Clinical features, risk factors, and outcome of cerebral venous thrombosis in Tehran, Iran

ABSTRACT Introduction: Despite increasing the use of magnetic resonance imaging (MRI), cerebral venous sinus thrombosis (CVST) has remained an under-diagnosed condition. In this study, characteristics and frequency of various risk factors of CVST patients in a tertiary referral hospital were closely assessed. Methods: Patients with an unequivocal diagnosis of CVST confirmed by MRI and magnetic resonance venography during 6 years of the study were included. All data from the onset of symptoms regarding clinical signs and symptoms, hospital admission, seasonal distribution, medical and drug history, thrombophilic profile, D-dimer, neuroimaging, cerebrospinal fluid findings, mortality, and outcome were collected and closely analyzed. Result: A total of 53 patients with female to male ratio of 3.07 and mean age of 33.7 years were included in the study. Headache and papilledema were the most frequent clinical features (44 and 36 patients, respectively). An underlying disease (diagnosed previously or after admission) was the most common identified risk factor for CVST in both females and males (21 patients). A total of 15 women used the oral contraceptive pill (OCP) where 12 of them had simultaneously other predisposing factors. Overall, 19 patients (36%) had more than one contributing factor. D-dimer had a sensitivity of 71.4% in CVST patients. The mortality of patients in this study was 3.7% (n = 2). Focal neurologic deficit and multicranial nerve palsy were associated with poor outcome which defined as death, recurrence, and massive intracranial hemorrhage due to anticoagulation (P = 0.050 and 0.004, respectively). Conclusion: Unlike most of the CVST studies in which OCP was the main factor; in this study, an underlying disease was the most identified cause. Considering the high probability of multiple risk factors in CVST that was shown by this study, appropriate work up should be noted to uncover them.

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Carotid Intima Media Thickness in Graves Disease: Comparing Overt Hyperthyroid and Remission State

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.578 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A284-A285

Author(s):

Intan Nurjannah ◽

Wismandari Wisnu ◽

Dicky L Tahapary ◽

Ika Prasetya Wijaya

Keyword(s):

Risk Factors ◽

Clinical Signs ◽

Signs And Symptoms ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Graves Disease ◽

Care Hospital ◽

Media Thickness ◽

Clinical Signs And Symptoms ◽

Overt Hyperthyroidism

Abstract Background/Objective: Hyperthyroid has been associated with increased cardiovascular event. Carotidintima media thickness (CIMT) is oftenly measured to evaluate the risk of cardiovascularevent. The aim of this study is to measure CIMT in Graves’ disease and to comparebetween subjects in overt hyperthyroidism and remission state. Methods: Our study was a cross-sectional study performed at the outpatient endocrinologyclinic of Dr. Cipto Mangunkusumo Hospital, a tertiary care hospital in Jakarta, Indonesia. Graves’ disease subjects were recruited, of whom then grouped into overthyperthyroidism (clinical signs and symptoms of hyperthyroidism, low THS, highthyroxine levels, treatment naïve of within 3 months of treatments) and remission state(no clinical signs and symptoms of hyperthyroidism, normal THs and thyroxine levels,without any anti thyroid drugs for at least 6 months). CIMT measurements wereperformed by trained physician on both right and left artery carotid arteries using anultrasound equipped with software that automatically measured the CIMT. We alsomeasured lipid profile, fasting blood glucose, and ECG. Results: We recruited 49 Graves’ disease subjects, of whom 32 and 17 subjects werein overt hyperthyroidism and remission state respectively. Median CIMT in overthyperthyroidism and remission state were 0,473 mm and 0,488 mm respectively, p:0,109. Among clinical and laboratory risk factors, only age which had an independentcorrelation with CIMT in Graves disease. (r: 0,371; p:<0,0001). Discussion: Our is the first study that measured CIMT among subjects with Graves’disease in remission and overt hyperthyroidism state, of which we observed nodifferences. This might be due to the fact that the atherosclerosis risk factors were notdistributed evenly on both group, of which subjects were older in the remission group. Ithas been reported that there are increasing CIMT along with aging (0,003-0,010 mm peryear). Furthermore, in remission state we need to take metabolic and physical changesinto consideration, such as increasing weight as much as 2,5% from prior weight alongwith increasing total cholesterol and LDL-cholesterol which both can affect CIMT levels. Conclusions: There are no significant differences in CIMT between overt hyperthyroid andremission state in Graves’ disease. Keywords: carotid intima media thickness, Graves’ disease, overt hyperthyroid, remission.

