scholarly journals Clinical characteristics of patients with subacute thyroidits and factors affecting development hypothyroidism after subacute thyroiditis

Author(s):  
İNAN ANAFOROĞLU ◽  
Murat Topbas

IntroductionSubacute thyroiditis (SAT) is typically a self-limiting, inflammatory disease. Patients can experience hypothyroidism during or after an episode. We examined the clinical characteristics based on laboratory and imaging studies in patients with SAT and possible factors contributing to the development of permanent hypothyroidism after SAT.Material and methodsWe retrospectively examined medical records of patients diagnosed with SAT at one medical facility in Turkey. Patients known to have previous thyroid disease, those with <6 months of follow-up after resolution of SAT, and those who lacked sufficient data for analysis were excluded. Of the 283 patients identified 119 met all inclusion criteria. We extracted data on demographics, laboratory tests, neck pain and other symptoms, ultrasonography findings, medication use, and SAT recurrence. We examined the relationships between these variables and development of permanent hypothyroidism.ResultsThe patients were 42 years old on average, and 78% were women. Most patients (70%) described flu-like symptoms before neck pain started; accordingly, 57% had initially visited a specialty other than endocrinology before SAT was diagnosed, and 28% had received antibiotics for misdiagnosed upper respiratory tract infection. In all, 10 patients (8.4%) developed permanent hypothyroidism after SAT. These patients had received steroids significantly longer than did those without permanent hypothyroidism (mean 17.7 vs. 8.9 weeks; P = .021). Development of hypothyroidism was significantly lower among patients with thyrotoxicosis.ConclusionsThe diagnosis of SAT can be challenging. Patients who require longer-term steroids after SAT and who have recurrent SAT should be closely monitored for development of hypothyroidism.

2020 ◽  
pp. 1098612X2092492
Author(s):  
Oliver Marsh ◽  
Giulia Corsini ◽  
Jan Van Dijk ◽  
Rodrigo Gutierrez-Quintana ◽  
Luisa De Risio

Objectives The study objective was to investigate the prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. Methods The medical records of two veterinary referral clinics from 2007 to 2017 were searched for cats fulfilling the inclusion criteria of a diagnosis of epilepsy, treatment with phenobarbitone and available follow-up information on the occurrence of adverse effects. Follow-up information was obtained from the medical records of the primary veterinarian and referral institutions and a questionnaire completed by the cats’ owners. Results Seventy-seven cats met the inclusion criteria. Fifty-eight were affected by idiopathic epilepsy and 19 by structural epilepsy. One or more of the following adverse effects were reported in 47% of the cats: sedation (89%); ataxia (53%); polyphagia (22%); polydipsia (6%); polyuria (6%); and anorexia (6%). Logistic regression analyses revealed significant associations between adverse effect occurrence and both phenobarbitone starting dosage and administration of a second antiepileptic drug (AED). For each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times. When a second AED was used, the likelihood of adverse effects increased 3.2 times. No association was identified between epilepsy aetiology and adverse effect occurrence. An idiosyncratic adverse effect, characterised by severe neutropenia and granulocytic hypoplasia, was diagnosed in one cat. This resolved following phenobarbitone discontinuation. Conclusions and relevance The prevalence of phenobarbitone-associated adverse effects was 47%. Sedation and ataxia were most common. These are type A adverse effects and are predictable from phenobarbitone’s known pharmacological properties. In the majority of cases, adverse effects occurred within the first month of treatment and were transient. Idiosyncratic (type B) adverse effects, which were not anticipated given the known properties of the drug, occurred in one cat. Increased phenobarbitone starting dosage and the addition of a second AED were significantly associated with the occurrence of adverse effects.


Author(s):  
Jonas Odermatt ◽  
Natalie Friedli ◽  
Alexander Kutz ◽  
Matthias Briel ◽  
Heiner C. Bucher ◽  
...  

AbstractBackground:Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI).Methods:A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure.Results:In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7–1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI –0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1–0.3; p<0.001) and in a 2.4 day (95% CI –2.9 to –1.9; p<0.001) shorter antibiotic exposure compared to control patients.Conclusions:PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.


