Better Health Through Research image
 Better Health Through Research image
      

Search Center...



SEARCH PARAMETERS
Search:
Journal: Author:
Years: through Show:  Display: 
 

  Page 1 of 100  
Clinical Laboratory of : Cephalgia
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging < Clinical Laboratory >
Improving the clinical diagnosis of influenza--a comparative analysis of new influenza A (H1N1) cases.
Author(s): Ong, AK; Chen, MI; Lin, L; Tan, AS; Nwe, NW; Barkham, T; Tay, SY; Leo, YS
Journal: PLoS One 2010 Mar 18; Vol. 4, Issue 12; Page(s) e8453
[Medline ID - 20041115]

BACKGROUND: The presentation of new influenza A(H1N1) is broad and evolving as it continues to affect different geographic locations and populations. To improve the accuracy of predicting influenza infection in an outpatient setting, we undertook a comparative analysis of H1N1(2009), seasonal influenza, and persons with acute respiratory illness (ARI) in an outpatient setting. METHODOLOGY/PRINCIPAL FINDINGS: Comparative analyses of one hundred non-matched cases each of PCR confirmed H1N1(2009), seasonal influenza, and ARI cases. Multivariate analysis was performed to look for predictors of influenza infection. Receiver operating characteristic curves were constructed for various combinations of clinical and laboratory case definitions. The initial clinical and laboratory features of H1N1(2009) and seasonal influenza were similar. Among ARI cases, fever, cough, headache, rhinorrhea, the absence of leukocytosis, and a normal chest radiograph positively predict for both PCR-confirmed H1N1-2009 and seasonal influenza infection. The sensitivity and specificity of current WHO and CDC influenza-like illness (ILI) criteria were modest in predicting influenza infection. However, the combination of WHO ILI criteria with the absence of leukocytosis greatly improved the accuracy of diagnosing H1N1(2009) and seasonal influenza (positive LR of 7.8 (95%CI 3.5-17.5) and 9.2 (95%CI 4.1-20.3) respectively). CONCLUSIONS/SIGNIFICANCE: The clinical presentation of H1N1(2009) infection is largely indistinguishable from that of seasonal influenza. Among patients with acute respiratory illness, features such as a temperature greater than 38 degrees C, rhinorrhea, a normal chest radiograph, and the absence of leukocytosis or significant gastrointestinal symptoms were all positively associated with H1N1(2009) and seasonal influenza infection. An enhanced ILI criteria that combines both a symptom complex with the absence of leukocytosis on testing can improve the accuracy of predicting both seasonal and H1N1-2009 influenza infection.

[Clinical features of 337 patients with recurrent nasopharyngeal carcinoma]
Author(s): Li, JX; Lu, TX; Huang, Y; Han, F; Chen, CY; Xiao, WW
Journal: Ai Zheng 2009 Dec 30; Vol. 29, Issue 1; Page(s) 82-6
[Medline ID - 20038316]

BACKGROUND AND OBJECTIVE: At present, although appropriate radiotherapy and combined treatments are widely used for the patients with primary nasopharyngeal carcinoma (NPC), local or regional recurrence rates are still high. According to clinical performance, pathology, and diagnostic imaging of the patients with the first recurrence of NPC, this study analyzed the clinical features of recurrent NPC to provide a reference for tracking the rules of recurrence after the treatment of patients with NPC. METHODS: Clinical data of 337 patients dia gnosed with recurrent NPC for the first time were collected. The diagnoses were based on pathology and/or imaging and the patients were treated at the Sun Yat-sen University Cancer Center between January 1999 and December 2004. Data used for statistical analysis included clinical performance during the patient visit, the extension of the invasion as shown on imaging, pathologic features, Epstein-Barr virus (EBV) serology, restaging, etc. RESULTS: Patients were staged according to the system developed by the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC) in 2002. Patients with diseases at stages I/II accounted for 25.2%, while those with stage III/IV accounted for 74.8%. The median interval of relapse was 25 months. Patients had local recurrence (69.4%), regional recurrence (4.5%), or both (26.1%). Epistaxis and headache were the most common symptoms. Abduct dysfunction and facial numbness induced by cranial nerve damage were the most common signs. The probability of invasion of structures adjacent to the nasopharynx, such as the oropharynx, the prestyloid space, and the carotid sheath area, was low in patients with recurrent NPC. By contrast, the probability of invasion of structures far from the nasopharynx, such as the base of the skull, the paranasal sinuses, cranial nerves, the cavernous sinus, the brain, the pterygopalatine fossa, the infratemporal fossa, the orbital apex, and the soft palate, was higher in recurrent NPC. CONCLUSIONS: The most common interval of relapse is about 2 years. The relapsed disease is usually more widespread and located deeper. Most recurrent NPC is advanced disease.