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2193. Factors Impacting the Duration of Antimicrobial Therapy for Community-Acquired Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1873 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S746-S747

Author(s):

Avnish Sandhu ◽

Erin Goldman ◽

Jordan Polistico ◽

Sarah Polistico ◽

Ahmed Oudeif ◽

...

Keyword(s):

Risk Factors ◽

Medical Center ◽

Clinical Signs ◽

Retrospective Chart Review ◽

Signs And Symptoms ◽

Community Acquired Pneumonia ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Factors Associated ◽

Specific Risk

Abstract Background Pneumonia is a common cause of infection associated with hospitalization. Treatment durations for community-acquired pneumonia (CAP) often exceed guideline recommended durations of 5–7 days without a clear explanation. The objective of this study was to determine factors that may lead to durations exceeding this recommendation. Methods A retrospective chart review of 89 patients admitted to the Detroit Medical Center (DMC) for the treatment of pneumonia was conducted. Demographics, clinical signs and symptoms, antibiotic data, pneumonia severity score (CURB 65), risk factors for resistance, microbiology results, and outcomes were recorded and analyzed for factors associated with increased durations of antibiotics. Average durations of antibiotics and durations of antibiotics greater that 7 days were assessed for each risk factor. Results Average durations of antibiotics was 9 days (SD 3.8) for the cohort, and 55 (61%) received durations of > 7 days. Average durations of antibiotics for risk factors are shown in Table 1. Factors associated with durations of antibiotics longer than 7 days are shown in Table 2. There was a trend toward longer average durations of antibiotics for persons with risk factors for resistance [Drug Resistance in Pneumonia (DRIP) score ≥ 4 (increased duration of antibiotics by 1.7 days, P = 0.07] and those with a positive legionella antigen [increased durations of antibiotics by 6.6 days, P = 0.07]. Conclusion Specific risk factors could not be associated with increased durations of antibiotics, although there was a trend toward longer durations for persons with markers for resistance and positive legionella testing. Efforts to reduce durations of antibiotics must target global clinician antibiotic prescribing patterns and not specific risk factors. Disclosures All authors: No reported disclosures.

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A serological and epidemiological evaluation of risk factors for toxocariasis in children in central Poland

Journal of Helminthology ◽

10.1017/s0022149x08912372 ◽

2008 ◽

Vol 82 (2) ◽

pp. 123-127 ◽

Cited By ~ 11

Author(s):

Hanna Żarnowska ◽

Anna Borecka ◽

Jakub Gawor ◽

Magdalena Marczyńska ◽

Sabina Dobosz ◽

...

Keyword(s):

Risk Factors ◽

Rural Areas ◽

Urban Areas ◽

Clinical Signs ◽

Signs And Symptoms ◽

Epidemiological Data ◽

Data Contamination ◽

Central Poland ◽

Epidemiological Risk ◽

Clinical Signs And Symptoms

AbstractThe level of specific anti-Toxocara IgG was examined in 343 children from central Poland with suspected Toxocara infection. Based on the presence of specific IgG antibodies and clinical signs and symptoms, toxocariasis was confirmed in 249 patients. The serological results of diagnosed cases were analysed in connection with epidemiological data (contamination of soil around the children's homes and presence of a dog or a cat). A higher prevalence of soil contamination with Toxocara eggs was found in suburban and rural areas (30.9% and 24.6%, respectively) whereas it was lower in urban areas (10.3%). In about 40% of the children whose households were not contaminated, a decrease in the antibody level was observed 2 years after treatment for toxocariasis, while there was no such decline in those living in contaminated places. The logistic regression model employed to determine the correlation between seropositivity in the children and selected epidemiological risk factors showed a statistically significant relationship in connection only with dog ownership (P = 0.0238). The present results have demonstrated the high risk of toxocariasis for children from rural and suburban areas in Poland. The sero-epidemiological investigations indicated that re-infection might be the reason for persistence of seropositivity after treatment.

