AN OBSERVATIONAL STUDY OF THE CLINICAL PROFILE AND OUTCOMES OF PATIENTS WITH MILIARY TUBERCULOSIS (TB).

2021 ◽  
pp. 11-14
Author(s):  
Rajeev Tandon ◽  
Prabhat Kumar ◽  
Pradeep Nirala ◽  
Ansha Sinha
Keyword(s):  
Mortality Rate ◽  
Observational Study ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Miliary Tuberculosis ◽  
Time Duration ◽  
Drug Induced ◽  
Treatment Regimens ◽  
Standardized Treatment ◽  
Almost All

Objectives: This study aimed to evaluate the clinical prole and outcome of the patients with miliary tuberculosis (TB). Methods: This was a retrospective observational study which involved evaluation of medical records of 44 patients with miliary TB in the department of respiratory medicine and internal medicine from 2016-2019. Miliary TB in these patients had been diagnosed on the basis of clinical symptoms, radiology and microbiology. The clinical prole of the patients in terms of age, gender, clinical presentations were recorded. Time duration for resolution of symptoms was noted. Radiological outcome was also studied. Final outcome was treatment success and mortality. Results: The mean age of the patients were 37.07 years with 27 males. Most common complaints were fever (86.36%), cough (72.73%), expectoration (65.91%) and anorexia (45.45%). Laboratory ndings showed hypertransaminasemia, anemia, and hyponatremia in 75.00%, 70.45%, and 43.18% patients, respectively. Standardized treatment (RHEZ) was given in 70.45% patients, and non-standardized treatment in 29.55% patients. Median duration of fever was relieved in 15 days. Mortality rate was 11.36% and drug induced liver injury (DILI) was seen in 4(9.09%) patients. Radiological resolution was seen in almost all of the patients except in 3 and in majority of patients clearing was seen within the rst two months of initiation of treatment. Among all variables, hyperbilirubinemia showed signicant association with mortality (OR=14.6, 95% CI 1.86 to 114.615, P=0.013). Conclusion: In conclusion, in our series miliary TB presents most commonly in the third decade of life and is predominant among males. The clinical features were similar to pulmonary tuberculosis. There was frequent association with derangements in liver function, electrolyte, and hemoglobin. Hyperbilirubinemia was associated with signicantly increased the odds of mortality. Non-standardized treatment regimens were associated with poorer outcome. Mortality rate in miliary TB was as high as 11.3% in our series.

scholarly journals Main metabolic and toxic polyneuropathies in clinical practice

2021 ◽  
pp. 134-146
Author(s):  
N. V. Pizova
Keyword(s):  
Clinical Symptoms ◽  
Diabetic Polyneuropathy ◽  
Pathological Process ◽  
Clinical Settings ◽  
Therapeutic Approaches ◽  
Clinical Form ◽  
Drug Induced ◽  
Diagnosis And Prognosis ◽  
Almost All ◽  
Attending Physicians

Polyneuropathies are diseases of the peripheral nervous system with lesions of motor, sensory or autonomic fibers which are encountered by attending physicians of almost all specialties in outpatient and clinical settings. To date, more than 100 different causes of polyneuropathies have been identified. Metabolic and toxic polyneuropathies are the most common in the group of secondary polyneuropathies. Diabetic, alcoholic, uremic, and drug-induced polyneuropathies take the leading place among these diseases. The main forms of diabetic polyneuropathy are presented. The main clinical form is distal symmetrical polyneuropathy. Clinical symptoms depend on the type of fibers involved in the pathological process - thin or thick. There is an assessment scale in points to determine the severity of diabetic polyneuropathy, which helps in clarifying the diagnosis and prognosis of the disease. The next most frequent among metabolic polyneuropathies is uremic polyneuropathy as the most frequent complication in patients suffering from chronic renal insufficiency. Risk factors of uremic polyneuropathy development, clinical picture, the course of the disease are described. Within the framework of toxic polyneuropathies, the main place is given to alcoholic polyneuropathies, chemotherapy-induced, and drug-induced. For each of these categories, clinical forms and pathophysiology of development are described. For all polyneuropathies, the main diagnostic aspects are presented. The main therapeutic approaches are shown. A separate place is given to the use of alpha-lipoic acid.

scholarly journals Recent update on the management of anaphylaxis

2021 ◽  
Vol 8 (3) ◽  
pp. 160-172
Author(s):  
Quang Luu Quoc ◽  
Tra Cao Thi Bich ◽  
Jae-Hyuk Jang ◽  
Hae-Sim Park
Keyword(s):  
Clinical Symptoms ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Drug Induced ◽  
Tryptase Level ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
New Guidelines ◽  
Almost All ◽  
Physical Findings

Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

Hemmkörperentwicklung bei Hämophilie-Patienten nach Präparate wechsel

2012 ◽  
Vol 32 (S 01) ◽  
pp. S39-S42 ◽  
Author(s):  
S. Kocher ◽  
G. Asmelash ◽  
V. Makki ◽  
S. Müller ◽  
S. Krekeler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Frequent Change ◽  
Patient Age ◽  
Treatment Regimens ◽  
Patient Âgé ◽  
The Relationship ◽  
Observation Period

SummaryThe retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn’t lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.

scholarly journals COVID-19 and gastrointestinal symptoms in Mexico, a systematic review: does location matter?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antonio Pizuorno ◽  
Nora A. Fierro ◽  
Edgar D. Copado-Villagrana ◽  
María E. Herrera-Solís ◽  
Gholamreza Oskrochi ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mortality Rate ◽  
Clinical Symptoms ◽  
Descriptive Analysis ◽  
Gastrointestinal Symptoms ◽  
Northwest Mexico ◽  
Obesity And Diabetes ◽  
West Mexico ◽  
Southeast Mexico

Abstract Background Covid-19 in Mexico is on the rise in different parts of the country. We aimed to study the symptoms and comorbidities that associate with this pandemic in 3 different regions of Mexico. Methods We analyzed data from SARS-CoV-2 positive patients evaluated at healthcare centers and hospitals of Mexico (n = 1607) including Northwest Mexico (Sinaloa state), Southeast Mexico (Veracruz state) and West Mexico (Jalisco state) between March 1 and July 30, 2020. Mexico consists of a total population that exceeds 128 million. Demographics, comorbidities and clinical symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities and mortality were performed. Results A total of 1607 hospitalized patients positive for COVID-19 across all 3 regions of Mexico were included. The average age was 54.6 years and 60.4% were male. A mortality rate of 33.1% was observed. The most common comorbidities were hypertension (43.2%), obesity (30.3%) and diabetes (31.4%). Hypertension was more frequent in West (45%), followed by Northwest (37%) and Southeast Mexico (29%). Obesity was around 30% in Northwest and West whereas an 18% was reported in Southeast. Diabetes was most common in West (34%) followed by Northwest (22%) and Southeast (13%). This might be related to the highest mortality rate in Northwest (31%) and West (37%) when compared to Southeast. Most common symptoms in our overall cohort were fever (80.8%), cough (79.8%), headache (66%), dyspnea (71.1%), myalgia (53.8%), joints pain (50.8%) and odynophagia (34.8%). Diarrhea was the main gastrointestinal (GI) symptom (21.3%), followed by abdominal pain (18%), and nausea/ vomiting (4.5%). Diarrhea and abdominal pain were more common in West (23.1 and 21%), followed by Southeast (17.8, and 9.8%) and Northwest (11.4 and 3.1%). Conclusion Our study showed a high mortality rate likely related to high frequencies of comorbidities (hypertension, obesity and diabetes). Mortality was different across regions. These discrepancies might be related to the differences in the frequencies of comorbidities, and partially attributed to differences in socio-economic conditions and quality of care. Thus, our findings stress the need for improved strategies to get better outcomes in our population.

scholarly journals Drug-Induced Photosensitivity—From Light and Chemistry to Biological Reactions and Clinical Symptoms

2021 ◽  
Vol 14 (8) ◽  
pp. 723
Author(s):  
Justyna Kowalska ◽  
Jakub Rok ◽  
Zuzanna Rzepka ◽  
Dorota Wrześniok
Keyword(s):  
Defense Mechanisms ◽  
Clinical Symptoms ◽  
Chemical Properties ◽  
Additional Treatment ◽  
Cosmetic Products ◽  
Aesthetic Value ◽  
Drug Usage ◽  
Drug Induced ◽  
Biochemical Level ◽  
The Aesthetic

