Concurrent Manifestations Research Articles

Unraveling the South Asian enigma: concurrent manifestations of child anthropometric failures and their determinants in selected South Asian countries

Malnutrition among children is pervasive in South Asia and there are also reports of overnutrition. To better understand this phenomenon, we need a composite measure. However, the existing measures such as CIAF (Composite Index of Anthropometric Failure) and its revised version have ignored the overnutrition aspect of the phenomenon. This study proposes an extended version of CIAF which also considers overnutrition. This new measure was compared with the existing measures by using data from 1990 to 2018 for three selected South Asian countries including Pakistan, India and Bangladesh. We also examined the effects of socioeconomic and environmental variables on the outcome variable. The results reveal that the new measure (ECIAF) is better at measuring the phenomena. The burden of overall malnutrition has been decreased in the region. However, an increase in the concomitant prevalence of wasting and underweight is observed in both Pakistan and India and stunting and overweight is observed only in India. Besides, political stability, prevalence of undernourishment, anemia in children, mother’s education, household size, dependency ratio, air pollution and unimproved sanitation are significantly correlated with childhood malnutrition. The findings also testified to long-run cointegrating relationship among the variables.

S3246 Hidden in Plain Sight: A Case Series of Inflammatory Bowel Disease With Dermatologic Lesions as Initial or Concurrent Manifestations

S3246 Hidden in Plain Sight: A Case Series of Inflammatory Bowel Disease With Dermatologic Lesions as Initial or Concurrent Manifestations

Who stewards whom? A paradox spectrum of human–nature relationships of Estonian dacha gardeners

This article contributes to the understanding of the complexity of human-nature relationships. Through hermeneutic analysis of more than 60 semi-structured in-depth interviews (2019-2021), I identify five prevalent human-nature relationship models within the Food Self-Provisioning (FSP) practice in Eastern Estonia (‘master', ‘user' and ‘steward of nature' as well as ‘partner with’ and ‘participant in nature'). As an ambiguous model, the ‘stewardship of nature’ merits my particular attention when exploring how gardeners perceive, relate to and act upon nature in general and their own gardening practice in particular.Using a relational sociological approach, I locate the observed relationship models within the so-called ‘space of social relationships with nature’ (see Eversberg et al. 2022 in this Special Issue) which allows me to capture the various ways in which humans mentally and practically relate to nature. The analysis reveals seemingly contrary yet concurrent manifestations of human-nature relationships that can only be explained by exploring their embeddedness in both social power relations and societal nature relations that constitute the individually observed human-nature relationships. Furthermore, I demonstrate how ‘immediate’ engagement with nature results in rather caring and partner-like relationships whereas ‘abstract’ and alienated experiences often feature instrumental logic with implicit or explicit hierarchy.

Concurrent manifestations of Horner\u2019s syndrome and esophageal metastasis of breast cancer: case report of a young woman after a period of non-adherence to treatment: a case report

BackgroundEsophageal involvement and Horner’s syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment. In addition to the more aggressive behavior of breast cancer diagnosed in young women, non-adherence to treatment is associated with increased risk of distant metastasis.Case presentationA 36-year-old Javanese woman presented to our institution with dysphagia, hoarseness, and frequent hiccups. In the 6 weeks prior to the current admission, the patient also reported tingling in the neck and shoulder, anhidrosis in the left hemifacial region, and drooping of the upper left eyelid. She was previously managed as tuberculoid laryngitis. Plain X-rays showed burst fractures of the cervical vertebrae and slight pleural effusion. Laryngoscopy revealed bowing of the vocal cords and liquid residue in the vallecula that was reduced upon chin tuck. Esophageal metastasis was confirmed with endoscopy showing thickening of the wall and positive cytology swab with ductal malignant cells. The patient had a history of breast cancer with a period of loss to follow-up of 4 years.ConclusionsPhysicians should consider potential distant metastasis of breast cancer to the esophagus and sympathetic nervous system of the neck particularly in a high-risk woman with presentation of dysphagia and manifestations of Horner’s syndrome.

Is Chikungunya Virus Infection an Independent Risk Factor for 2-Year Mortality in Older Afro-Caribbean Subjects?