[Influenza A/H1N1 in Israel--clinical and epidemiological characteristics]
Author(s): Balicer, RD; Anis, E; Goldmann, D; Dahan, D; Singer, R; Grotto, I
Journal: Harefuah 2010 Mar 25; Vol. 148, Issue 11; Page(s) 738-42, 795
[Medline ID - 20027971]

BACKGROUND: In March 2009, a novel A/H1N1 influenza virus began its inexorable spread around the world. Information regarding disease characteristics, groups at risk and prognosis remain partial. The Epidemiology Division of the Israeli Ministry of Health performs ongoing influenza surveillance and tracking of patients in Israel. The authors set out to characterize the disease and its spread in Israel. METHODS: Surveillance and investigation procedures were modified in accordance with changing Ministry of Health policy. From the outset of the outbreak and until June 30, 2009, all suspected cases of influenza A/H1N1 were investigated and laboratory verified. Starting July 1, 2009, lab confirmation was reserved for severely ill patients or those at high risk of complications. All hospitalized cases were monitored and tracked daily. RESULTS: By June 30, 2009, 596 patients had laboratory confirmed Influenza A/H1N1: 58% of these were aged 10-30 years, and only 5% were above 50 years of age; 58% were male. In addition to fever (83%), patients reported cough (74%), rhinorrhea (59%), and headache and sore throat (53% each). Thirty three patients were considered at high risk for complications, four of which required hospitalization in an intensive care unit; 64% of infections were acquired in Israel and 22% in the United States. By July 29, 2009, 952 additional cases had been verified. Overall, 13 of the cases had been hospitalized in intensive care, 3 of whom died. DISCUSSION: Early data indicate spread particularly to younger populations, expressing non-specific respiratory symptoms. Ongoing investment in real-time data collection and analysis will enable epidemiologists to supply the information necessary to deal with the influenza epidemic.

Prevalence of intracardiac shunting in children with sickle cell disease and stroke.
Author(s): Dowling, MM; Lee, N; Quinn, CT; Rogers, ZR; Boger, D; Ahmad, N; Ramaciotti, C; Buchanan, GR
Journal: J Pediatr 2010 Apr 30; Vol. 156, Issue 4; Page(s) 645-50
[Medline ID - 20022343]

OBJECTIVE: To determine the prevalence of potential intracardiac shunts, including patent foramen ovale (PFO), in children with sickle cell disease (SCD) and stroke. STUDY DESIGN: We performed a transthoracic echocardiogram (TTE) on 40 children with SCD (39 with hemoglobin SS and 1 with sickle-beta0 thalassemia) and earlier stroke (overt stroke in 30, silent infarction in 10). We compared 3 TTE techniques: conventional 2-dimensional imaging, color Doppler ultrasound, and intravenous agitated saline contrast injection for the detection of intracardiac shunts. We also evaluated the clinical, laboratory, and radiographic findings of the children with and without shunts. RESULTS: We identified PFO or other potential intracardiac shunts in 10 of 40 children with SCD and earlier stroke (25%; 95% CI, 11.6-38.4). With contrasted TTE, we failed to detect potential shunts in 2 children. In a comparison group of 60 children with stroke but without SCD, retrospective review of clinical echocardiograms identified PFO in 7 of 60 (11.7%; 95% CI, 3.6-19.8). Clinical features significantly associated with the presence of intracardiac shunts were stroke in the setting of vaso-occlusive crisis (P = .026) and headache at stroke onset (P = .014). CONCLUSION: One-quarter of children with SCD and stroke have potential intracardiac shunts. A combination of echocardiographic techniques is required for optimal shunt detection. Intracardiac shunting could be a risk factor for stroke in children with SCD because they are predisposed to thrombosis and elevations of right heart pressure, which could promote paradoxical embolization across an intracardiac shunt.

Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.
Author(s): Singh, RR; Chaudhary, SK; Bhatta, NK; Khanal, B; Shah, D
Journal: Indian J Pediatr 2010 Apr 16; Vol. 76, Issue 11; Page(s) 1109-11
[Medline ID - 20012797]

OBJECTIVE: To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal. METHODS: 107 children (aged 1 month to 14 yrs) presenting to the emergency with fever ( > 38 C) of less than 2 weeks duration with altered sensorium with/or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated. RESULTS: The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case. CONCLUSION: Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.