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Clinical Features, Diagnosis and Management of Patients with Suspicion of Fascioliasis in Kohgiluyeh and Boyer-Ahmad Province, Southwestern Iran

Iranian Journal of Parasitology ◽

10.18502/ijpa.v15i1.2530 ◽

2020 ◽

Author(s):

Abdolali MOSHFE ◽

Arash ARIA ◽

Najme ERFANI ◽

Ali JAMSHIDI ◽

Bahador SARKARI ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Epigastric Pain ◽

Serological Test ◽

Demographic Data ◽

Clinical Signs ◽

Signs And Symptoms ◽

Diagnosis And Management ◽

History Of ◽

Clinical Signs And Symptoms

Background: In the current study, we described the epidemiological features, clinical presentation, diagnosis and management of patients with suspicion of fascioliasis in Kohgiluyeh and Boyer-Ahmad Province in southwest of Iran. Methods: Overall, 56 patients with suspicion of fascioliasis, based on their clinical signs and symptoms that referred to Clinic of Internal Medicine in Yasuj city, from 2014 to 2016 were enrolled. Demographic data, history of eating aquatic local plants, the chief complains, and laboratory findings were recorded for each patient. Stool samples were obtained from each case for detection of Fasciola eggs. Moreover, blood samples were taken from each patient and evaluated for detection of anti-Fasciola antibodies by an indirect ELISA. Patients who defined as having fascioliasis were treated with triclabendazole and were followed for at least three months for clinical improvement. Results: Serological test was positive in 5 patients. Of these 5 cases, three cases had a history of ingesting raw aquatic vegetables. The main clinical signs and symptoms in positive cases were; abdominal pain (60%), epigastric pain (40%), anemia (60%), and dermal pruritus (20%). Hypereosinophilia was seen in all of 5 positive cases. No Fasciola egg was found in stool specimens of any of the patients. The fascioliasis cases were treated by triclabendazole and clinical symptoms disappeared in all of 5 cases. Conclusion: Our observation further confirmed Yasuj district as a human endemic area for fascioliasis in Iran. The study also highlighted the importance of clinical features together with eosinophilia, as key parameters, in the diagnosis of human fascioliasis. Clinicians need to be aware of this disease and should keep in mind fascioliasis when hypereosinophilia present in patients in such endemic areas.

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Internal Carotid Dissection as the Cause of Stroke in Childhood

Case Reports in Pediatrics ◽

10.1155/2021/5568827 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Giulia Cinelli ◽

Vitaliana Loizzo ◽

Lisa Montanari ◽

Ilaria Filareto ◽

Elisa Caramaschi ◽

...

Keyword(s):

Risk Factors ◽

Magnetic Resonance ◽

Internal Carotid ◽

Clinical Signs ◽

Cervical Pain ◽

Resonance Imaging ◽

Cervical Trauma ◽

History Of ◽

Associated Risk Factors ◽

The Right

Internal carotid artery (ICA) dissection is a cause of stroke, but it is often underdiagnosed in children. ICAs’ risk factors and pathogenic mechanisms are poorly understood, and the treatment is still empirical. We report the case of a previously healthy 9-year-old girl who presented with involuntary hypertonic closure of the right hand associated with transient difficulty for both fine movements of the right arm and speech. She had a history of minor cervical trauma occurring 20 days prior to our observation without other associated risk factors. Magnetic resonance imaging and magnetic resonance angiography showed ischemic lesions due to the left ICA dissection. Treatment with both acetylsalicylic acid and levetiracetam allowed recanalization of the ICA associated with the resolution of clinical signs. Our clinical case suggests that the ICA dissection must be suspected early whenever a child manifests mild neurologic deficits after a cervical trauma, especially if they are associated with headache and/or cervical pain. Moreover, the management of ICA dissection must be improved.

