Cases Of Sickness Research Articles

THE CONSTRUCTION OF THE FEATURE VECTOR IN THE DIAGNOSIS OF SARCOIDOSIS BASED ON THE FRACTAL ANALYSIS OF CT CHEST IMAGES

CT images corresponding to the cross-sections of the patients’ upper torso were analysed. The data set included the healthy class and 3 classes of cases affected by sarcoidosis. It was a state involving only the trachea – Sick(1), a state including trachea and lung parenchyma – Sick(2) and a state involving only lung parenchyma – Sick(3). Based on a fractal analysis and a feature selection by linear stepwise regression, 4 descriptors were obtained, which were later used in the classification process. These were 2 fractal dimensions calculated by the variation and box counting methods, lacunarity calculated also with the box counting method and the intercept parameter calculated using the power spectral density method. Two descriptors were obtained as a result of a gray image analysis, and 2 more were the effect of a binary image analysis. The effectiveness of the descriptors was verified using 8 popular classification methods. In the process of classifier testing, the overall classification accuracy was 90.97%, and the healthy cases were detected with the accuracy of 100%. In turn, the accuracy of recognition of the sick cases was: Sick(1) – 92.50%, Sick(2) – 87.50% and Sick(3) – 90.00%. In the classification process, the best results were obtained with the support vector machine and the naive Bayes classifier. The results of the research have shown the high efficiency of a fractal analysis as a tool for the feature vector extraction in the computer aided diagnosis of sarcoidosis.

Responding to the Ebola virus disease outbreak in DR Congo: when will we learn from Sierra Leone?

Responding to the Ebola virus disease outbreak in DR Congo: when will we learn from Sierra Leone?

Journal Digest

Journal Digest

Identification of 3-(trifluoromethyl)phenol as the malodorous compound in a pollution incident in the water supply in Catalonia (N.E. Spain).

A study of organic compounds that caused a serious taste and odor episode of water supply in two residential areas in Catalonia (N.E. Spain) was carried out. Sweet and paint/solvent odor were the main descriptors used by consumers. Some cases of sickness and nausea were also associated with drinking water consumption by the consumers. Closed-loop stripping analysis (CLSA) combined with sensory gas chromatography and gas chromatography mass spectrometry detection were used to study the problem. As a result, 3-(trifluoromethyl)phenol (CAS number 98-17-9) was for the first time identified as a responsible of an odor incident in drinking water. Concentration levels of this compound were up to 17,000ng/L in groundwater and up to 600ng/L in distributed water. Odor threshold in water for 3-(trifluoromethyl)phenol was determined as 13ng/L (45°C).

Nursing Care for the transgender population: genders from the perspective of professional practice.

To describe and analyze the national and international scientific production on Nursing care for the transgender or gender-variance population. Integrative review of the literature, conducted throughout the Virtual Health Library, Cumulative Index to Nursing and Allied Health Literature, Public Medline and Web of Science databases, without pre-established periods of time and using the descriptors "Transgender AND 'Nursing Assistance'" and "Transgender AND 'Nursing care'". We included 11 articles, published between 2005 and 2016, broadly North American with only one Brazilian, so categorized: I- Fragility in the care of transgender people; II - Health of the transgender population: general and specific demands; III- Public health policies for transgender people. Transgender people have not found yet answers to their health demands; they are victims of prejudices and violence in services and seek care in extreme cases of sickness. Understanding their needs is primordial to build knowledge and practices that support nursing care.

Sustaining Efforts of Controlling Zoonotic Sleeping Sickness in Uganda Using Trypanocidal Treatment and Spray of Cattle with Deltamethrin.

