Dominant Symptom Research Articles

Dampak Pajanan Timbal terhadap Anemia Pekerja dan Strategi Intervensi

Lead poisoning is still a major case of industrial and environmental problems in developing countries. In the last decade, several studies have been conducted on the impact of lead exposure on health, one of which is the risk of anemia in both workers and communities around exposed factories. The aim of this research is to determine the impact of lead on the risk of anemia in the work environment, and intervention strategies that can be carried out by the parties involved. This research includes a literature review obtained from a search using the PRISMA 2009 system. Of the 246 journals obtained from the first search, 20 journals were included in this research. The research results showed that factors that influence blood lead levels are environmental conditions, work area, use of PPE, worker hygiene behavior, and duration of work, either daily or long term. Anemia is one of the dominant symptoms and has an impact on work productivity. Intervention strategies for cases of anemia due to lead exposure can be carried out using the principle of hierarchy control and improving individual hygiene behavior, as well as providing additional supplements. In severe cases, chelation and alternative therapies need to be considered. Controlling the impact of lead exposure needs to be carried out by company management and requires worker participation to be protected from the effects of intoxication on health.

CHILDHOOD TUBERCULOSIS: STUDY OF CLINICAL PROFILE OF TUBERCULOSIS IN PEDIATRIC PATIENTS AND CORRELATION OF CB-NAAT RESULT IN CLINICALLY SUSPECTED TUBERCULOSIS

Introduction: Tuberculosis is a chronic infectious disease caused by predominantly Mycobacterium tubercle bacilli. Pediatric tuberculosis is among the top 10 causes of death in children. India accounts for one fourth of the global tuberculosis burden, standing one among the thirty high TB burden countries. Hence, children in India are at increased risk of acquiring TB infection and developing TB disease and death following infection. Latent TB infection in children may be reactivated in later life and become active adulthood tuberculosis and thereby a potent TB reservoir in the community. Aim: To study clinical profile of tuberculosis in pediatric patients and correlation of CB-NAAT result in clinically suspected tuberculosisat tertiary care center. Method: Prospective Observational study from1 August 2020 to 31 August 2022. Result: Out of 52 patients cough was presenting symptom of 19(36.53%), fever was present in 25(48.07%), loss of weight >5% in last 3 month was present in 12(23.07%),fever(83.8 %) was most dominant symptom. Out of 52 patients, tachypnoea was presenting sign in 5(9.6%), ascites was present in 5(9.6%) and lymphadenopathy for more than 2 weeks were present in 25(48.07%). Out of 52 patients Anaemia was present in 42(80.76%), High ESR was present in 22(42.30%) and Mantoux test was positive in 16(30.76%). Conclusion: Reliable diagnosis of tuberculosiscan be done by clinical parameters like presence of tachypnea, fever and lymphadenopathy. CB NAAT in correlation to clinical parameters is very useful for diagnosis of tubercular cases.

From Molar Pregnancy, Thyrotoxicosis, to Pulmonary Hypertension: A Case Report

Background: Molar pregnancy is a benign condition with the dominant symptom being dark brown to bright red bleeding from the vagina. This disease can induce hyperthyroidism and result in pulmonary hypertension. This case report describes a patient who had molar pregnancy with thyrotoxicosis and pulmonary hypertension.Case: A 30-year-old woman presented with complaints of lower abdominal pain for the last month. The patient feels that her stomach has enlarged in the last 3 months. Other complaints include bleeding and observed bubbles from the birth canal, shortness of breath, and chest pain. The serum cobas β-hCG level of 7954.00 mIU/mL. On abdominal ultrasound examination, vesicles formed a honeycomb appearance, measuring 7.4 cm×5.3 cm. Hematologic laboratory tests revealed low TSH levels (<0.01 μIU/mL), T3 levels of 2.35 ng/ml, and FT4 levels of 2.62 ng/dL. The results of the echocardiography examination showed there is a high probability of pulmonary hypertension.Conclusion: Molar pregnancy can exacerbate thyrotoxicosis through hCG activity. Smoking and breastfeeding also have similar effects. Consequently, increased thyroid hormone levels can worsen or cause pulmonary hypertension.

