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The importance of heart murmur in the neonatal period and justification of echocardiographic review.Medical Archives (Sarajevo, Bosnia and... Aug 2014Heart murmurs can be functional (innocent) and pathological (organic). Although it is not considered a major sign of heart disease, it may be a sign of a serious heart... (Review)
Review
INTRODUCTION
Heart murmurs can be functional (innocent) and pathological (organic). Although it is not considered a major sign of heart disease, it may be a sign of a serious heart defect. In most cases the noise is initiation for cardiac treatment. Is it possible to differentiate on the basis of auscultation innocent from pathological heart murmur? In this article we present the results of ultrasonography of newborns with positive auscultation finding of the heart in the neonatal and early infancy period.
GOAL
To determine the role of murmurs in the heart detected by routine clinical examination in the neonatal period and early infancy, and to establish the legitimacy of cardiology consultation and ultrasound of the heart.
METHODS
A retrospective review of medical records in the period from January 1 to December 31, 2011 at the Maternity ward of Cantonal Hospital in Bihac 1899 children was born. In 32 neonates was registered a heart murmur, in the period from birth up to 6 weeks of life. All children with positive auscultation finding of the heart were examined echocardiography by ultrasound ALOCA 2000, multifrequency probe from 3.5 to 5 MHz, and used M-mode, 2-D, continuous, pulsed and color Doppler.
RESULTS
Of the 32 examined children regular echocardiographic findings had two children (6.25%), aberrant bunch of left ventricle 11 (34.37%), patent foramen ovale 5 (15.62%), atrial septal defect 3 children (9.37%), ventricular septal defect 8 children (25%), cyanogen anomaly 2 children (6.25%), stenosis of the pulmonary artery 1 child (3.12%). We see that 14 children (43.75%) had a structural abnormality of the heart that requires further treatment and monitoring.
CONCLUSION
Echocardiography is necessary to set up or refute the diagnosis of structural heart defect in children with positive auscultation finding in the neonatal period.
Topics: Congenital Abnormalities; Echocardiography; Female; Heart Auscultation; Heart Murmurs; Humans; Infant; Infant, Newborn; Male; Retrospective Studies
PubMed: 25568554
DOI: 10.5455/medarh.2014.68.282-284 -
CJEM Sep 2020To slow down the transmission of coronavirus disease 2019 (COVID-19), it is important to identify specific symptoms for effective screening. While anosmia/hyposmia and...
OBJECTIVES
To slow down the transmission of coronavirus disease 2019 (COVID-19), it is important to identify specific symptoms for effective screening. While anosmia/hyposmia and dysgeusia/ageusia have been identified as highly prevalent symptoms, there are wide geographic variations, necessitating the regional evaluation of the prevalence of the symptoms.
METHODS
A cross-sectional study was performed to evaluate the self-reported symptoms among adults (over 18 years old) who underwent COVID-19 tests at an ambulatory assessment centre. We identified 1,345 patients (102 positive and 1,243 negative) who visited the assessment centre between March 16 and April 15, 2020. We randomly sampled negative patients in a 1:3 ratio. The primary outcome was the prevalence of self-reported anosmia/hyposmia and dysgeusia/ageusia. Logistic regression was performed to evaluate the association between COVID-19 positivity and loss of smell and taste.
RESULTS
Fifty-six of 102 (50%) positive patients and 72 of 306 (23.5%) negative patients completed the survey. Anosmia/hyposmia and dysgeusia/ageusia were more prevalent among COVID-19 positive patients (41.1% v. 4.2%, p < 0.001 for smell and 46.4% v. 5.6%, p < 0.001 for taste). Anosmia/hyposmia and dysgeusia/ageusia were independently highly associated with COVID-19 positivity (adjusted odds ratios 14.4 and 11.4 for smell and taste, respectively).
CONCLUSION
In this Canadian study, smell and taste loss may be key symptoms of COVID-19. This evidence can be helpful in the clinical diagnosis of COVID-19, particularly settings of limited testing capacity.