PurposeThe aim of this study was to investigate whether Chikungunya virus infection (CVI) was an independent risk factor for 2-year mortality in Afro-Caribbean subjects aged 65 years or older.Patients and methodsA retrospective cohort study was performed from January 2014 to December 2016 in the University Hospital of Martinique. Subjects aged ≥65 years admitted to the hospital were included. Baseline characteristics and concurrent manifestations at admission were collected. Subjects were followed up by phone for 2 years.ResultsA total of 687 old Afro-Caribbean subjects (80.4±8.0 years) were included: 467 positive for CVI (Chik+) and 220 negative for CVI (Chik-). During the follow-up, 180 (26.2%) died. The proportion of deaths was higher among Chik- (40.9%) than among Chik+ subjects (21.6%) (p<0.0001). By multivariable analysis, when adjusted for age polyarthralgia, neurological troubles, cardiovascular disorders, absence of neutrophilia, thrombocytopenia, hypernatremia, and hospital stay, Chik+ subjects had significantly higher survival rates (HR: 0.58; 95% CI: 0.40–0.85) than Chik- ones.ConclusionWithin the two years following hospital admission of subjects aged ≥65 years or older, Chik+ subjects had significantly higher survival rates than Chik- ones.

Radiation-Associated Cardiac Disease: From Molecular Mechanisms to Clinical Management.

Radiation-associated cardiac disease (RACD) is an increasingly recognized latent manifestation of chest and mediastinal radiation therapy. The delayed presentation reflects increased survival rates from malignancies successfully treated decades previously. However, individuals are now presenting with multiple coexistent manifestations of RACD and pulmonary disease as a consequence of high-dose radiation administered prior to the routine institution of modern dose-modulating regimens. Increased awareness of RACD is critical for implementation of appropriate screening algorithms and for specific management strategies involving the timing and strategies of intervention in these patients. Recent advances in multimodality cardiac imaging have demonstrated pathognomonic findings of RACD, which can predict outcomes including mortality. Accurate diagnosis of these typically concurrent manifestations is critical and should prompt referral to a center experienced in managing RACD as surgical risk is significantly increased for this patient cohort, particularly for those undergoing redo operation. The latent effect of RACD and its unique combination of manifestations means that these patients will increasingly present with challenging management issues, resulting in increased rates of morbidity and mortality. Timing of treatment intervention must be carefully considered, although percutaneous options may provide alternative future strategies for this higher risk cohort.

Fulminant Disseminated Intravascular Coagulation as Initial Presentation of BRAF-Mutated Melanoma

Acute disseminated intravascular coagulation (DIC) is a pathological process involving dysfunction of the coagulation cascade. In this case report, we discuss a 33-year-old woman with BRAF V600E-mutated metastatic melanoma who presented in fulminant DIC with concurrent hemorrhagic and thrombotic manifestations and discuss the patient's brief response to combination therapy. In our discussion, we highlight the current understanding of DIC and also identify opportunities for future research to elucidate the genetic aberrations in melanoma that may result in treatment resistance to combination therapy.

Habituation deficit of auditory N100m in patients with fibromyalgia.

Habituation refers to the brain's inhibitory mechanism against sensory overload and its brain correlate has been investigated in the form of a well-defined event-related potential, N100 (N1). Fibromyalgia is an extensively described chronic pain syndrome with concurrent manifestations of reduced tolerance and enhanced sensation of painful and non-painful stimulation, suggesting an association with central amplification of all sensory domains. Among diverse sensory modalities, we utilized repetitive auditory stimulation to explore the anomalous sensory information processing in fibromyalgia as evidenced by N1 habituation. Auditory N1 was assessed in 19 fibromyalgia patients and age-, education- and gender-matched 21 healthy control subjects under the duration-deviant passive oddball paradigm and magnetoencephalography recording. The brain signal of the first standard stimulus (following each deviant) and last standard stimulus (preceding each deviant) were analysed to identify N1 responses. N1 amplitude difference and adjusted amplitude ratio were computed as habituation indices. Fibromyalgia patients showed lower N1 amplitude difference (left hemisphere: p=0.004; right hemisphere: p=0.034) and adjusted N1 amplitude ratio (left hemisphere: p=0.001; right hemisphere: p=0.052) than healthy control subjects, indicating deficient auditory habituation. Further, augmented N1 amplitude pattern (p=0.029) during the stimulus repetition was observed in fibromyalgia patients. Fibromyalgia patients failed to demonstrate auditory N1 habituation to repetitively presenting stimuli, which indicates their compromised early auditory information processing. Our findings provide neurophysiological evidence of inhibitory failure and cortical augmentation in fibromyalgia. WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?: Fibromyalgia has been associated with altered filtering of irrelevant somatosensory input. However, whether this abnormality can extend to the auditory sensory system remains controversial. N!00, an event-related potential, has been widely utilized to assess the brain's habituation capacity against sensory overload. WHAT DOES THIS STUDY ADD?: Fibromyalgia patients showed defect in N100 habituation to repetitive auditory stimuli, indicating compromised early auditory functioning. This study identified deficient inhibitory control over irrelevant auditory stimuli in fibromyalgia.

