Clinical Features Of Different Types Research Articles

Outcome measures of disease activity in inflammatory arthritis.

The most common types of chronic inflammatory arthritis are rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. In order to assess the activity of these diseases and tailor therapy, several outcome measures have been developed. They include composite scores based on clinical findings, biochemical markers and patient questionnaires. This article discusses the most commonly used outcome measures and looks at their limitations in quantifying the complex clinical features of different types of inflammatory arthritis, focusing in particular on rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.

A single-center retrospective study: Clinical features of different types of Budd-Chiari syndrome in Chinese patients in the Hubei area.

Background The characteristics and prevalence of Budd-Chiari syndrome in China remain unclear. This study aimed to analyze the clinical features of Budd-Chiari syndrome in Chinese patients in the Hubei area. Methods One-hundred and thirty patients with Budd-Chiari syndrome, admitted to Union Hospital from January 2002 to January 2011, were included in this retrospective study. Clinical features, laboratory data, imaging characteristics, and cumulative patency rates were analyzed. Results Of the 130 patients with Budd-Chiari syndrome, 77 were men (59.2%) and 53 women (40.8%). Budd-Chiari syndrome was more commonly associated with inferior vena cava block (56.9%, 74/130) than hepatic vein block (19.2%, 25/130) and combined inferior vena cava/hepatic vein block (23.9%, 31/130). The clinical features of Budd-Chiari syndrome varied based on the location of the obstruction. The incidence of bilirubin abnormality, elevated alkaline phosphatase, and γ-glutamyl peptide transferase levels was common in patients with Budd-Chiari syndrome. Liver injury was more severe in cases with combined inferior vena cava/hepatic vein block than in the other two types of Budd-Chiari syndrome. Color Doppler ultrasound imaging was better for the diagnosis of hepatic vein obstruction, while computed tomography and magnetic resonance imaging were superior in diagnosing inferior vena cava obstruction. The cumulative 1-, 5-, and 10-year patency rates were 97%, 69%, and 59%, respectively. Univariate analysis indicated that liver cirrhosis was an independent risk factor of recurrence. Conclusion The most prevalent type of Budd-Chiari syndrome is inferior vena cava obstruction in Chinese patients in the Hubei area. Different types of Budd-Chiari syndrome have diverse clinical and biochemical features, which may assist clinicians in diagnosing Budd-Chiari syndrome. Liver cirrhosis was found as an independent risk factor of recurrence.

Clinical features of different types of drug-induced liver injury and their association with liver histological changes

Clinical features of different types of drug-induced liver injury and their association with liver histological changes

Significance of detection of different types human rhinovirus in pediatric intensive care unit

Objective To discuss the significance of different types of human rhinovirus (HRV) as pathogen and the clinical features of different types of HRV in pediatric intensive care unit(PICU). Methods Eight hundred and fifty-two nasopharyngeal aspirates specimen (NPA) were collected from children who were admitted to PICU, the Second Affiliated Hospital of Shantou University Medical College from November 2010 to October 2015 and were tested by using nested reverse transcription-polymerase chain reaction(RT-PCR). Gene fragments for VP4/VP2 capsid protein amplified from HRV positive specimens were sequenced for HRV genotype confirmation.Then clinical characte-ristics of these HRV positive cases were analyzed. Results Among these 852 specimens tested, 214(25.12%) were HRV positive, including 95 samples(44.39%)positive for HRV-A, 17 samples(7.94%)for HRV-B, and 55 samples(25.70%)for HRV-C determined by sequence analysis; while the species of 47 samples (21.96%) of the total were unclassified clearly.HRV-A, HRV-B, HRV-C co-infection with other respiratory viruses accounted for 33.68%(32/95 cases), 29.41%(5/17 cases), and 29.09%(16/55 cases), respectively.The clinical characteristics of children infected with HRV-A, HRV-B, HRV-C were similar, and wheezing and polypnea were more common with HRV-C infections than HRV-A and HRV-B infections.The severity among children positive for different groups HRV showed no significant difference(H=0.631, P>0.05), as well as that between children co-infected with HRV and other viruses and those infected with HRV only(H=0.886, P>0.05). Conclusions Different types of HRV were major causes of infectious disease in pediatric critical disease.The clinical characteristics of children infected with HRV-A, HRV-B, HRV-C were similar.Wheezing and polypnea were more common with HRV-C infections than HRV-A and HRV-B infections. Key words: Rhinovirus; Genotype; Child; Intensive care