Topics: Adult; COVID-19; COVID-19 Testing; Canada; Clinical Laboratory Techniques; Coronavirus Infections; Cross-Sectional Studies; Dysgeusia; Female; Humans; Incidence; Male; Middle Aged; Olfaction Disorders; Pandemics; Pneumonia, Viral; Reference Values; Risk Assessment; Self Report; Sensitivity and Specificity
PubMed: 32507123
DOI: 10.1017/cem.2020.420 -
JAMA Network Open Oct 2022Characterizing the clinical symptoms and evolution of community-based SARS-CoV-2 infections may inform health practitioners and public health officials in a rapidly...
IMPORTANCE
Characterizing the clinical symptoms and evolution of community-based SARS-CoV-2 infections may inform health practitioners and public health officials in a rapidly changing landscape of population immunity and viral variants.
OBJECTIVES
To compare COVID-19 symptoms among people testing positive with a rapid antigen test (RAT) during the Omicron BA.1 variant period (December 1, 2021, to January 30, 2022) with the pre-Delta (January 10 to May 31, 2021) and Delta (June 1 to November 30, 2021) variant periods and to assess the duration of RAT positivity during the Omicron BA.1 surge.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study was conducted from January 10, 2021, to January 31, 2022, at a walk-up community COVID-19 testing site in San Francisco, California. Participants included children and adults seeking COVID-19 testing with an RAT, regardless of age, vaccine status, or symptoms.
MAIN OUTCOMES AND MEASURES
Fisher exact tests or χ2 tests were used to compare COVID-19 symptoms during the Omicron BA.1 period with the pre-Delta and Delta periods for vaccination status and age group. Among people returning for repeated testing during the Omicron period, the proportion with a positive RAT between 4 and 14 days from symptom onset or since first positive test if asymptomatic was estimated.
RESULTS
Among 63 277 persons tested (median [IQR] age, 32 [21-44] years, with 12.0% younger than 12 years; 52.0% women; and 68.5% Latinx), a total of 18 301 people (28.9%) reported symptoms, of whom 4565 (24.9%) tested positive for COVID-19. During the Omicron BA.1 period, 3032 of 7283 symptomatic participants (41.6%) tested positive, and the numbers of these reporting cough and sore throat were higher than during pre-Delta and Delta periods (cough: 2044 [67.4%] vs 546 [51.3%] of 1065 participants, P < .001 for pre-Delta, and 281 [60.0%] of 468 participants, P = .002, for Delta; sore throat: 1316 [43.4%] vs 315 [29.6%] of 1065 participants, P < .001 for pre-Delta, and 136 [29.1%] of 468 participants, P < .001, for Delta). Compared with the 1065 patients with positive test results in the pre-Delta period, congestion among the 3032 with positive results during the Omicron BA.1 period was more common (1177 [38.8%] vs 294 [27.6%] participants, P < .001), and loss of taste or smell (160 [5.3%] vs 183 [17.2%] participants, P < .001) and fever (921 [30.4%] vs 369 [34.7%] participants, P = .01) were less common. In addition, during the Omicron BA.1 period, fever was less common among the people with positive test results who had received a vaccine booster compared with those with positive test results who were unvaccinated (97 [22.5%] of 432 vs 42 [36.2%] of 116 participants, P = .003), and fever and myalgia were less common among participants who had received a booster compared with those with positive results who had received only a primary series (fever: 97 [22.5%] of 432 vs 559 [32.8%] of 1705 participants, P < .001; myalgia: 115 [26.6%] of 432 vs 580 [34.0%] of 1705 participants, P = .003). During the Omicron BA.1 period, 5 days after symptom onset, 507 of 1613 people (31.1%) with COVID-19 stated that their symptoms were similar, and 95 people (5.9%) reported worsening symptoms. Among people testing positive, 80.2% of participants who were symptomatic and retested remained positive 5 days after symptom onset.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, COVID-19 upper respiratory tract symptoms were more commonly reported during the Omicron BA.1 period than during the pre-Delta and Delta periods, with differences by vaccination status. Rapid antigen test positivity remained high 5 days after symptom onset, supporting guidelines requiring a negative test to inform the length of the isolation period.