Benign Lymphoepithelial Lesion of Parotid Gland and Secondary Amyloidosis as Concurrent Manifestations in Sjögren's Syndrome.

Benign Lymphoepithelial Lesion of Parotid Gland and Secondary Amyloidosis as Concurrent Manifestations in Sjögren's Syndrome.

Hereditary cerebellar ataxias with polyneuropathy

The paper gives a brief clinical characterization of hereditary cerebellar ataxias running with polyneuropathy. Particular attention is paid to the pathogenesis, clinical presentation, and treatment of gluten ataxia. A mutant gene and concurrent symptoms are indicated. The differential diagnosis of cerebellar ataxias should be started by ruling out the hereditary nature of the disease, which is verified by molecular genetic testing. In recent years, some genetic diseases manifesting themselves by a concurrence of ataxia and polyneuropathy have been replenished by a description of new hereditary syndromes. The knowledge of the nature of inheritance, age at disease onset, and concurrent manifestations will assist a practitioner in presuming the diagnosis of a rare disease and in referring a patient for medical genetic testing. Only a precise diagnosis will be able to assess prognosis and to use specific treatment.

Clindamycin, Clotrimazole and Tinidazole in Mixed Vaginosis- A “Real World” Clinical Experience

Background: Vaginal infections are among the most frequent disorders affecting a woman and comprise over 95% of lower female genital tract infections. Seventy five percent of the women world-wide suffer from vaginosis resulting from bacterial, fungal and protozoal infections. Several studies have shown that mixed vaginal infections occur frequently and hence, in co-infection, each pathogen requires specific therapy for complete eradication of concurrent manifestations. Materials and Methods: A multicenter, prospective, open-label, non-comparative clinical study was carried out in 495 patients with mixed vaginosis of bacterial, fungal and protozoal origin. A fixed dose combination of Clindamycin 100 mg, Clotrimazole 100 mg and Tinidazole 100 mg was administered intravaginally for 7 consecutive nights. Results: Treatment led to significant reduction in various symptoms of vaginal infection within 3 days of treatment initiation. On day 7 of treatment, 98.6% patients had normal and odourless vaginal discharge, the mean vaginal burning and irritation score declined by 99.2% and 99.3% respectively. Also, there was remission of vulvar, cervical and vaginal erythema in more than 98% of patients. Physicians and patients rated the treatment efficacy as good to very good improvement and tolerability to the treatment was regarded as good to excellent. No serious adverse events were reported. Conclusion: The present study demonstrates that fixed dose combination of Clindamycin, Clotrimazole and Tinidazole is effective and well tolerated in the treatment of mixed vaginosis due to bacterial, fungal and protozoal infection.

Rippling transition from electron-induced condensation of curvature field in graphene

A quantum field theory approach is applied to investigate the dynamics of flexural phonons in a metallic membrane like graphene, looking for the effects deriving from the strong interaction between the electronic excitations and elastic deformations. Relying on a self-consistent screening approximation to the phonon self-energy, we show that the theory has a critical point characterized by the vanishing of the effective bending rigidity of the membrane at low momentum. We also check that the instability in the sector of flexural phonons takes place without the development of an in-plane static distortion, which is avoided due to the significant reduction of the electron-phonon couplings for in-plane phonons at large momenta. Furthermore, we analyze the scaling properties of the many-body theory to identify the order parameter that opens up at the point of the transition. We find that the vanishing of the effective bending rigidity and the onset of a nonzero expectation value of the mean curvature are concurrent manifestations of the critical behavior. The results presented here imply that, even in the absence of tension, the theory has a critical point at which the flat geometry becomes an unstable configuration of the metallic membrane, with a condensation of the mean curvature field that may well reproduce the smooth distribution of ripples observed in free-standing graphene.

The clinical spectrum of laryngeal dystonia includes dystonic cough: observations of a large series.