Fluid Collections in and Around the Pancreas in Acute Pancreatitis

The advent of computed tomographic scan with its wide use in the evaluation of acute pancreatitis has opened up a new topic in pancreatology i.e. fluid collections. Fluid collections in and around the pancreas occur often in acute pancreatitis and were defined by the Atlanta Symposium on Acute Pancreatitis in 1992. Two decades since the Atlanta Conference additional experience has brought to light the inadequacy and poor understanding of the terms used by different specialists involved in the care of patients with acute pancreatitis when interpreting imaging modalities and the need for a uniformly used classification system. The deficiencies of the Atlanta definitions and advances in medicine have led to a proposed revision of the Atlanta classification promulgated by the Acute Pancreatitis Classification Working Group. The newly used terms "acute peripancreatic fluid collections," "pancreatic pseudocyst," "postnecrotic pancreatic/peripancreatic fluid collections," and "walled-off pancreatic necrosis" are to be clearly understood in the interpretation of imaging studies. The current treatment methods for fluid collections are diverse and depend on accurate interpretations of radiologic tests. Management options include conservative treatment, percutaneous catheter drainage, open and laparoscopic surgery, and endoscopic drainage. The choice of treatment depends on a correct diagnosis of the type of fluid collection. In this study we have attempted to clarify the management and clinical features of different types of fluid collections as they have been initially defined under the 1992 Atlanta Classification and revised by the Working Group's proposed categorization.

Urinary proteins from patients with nephrotic syndrome alters the signalling proteins regulating epithelial–mesenchymal transition

SUMMARY AT A GLANCE Patients with MCD and FSGS had significant changes in the expression of several EMT-related urinary proteins through activation ERK1/2 and p38 signaling pathways. Further studies to explore the molecular mechanisms behind the distinct clinical features of different types of nephrotic syndrome are warranted. Proteinuria plays an important role in the progression of tubulointerstitial fibrosis, but the mechanism for the differential renal damage induced by proteinuria is unknown. This study examined the effects of urinary proteins from patients with idiopathic minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) on several epithelial-mesenchymal transition (EMT)-related marker proteins in cultured proximal tubular HK-2 cells. Urinary proteins from MCD and FSGS patients were extracted by ultrafiltration and incubated with HK-2 cells; the expression of the cytokeratin-18, alpha-smooth muscle actin (alpha-SMA) and vimentin were assessed. p38 and extracellular regulated kinase (ERK) activation were measured by western blotting, and SB203580 (a p38 inhibitor) and PD98059 (an ERK1/2 inhibitor) were used to inhibit their activation. It was observed that urinary proteins from FSGS patients more significantly induced the expression of alpha-SMA and vimentin and reduced cytokeratin-18 expression than those from MCD patients in HK-2 cells. Both ERK1/2 and p38 were activated by urinary proteins from MCD or FSGS patients. Pretreatment of the cells with SB203580 or PD98059 abolished the effect of urinary proteins from FSGS patients on the expression of alpha-SMA, vimentin and cytokeratin-18, while only SB203580 elicited this effect when cells were treated with urinary proteins from MCD patients. The urinary proteins from MCD and FSGS patients induced significant changes of EMT-related proteins through activation of distinct mitogen-activated protein kinase-related signalling pathways. Quality of proteinuria may play an important role in determining the severity and progression of tubular injury associated with different kidney diseases.

