White Nail as a Static Physical Finding: Revitalization of Physical Examination

Physical examinations are critical for diagnosis and should be differentiated into static and dynamic categories. One of the static findings is white nail, such as Terry’s and Lindsay’s nails. Here, we report the cases of two older patients with acute diseases who had nail changes that aided evaluation of their clinical course. Two elderly women who presented with acute conditions were initially thought to have normal serum albumin levels. They were found to have white nail with differences in nail involvement of the first finger, which subsequently revealed their hypoalbuminemia. The clinical courses were different following the distribution of nail whitening. Our findings show that examination of a white nail could indicate the previous clinical status more clearly than laboratory data. It can be useful for evaluating preclinical conditions in patients with acute diseases. Further evaluation is needed to establish the relationship between clinical outcomes and the presence of white nail in acute conditions among older patients.

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COVID-19 in children: Pathogenesis and current status

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.42.200104 ◽

2020 ◽

Author(s):

Lawrence Frenkel ◽

Fernando Gomez ◽

Joseph A Bellanti

Keyword(s):

Respiratory Disease ◽

Respiratory Symptoms ◽

Distress Syndrome ◽

Clinical Course ◽

Current Status ◽

Current Evidence ◽

Initial Description ◽

Relationship Of ◽

Inflammatory Syndrome ◽

The Relationship

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, thereare children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to thatseen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C).Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions.Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19–associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C.Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. Ithas become apparent that children are infected as easily as adults but are more often asymptomatic and have milder diseasebecause of their immature immune systems. Although children are largely spared from severe respiratory disease, they canpresent with a SARS-CoV-2–associated MIS-C similar to KD.

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Terson sign:

Jornal Memorial da Medicina ◽

10.37085/jmmv2.n1.2020.pp.38-43 ◽

2020 ◽

Vol 2 (1) ◽

pp. 38-43

Author(s):

Luiz Severo Bem Junior ◽

Gustavo De Souza Andrade ◽

Joao Ribeiro Memória Júnior ◽

Hildo Rocha Cirne de Azevedo Filho

Keyword(s):

Subarachnoid Hemorrhage ◽

Early Recognition ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Case Reports ◽

Clinical Status ◽

Vitreous Hemorrhage ◽

Anterior Communicating Artery ◽

Inclusion Criteria ◽

Relationship Of ◽

The Relationship

Terson's sign (TS) is classically defined as vitreous hemorrhage associated with subarachnoid hemorrhage of aneurysmal origin, being an important predictor of severity, indicating greater morbidity and mortality when compared to patients without the sign. The objective of this study is to review the relationship of Terson syndrome/Terson sign with the prognosis of aneurysmal subarachnoid hemorrhage. A search for original articles, research and case reports was performed on the PubMed, Scielo, Cochrane and ScienceDirect platform, with the following descriptors: Terson sign and subarachnoid hemorrhage. Retrospective, prospective articles and case reports published in the last 5 years and which were in accordance with the established objective and inclusion criteria were selected. Ten (10) articles were selected, in which the available results show an unfavorable prognostic relationship of TS and subarachnoid hemorrhage, because these patients had a worse clinical status assessed on the Glasgow scales ≤ 8, Hunt & Hess > III, Fisher > 3, in addition to intracranial hypertension and location of the aneurysm in the anterior communicating artery complex. The early recognition of this condition described by Albert Terson in 1900 brought an important contribution to neurosurgery, being recognized until nowadays.

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Postoperative Rise of Circulating Mitochondrial DNA Is Associated with Inflammatory Response in Patients following Pancreaticoduodenectomy

European Surgical Research ◽

10.1159/000514661 ◽

2021 ◽

pp. 1-7

Author(s):

Niv Pencovich ◽

Nadav Nevo ◽

Roi Weiser ◽

Ekaterina Bonder ◽

Yoel Bogoch ◽

...