Photosensitivity is one of the most common cutaneous adverse drug reactions. There are two types of drug-induced photosensitivity: photoallergy and phototoxicity. Currently, the number of photosensitization cases is constantly increasing due to excessive exposure to sunlight, the aesthetic value of a tan, and the increasing number of photosensitizing substances in food, dietary supplements, and pharmaceutical and cosmetic products. The risk of photosensitivity reactions relates to several hundred externally and systemically administered drugs, including nonsteroidal anti-inflammatory, cardiovascular, psychotropic, antimicrobial, antihyperlipidemic, and antineoplastic drugs. Photosensitivity reactions often lead to hospitalization, additional treatment, medical management, decrease in patient’s comfort, and the limitations of drug usage. Mechanisms of drug-induced photosensitivity are complex and are observed at a cellular, molecular, and biochemical level. Photoexcitation and photoconversion of drugs trigger multidirectional biological reactions, including oxidative stress, inflammation, and changes in melanin synthesis. These effects contribute to the appearance of the following symptoms: erythema, swelling, blisters, exudation, peeling, burning, itching, and hyperpigmentation of the skin. This article reviews in detail the chemical and biological basis of drug-induced photosensitivity. The following factors are considered: the chemical properties, the influence of individual ranges of sunlight, the presence of melanin biopolymers, and the defense mechanisms of particular types of tested cells.

A case of statin-induced liver injury with positive rechallenge with a second statin. Is there a class effect?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Giovanna Onfiani ◽  
Fabio Nascimbeni ◽  
Francesca Carubbi
Keyword(s):  
Liver Injury ◽  
Clinical Symptoms ◽  
High Risk Population ◽  
Drug Induced ◽  
Case Presentation ◽  
Drug Induced Liver Injury ◽  
Aged Woman ◽  
Cardiovascular Morbidity And Mortality ◽  
Middle Aged Woman

Abstract Objectives Statins have proved to reduce cardiovascular morbidity and mortality in high-risk population and are generally well tolerated, although adverse events can occur. Up to 3% of patients develop aminotransferases elevation, which usually normalizes with continued treatment and hardly is associated with clinical symptoms. Serious statin-related liver injury is exceedingly rare. Furthermore, literature regarding rechallenge with a second statin is extremely poor. Some authors caution that re-exposure to these drugs is associated with a more serious liver injury but safe switching to a second statin after drug-induced liver injury (DILI) is also reported. Case presentation We describe a case of a middle-aged woman who developed hepatocellular liver injury after simvastatin dose escalation; a rechallenge with low dose rosuvastatin caused rapid recurrence of DILI. Conclusions In our opinion, clinicians should be very cautious upon rechallenge and closely follow-up patients who experienced statin-induced liver injury when trying re-exposure to another statin.

scholarly journals Outcomes of Endodontic Therapy Comparing Conventional Sodium Hypochlorite Irrigation with Passive Ultrasonic Irrigation Using Sodium Hypochlorite and Ethylenediaminetetraacetate. A Retrospective Analysis

2016 ◽  
Vol 10 (1) ◽  
pp. 375-381 ◽  
Author(s):  
Moritz Hertel ◽  
Katja Sommer ◽  
Eckehard Kostka ◽  
Sandra Maria Imiolczyk ◽  
Husam Ballout ◽  
...  
Keyword(s):  
Sodium Hypochlorite ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Success Rates ◽  
Chi Square ◽  
Passive Ultrasonic Irrigation ◽  
Ultrasonic Irrigation ◽  
Endodontic Irrigation ◽  
Group 2

The aim of the present study was to investigate the clinical outcomes of two different standardized endodontic irrigation protocols. It was assumed that the additional use of ethylenediaminetetraacetate (EDTA) and passive ultrasonic irrigation (PUI) would result in an increased rate of absence of symptoms and remission based on the periapical index (PAI) compared to passive irrigation using only sodium hypochlorite (NaOCl). Data and radiographs from 199 teeth retrieved from the institutional endodontic database were analyzed retrospectively. In 106 teeth irrigation was performed using only NaOCl (protocol 1). Ninety-three teeth were irrigated using NaOCl and EDTA (protocol 2). Chlorhexidine (CHX) was additionally used in revision treatments in both groups. All irrigants in group 2 were activated by PUI. Mean follow-up periods were: protocol 1 = 9.2 ± 4.4 and protocol 2 = 6.6 ± 2.5 months (p < 0.0001 (chi-square test). The frequencies of the PAImasterpoint and PAIfollow-up scores did not differ significantly between teeth, which received either protocol 1 or 2 (p = 0.555 and 0.138). Statistical analysis revealed no significant association between treatment success (absence of clinical symptoms and PAIfollow-up = I or PAImasterpoint > PAIfollow-up > I) and the applied protocol (success rates: protocol 1 = 72.6% vs. protocol 2 = 82.8%; p = 0.203). Furthermore, the frequency of extractions did not differ significantly between the two protocols (p = 0.102). No association was found between follow-up time and treatment success (p = 0.888). The hypothesis was not confirmed. Even though the obtained success rate was higher after supplementing the irrigation protocol with EDTA and PUI, no significance was recorded. Hence, protocol 2 was not superior to protocol 1 regarding therapy success, at least within the limited follow-up period. It may be cautiously concluded that sufficient mechanical debridement combined with passive NaOCl irrigation results in comparably high success rates compared to EDTA and PUI.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