Clinical Characteristics of Dural Arteriovenous Shunts in 446 Patients of Three Different Ethnicities

Dural arteriovenous shunts (DAVSs) developing in either the ventral, dorsal or lateral epidural spaces (VE, DE and LE-shunts) predictably drain in either cranio/spino-fugal or -petal directions. Associated conditions like venous outflow restrictions (VOR) may be responsible for changes in this drainage pattern. The goal of this study was to compare demographic, angiographic and clinical characteristics of different types of DAVS in Europe, South America, and Asia to find out whether the same clinical profile is present in different ethnicities. Charts and angiographic films of 446 patients with DAVS from three hospitals in Europe, Asia and South America were retrospectively evaluated. Clinical symptoms were separated into benign and aggressive and the presence or absence of cortical venous reflux (CVR) and VOR was noted. LE-shunts were present in elderly men and were always associated with CVR resulting in aggressive symptoms. VE-shunts were present in females and almost always had benign symptoms. There were no differences among the three populations for these shunts. DE-shunts in the Asian population were more aggressive secondary to a higher rate of VOR with associated CVR. VE-shunts rarely lead to CVR even in the presence of VOR, whereas LE-shunts invariably lead to CVR, irrespective of the population investigated. CVR in DE-shunts is not related to the primary disease (i.e. the shunt itself) but to associated factors that led to VOR. Since the occurrence of these varied between different ethnicities, DE-shunts were aggressive in the Asian population and benign in the European and South American populations.

Feline inflammatory liver disease: diagnosis and management

FELINE inflammatory liver disease is the most common primary hepatic disorder of cats encountered in the UK but, despite this, there is still much confusion surrounding its diagnosis and management....

Analysis of the images of optical cohference tomography in the patients with macular hole caused by closed ocular trauma

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies. Key words: Retinal perforations/ diagnosis; Macula lutea; Tomography, optical coherence; Diagnostic imaging

The classification and surgical treatment strategy of double disruption of the superior shoulder suspensory complex

Objective To discuss the clinical characteristics of different types of double disruption of the superior shouhter suspensory complex (SSSC) and their surgical treatment strategy. Methods Fifteen cases with double disruption of the SSSC between May 2006 and March 2008 were retrospectively evaluated. There were 13 males and 2 females with an average age of 40.1 (20-55) years. There were seven cases of type Ⅰ which involved the scapular neck fracture combined with ipsilateral clavicular fracture; one case of type Ⅱ which involved the clavicular-coracoclavicular ligamentous-coracoid(C4) linkage injury; six cases of type Ⅲ which involved acromion-upper glenoid-coracoid fracture; one case of type Ⅳ which involved the clavicular-acromioclavicular joint-acromial strut injury. Twelve patients were treated operatively while the remaining three with critical associated injuries were treated conservatively. The clinical outcomes were evaluated according to the Constant score, Rowe score and Herscovici score. Results All cases were followed for an average of 13.2 (6-24) months. All fractures healed for a mean time of 10.2 (8-12) weeks. The mean Constant score for the surgical group was 91.3. The mean Rowe score for the surgical group was 92.9. The mean Herscovici score was 14.6. Conclusion The classification of double disruption of SSSC injury was established on Goss description. The surgical treatment should restore the integrity and stability of the SSSC in order to maintain the shoulder girdle function. Key words: Wounds and injuries; Acromion; Scapula; Shoulder fractures; Fracture fixation,internal

Movement Disorder-Childhood Rating Scale: Reliability and Validity

A new scale for children and adolescents aged 4-18 years, called the Movement Disorder Childhood Rating Scale, was designed to: (1) describe clinical features of different types of movement disorders; (2) evaluate the intensity of movement disorders in different body regions at rest and during specific tasks; and (3) assess the influence of movement disorders on motor function and daily living activities. The scale is divided into 2 parts: Part I for general assessment, and Part II for movement-disorder severity. It includes a 20-minute standardized video protocol of all items. The scale was applied to 61 patients with different types of movement disorder, and was independently scored by 3 observers. Reliability, construct validity, and consistency indexes are reported. High interrater agreement on each item, and a high degree of internal consistency on several proposed items, were evident.

