureau: Lily (not relevant for the present study).

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy

2020 ◽  
pp. 60-82
Author(s):  
Igor Sergeevich Trifonov ◽  
Mikhail Vladimirovich Sinkin ◽  
Elena Vladimirovna Grigoryeva ◽  
Rashid Abdurakhmanovich Navruzov
Keyword(s):  
Surgical Treatment ◽  
Temporal Lobe ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Epileptogenic Zone ◽  
Pharmacoresistant Epilepsy ◽  
Modern Methods ◽  
Selection For ◽  
Selection Of Patients ◽  
Selection Of

Surgical treatment of bilateral temporal lobe pharmacoresistant epilepsy is associated with some difficulties: particularly, the lack of stereotypical clinical picture in the same patient and controversial data on modern methods of diagnostics — all these statements make identifying epileptogenic zone more difficult and lack of clear criteria for the selection of patients for surgical treatment. In this review, issues of aetiology, pathogenesis, clinical manifestations and criteria for the selection for surgical treatment suggested by different authors are presented.

POLYNEURITIS IN CHILDREN

PEDIATRICS ◽  
1958 ◽  
Vol 22 (5) ◽  
pp. 972-990
Author(s):  
Niels L. Low ◽  
Julia Schneider ◽  
Sidney Carter
Keyword(s):  
Clinical Picture ◽  
Cranial Nerve ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Severity Of The Disease ◽  
Clinical Records

Polyneuritis in children is becoming more common. The clinical picture is variable; it may be manifested by motor and sensory findings, or by a combination of peripheral and cranial nerve signs and symptoms. The etiology is usually obscure. The pathologic picture varies with the severity of the disease and differs according to the stage at which the patient dies, but all fatal cases show the same main characteristic changes. Clinical records of 30 cases, 17 boys and 13 girls from 17 months to 16 years of age, are reviewed. The clinical manifestations, course and treatment are described.

scholarly journals Apolipoprotein E Gene Polymorphisms in Saudi Patients with Systemic Lupus Erythematosus

2016 ◽  
Vol 9 ◽  
pp. CMAMD.S38090 ◽  
Author(s):  
Hannan Al-Rayes ◽  
Ghaleb Huraib ◽  
Saeed Julkhuf ◽  
Misbahul Arfin ◽  
Mohammad Tariq ◽  
...  
Keyword(s):  
Apolipoprotein E ◽  
Lupus Erythematosus ◽  
Neuropsychiatric Symptoms ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Biological Properties ◽  
Apoe Polymorphism ◽  
Genotype 3 ◽  
Apolipoprotein E Gene ◽  
Apoe Gene Polymorphism

Apolipoprotein E (APOE) is a glycosylated protein with multiple biological properties. APOE gene polymorphism plays a central role in lipid metabolism and has recently been suggested to regulate inflammation. Our objective is to evaluate whether APOE polymorphism affects susceptibility to SLE. APOE genotyping was performed using ApoE StripAssay™ kit. Results indicated significantly higher frequencies of allele ∊4 and genotype ∊3/∊4 and lower frequencies of allele ∊3 and genotype ∊3/∊3 in SLE patients than controls. APOE ∊2 allele was found in three patients, whereas it was absent in controls. The frequencies of allele ∊4 and genotype ∊3/∊4 were significantly higher in SLE patients with renal involvement and those of alleles ∊2, ∊4 and genotypes ∊2/∊3, ∊3/∊4 were higher in patients with neuropsychiatric symptoms. It is concluded that APOE allele ∊4 is associated with susceptibility risk/clinical manifestations of SLE and ∊2 may increase its severity while ∊3 is protective for SLE in Saudis.

scholarly journals Early Diagnosis and Treatment of Patients with Mucopolysaccharidosis IV and VI

2016 ◽  
Vol 23 (3) ◽  
pp. 63-70
Author(s):  
L. K Mikhailova ◽  
T. V Sokolova ◽  
O. A Polyakova
Keyword(s):  
Early Childhood ◽  
Early Diagnosis ◽  
Enzyme Replacement Therapy ◽  
Clinical Picture ◽  
Surgical Intervention ◽  
Clinical Manifestations ◽  
Dna Testing ◽  
Enzyme Replacement ◽  
Skeletal Changes ◽  
Fatal Complications