Topics: COVID-19; COVID-19 Testing; Cough; Cross-Sectional Studies; Female; Fever; Humans; Male; Myalgia; Pharyngitis; SARS-CoV-2
PubMed: 36215069
DOI: 10.1001/jamanetworkopen.2022.35844 -
AJNR. American Journal of Neuroradiology Sep 2022To determine the accuracy of MR imaging for diagnosis of meningitis in infants.
PURPOSE
To determine the accuracy of MR imaging for diagnosis of meningitis in infants.
MATERIALS AND METHODS
Retrospective review of infants less than 1 year of age who underwent a brain MR imaging for meningitis from 2010-2018. Gold standard for diagnosis of bacterial meningitis was a positive bacterial CSF culture or a positive blood culture with an elevated CSF WBC count, and diagnosis of viral meningitis was a positive CSF PCR result and elevated CSF WBC count. Sensitivity, specificity, PPV, NPV, and accuracy for MR imaging diagnosis of meningitis were calculated.
RESULTS
Two hundred nine infants with mean age 80 days (range 0-347 days) were included. There were 178 true positives with the most common pathogens being: (58), (50), (21), (4); Herpes simplex virus 1 or 2 (18); Enterovirus (4); and other (23). There were 31 true negatives. Range of sensitivity, specificity, PPV, NPV, and accuracy of MR imaging for detection of meningitis was 67.4-83.5%, 92.3-95.7%, 95.0-98.6%, 33.3-76.5%, and 71.3-86.5% respectively. MR imaging sensitivity decreased after 10 days from time of presentation while specificity remained stable. Among individual MR imaging findings, leptomeningeal enhancement was the most sensitive finding, while cerebritis, infarction, ventriculitis, abscess, and intraventricular purulent material were the most specific findings.
CONCLUSIONS
MR imaging of the brain demonstrates high specificity and moderate sensitivity for diagnosis among infants presenting with signs and symptoms of meningitis. The results reflect current standard of care for imaging of infants with meningitis however a selection bias for imaging of more severe meningitis may affect these results.
Topics: Infant; Humans; Escherichia coli; Meningitis, Bacterial; Streptococcus pneumoniae; Streptococcus agalactiae; Encephalitis; Magnetic Resonance Imaging; Sensitivity and Specificity
PubMed: 36574323
DOI: 10.3174/ajnr.A7610 -
American Family Physician Jan 2001Infectious diseases account for one third of all deaths in people 65 years and older. Early detection is more difficult in the elderly because the typical signs and... (Review)
Review
Infectious diseases account for one third of all deaths in people 65 years and older. Early detection is more difficult in the elderly because the typical signs and symptoms, such as fever and leukocytosis, are frequently absent. A change in mental status or decline in function may be the only presenting problem in an older patient with an infection. An estimated 90 percent of deaths resulting from pneumonia occur in people 65 years and older. Mortality resulting from influenza also occurs primarily in the elderly. Urinary tract infections are the most common cause of bacteremia in older adults. Asymptomatic bacteriuria occurs frequently in the elderly; however, antibiotic treatment does not appear to be efficacious. The recent rise of antibiotic-resistant bacteria (e.g., methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus) is a particular problem in the elderly because they are exposed to infections at higher rates in hospital and institutional settings. Treatment of colonization and active infection is problematic; strict adherence to hygiene practices is necessary to prevent the spread of resistant organisms.