Keyword(s):

Mitochondrial Dna ◽

Inflammatory Response ◽

Delayed Gastric Emptying ◽

Clinical Course ◽

Severe Trauma ◽

Postoperative Fever ◽

Postoperative Course ◽

Cell Counts ◽

White Blood Cell Counts ◽

The Relationship

Introduction: Accumulation of plasma mitochondrial DNA (mtDNA) following severe trauma has been shown to correlate with the development of systemic inflammatory response syndrome (SIRS) and may predict mortality. Our objective was to investigate the relationship between levels of circulatory mtDNA following pancreaticoduodenectomy (PD) and the postoperative course. Methods: Levels of plasma mtDNA were assessed by real-time PCR of the mitochondrial genes ND1 and COX3 in 23 consecutive patients who underwent PD 1 day prior to surgery, within 8 h after surgery, and on postoperative day (POD)1 and POD5. The abundance of mtDNA was assessed relative to preoperative levels and in relation to parameters reflecting the postoperative clinical course. Results: When pooled for all patients, the circulating mtDNA levels were significantly increased after surgery. However, while a significant (at least >2-fold and up to >20-fold) rise was noted in 11 patients, no change in mtDNA levels was noted in the other 12 following surgery. Postoperative rise in circulating mtDNA was associated with an increased rate of postoperative fever until day 5, decreased hemoglobin and albumin levels, and increased white blood cell counts. These patients also suffered from increased rates of delayed gastric emptying. No significant differences were demonstrated in other postoperative parameters. Conclusion: Circulating mtDNA surge is associated with an inflammatory response following PD and may potentially be used as an early marker for postoperative course. Studies of larger patient cohorts are warranted.

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CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00389-7 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aya Yassin ◽

Maryam Ali Abdelkader ◽

Rehab M. Mohammed ◽

Ahmed M. Osman

Keyword(s):

Pulmonary Embolism ◽

Disease Severity ◽

Laboratory Data ◽

Pulmonary Angiography ◽

Significant Relation ◽

Ct Pulmonary Angiography ◽

Laboratory Results ◽

Severity Of The Disease ◽

The Relationship ◽

D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

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Association of apolipoprotein E and myeloperoxidase genotypes to clinical course of familial and sporadic multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458504ms1015oa ◽

2004 ◽

Vol 10 (3) ◽

pp. 266-271 ◽

Cited By ~ 33

Author(s):

B Zakrzewska-Pniewska ◽

M Styczynska ◽

A Podlecka ◽

R Samocka ◽

B Peplonska ◽

...

Keyword(s):

Multiple Sclerosis ◽

Apolipoprotein E ◽

Brain Atrophy ◽

Genetic Factors ◽

Clinical Course ◽

Progression Rate ◽

Disease Course ◽

Familial Cases ◽

Sporadic Cases ◽

The Relationship

The importance of apolipoprotein E (ApoE) and myeloperoxidase (MPO) genotypes in the clinical characteristics of multiple sclerosis (MS) has been recently emphasized. In a large group of Polish patients we have tested the hypothesis that polymorphism in ApoE and MPO genes may influence the course of the disease. G enotypes were determined in 117 MS patients (74 females and 43 males; 99 sporadic and 18 familial cases) with mean EDSS of 3.6, mean age of 44.1 years, mean duration of the disease 12.8 years and mean onset of MS at 31.2 years, and in 100 healthy controls. The relationship between ApoE and MPO genes’ polymorphism and the MS activity as well as the defect of remyelination (diffuse demyelination) and brain atrophy on MRI were analysed. The ApoE o4 allele was not related to the disease course or the ApoE o2 to the intensity of demyelination on MRI. The genotype MPO G/G was found in all familial MS and in 57% (56/99) of sporadic cases. This genotype was also related to more pronounced brain atrophy on MRI. The MPO G/G subpopulation was characterized by a significantly higher proportion of patients with secondary progressive MS (PB- 0.05) and by a higher value of EDSS. A ccording to our results the MPO G allele is frequently found (in 96% of cases) among Polish patients with MS. More severe nervous tissue damage in the MPO G/G form can be explained by the mechanism of accelerated oxidative stress. It seems that MPO G/G genotype may be one of the genetic factors influencing the progression rate of disability in MS patients.