1997 ◽  
Vol 55 (4) ◽  
pp. 722-727 ◽  
Author(s):  
Thiago D. Gonçalves-Coêlho ◽  
Carlos Newton D. Pinheiro ◽  
Ezon V.A.P. Ferraz ◽  
José Luiz Alonso-Nieto

The idiopathic facial paralysis or Bell's palsy installs abruptly or within a few hours, without any apparent cause. It corresponds to approximately 75% of all peripheral facial palsies. Three theories try to explain its pathogenecity: vascular-ischemic, viral and auto-immune. We reviewed the records of the EMG Sector, Hospital do Servidor Público Estadual (São Paulo, Brazil), from 1985 to 1995 and found 239 cases of Bell's palsy. Data were analysed according to age, gender, seasonal distribution of cases. There was a predominance of cases in the 31 - 60 age bracket (40.59 %). The female gender was responsible to 70.71 % of cases. There was a predominance of cases in winter (31.38 %) and autumn (30.13 %), which was statiscally significant. These findings let us to suppose that Bell's palsy predominates in females, in 41-60 years age bracket, and occurs predominantly in cold months. There are groups of clusters throughout temporal distribution of cases and cases are dependent on one each other or on factors affecting them all, which reinforces the infectious hypothesis (there is a rise in the incidence of viral upper respiratory tract infection during cold months).


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dae Hyun Kim ◽  
Ha Jeong Noh

Abstract Background Acute acquired comitant esotropia (AACE) is a type of strabismus characterized by a sudden onset of large angle esotropia with diplopia, which often occurs in children after infancy, teenagers, and young adolescents. However, studies on the surgical outcomes of only adults are rare. The purpose of this article is to analyze the surgical outcomes for adult patients diagnosed with AACE. Methods Medical records of 24 patients who had undergone surgery for AACE were retrospectively analyzed. The main outcome measures were the final motor and sensory success rate after surgery and factors affecting motor and sensory outcomes. Motor success was considered alignment within 8 prism diopter (PD) at both near and distance and sensory success was stereoacuity ≥ 60 sec/arc. Results The preoperative mean esodeviation angles were 33.1 ± 10.4 PD at distance and 33.3 ± 11.2 PD at near. The mean period of postoperative follow up was 7.5 ± 4.5 months (range 1–8 months). The postoperative mean esodeviation angles at final follow-up time were 3.4 ± 6.1 PD at distance and 3.8 ± 6.7 PD at near. The surgical motor success rate at final follow-up was 79.2% (19/24). The sensory success rate at final follow-up was 50.0% (12/24). The factor affecting the motor outcome was the type of surgery (p < 0.05). The factor affecting sensory outcome was postoperative follow-up time (p < 0.05). Conclusions Surgery type appears to affect surgical motor outcomes in adults with AACE. Although the sensory outcome was favorable, it seems that regaining bifoveal fixation takes time.


2021 ◽  
Author(s):  
Yophtahe Woldegerima ◽  
Desalegn Muche ◽  
Wubie Birlie ◽  
Habtu Adane ◽  
Misganaw Mengie

Abstract Introduction: Perioperative respiratory adverse events (PRAEs) are the most frequent complications in pediatrics which frequently result in morbidity and mortality. They are accountable for 75% of perioperative critical incidents and 33% of cardiac arrests. The occurrence and severity of PRAEs depends on the natures of surgery, anesthesia & patient’s status.Objective: To assess the incidence and factors associated with PRAEs in general anesthesia among pediatric surgical patients at the University of Gondar and Tibebe-Ghion Comprehensive Hospital and Specialized Hospitals, Northwest Ethiopia, 2020.Methods: After obtaining the ethical approval, a hospital-based prospective cross-sectional follow-up study was conducted among pediatric surgical patients who underwent variety of surgical operations. A total of 225 patients were included. The associations between independent variables and the outcome variables were determined at 95% CI with the Chi-squared test, Fisher–exact test, bivariate, and multivariate logistic regression. Hosmer-Lemeshow test was used to assess the goodness of fit. Variables with a p-value < 0.05 were considered significant.Results: The incidence of PRAEs among 210 (93.3% response rate) pediatrics surgical patients was 26.2% (95% CI: 20.5, 30.9). A total of 129 episodes of PRAEs were observed. Most of the adverse events (89 (69.0%)) were occurred postoperatively. Desaturation was found to be the predominant adverse event which was occurred 61 (47.3%) times. Age < 1 year (AOR: 3.6, 95% CI: 1.3, 10.0), ASA ≥ 3 (AOR: 5.2, 95% CI: 1.9, 22.9), upper respiratory tract infections (AOR: 7.6, 95% CI: 1.9, 30.2), presence of secretions in the upper airway (AOR: 4.8, 95% CI: 1.4, 15.9) and airway related procedures (AOR: 6.0, 95% CI: 1.5, 24.1) were significantly associated PRAEs.Conclusions: The incidence of PRAEs among pediatric surgical patients was relatively high (26.2%). Especially, the postoperative phase is the most critical time for the occurrence of PRAEs and desaturation was the predominant adverse event. Age less than a year, presence of upper respiratory tract infections, presence of secretions in the upper airways, ASA ≥ 3 and airway related procedures were associated with PRAEs. Clinicians should carry out effective risk assessment, optimization and adequate preparation for the management of perioperative respiratory adverse events.


Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 773
Author(s):  
Sam Ghebrehewet ◽  
Wendi Shepherd ◽  
Edwin Panford-Quainoo ◽  
Saran Shantikumar ◽  
Valerie Decraene ◽  
...  

Background: High levels of antimicrobial resistance (AMR) in Ghana require the exploration of new approaches to optimise antimicrobial prescribing. This study aims to establish the feasibility of implementation of different delayed/back-up prescribing models on antimicrobial prescribing for upper respiratory tract infections (URTIs). Methods: This study was part of a quality improvement project at LEKMA Hospital, Ghana, (Dec 2019–Feb 2020). Patients meeting inclusion criteria were assigned to one of four groups (Group 0: No prescription given; Group 1; Patient received post-dated antibiotic prescription; Group 2: Offer of a rapid reassessment of patient by a nurse practitioner after 3 days; and Group 3: Post-dated prescription forwarded to hospital pharmacy). Patients were contacted 10 days afterwards to ascertain wellbeing and actions taken, and patients were asked rate the service on a Likert scale. Post-study informal discussions were conducted with hospital staff. Results: In total, 142 patients met inclusion criteria. Groups 0, 1, 2 and 3 had 61, 16, 44 and 21 patients, respectively. Common diagnosis was sore throat (73%). Only one patient took antibiotics after 3 days. Nearly all (141/142) patients were successfully contacted on day 10, and of these, 102 (72%) rated their experiences as good or very good. Informal discussions with staff revealed improved knowledge of AMR. Conclusions: Delayed/back-up prescribing can reduce antibiotic consumption amongst outpatient department patients with suspected URTIs. Delayed/back-up prescribing can be implemented safely in low and middle-income countries (LMICs).


2010 ◽  
Vol 55 (No. 11) ◽  
pp. 561-565 ◽  
Author(s):  
F. Laus ◽  
E. Paggi ◽  
M. Cerquetella ◽  
D. Spaziante ◽  
A. Spaterna ◽  
...  

Guttural pouch mycosis is an emergency disease of the upper respiratory tract in equine species. In the present report a case of guttural pouch mycosis in a female, seven year-old pregnant donkey is described. A serious dyspnea which necessitated tracheotomy and preceding epistaxis was the most important clinical feature of guttural pouch mycosis in the donkey. A full and rapid effectiveness of the topical therapy, the protocol for which is described, is the main distinguishing feature with regard to treatment. In the Authors' knowledge a detailed description of clinical features, treatment and follow up of guttural pouch mycosis in a donkey is not available in the scientific literature. The anatomical and physiological peculiarity of donkeys could explain some of the differences with horses in clinical presentation and therapeutic management.


1996 ◽  
Vol 85 (01) ◽  
pp. 4-14
Author(s):  
J. Blommers ◽  
D.J. Kuik ◽  
L. Feenstra ◽  
P.D. Bezemer ◽  
E.S.M. De Lange-De Klerk

AbstractThe effects of homoeopathic medicines on children suffering from recurrent upper respiratory tract infection (URTI) were studied in a randomized double-blind placebo-controlled clinical trial conducted at the paediatric outpatients department of the university hospital of the Vrije Universiteit in Amsterdam from 1987 to 1992.The study was designed to meet both the requirements of proper homoeopathic practice and the current standards of a clinical trial. The purpose of a randomized placebo-controlled double-blind trial is to identify the effects of the agents under investigation by equalizing the effects of other factors that may influence outcome.The object of the trial, eligibility criteria, follow-up period, treatments and concurrent interventions, data collection and effect measures are discussed in the light of homoeopathic thinking.


2015 ◽  
Vol 28 (04) ◽  
pp. 288-293 ◽  
Author(s):  
T. Nicetto ◽  
M. Petazzoni

SummaryObjectives: To describe the use of the Fixin locking plate system for stifle arthrodesis in dogs and to retrospectively report the clinical and radiographic outcomes in six cases.[uni2028]Materials and methods: Medical records of dogs that had arthrodesis with the Fixin locking plate system were reviewed. For each patient, data pertaining to signalment and implant used were recorded. Plate series and thickness, number of screws placed, number of cortices engaged, and screw diameters were also recorded. The outcome was determined from clinical and radiographic followups. Radiographic outcomes assessed included the measurement of the postoperative femoral-tibial angle in the sagittal plane.Results: Six dogs met the inclusion criteria for the study. Mean body weight was 13 kg (range: 3 - 34 kg). Radiographic follow-up (mean: 32 weeks, range: 3 - 52 weeks) was available for all dogs. In one case, an intra-operative complication occurred. In another case, a tibial fracture occurred 20 days after surgery. All arthrodeses healed and no implant complication was detected although all cases had mechanical lameness.Clinical significance: Stifle arthrodesis can be performed successfully using a Fixin locking plate system.


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