Topics: Aged; Communicable Diseases; Community-Acquired Infections; Enterococcus; Gram-Positive Bacterial Infections; Herpes Zoster; Humans; Influenza, Human; Methicillin Resistance; Neuralgia; Pneumonia, Bacterial; Staphylococcal Infections; Urinary Tract Infections; Vancomycin Resistance
PubMed: 11201692
DOI: No ID Found -
Journal of Neurology Dec 2020Acute diplopia is a diagnostic challenge for clinicians, in particular in the emergency department. The most common cause of acute diplopia are ocular motor nerve...
OBJECTIVES
Acute diplopia is a diagnostic challenge for clinicians, in particular in the emergency department. The most common cause of acute diplopia are ocular motor nerve palsies (OMP). In this prospective study, we focused on identifying the most crucial signs and symptoms for differentiating between peripheral and central OMP.
METHODS
We prospectively evaluated 56 non-consecutive patients who presented at our emergency department with acute binocular diplopia (≤ 10 days). The patient history was taken using a standardized questionnaire and patients underwent a neurological, neuro-ophthalmological and neuro-otological examination, including measurement of the subjective visual vertical (SVV), Harms tangent screen test, and cranial MRI.
RESULTS
Forty-six out of 56 patients were diagnosed with an ocular motor cranial nerve palsy (OMP), 21 of peripheral and 23 of central origin; in two patients, the etiology remained unknown. The following features were different in peripheral and central OMP: (1) the presence of vertigo/dizziness was more frequent in central (43.5%) than in peripheral (9.5%) OMP. (2) Central ocular motor signs, such as saccadic smooth pursuit, additional internuclear ophthalmoplegia, skew deviation, and saccade palsies, were also found more frequently in the central than in the peripheral group (86.7% vs. 33.3%). (3) Further, a pathological SVV deviation by monocular testing of the non-affected eye was also more common in central (77.3%) than in peripheral OMP (38.9%). The presence of all three factors has a positive predictive value of 100% (CI 50-100%) for the presence of a central lesion.
CONCLUSIONS
In acute diplopia due to central OMP, the most important accompanying symptom is vertigo/dizziness, and the most important clinical signs are central ocular motor disorders (which require examination of the non-paretic eye) and an SVV deviation in the non-paretic eye.
Topics: Cranial Nerve Diseases; Diplopia; Humans; Magnetic Resonance Imaging; Prospective Studies; Saccades
PubMed: 32797299
DOI: 10.1007/s00415-020-10088-y -
The Clinical Journal of Pain Nov 2019Our knowledge of central sensitization (CS) in chronic low back pain (CLBP) is limited. 2011 fibromyalgia criteria and severity scales (2011 FM survey) have been used to...
BACKGROUND
Our knowledge of central sensitization (CS) in chronic low back pain (CLBP) is limited. 2011 fibromyalgia criteria and severity scales (2011 FM survey) have been used to determine FM positive as a surrogate of CS. The major features of CS including widespread hyperalgesia and dysfunction of the descending inhibitory pathways can be identified by pressure pain threshold (PPT) and conditioned pain modulation (CPM) tests. The purpose of the study was to examine neurophysiological characteristics and psychosocial symptoms in a subgroup of FM-positive CLBP compared with FM-negative CLBP patients.
METHODS
A total of 46 participants with CLBP and 22 pain-free controls completed outcome measures of the 2011 FM survey, PPT and CPM tests, and psychosocial questionnaires. Differences between FM-positive and FM-negative CLBP participants on these measures and correlations were analyzed.
RESULTS
The 2011 FM survey identified 22 (48%) participants with CLBP as FM positive. FM-positive CLBP participants showed lower PPT values of the thumbnail (P=0.011) and lower back (P=0.003), lower CPM values of the thumbnail (P=0.002), and more severe pain catastrophizing, anxiety, and depression symptoms (P<0.05) than FM-negative CLBP participants. The 2011 FM scores were significantly correlated with the PPT and CPM values of the thumbnail and with psychosocial symptoms (P<0.001).