Laryngeal dystonia is a movement disorder of the muscles within the larynx, which most commonly manifests as spasmodic dysphonia (SD). Rarer reported manifestations include dystonic respiratory stridor and dyscoordinate breathing. Laryngeal dystonia has been treated successfully with botulinum neurotoxin (BTX) injections since 1984. We reviewed prospectively collected data in a consecutive series of 193 patients with laryngeal dystonia who were seen at St. Vincent's Hospital between 1991 and 2011. Patient data were analyzed in Excel, R, and Prism. Laryngeal dystonia manifested as SD (92.7%), stridor (11.9%), dystonic cough (6.2%), dyscoordinate breathing (4.1%), paroxysmal hiccups (1.6%), and paroxysmal sneezing (1.6%). There were more women (68.4%) than men (31.6%), and the average age at onset was 47 years. A positive family history of dystonia was present in 16.1% of patients. A higher incidence of extra-laryngeal dystonia (ie, torticollis and blepharospasm) and concurrent manifestations of laryngeal dystonia were present in patients with dystonic cough, dyscoordinate breathing, paroxysmal sneezing, and hiccups than in other patients (P = 0.003 and P < 0.0001, respectively). The average starting dose of BTX decreased from 2.3 to 0.5 units between 1991 and 2011. The median treatment rating was excellent across all subgroups. Patients with adductor SD, stridor, extra-laryngeal dystonia and male patients had relatively better treatment outcomes. Technical failures were rare (1.1%). Dysphonia secondary to vocal cord paresis followed 38.7% of treatments. Laryngeal dystonia manifests predominantly as SD, but other manifestations include stridor, dyscoordinate breathing, paroxysmal cough, hiccups, and sneezing. BTX injections are very effective across all subgroups. Severe adverse events are rare.

Negative Association between Testosterone Concentration and Inflammatory Markers in Young Men: A Nested Cross-Sectional Study

ObjectiveLow grade systemic inflammation (LGSI) as well as androgen deficiency has in older men been associated with several pathologies, including cardiovascular disease (CVD). We wanted to investigate whether low testosterone levels are linked to biomarkers of LGSI already in young age, before any concurrent manifestations of CVD or other systemic diseases.DesignNested cross-sectional study.MethodsForty subfertile biochemically hypogonadal (n = 20) or eugonadal (n = 20) men (mean age 37 years, SD = 4.3) and 20 age-matched controls were randomly selected from an ongoing study on male subfertility. Subjects comprised male partners in infertile couples in whom also subnormal sperm concentration was present. Blood sampling, interviews, and anthropometric measures were undertaken. Serum levels of testosterone, LH, estradiol, SHBG, and 21 LGSI-markers were assessed.ResultsAmong 21 inflammatory markers, macrophage inflammatory protein 1-alpha (MIP1a) (ß = −0.025; p = 0.028), 1-beta (MIP1B) (ß = −0.015; p = 0.049) and tumor necrosis factor alpha (TNFa) (ß = −0.015; p = 0.040) showed negative association to total testosterone (TT) levels. MIP1a (ß = −1.95; p = 0.001) and TNFa (ß = −0.95; p = 0.014) showed negative association to calculated free testosterone (cFT) levels. Compared to men with normal TT and cFT levels, TNFa levels were higher in men with subnormal levels of TT (mean ratio 1.61; p = 0.006) and cFT (mean ratio 1.58; p = 0.007). Also, MIP1a levels were higher in men with subnormal levels of TT (mean ratio 1.84; p = 0.030).ConclusionsSubnormal testosterone may already in young age associate to LGSI, which might be a part of the mechanism underlying adverse health outcomes of male hypogonadism.

Mixed Vaginitis—More Than Coinfection and With Therapeutic Implications

Mixed vaginitis is due to the simultaneous presence of at least two vaginal pathogens, both contributing to an abnormal vaginal milieu and, hence, symptoms and signs of vaginitis. In mixed vaginitis, both pathogens require specific therapy for complete eradication of concurrent manifestations. In coinfection, although two pathogens are identified, a potential pathogen may be present but may not be a cause of existing vaginal symptoms. Although data remain sparse, mixed vaginitis occurs rarely (<5%). By contrast, pathogen coinfection occurs frequently in women with vaginitis. Approximately 20%-30% of women with bacterial vaginosis (BV) are coinfected with Candida species. Coexistence of BV pathogens and T. vaginalis is even more common, with coinfection rates of 60%-80%. Both coinfection and mixed vaginitis have significant clinical and therapeutic implications and are worthy of further investigation.