In 2005, the zoonotic acute sleeping sickness was spreading rapidly from the endemic areas of southeastern Uganda with potential for merger into areas affected by the chronic form of the disease in northwest Uganda. Movement of cattle reservoirs due to restocking was blamed for the rapid spread. To stop the spread of the zoonotic sleeping sickness, cattle in the disease endemic areas had to be treated with trypanocidal drugs and sprayed with deltamethrin to promote the live bait technology that helps suppress the tsetse vector. The initiative that started in five high-risk districts in 2006 with a mix of using several undergraduate veterinary students has now been integrated in the local government veterinary service delivery in 23 high-risk districts. By 2016, the annual spray of cattle with deltamethrin and treatment with diminazene aceturate had reached one million with 1,065,444 cattle sprayed in the reporting year July 1, 2016 to June 30, 2017. This is believed to have contributed significantly to the reduction in the number of Trypanosoma brucei rhodesiense sleeping sickness cases (from 473 recorded in 2005 to 14 in 2016, and only about 10 reported to the Coordinating Office for Control of Trypanosomiasis in Uganda [COCTU] in 2017). The initiative that started as the Stamp Out Sleeping Sickness Consortium with a public good approach, implemented in a public-private partnership with the faculty of Veterinary Medicine, Makerere University, has today been integrated in both private and public sectors to fast-track the elimination of T. b. rhodesiense sleeping sickness with active financial contribution from the affected communities in sustaining the delivery of live bait technology.

The Effect of the basilar Membrane roughness on the Otoacoustic Emissions

Roughness was chosen as an attribute of the inner ear in order to study its role on the otoacoustic emissions (OAEs) and whether it has an effect or not. The role of roughness on the OAE was studied by using the nonlinear model. The roughness of the basilar membrane (BM) is minimized so that the negligibility at first is almost zero and increases until after a certain number of stages the total neglect of the BM. In this work, it was found that roughness has a very important effect on the OAE and we believe that there are cases of hearing sickness may be due to ear dysfunction in terms of roughness.

Epidemiological Considerations Concerning Food Poisoning Infections

What we eat and drink can become contaminated by bacteria, viruses, parasites, toxins or chemicals that can cause food-borne disease or named usual food poisoning, which is for CDC a common but preventable problem today. That for anyone can get sick from eating contaminated food. During the last 2 years: 2016-2017 it was received data for a complex epidemiological and clinical study, with several interesting interpretations and conclusions in Transylvania region from Romania. There were 109 Food borne diseases, with 2049 sick cases, almost during the summer season. The out breaks appeared in Urban or Rural parts as well in family or collectivity situations. Most of the illness appeared in usual forms-70% or 22 as middle forms and only 5% have needed hospitalization and only 3% from were just emergency cases. In our cases the microbiological etiology was: Salmonella spp-67%, mostly Salmonella enteritidis in 29%. Also 14% were determined by Staphylococcus aureus. To prevent such diseases in population, there are some food safety recommended steps. For a useful prevent and control activity in Food born infection, it has to be put together specialists for: laboratory, epidemiology, and environmental health, as all other with possible enteric disease outbreak and therapy responsibilities.

Inpatient treatment of trekkers and Nepalese workers in the high-altitude environment of Mt. Everest Region 1996-2011: A retrospective analysis.

The study investigates the diagnoses of inpatients (tourists and Nepali workers) of Kunde Hospital (Mt.Everest region) over 15 years. Records from January 1996 to September 2011 were analyzed concerning date, gender, age group, nationality, purpose of visit, diagnosis, length of treatment, and condition at discharge. Diagnoses were coded according to ICD-10-WHO 2010. Data were analyzed using descriptive statistics and non-parametric tests. P < 0.05 was defined as significant. 479 inpatients were included: 363 (75.8%) males (202 trekkers (42.2%), 277 Nepalese workers (57.8%)). Most suffered from altitude sickness (45.5%), acute gastroenteritis (10.4%) or acute respiratory infection (8.4%). Severe cases of altitude sickness amongst trekkers decreased but increased amongst workers. Severe cases of acute gastroenteritis amongst trekkers increased. Mean length of inpatient treatment was 4.6 days ±2.7 days. 573/2030 days of treatment were caused by altitude sickness. 70 patients were evacuated, 9 died. Altitude illness caused the majority of inpatient treatment and acute gastroenteritis may be an underestimated risk for both groups. Other severe problems were mostly illnesses, not trauma. Improved prevention strategies are needed for both groups. For tourists who often show pre-existing diseases this includes an individual pre-travel expert advice. Nepali workers should be instructed concerning acclimatization.

SERUM SICKNESS, CAN IT HAPPEN SECONDARY TO ATYPICAL ANTIPSYCHOTICS?