Tuberculous meningitis in HIV-infected patients in Brazil: clinical and laboratory characteristics and factors associated with mortality.
Author(s): Croda, MG; Vidal, JE; Hern; ández, AV; Dal Molin, T; Gualberto, FA; de Oliveira, AC
Journal: Int J Infect Dis 2009 Dec 17; Vol. 14, Issue 7; Page(s) e586-91
[Medline ID - 20005759]

BACKGROUND: Tuberculous meningitis (TBM) is a growing problem in HIV-infected patients in developing countries, where there is scarce data about this co-infection. Our objectives were to analyze the main features and outcomes of HIV-infected patients with TBM. METHODS: This was a retrospective study of HIV-infected Brazilian patients admitted consecutively for TBM. All patients had Mycobacterium tuberculosis isolated from the cerebrospinal fluid (CSF). Presenting clinical and laboratory features were studied. Multivariate analysis was used to identify variables associated with death during hospitalization and at 9 months after diagnosis. Survival was estimated using the Kaplan-Meier method. RESULTS: We included 108 cases (median age 36 years, 72% male). Only 15% had fever, headache, and meningeal signs simultaneously. Forty-eight percent had extrameningeal tuberculosis. The median CD4+ cell count was 65 cells/microl. Among 90 cases, 7% had primary resistance to isoniazid and 9% presented multidrug-resistant strains. The overall mortality during hospitalization was 29% and at 9 months was 41%. Tachycardia and prior highly active antiretroviral therapy (HAART) were associated with 9-month mortality. The 9-month survival rate was 22% (95% confidence interval 12-43%). CONCLUSIONS: Clinical and laboratory manifestations were unspecific. Disseminated tuberculosis and severe immunosuppression were common. Mortality was high and the 9-month survival rate was low. Tachycardia and prior HAART were associated with death within 9 months of diagnosis.

Retinal peripapillary nerve fiber layer thickness in a 13-year-old boy with neuromyelitis optica.
Author(s): Camicione, P; Fodor, E; Pannarello, S; Barabino, S
Journal: Eur J Ophthalmol 2010 Jul 9; Vol. 20, Issue 2; Page(s) 485-8
[Medline ID - 19967672]

PURPOSE: To report changes in retinal nerve fiber layer (RNFL) thickness in a patient with neuromyelitis optica (NMO). METHODS: A 13-year-old Caucasian boy presented with reduced visual acuity in both eyes, headache, and neck pain associated with left hand burning sensation. Clinical and laboratory examination, including magnetic resonance imaging (MRI) and optical coherence tomography (OCT), were performed. RESULTS: MRI showed spinal cord abnormality and acute myelitis, but normal optic nerve head. A significant reduction of the average and temporal area RNFL thickness was recorded in both eyes by OCT. Six months after initial steroid treatment, visual acuity and visual field slightly improved, but RNFL thickness was further reduced. CONCLUSIONS: RNFL thickness measurement with OCT should be performed not only in adults, but also in young patients in case of suspected NMO to confirm the diagnosis and to monitor the disease.

The Italian Brain Normative Archive of structural MR scans: norms for medial temporal atrophy and white matter lesions.
Author(s): Galluzzi, S; Testa, C; Boccardi, M; Bresciani, L; Benussi, L; Ghidoni, R; Beltramello, A; Bonetti, M; Bono, G; Falini, A; Magnani, G; Minonzio, G; Piovan, E; Binetti, G; Frisoni, GB
Journal: Aging Clin Exp Res 2010 Apr 9; Vol. 21, Issue 4-5; Page(s) 266-76
[Medline ID - 19959913]

BACKGROUND AND AIMS: To describe the clinical and neuropsychological features of a large group of cognitively intact persons subjected to brain high-resolution magnetic resonance (MR), to compare them with the general population, and to set norms for medial temporal atrophy and white matter lesions. METHODS: Participants in the Italian Brain Normative Archive (IBNA) study were 483 consecutive volunteers undergoing MR for reasons unrelated to cognition (migraine or headache, visual and balance or auditory disturbances, paresthesias, and others) and showing no brain damage. Manual tracing of hippocampal and amygdalar volumes and visual rating of white matter lesions were made. The whole study group was stratified by age ( < /=60 and 60+ yrs) and by the reason for MR prescription. RESULTS: In the whole group, mean age and education were 52.4+/-13.7 and 9.8+/-4.2 years, respectively, and the prevalence of women was 63%. Clinical, neuropsychological and morphometric features were similar in the stratified subgroups. Neuropsychological features were those expected for age and education based on Italian normative values. Hippocampal and amygdalar volumes were not associated with age, except for the right amygdala (B -0.159, 95% CI -0.28 to -0.03, p=0.016). CONCLUSIONS: Persons in the IBNA study had clinical and neuropsychological features consistent with that of the general population. Their brain morphometric features may be used as normative references for patients with suspected neurodegenerative disorders.