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Pathophysiology and management of pre-eclampsia, eclampsia, and HELLP syndrome

10.1093/med/9780199600830.003.0366 ◽

2016 ◽

Author(s):

Muna Noori ◽

Catherine Nelson-Piercy

Keyword(s):

Risk Factors ◽

Genetic Susceptibility ◽

Antihypertensive Therapy ◽

Hellp Syndrome ◽

Clinical Signs ◽

Signs And Symptoms ◽

Screening Tests ◽

Close Monitoring ◽

Multisystem Disorder ◽

Clinical Signs And Symptoms

Pre-eclampsia is a multisystem disorder of pregnancy, characterized by the gestational onset of hypertension and proteinuria, which presents as part of a spectrum of disease with potentially serious consequences for both mother and foetus. Pre-eclampsia is a syndrome with multiple aetiologies, which has made it difficult to develop adequate screening tests and treatments. Pre-eclampsia is likely to develop only in vulnerable women with a mix of genetic susceptibility, vascular, metabolic, and inflammatory dysfunction. A number of prepregnancy risk factors for pre-eclampsia have been identified. However, not all women with risk factors develop pre-eclampsia, while many women without do, making it a challenging condition to predict. As pre-eclampsia cannot be prevented, its management remains supportive, with close monitoring of clinical signs and symptoms, antihypertensive therapy, seizure prophylaxis, and ultimately delivery when necessary. This chapter outlines the pathophysiology, diagnosis, and sequelae of pre-eclampsia, and provides an overview of antenatal, intrapartum, and post-natal management of women with pre-eclampsia.

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Evaluation of renal biopsies in various kidney diseases with reference to staining

IP Archives of Cytology and Histopathology Research ◽

10.18231/j.achr.2021.058 ◽

2021 ◽

Vol 6 (4) ◽

pp. 269-274

Author(s):

Kaushlendra Kumar Pandey ◽

Wilma Delphine Silvia CR ◽

Aparna Pandey ◽

Asha Agarwal

Keyword(s):

Kidney Diseases ◽

Clinical Signs ◽

Disease Process ◽

Membranous Glomerulonephritis ◽

Signs And Symptoms ◽

Underlying Disease ◽

Renal Diseases ◽

Amyloid Deposits ◽

Renal Biopsies ◽

Staining Techniques

Renal diseases of different origin and nature may produce essentially similar disturbances of renal functions and may have clinical similarities and hence there was a need to classify renal diseases more scientifically. The basic approach was to correlate clinical signs and symptoms with histological changes in the tissue, using both simple and special staining techniques so as to reach to a definitive diagnosis.The present study was conducted on renal biopsy referred to pathology department. Criteria for successful biopsy were as follows-Adequate biopsy sample size, correct processing of specimen, informed interpretation and issue of an accurate report. A total of 29 renal biopsies were examined. In minimal change disease, only in 4 patients the glomerulus was sclerosed. Membranous glomerulonephritis comprised of the maximum number of cases (9/30). Total of 3 cases of renal biopsies revealed amyloidosis. Focal amyloid deposits with deposits either near the hilum or perivascular areas were found in 33.3% of cases, while extensive amyloid deposits were found in 33.3% of the cases.It is necessary to determine both the type of renal disease and the cause of the primary disorder in order to make the diagnosis and various staining techniques play a very helpful role. The likelihood that the biopsy specimen accurately reflects the type and severity of the underlying disease is directly related to both the diffuseness of the disease process and the amount of tissue examined.

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Risk factors and treatment methods affecting quality of life in patients with benign prostatic hyperplasia and prostate cancer

Spravočnik vrača obŝej praktiki (Journal of Family Medicine) ◽

10.33920/med-10-2101-07 ◽

2021 ◽

pp. 46-58

Author(s):

Maya Andreevna Kuzmina ◽

Darya Dmitrievna Vasina ◽

Mark Albertovich Volodin ◽

Denis Igorevich Volodin ◽

Evgeniy Nikolaevich Bolgov ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Risk Factors ◽