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The relationship of adrenomedullin and left ventricular remodeling in older patients with essential hypertension

Heart ◽

10.1136/heartjnl-2011-300867.335 ◽

2011 ◽

Vol 97 (Suppl 3) ◽

pp. A113-A114

Author(s):

H. Jiang ◽

S. Peng

Keyword(s):

Essential Hypertension ◽

Older Patients ◽

Ventricular Remodeling ◽

Left Ventricular Remodeling ◽

Left Ventricular ◽

Relationship Of ◽

The Relationship

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Clinical Significance of the Serotonin Release Assay and Platelet Count Monitoring After Cardiac Surgery

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029617734308 ◽

2017 ◽

Vol 24 (6) ◽

pp. 944-949 ◽

Cited By ~ 1

Author(s):

Shinya Motohashi ◽

Takefumi Matsuo ◽

Hidenori Inoue ◽

Makoto Kaneko ◽

Shunya Shindo

Keyword(s):

Cardiac Surgery ◽

Platelet Count ◽

Clinical Course ◽

Serotonin Release ◽

Enzyme Linked Immunosorbent Assay ◽

Heparin Induced Thrombocytopenia ◽

Release Assay ◽

Immunological Assays ◽

Platelet Count Monitoring ◽

The Relationship

Heparin-induced thrombocytopenia (HIT) is one of the serious complications in patients who undergo cardiac surgery. However, there remains a major problem in diagnosing HIT because the current immunological assays for detection of HIT antibody have limitations. Furthermore, the clinical course of thrombocytopenia in this surgery makes it increasingly difficult to diagnose HIT. We investigated the relationship between platelet count and HIT antibody in 59 patients who underwent cardiac surgery using cardiopulmonary bypass (CPB). The number of postoperative HIT antibody-positive patients evaluated using enzyme-linked immunosorbent assay kit (polyanion IgG/IgA/IgM complex antibodies/antiplatelet factor 4 enhanced) was 37 (62.7%). In contrast, platelet activation by HIT antibody was evaluated using the serotonin release assay (SRA). More than 20% and 50% release of serotonin was obtained from 12 patients (20.3%) and 8 patients (13.6%), respectively. The levels of d-dimer were significantly different on postoperative day 14 between SRA-positive and SRA-negative groups; however, postoperative thrombus complication was not detected using sonography in the patients with positive serotonin release at all. After being decreased by the operation, their platelet count recovered within 2 weeks in both groups equally. In our study, although the patients were positive in the platelet activating HIT antibody assay, they remained free from thrombosis and their platelet count recovered after early postoperative platelet decrease. Therefore, in addition to the SRA, monitoring of platelet count might be still considered an indispensable factor to facilitate the prediction of HIT thrombosis prior to manifestation in the patients undergoing cardiac surgery using CPB.

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Older people's satisfaction with intermediate care: a systematic review

Reviews in Clinical Gerontology ◽

10.1017/s0959259808002475 ◽

2007 ◽

Vol 17 (3) ◽

pp. 199-218 ◽

Cited By ~ 3

Author(s):

Andrew Wilson ◽

Suzanne Richards ◽

Janette Camosso-Stefinovic

Keyword(s):

Systematic Review ◽

Older People ◽

Older Patients ◽

Hospital Care ◽

Patient Choice ◽

Intermediate Care ◽

Care Services ◽

The Relationship

Although intermediate care takes a variety of different forms and has developed somewhat differently in different countries, we believe that intermediate-care schemes have enough in common to make it meaningful to examine the relationship between this method of care and the views of older patients receiving either it or its alternatives. This is particularly important as one of the underlying principles of intermediate care is to extend patient choice; furthermore, most intermediate-care services target older people. In this review we examine evidence about whether older people prefer intermediate or hospital care, and what they like and dislike about intermediate care.

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