2009 ◽  
Vol 24 (5) ◽  
pp. 287-296 ◽  
Author(s):  
J.M. Olivares ◽  
A. Rodriguez-Morales ◽  
J. Diels ◽  
M. Povey ◽  
A. Jacobs ◽  
...  
Keyword(s):  
Observational Study ◽  
Treatment Adherence ◽  
Prospective Observational Study ◽  
Clinical Symptoms ◽  
Retrospective Chart Review ◽  
Treatment Retention ◽  
Severity Scores ◽  
Long Term Treatment ◽  
Long Acting

AbstractBackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (−1.14 for RLAI versus −0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

scholarly journals Toxic epidermal necrolysis

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 951 ◽  
Author(s):  
Wolfram Hoetzenecker ◽  
Tarun Mehra ◽  
Ieva Saulite ◽  
Martin Glatz ◽  
Peter Schmid-Grendelmeier ◽  
...  
Keyword(s):  
Cell Death ◽  
Mortality Rate ◽  
Toxic Epidermal Necrolysis ◽  
Human Leukocyte ◽  
Best Supportive Care ◽  
Drug Induced ◽  
Leukocyte Antigen ◽  
Mucosal Involvement ◽  
Keratinocyte Cell ◽  
Life Threatening

Toxic epidermal necrolysis (TEN) is a rare, life-threatening drug-induced skin disease with a mortality rate of approximately 30%. The clinical hallmark of TEN is a marked skin detachment caused by extensive keratinocyte cell death associated with mucosal involvement. The exact pathogenic mechanism of TEN is still uncertain. Recent advances in this field have led to the identification of several factors that might contribute to the induction of excessive apoptosis of keratinocytes. In addition, specific human leukocyte antigen types seem to be associated with certain drugs and the development of TEN. As well-controlled studies are lacking, patients are treated with various immunomodulators (e.g. intravenous immunoglobulin) in addition to the best supportive care.

scholarly journals Evaluation of maternal and fetal outcome in pregnancies complicated by jaundice-an observational study

2021 ◽  
Author(s):  
Ruchi Kishore ◽  
Neha Thakur ◽  
Mitali Tuwani
Keyword(s):  
Mortality Rate ◽  
Observational Study ◽  
Maternal Mortality ◽  
Viral Hepatitis ◽  
Hellp Syndrome ◽  
Fetal Outcome ◽  
Maternal Outcome ◽  
Fetal Mortality ◽  
Maternal Mortality Rate ◽  
In Pregnancy

Background: The spectrum of jaundice in pregnancy varies from a benign condition with good maternal and fetal outcome to a severe form resulting in liver failure and maternal and fetal mortality. Jaundice may complicate 3-5% of pregnancies. Present study was aimed to analyze the cause, course and impact of jaundice during pregnancy so as to have better understanding and hence better feto-maternal outcome. The present study aimed to analyze the various causes of hepatic dysfunction in pregnancy, maternal and fetal outcome in pregnancies complicated by jaundice and various hematological and liver function variables for predicting maternal and fetal outcome.Methods: The present study was an observational study conducted in the department of obstetrics and gynecology, Pt. JNM medical college and associated Dr. BRAM hospital, Raipur (CG) over period of 2 year from September 2018 to September 2020.Results: Total 0.72% pregnancies were complicated by jaundice. HELLP syndrome was the commonest cause of jaundice in pregnancy (36.7%), followed by viral hepatitis (32.7%). Hepatitis E was the most common type of viral hepatitis (91.8%). Hemolytic jaundice presented with best maternal outcome (maternal mortality rate 8.6%). Worst maternal outcome was seen in AFLP (maternal mortality rate 100%). Best fetal outcome was seen in viral hepatitis (live birth rate 67.6%), whereas worst noted with AFLP (fetal death rate 66.6%). Higher total serum bilirubin, higher serum AST, anemia and deranged INR had significant correlation with maternal mortality.Conclusions: HELLP syndrome and viral hepatitis are preventable causes of jaundice yet it contributed to significant proportion of maternal deaths in 26.5 and 18.5% cases respectively. AFLP is often under diagnosed and had a fulminant course in pregnancy causing maternal and fetal mortality.

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