Mucopolysaccharidosis (MPS) is an orphan pathology characterized by polymorphism of clinical manifestations and development of typical skeletal changes. However in early childhood the clinical picture is not clear that leads to misdiagnosis and results in inadequate management of patients including unjustified surgical intervention. Early clinical and roentgenologic changes specific to mucopolysaccharidosis IV and VI that enable to suspect the pathology development, to perform required examination with compulsory confirmation by DNA testing results and prescribe vital enzyme replacement therapy as soon as possible are presented. Early diagnosis and initiation of etiotropic treatment and timely correction of the occurring pathology ensure prevention of fatal complications.

scholarly journals Effect of the Route of Administration of the Vaccinia Virus Strain LIVP to Mice on Its Virulence and Immunogenicity

Viruses ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 795
Author(s):  
Sergei N. Shchelkunov ◽  
Stanislav N. Yakubitskiy ◽  
Alexander A. Sergeev ◽  
Alexei S. Kabanov ◽  
Tatiana V. Bauer ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Vaccinia Virus ◽  
Vaccination Campaign ◽  
Lethal Dose ◽  
Clinical Manifestations ◽  
Immune Defense ◽  
Smallpox Vaccination ◽  
Laboratory Animals ◽  
Optimal Method ◽  
Clonal Variant

The mass smallpox vaccination campaign has played a crucial role in smallpox eradication. Various strains of the vaccinia virus (VACV) were used as a live smallpox vaccine in different countries, their origin being unknown in most cases. The VACV strains differ in terms of pathogenicity exhibited upon inoculation of laboratory animals and reactogenicity exhibited upon vaccination of humans. Therefore, each generated strain or clonal variant of VACV needs to be thoroughly studied in in vivo systems. The clonal variant 14 of LIVP strain (LIVP-14) was the study object in this work. A comparative analysis of the virulence and immunogenicity of LIVP-14 inoculated intranasally (i.n.), intradermally (i.d.), or subcutaneously (s.c.) to BALB/c mice at doses of 108, 107, and 106 pfu was carried out. Adult mice exhibited the highest sensitivity to the i.n. administered LIVP-14 strain, although the infection was not lethal. The i.n. inoculated LIVP-14 replicated efficiently in the lungs. Furthermore, this virus was accumulated in the brain at relatively high concentrations. Significantly lower levels of LIVP-14 were detected in the liver, kidneys, and spleen of experimental animals. No clinical manifestations of the disease were observed after i.d. or s.c. injection of LIVP-14 to mice. After s.c. inoculation, the virus was detected only at the injection site, while it could disseminate to the liver and lungs when delivered via i.d. administration. A comparative analysis of the production of virus-specific antibodies by ELISA and PRNT revealed that the highest level of antibodies was induced in i.n. inoculated mice; a lower level of antibodies was observed after i.d. administration of the virus and the lowest level after s.c. injection. Even at the lowest studied dose (106 pfu), i.n. or i.d. administered LIVP-14 completely protected mice against infection with the cowpox virus at the lethal dose. Our findings imply that, according to the ratio between such characteristics as pathogenicity/immunogenicity/protectivity, i.d. injection is the optimal method of inoculation with the VACV LIVP-14 strain to ensure the safe formation of immune defense after vaccination against orthopoxviral infections.

scholarly journals BT-06 CENTRAL NERVOUS SYSTEM HEMANGIOBLASTOMA; DIFFERENCES IN CLINICAL PICTURE OF SPORADIC CASES AND VON-HIPPEL LINDAU DISEASE IN 184 CASES

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii37-ii37
Author(s):  
Hirokazu Takami ◽  
Terry Burns ◽  
Ian Parney
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Picture ◽  
Mayo Clinic ◽  
Tumor Biology ◽  
Clinical Manifestations ◽  
Von Hippel Lindau ◽  
Significant Difference ◽  
Sporadic Cases ◽  
Central Nervous System Hemangioblastoma