Safety and tolerability of rufinamide in children with epilepsy: a pooled analysis of 7 clinical studies.
Author(s): Wheless, JW; Conry, J; Krauss, G; Mann, A; LoPresti, A; Narurkar, M
Journal: J Child Neurol 2010 Mar 6; Vol. 24, Issue 12; Page(s) 1520-5
[Medline ID - 19955344]

Rufinamide is a novel antiepileptic agent recently approved in the United States for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome. To help inform clinical decision making, the authors analyzed safety and tolerability data from the entire pediatric population in the rufinamide epilepsy clinical development program. The analysis population comprised 212 rufinamide-treat ed (age range 3-16 years) and 197 placebo patients (age range 4-17 years) in the double-blind studies, and 391 patients receiving rufinamide in the double-blind and/or open-label extensions. The most common adverse effects observed in rufinamide-treated patients in the double-blind studies were somnolence, vomiting, and headache. Changes in laboratory values, vital signs, and weight were generally clinically insignificant. This pooled analysis of data from pediatric patients in clinical studies of rufinamide for the treatment of seizures, mainly as adjunctive therapy, suggests a favorable safety and tolerability profile in this patient population.

Demographic and clinical features related to a symptomatic onset of Paget's disease of bone.
Author(s): Varenna, M; Zucchi, F; Galli, L; Manara, M; De Marco, G; Sinigaglia, L
Journal: J Rheumatol 2010 Apr 7; Vol. 37, Issue 1; Page(s) 155-60
[Medline ID - 19955055]

OBJECTIVE: Paget's disease of bone (PDB) is a focal disorder of skeletal remodeling that can lead to bone pain, deformity, and fractures, but it can often be asymptomatic for a long time. This study investigated which factors may distinguish patients with clinical manifestations from asymptomatic patients. METHODS: The study group consisted of 224 patients with PDB referred to our Bone Disease Unit. For all patients, data were collected about clinical and demographic variables and diagnostic procedures. Logistic regression analyses were used to assess the role of recorded variables on the odds of being diagnosed clinically rather than by chance. RESULTS: Among the 124 patients with clinical manifestations leading to the diagnosis (55.4%), 36 subjects complained of bone pain, 32 articular pain, 42 back pain, 2 headache; 9 had fractures in Paget bone, and 3 had bone deformity. In 100 patients (44.6%) PDB was diagnosed by chance. At the multivariate analysis, only the number of bones involved (OR for 1 site increment = 1.18, 95% CI: 1.007-1.402; p = 0.04) acted as an independent predictor for a clinical diagnosis. Some skeletal localizations were associated with a clinical diagnosis: the involvement of lumbar spine (OR = 2.085, 95% CI: 1.024-4.224; p = 0.043) was more likely in symptomatic patients; pelvis and tibia showed a borderline statistical significance. The skull was predictive for asymptomatic PDB. CONCLUSION: A systematic laboratory screening including serum alkaline phosphatase of an older subject complaining of bone pain, articular pain, or back pain is the sole strategy to improve the diagnostic sensitivity for PDB.
  Page 1 of 100  




 



Resource Center

 - Merck Manual

 - Lab Test On-Line

 - MeSH Search



Clinical Conditions

 - A/C Degeneration

 - Adolescent Low Back

 - Ankle Sprain

 - Ankylosing Spondylitis

 - Arthritides

 - Brachial Plexus Neuritis

 - Carpal Tunnel Syndrome

 - Headache/Cephalgia

 - Cervical Disc Degen

 - Cervical Sprain

 - Cervical Strain

 - Cervical Osteoarthritis

 - Cervical Radiculopathy

 - Cervical Spine Instability

 - Cervical Spondylosis

 - Cervical Torticollis

 - Chronic Low Back Pain

 - Chronic Pain

 - Disc Displacement

 - Facet Arthropathy

 - Facet Capsulitis

 - Failed Back

 - Fibromyalgia

 - Frozen Shoulder

 - Knee Sprain

 - Lateral Epicondylitis

 - Low Back Pain

 - Lumbar Disc Degen

 - Lumbar Stenosis

 - Metatarsalgia

 - Psoriatic Arthritis

 - Reactive Arthritis

 - Rheumatoid Arthritis

 - Rotator Cuff Syndrome

 - SI Dysfunction

 - Sciatica

 - Scoliosis

 - Shoulder Bursitis

 - Spondylolisthesis

 - Stroke

 - Tarsal Tunnel Syndrome

 - TMD

 - Tendinopathy

 - Thoracic Outlet Syn

 - Ulnar Nerve Entrapment

 - Whiplash Injuries

 - Wrist Sprain



Resources

 - Chiropractic Organizations

 - State Associations

 - Schools & Institutions

 - NIH Grants Feed

 - HRSA Grants Feed

 - Evidence-Based Resource

 - Journal Links


Bookmark and Share

|  Home  |


 Copyright © 2007 - | DCConsult.com | All Rights Reserved.


the primary url for this site ( "DCConsult" ) is http://DCConsult.com




Category : Topics




Support for DCConsult provided by :