Benign Prostatic Hyperplasia ◽

Clinical Signs ◽

Underlying Disease ◽

Modern Medicine ◽

Prostatic Hyperplasia ◽

Timely Diagnosis

One of the key concepts of modern medicine is the quality of life associated with health, which is influenced by the initial underlying disease, its timely diagnosis and quality treatment, as well as rehabilitation, further prevention and identification of complications that have arisen. The conditions and lifestyle of the patient play an important role, not only his physical health, but also mental health. Despite the fact that benign prostatic hyperplasia (BPH) is not a life-threatening disease, its main clinical signs are symptoms of dysfunction of the lower urinary tract, which to a greater extent cause discomfort to patients and significantly reduce their quality of life. One of the triggering factors for the development of prostate cancer is neglected cases of BPH progression. The occurrence of prostate cancer, as a consequence of BPH, undoubtedly worsens the patient's quality of life and requires timely diagnosis, detection and immediate treatment. Based on the literature data, the article analyzes the risk factors for the occurrence and the main methods of treatment for BPH and prostate cancer, which negatively affect the patient's quality of life.

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Neuroleptic malignant syndrome

European Psychiatry ◽

10.1016/s0924-9338(11)72940-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1235-1235

Author(s):

A. Cruz

Keyword(s):

Risk Factors ◽

Neuroleptic Malignant Syndrome ◽

Rare Complication ◽

Clinical Signs ◽

Specific Treatment ◽

Signs And Symptoms ◽

Clinical History ◽

Altered Mental Status ◽

Antipsychotic Therapy ◽

Mesh Terms

IntroductionNeuroleptic malignant syndrome (NMS) is a rare and potentially fatal idiosyncratic drug reaction usually defined as a complication of treatment with antipsychotics. It is manifested by altered mental status, hyperpyrexia, rigidity and autonomic instability. This syndrome occurs in response to administration of drugs that induce dopamine blockage.ObjectivesStudy the risk factors, diagnosis, treatment and complications of NMS, by performing a literature review.AimsSummarize the main aspects of NMS that may have importance in usual clinical practice.MethodsPubMed was used to identify NMS articles published after 2000, associated with the MeSH terms “neuroleptic malignant syndrome” and “antipsychotic agents”.ResultsNMS is not dose-related and its aetiology is still unknown. There are many risk factors associated with the syndrome, such as demographic, individual, genetic and environmental factors and medication. In order to evaluate the medical situation, an accurate clinical history and physical examination should be fulfilled. NMS is also characterized by changes in laboratory investigation. There are no patognomonic findings, thus other different diagnosis should be considered. Specific treatment remains controversial. Treatment should be individualized for each patient, regarding characteristics, duration and severity of the clinical signs and symptoms. Resolution is usually verified in one to two weeks. Though there are cases in which the symptoms persist and comorbid process may occur.ConclusionsAlthough NMS is a rare complication of antipsychotic therapy, early diagnosis and treatment is essential to improve prognosis.

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Sigmoid Sinus Thrombosis Associated with Internal Jugular Venous Occlusion: Direct Thrombolytic Treatment

Journal of Endovascular Therapy ◽

10.1177/152660289600300311 ◽

1996 ◽

Vol 3 (3) ◽

pp. 306-314 ◽

Cited By ~ 4

Author(s):

Melissa B. Gurley ◽

Teresa S. King ◽

Fong Y. Tsai

Keyword(s):

Internal Jugular Vein ◽

Jugular Vein ◽

Sinus Thrombosis ◽

Balloon Dilation ◽

Clinical Signs ◽

Signs And Symptoms ◽

Sigmoid Sinus ◽

Dural Sinus ◽

Jugular Vein Thrombosis ◽

Transfemoral Approach

Purpose: To report our experience with transfemoral direct venous thrombolysis and angioplasty to treat central venous and dural sinus occlusion. The cases presented are rare examples of internal jugular occlusion associated with sigmoid sinus thrombosis. Methods and Results: Two middle-aged, symptomatic female patients were diagnosed with sigmoid sinus and internal jugular vein thrombosis. Venography was performed from a contralateral transfemoral approach, followed immediately by urokinase infusion directly to the occlusion using an intermittent “burst-bolus” technique. Successful thrombolysis of the sigmoid sinus and internal jugular vein was documented in both patients. In one case, a venous stenosis was treated with balloon angioplasty. Clinical signs and symptoms resolved in both patients. Conclusions: Occluded dural sinuses and central veins can be treated with direct administration of thrombolytic agents. When an underlying stenosis is identified, balloon dilation should be used to reduce the likelihood of recurrence.

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