Abstract INTRODUCTION Central nervous system hemangioblastoma (CNS HGB) is a rare neoplasm, which predominantly arise in the posterior fossa and spinal cord. The etiology is divided into sporadic and von-Hippel Lindau (VHL) disease. The difference in clinical picture of these 2 types of HGB and differentiation of treatment have not been extensively unraveled yet. METHODS Retrospective analysis of consecutive, neurosurgically managed CNS HGB at Mayo Clinic, 1988–2018. RESULTS 117 sporadic and 67 VHL HGBs were treated by Mayo Clinic. No significant difference in sex was observed. Compared with sporadic cases, VHL cases were younger (51.8 vs 36.0 years old, p<0.0001), had more frequent family history (0.0 vs 41.5 %, p<0.0001), and higher frequency of germline alteration (0.0 vs 84.2 %, p<0.0001). Regarding imaging findings, VHL cases had multiple lesions at presentation more frequently (3.4 vs 82.1 %, p<0.0001), it was more common for sporadic lesions to contain cysts (72.2 vs 51.0 %, p=0.0004), the solid portion rate in the entire lesion was larger in VHL lesions (60.2 vs 69.5 %, p=0.02), and the volume was larger in sporadic cases (15.1 vs 6.6 cc, p<0.0001). Regarding treatment, 131 and 123 surgeries were performed for sporadic and VHL cases, respectively, among which the indication of surgery was preventative in 8.4 and 47.3 %, respectively (p<0.0001). VHL cases had higher number of treatments per case in the follow-up (1.3 vs 2.1, p<0.0001). Recurrence-free survival of sporadic cases was significantly longer than that of VHL cases (p=0.007) and overall survival was longer in sporadic cases than VHL, but not significant (p=0.07). CONCLUSION Clinical presentation and tumor appearance on imaging are highly dependent on the etiology. Differences in clinical manifestations require further study, but may reflect contrasting tumor biology that are tied to genetic differences.

Combined Treatment in Wegener'S Granulomatosis with Crescentic Glomerulonephritis -Clinical Course and Longterm Outcome

1993 ◽  
Vol 16 (1) ◽  
pp. 11-19 ◽  
Author(s):  
G.M. Frascà ◽  
N.G. Zoumparidis ◽  
L.C. Borgnino ◽  
Lu. Neri ◽  
Lo. Neri ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Clinical Picture ◽  
Wegener’S Granulomatosis ◽  
Combined Treatment ◽  
Immunosuppressive Treatment ◽  
Clinical Signs ◽  
Wegener's Granulomatosis ◽  
Antithrombotic Agent ◽  
Methyl Prednisolone ◽  
Severe Clinical Picture

This study reports on 9 patients suffering from Wegener's granulomatosis (WG) with crescentic GN and severe systemic manifestations. On admission the mean serum creatinine was 10.9 ± 5.1 mg/dl (4-20 mg/dl); 8 patients were oliguric and required dialysis treatment. Renal biopsy showed crescents in all cases, involving 66 to 100% of glomeruli. Patients were treated with a protocol including: a plasmaexchange (PE) course; methyl-prednisolone; cyclophosphamide; and an antithrombotic agent (defibrotide). Clinical picture and renal function progressively improved in all patients within the first 4 weeks of treatment. After 1 month serum creatinine was 2.7 ± 0.8 mg/dl and dialysis was no longer needed in any patient. Five relapses occurred in 3 patients 12-26 months after the onset of the disease, while they were still receiving immunosuppressive treatment. At follow-up (22 to 112 months: mean 71) all patients were alive with no clinical signs of disease activity. One patient was on regular dialysis while the others had a serum creatinine of 1.2-2.8 mg/dl (mean 1.9). Our results confirm that crescentic GN associated with WG can be successfully treated even when associated with severe clinical picture and suggest that PE can contribute to control the disease without increasing immunosuppression.

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