Introduction Serum sickness is a type III hypersensitivity reaction. The deposition of immune complexes activates complement pathways and cause fever, vasculitic rash, arthritis and lymphadenopathy. Medications are known to trigger serum sickness. Risperidone is an atypical antipsychotic and to our knowledge, this is the first report presenting a case of serum sickness to risperidone in paediatric population. Case Discussion 7 years old male with Attention Deficit Hyperactivity Disorder started on risperidone 0.25 mg and subsequently 0.5 mg once daily after a week. On third week, patient developed generalized purpuric, confluent, maculopapular patches. Although he did not have any sign and symptoms of a viral illness, he was diagnosed with viral-induced exanthema and continued risperidone. On day 28, he developed extremities swelling, angioedema, lymphadenopathy, arthralgia and arthritis in ankles, knees, hands and elbows with no fever. Investigations showed normal C3 and C4 (mostly remains normal in serum sickness to medication). C1 esterase inhibitor, anti-nuclear antibody and urinalysis were normal. ESR, CRP and leukocytes were elevated. The diagnosis of serum sickness to risperidone was made and patient was treated with citerizine, hydrocortisone and prednisone with significant improvement. Skin biopsy suggested vasculitic urticaria which lasted 6 weeks. Challenge to risperiodone was not considered because of clear suggestive history and ethical consideration. Discussion Psychotropic medications are known to cause cutaneous eruptions. Serum Sickness can happen upon exposure to risperidone. The clinicians should be aware of this potential adverse reaction that can develop weeks after therapy initiation and be encouraged to discontinue risperidone when the suggestive symptoms emerges.

A Systematic Review and Meta-Analysis of Decompression Sickness in Altitude Physiological Training.

INTRODUCTION: A review of decompression sickness (DCS) cases associated with the NASA altitude physiological training (APT) program at the Johnson Space Center (JSC) motivated us to place our findings into the larger context of DCS prevalence from other APT centers.METHODS: We reviewed JSC records from 1999 to 2016 and 14 publications from 1968 to 2004 about DCS prevalence in other APT programs. We performed a meta-analysis of 15 APT profiles (488 cases / 385,116 exposures). We used meta-regression to evaluate the relation between estimated exposures and probability of DCS in a test group, accounting for the heterogeneity between studies.RESULTS: Our in-house review identified 6 Type I DCS (1 from an inside observer) and 1 Type II DCS. There were 6 cases in 9560 student hypobaric exposures from 3 NASA training flights; a student pooled prevalence rate of 0.44 cases / 1000 exposures compared to 1.44 cases / 1000 from 12 published APT profiles. The overall pooled DCS prevalence rate was 1.16 cases / 1000 exposures. There was substantial heterogeneity in DCS prevalence across studies. Denitrogenation time, exposure pressure, and exposure time were associated with probability of DCS in the meta-regression model.CONCLUSIONS: While the overall DCS prevalence rate is relatively low, there is marked heterogeneity among profiles. The pooled DCS prevalence rate estimate for the NASA profiles was lower than the overall rate. Variability in APT profile DCS prevalence could be further explained given student level and additional test-level covariates.Conkin J, Sanders RW, Koslovsky MD, Wear ML, Kozminski AG, Abercromby AFJ. A systematic review and meta-analysis of decompression sickness in altitude physiological training. Aerosp Med Hum Perform. 2018; 89(11):941-951.

Serum Sickness Secondary to Fluoxetine

Drug-related cutaneous eruptions are common, affecting approximately 2-3% of hospitalized patients, and can vary in severity from benign to life-threatening. Understanding the pathophysiologic mechanism of the eruption is important for being able to identify the culprit drug and develop an appropriate treatment plan. We present a unique case of serum sickness that presented with a pruritic dermatitis associated with arthralgias and hypocomplementemia, observed shortly after initiation of fluoxetine.

Using the Natural Experiment Study Design to Evaluate the Effect of a Change in Doctor's Roster on Patient Flow in an Emergency Department.