DISCUSSION
Our findings suggest a subgroup of CLBP patients exhibiting with signs and symptoms of CS. Associations between subjective and objective CS measures indicate that the 2011 FM survey can be utilized to identify the presence of CS in CLBP in clinical practice.
Topics: Adult; Central Nervous System Sensitization; Chronic Pain; Cross-Sectional Studies; Female; Humans; Hyperalgesia; Low Back Pain; Male; Middle Aged; Pain Measurement; Pain Threshold
PubMed: 31408011
DOI: 10.1097/AJP.0000000000000755 -
Advances in Nutrition (Bethesda, Md.) May 2014Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even... (Review)
Review
Obesity is currently the most prevalent chronic childhood disease in Western countries. It is one of the most frequent consultations in general pediatrics and is even more common in pediatric endocrinology. As might be predicted, the prevalence of obesity-associated comorbidities is also increasing in children and adolescents. It is widely accepted that this increase in obesity results from an imbalance between energy intake and expenditure, with an increase in positive energy balance being closely associated with the current lifestyle in Western countries. However, there is increasing evidence indicating that an individual's genetic background is important in determining obesity risk. The physiologic mechanisms controlling appetite and energy expenditure are being revealed in part because of the identification of new causes of human monogenic, syndromic, and endocrine-related obesity. Thus, it is no longer appropriate to talk about obesity, but rather about "obesities" or "different diseases causing obesity," because their pathophysiologic bases differ. Moreover, these obesities require different diagnostic and management approaches. The pediatrician must be aware of this issue and focus the clinical history and physical examination toward specific clinical signs and symptoms to better exploit the available diagnostic and therapeutic resources when facing a child with obesity. Genetic, genomic, and metabolomic studies are often necessary to obtain a more appropriate diagnosis. Cognitive behavioral therapy is fundamental in obese children. The identification of potential targets will hopefully result in new pharmacologic approaches for translational and personalized medicine for obesity in the near future.
Topics: Adolescent; Appetite; Child; Chronic Disease; Comorbidity; Diagnosis, Differential; Energy Intake; Energy Metabolism; Humans; Incidence; Life Style; Metabolic Syndrome; Pediatric Obesity; Prevalence; Risk Factors
PubMed: 24829481
DOI: 10.3945/an.113.004853 -
Best Practice & Research. Clinical... Oct 2021Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species.... (Review)
Review
Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.
Topics: Adenosine Monophosphate; Adrenal Cortex Hormones; Alanine; Animals; Antiviral Agents; COVID-19; Coronavirus; Cough; Diabetes Mellitus; Fatigue; Fever; Heart Diseases; Humans; Positive-Pressure Respiration; Prognosis; Pulmonary Disease, Chronic Obstructive; SARS-CoV-2; Treatment Outcome
PubMed: 34511219
DOI: 10.1016/j.bpa.2020.12.003 -
JNMA; Journal of the Nepal Medical... Feb 2021Idiopathic Intracranial Hypertension is a rare occurrence in young, physically fit male and a diagnosis of exclusion among most patients presenting with signs and...
Idiopathic Intracranial Hypertension is a rare occurrence in young, physically fit male and a diagnosis of exclusion among most patients presenting with signs and symptoms of raised intracranial pressure. Here we describe a case of a young male in the ideal weight range with no previous exposure to offending chemicals presented with a history of headache, obscuration of vision, and photopsia. On examination, there were no positive neurological findings. Increased opening pressure was found on the lumbar puncture. Ophthalmological examination revealed bilateral papilledema. Humphrey’s Visual field test showed peripheral field loss. Magnetic resonance imaging scan of the brain and orbits were normal. The patient was diagnosed and managed in primary care setting after neurosurgical consultation. Though rare, we should suspect idiopathic intracranial hypertension in ideal body weighted male if the headache is persistent after other causes of headache have been ruled out.
Topics: Headache; Humans; Intracranial Hypertension; Male; Papilledema; Pseudotumor Cerebri; Vision Disorders
PubMed: 34506475
DOI: 10.31729/jnma.5176