Restless legs syndrome and primary headaches: a clinical study

Based on recent data about the association between restless legs syndrome (RLS) and migraine, we performed an observational study on the occurrence of RLS in patients affected by primary headaches. Two hundred headache patients (149 women and 51 men) and 120 (90 women and 30 men) sex-and age-matched control subjects were included. In the headache group, migraine without aura (MO) was the most represented headache type (n=114), followed by the "mixed" group (n=40) with MO, migraine with aura (MA) and frequent episodic tension-type headache (ETTH) in various combinations, and by ETTH alone (n=22). The remaining patients suffered from MA alone (n=10 MA), episodic cluster headache (ECH n=12) and primary stabbing headache (n=2). RLS frequency was significantly higher in headache patients than in control subjects (22.4% vs. 8.3, p=0.002) independently of sex, although with a female preponderance (84%) in both groups. More than 60% (n=27) of RLS patients were affected by MO and 30% (n=13) by a combination of two headache types (p> or =0.001), with a very low frequency of RLS for the other types of headache. No RLS patient had ECH. No statistical differences were observed among clinical characteristics of different types of headache in groups with and without RLS. In both headache and control groups, higher scores for depression and anxiety were more frequent in subjects with RLS compared with those without RLS. Furthermore, headache patients with RLS reported sleep disturbances more frequently compared to those without RLS (50.0% vs. 32.7%; p<0.0001) and showed a normal or underweight body mass index. Our data seem to confirm the existence of an association between RLS and primary headaches, particularly with migraine, as already demonstrated. The absence of RLS in ECH patients is very interesting. Many pathogenetic considerations about links between RLS and primary headaches could be given, the most fitting involving dopamine and melatonin.

Emergency treatment of a snake bite: Pearls from literature

Snake bite is a well-known occupational hazard amongst farmers, plantation workers, and other outdoor workers and results in much morbidity and mortality throughout the world. This occupational hazard is no more an issue restricted to a particular part of the world; it has become a global issue. Accurate statistics of the incidence of snakebite and its morbidity and mortality throughout the world does not exist; however, it is certain to be higher than what is reported. This is because even today most of the victims initially approach traditional healers for treatment and many are not even registered in the hospital. Hence, registering such patients is an important goal if we are to have accurate statistics and reduce the morbidity and mortality due to snakebite. World Health Organization/South East Asian Region Organisation (WHO/SEARO) has published guidelines, specific for the South East Asian region, for the clinical management of snakebites. The same guidelines may be applied for managing snakebite patients in other parts of the world also, since no other professional body has come up with any other evidence-based guidelines. In this article we highlight the incidence and clinical features of different types of snakebite and the management guidelines as per the WHO/SEARO recommendation.

Epileptic Syndromes and Photosensitive Seizures

The clinical features of different types of photic-induced seizures and epileptic syndromes characterized by visual sensitivity are reviewed from the University of Pisa, Italy, and Centre St Paul, Marseille, France.

Clinical profiles of cerebrovascular disorders in a population-based patient sample

Clinical features of different types of stroke were investigated in a sample of 409 patients representative of all cases admitted for acute stroke, except subarachnoidal hemorrhages, within a well defined population. A specific cerebrovascular diagnosis was obtained by detailed clinical investigation, including CT scan. In people > 50 years old, men/women risk for stroke was estimated to be 1.40:1. The risk was higher in men up to the age of 80; above this age similar risk for the two genders was observed. Eleven per cent had intracerebral hemorrhage, 13% TIA, 51% non-embolic and 25% embolic brain infarction. In all diagnostic categories there were similar proportions of patients who had a history of hypertension and previous stroke, neither did hemoglobin and hematocrit levels differ between the different stroke disorders. TIA preceded intracerebral hemorrhage in 11% and brain infarction in 15–20%. As opposed to patients with ischemic lesions, subjects with intracerebral hemorrhage had higher systolic blood pressure levels and more severe symptoms on admission to hospital. Ischemic stroke was associated with male predominance, different ischemic manifestations of heart diseases and diabetes.