IntroductionThe effect of changes in doctors’ rosters is rarely subjected to scientific evaluation. We describe how a natural experiment (NE) study design can be used to evaluate if a managerial decision about doctors’ rosters has an effect on patient flow in an emergency department (ED). We hypothesized that an extra doctor each morning from 6 a.m. (i.e., a modified “casino shift”) might improve the productivity of a hospital’s ED.MethodsThis was an NE observational study using data on patient flow in the ED of Zealand University Hospital, Denmark, between April 1, 2016, and April 1, 2017. We compared days on which the 6 a.m. emergency physician called in sick (case days) with data from the same weekday a week later where staffing was as scheduled (control days).ResultsPatient caseload did not did differ significantly on days with and without the extra doctor from 6 a.m. (measured by number of admissions, triage scores and mean patient age). Door-to-doctor time was 70 minutes (mean, standard deviation [SD], 49) on days without the extra doctor and 56 minutes (mean, SD 41) on days with the early-morning doctor present (p > 0.05). ED length of stay was 250 minutes (mean, SD 119) on days without the extra doctor and 209 minutes (mean, SD 109) on days with the early-morning doctor present (p > 0.05).ConclusionIn our setting, an extra doctor in the ED from 6 a.m. did not change patient flow. These results suggest that the workflow in the ED should be viewed as a connected supply chain. The study also demonstrates that a natural experiment study design can be used to evaluate ED managerial decisions.

Serum Sickness in Patients Receiving Equine Rabies Immunoglobulin

Background: Equine Rabies Immunoglobulin (ERIG) is being used for treatment of category-III animal bite cases. ERIG is economical as compared to Human Rabies Immunoglobulin (HRIG) and hence more affordable to patients in developing countries, like India. Despite high degree of purification, there are reported cases of serum sickness like reactions, anaphylaxis, and other allergic reactions following ERIG administration. Serum sickness is a type III or immune-complex-mediated hypersensitivity reaction that results from the injection of heterologous or foreign protein or serum. Because of fear of side effects (including serumsickness- like reaction) following ERIG, the use of ERIG is minimal among doctors. Objective: (1) To assess the incidence of serum sickness following the administration of ERIG. (2) To see the clinical features of serum sickness. Methods: This is a hospital-based cross-sectional study carried out in the ARV OPD of SCB Medical College, Cuttack, Odisha, India. All patients who received ERIG between September 2016 and December 2016 were included in the study. Side effects were monitored during the subsequent follow-up visits. Results: Out of 1548 category-III animal bite cases who received ERIG, 3.1% developed serum-sickness-like reactions, which manifested as rashes in 97.82%. Most of them had symptoms after seventh day following ERIG administration. Symptomatic relief with oral antihistamines like Cetirizine, Levocetirizine in 60% of cases and Inj. Avil (chlorpheniramine maleate) in 17% was achieved, and only one case required shortcourse corticosteroids. Conclusion: Despite 3.1% of serum sickness cases reported in our present study, the safety of ERIG has been proved and serum sickness can be managed with oral analgesics and antihistamines. Hence ERIG should be encouraged among doctors for use in category-III animal bite patients to prevent rabies.

A spatial genetics approach to inform vector control of tsetse flies (Glossina fuscipes fuscipes) in Northern Uganda.

Tsetse flies (genus Glossina) are the only vector for the parasitic trypanosomes responsible for sleeping sickness and nagana across sub‐Saharan Africa. In Uganda, the tsetse fly Glossina fuscipes fuscipes is responsible for transmission of the parasite in 90% of sleeping sickness cases, and co‐occurrence of both forms of human‐infective trypanosomes makes vector control a priority. We use population genetic data from 38 samples from northern Uganda in a novel methodological pipeline that integrates genetic data, remotely sensed environmental data, and hundreds of field‐survey observations. This methodological pipeline identifies isolated habitat by first identifying environmental parameters correlated with genetic differentiation, second, predicting spatial connectivity using field‐survey observations and the most predictive environmental parameter(s), and third, overlaying the connectivity surface onto a habitat suitability map. Results from this pipeline indicated that net photosynthesis was the strongest predictor of genetic differentiation in G. f. fuscipes in northern Uganda. The resulting connectivity surface identified a large area of well‐connected habitat in northwestern Uganda, and twenty‐four isolated patches on the northeastern margin of the G. f. fuscipes distribution. We tested this novel methodological pipeline by completing an ad hoc sample and genetic screen of G. f. fuscipes samples from a model‐predicted isolated patch, and evaluated whether the ad hoc sample was in fact as genetically isolated as predicted. Results indicated that genetic isolation of the ad hoc sample was as genetically isolated as predicted, with differentiation well above estimates made in samples from within well‐connected habitat separated by similar geographic distances. This work has important practical implications for the control of tsetse and other disease vectors, because it provides a way to identify isolated populations where it will be safer and easier to implement vector control and that should be prioritized as study sites during the development and improvement of vector control methods.