Prevalence of intraventricular block in the general population: The Framingham Study

QRS intervals in the ECGs of members of the Framingham Heart Study cohort and offspring were measured to provide an estimate of the prevalence of intraventricular block in the general population. Intervals of ≥ 0.09 second appear in men twice as commonly as in women, are rare before age 50 to 60, and shift from a predominance of right bundle branch block in the young to an indeterminate pattern in the elderly. Complete intraventricular block (QRS interval ≥ 0.12 second) is seen in 11% of elderly men and 5% of elderly women. Aside from age and sex, logistic regression indicates strong associations with concurrent manifestations of coronary heart disease, congestive heart failure, and atrioventricular block, as well as hypertension, left ventricular hypertrophy, and ventricular extrasystoles. Among those subjects free of clinical coronary disease and congestive heart failure, associations between QRS interval and age, sex, atrioventricular block, and ECG left ventricular hypertrophy remain significant by multivariate analysis. Whether people with prolonged QRS intervals need special monitoring or attention cannot be told from these data.

A CASE OF BURKITT'S LYMPHOMA OF THE BREAST (FURTHER REPORT)

A further follow-up result of a case of Burkitt lymphoma with bilateral breast tumors reported previously is presented, and the literture as to this disease is reviewed. A 34-year-old feamale was admitted because of diffuse turmors of the bilateral breasts which grew during lactation. There is no concurrent manifestations of the disease elsewhere except palpable supraclavicular nodes. Modified radical mastectomy with supraclavicular lymphnodes dissection was performed on Septembar 12, 1985. Microscopic study revealed diffuse lymphoma Burkitt type. Postoperative course was uneventful, but 14 days after operation she suddenly fell into a coma due to brain involvement. Clinical symptoms and signs wer improved by chemotherapy (VEPA) and irradiation, and she was able to discharged. Exacerbation and recovery were repeated during the subsequent admission for four times. On May 5, 1987, she fell into a coma again, and died six months after admission.

Facial paralysis in lyme disease

Lyme disease is a multisystemic illness caused by a tick-borne spirochete. Once considered unique to the Connecticut coastline, thousands of cases are now documented throughout the United States, northern Europe, and Australia. Unilateral and bilateral facial paralysis may occur in up to 11% of patients with Lyme disease. This paper reviews the clinical course, distinguishing features, and outcome of 124 such palsies in 101 patients seen between 1975 and 1984. The 99.2% spontaneous recovery rate demonstrates the unequivocally excellent prognosis of this palsy and confirms that operative intervention is not indicated. The otolaryngologist should consider this etiology in all otherwise idiopathic facial paralyses, especially when presenting in summer months in endemic areas, or when bilateral. Positive Lyme disease spirochete titers are helpful in the diagnosis. We believe antibiotics should be given to patients with this facial palsy in order to treat any other concurrent manifestations of the illness and to prevent subsequent complications.

Primary arteritis of the aorta as a cause of renovascular hypertension in Singapore.

Summary: One hundred and twenty-seven Asian hypertensive patients between the ages of 12 and 40 were investigated for causes of hypertension. Twelve of these patients had renovascular hypertension. Five of these twelve patients were found to have primary arteritis of the aorta, emphasising the importance of this disorder as a cause of renovascular hypertension in an Asian community. One of these cases presented with concurrent manifestations of rheumatic fever. The pathogenic considerations relating to these cases are discussed together with an evaluation of some immunologic phenomena previously described.

Electromyogram in evaluation of neurological complications of spinal anesthesia.

Some assume that spinal anesthesia is responsible for the development of any concurrent neurological manifestations. Of 482 patients whose neurological complaints seemed to be related to spinal anesthesia, 478 showed neurological complaints due to some other concurrent and entirely unrelated conditions imitating actual complications of the spinal anesthetic agent. In the majority of instances, the causative disease proves to be either an infectious neuronitis or a peripheral neuropathy. The electromyogram plays a fundamental role in the evaluation of these complications. Differentiation in the two groups of lesions is based on the following two basic elements: (1) the distribution of the denervation, that is, electromyographic changes, and (2) the time in which the denervation activity is first detected electromyographically. The prevention of misunderstanding about spinal anesthesia is of great importance.