Managing the chronic grass sickness case

The acute and subacute forms of equine grass sickness (EGS) are invariably fatal. In comparison, approximately 45–55% of cases with the chronic form of EGS recover with intensive nursing care. Prior to, and throughout the period of nursing, the clinician can be faced with difficult decision making dilemmas, including the identification of suitable candidates for treatment, the selection of an applicable treatment plan and the establishment of appropriate criteria to inform the decision for continued treatment or euthanasia. This article will cover the various aspects of nursing care and will also address some of the difficult clinical decisions, the outcomes of which have a major impact both on the case and the owner.

Development of a clinical prediction score for detection of suspected cases of equine grass sickness (dysautonomia) in France.

Equine grass sickness (EGS) (equine dysautonomia) is a neurodegenerative condition of grazing equines. Pre-mortem diagnosis of EGS is a challenge for practitioners as definitive diagnosis requires ileal/myenteric lymph node biopsies. This study aimed to develop a clinical score that could be used by practitioners to improve the detection of acute or subacute EGS cases in the field. Suspected EGS cases were declared by veterinary practitioners. A case was classified as confirmed positive if ileal or rectal biopsy samples showed neuronal degeneration typical of EGS. A semi-quantitative scoring system, including epidemiological and clinical data, was created to attempt to classify suspected EGS horses into confirmed positive or negative cases. Each variable was weighted based on a boosted regression trees model, while taking into account its clinical relevance. Twenty-eight EGS cases were confirmed by biopsy during the entire study period. The best cut-off value for the score to have a high sensitivity while maximizing specificity was 8, with a sensitivity of 100% and a specificity of 53%. In our dataset, 77% of animals would be correctly classified with this cut-off value of 8. Highest sensitivity was chosen in order to detect the highest number of potential cases. Our score represents an inexpensive and useful tool to aid in the identification of suspected EGS cases in the field and selection for further diagnostics procedures to confirm or rule out the disease. Application of the score to larger populations of animals would be required to further adapt and refine the score.

Iso-risk air no decompression limits after scoring marginal decompression sickness cases as non-events

Decompression sickness (DCS) in humans is associated with reductions in ambient pressure that occur during diving, aviation, or certain manned spaceflight operations. Its signs and symptoms can include, but are not limited to, joint pain, radiating abdominal pain, paresthesia, dyspnea, general malaise, cognitive dysfunction, cardiopulmonary dysfunction, and death. Probabilistic models of DCS allow the probability of DCS incidence and time of occurrence during or after a given hyperbaric or hypobaric exposure to be predicted based on how the gas contents or gas bubble volumes vary in hypothetical tissue compartments during the exposure. These models are calibrated using data containing the pressure and respired gas histories of actual exposures, some of which resulted in DCS, some of which did not, and others in which the diagnosis of DCS was not clear. The latter are referred to as marginal DCS cases. In earlier works, a marginal DCS event was typically weighted as 0.1, with a full DCS event being weighted as 1.0, and a non-event being weighted as 0.0. Recent work has shown that marginal DCS events should be weighted as 0.0 when calibrating gas content models. We confirm this indication in the present work by showing that such models have improved performance when calibrated to data with marginal DCS events coded as non-events. Further, we investigate the ramifications of derating marginal events on model-prescribed air diving no-stop limits.

Dive Risk Factors, Gas Bubble Formation, and Decompression Illness in Recreational SCUBA Diving: Analysis of DAN Europe DSL Data Base.

Introduction: The popularity of SCUBA diving is steadily increasing together with the number of dives and correlated diseases per year. The rules that govern correct decompression procedures are considered well known even if the majority of Decompression Sickness (DCS) cases are considered unexpected confirming a bias in the “mathematical ability” to predict DCS by the current algorithms. Furthermore, little is still known about diving risk factors and any individual predisposition to DCS. This study provides an in-depth epidemiological analysis of the diving community, to include additional risk factors correlated with the development of circulating bubbles and DCS.Materials and Methods: An originally developed database (DAN DB) including specific questionnaires for data collection allowed the statistical analysis of 39,099 electronically recorded open circuit dives made by 2,629 European divers (2,189 males 83.3%, 440 females 16.7%) over 5 years. The same dive parameters and risk factors were investigated also in 970 out of the 39,099 collected dives investigated for bubble formation, by 1-min precordial Doppler, and in 320 sea-level dives followed by DCS symptoms.Results: Mean depth and GF high of all the recorded dives were 27.1 m, and 0.66, respectively; the average ascent speed was lower than the currently recommended “safe” one (9–10 m/min). We found statistically significant relationships between higher bubble grades and BMI, fat mass, age, and diving exposure. Regarding incidence of DCS, we identified additional non-bubble related risk factors, which appear significantly related to a higher DCS incidence, namely: gender, strong current, heavy exercise, and workload during diving. We found that the majority of the recorded DCS cases were not predicted by the adopted decompression algorithm and would have therefore been defined as “undeserved.”Conclusion: The DAN DB analysis shows that most dives were made in a “safe zone,” even if data show an evident “gray area” in the “mathematical” ability to predict DCS by the current algorithms. Some other risk factors seem to influence the possibility to develop DCS, irrespective of their effect on bubble formation, thus suggesting the existence of some factors influencing or enhancing the effects of bubbles.

Editorial.

As the end of the year approaches rapidly, it is time for some of us to meet our continuing education (CE) credit requirements. Since the March/April 2016 issue, IJMSC has been offering CE credits to physicians and nurses for reading some of the articles published in its pages and completing a posttest. To our editorial team, this initiative represents a way to further the journal's educational mission, and the number of credits claimed to date suggests that it is beneficial to our readers. We thank our authors and reviewers, our editorial board, and the Consortium of Multiple Sclerosis Centers (CMSC) leadership and staff for their contribution to this effort.In this issue, CE credit is offered for the article by Rabadi and Aston, which reports on predictors of mortality among veterans with MS treated in an outpatient setting. Better knowledge of the predictors and causes of excess mortality related to MS may help develop strategies to increase life expectancy in the most vulnerable groups of patients.Measuring clinical disease activity and the outcomes of multidisciplinary care requires valid and reliable measurement tools. Bennett and colleagues provide additional data on the psychometric properties of four measures of walking that can be administered in a clinical setting. These measures can be useful in complementing the Timed 25-Foot Walk test, particularly for the purpose of rehabilitation, as they assess various aspects of walking such as dynamic balance and endurance. Mañago and colleagues introduce a protocol for measuring strength, a common target of rehabilitation associated with functional performance, using a handheld dynamometer and simple endurance tests. This protocol, which is feasible in a clinical setting, exhibits satisfactory discriminant validity, test-retest reliability, and response stability in this first validation study.Neurologic symptoms represent the “face of the disease” for those affected by MS. Symptoms often start months to years before the diagnosis, and their management is an essential component of care. Fatigue is one of the most commonly reported symptoms of MS, but its pathophysiology has not been fully elucidated. The article by Aldughmi and colleagues reminds us that perceived fatigue does not always correlate with fatigability on physical and cognitive performance tasks, suggesting that they represent different, albeit overlapping, phenomena. Trigeminal neuralgia is known as one of the less common symptoms of MS, but Fallata and colleagues found that nearly 10% of over 8,500 North American Research Committee on Multiple Sclerosis Registry participants reported experiencing symptoms of trigeminal neuralgia, and in 15% of them the symptoms preceded the diagnosis of MS.It is essential for the safety of our patients to disseminate information about unusual adverse effects of disease-modifying therapies. Ferguson reports a case of serum sickness with glatiramer acetate, which occurred again after rechallenge with the medication.Mind-body therapies are increasingly sought by MS patients, and their use is supported by a growing body of data. However, there are still few evidence-based programs available in the community. Gilbertson and Klatt report encouraging feasibility and efficacy results from a pilot study of Mindfulness in Motion, an 8-week program combining yoga, mindfulness meditation, and relaxing music.I wish you pleasant and instructive readings.