From Molar Pregnancy, Thyrotoxicosis, to Pulmonary Hypertension: A Case Report

Background: Molar pregnancy is a benign condition with the dominant symptom being dark brown to bright red bleeding from the vagina. This disease can induce hyperthyroidism and result in pulmonary hypertension. This case report describes a patient who had molar pregnancy with thyrotoxicosis and pulmonary hypertension.Case: A 30-year-old woman presented with complaints of lower abdominal pain for the last month. The patient feels that her stomach has enlarged in the last 3 months. Other complaints include bleeding and observed bubbles from the birth canal, shortness of breath, and chest pain. The serum cobas β-hCG level of 7954.00 mIU/mL. On abdominal ultrasound examination, vesicles formed a honeycomb appearance, measuring 7.4 cm×5.3 cm. Hematologic laboratory tests revealed low TSH levels (<0.01 μIU/mL), T3 levels of 2.35 ng/ml, and FT4 levels of 2.62 ng/dL. The results of the echocardiography examination showed there is a high probability of pulmonary hypertension.Conclusion: Molar pregnancy can exacerbate thyrotoxicosis through hCG activity. Smoking and breastfeeding also have similar effects. Consequently, increased thyroid hormone levels can worsen or cause pulmonary hypertension.

Fifteen-year symptomatic outcome of patients with nonactionable motor findings on high-resolution manometry.

High-resolution manometry (HRM) is performed for evaluation of esophageal symptoms, but patient outcome is unclear when no actionable motor disorder is identified. We evaluated long-term symptomatic outcome of patients with nonactionable HRM findings. Patients who underwent (HRM) studies in 2006-2008 were tracked. Patients with achalasia spectrum disorders, foregut surgery before or after HRM, and incomplete symptom documentation were excluded. Symptom questionnaires assessing dominant symptom intensity (DSI, product of symptom severity and frequency recorded on 5-point Likert scales) and global symptom severity (GSS, from 10 cm visual analog scale) were repeated. Change in symptom burden was compared against HRM motor findings using Chicago Classification 4.0 (CCv4.0), applied retroactively to 2006-2008 data. Overall, 134 patients (median age 68 years, 64.5% female) could be contacted. The majority (73.1%) had normal motility; others had ineffective esophageal motility (8.2%), esophagogastric junction outflow obstruction (13.4%), hypercontractile esophagus (3.0%), or absent contractility (2.2%), none managed invasively. Over 15 years of follow-up, DSI decreased from 8.0 (4.0-16.0) to 1.0 (0.0-6.0) (p < 0.001) and GSS improved from 5.5 (3.3-7.7) to 2.0 (0.0-4.0) (p < 0.001); improvement was consistent across CCv4.0 diagnoses and subgroups. The majority (82.8%) reported improvement over time, and antisecretory medication was the most effective intervention (83.0% improvement). There was no difference in medication efficacy (p = 0.75) or improvement in symptoms (p = 0.20) based on CCv4 diagnosis. Esophageal symptoms improve with conservative symptomatic management over long-term follow-up when no conclusive obstructive motor disorders or achalasia spectrum disorders are found on HRM.

Membrane trafficking in neurodevelopmental disorders – new insight and therapeutic implications

Introduction: Membrane trafficking processes are essential for cell viability and basic functions, as well as for interactions between the cell interior and the surrounding environment.&#x0D; Purpose: This article focuses on the review of specific subgroup of inherited neurodevelopmental disorders caused by membrane trafficking dysfunction. The possibility of innovative therapeutic approaches based on selective effects on membrane trafficking processes is also discussed.&#x0D; State of knowledge: Most previously published reviews are lists of multi-organ diseases related to membrane trafficking dysfunction that are grouped by damaged genes/proteins or by single dominant clinical symptom. No review that focused exclusively on the subgroup of neurodevelopmental diseases related to membrane trafficking defects and their differential diagnosis useful in clinical practice, could be identified.&#x0D; Conclusions: Neurodevelopmental diseases related to membrane trafficking defects constitute a significant still growing group of rare/ultra-rare disorders which, due to the spectrum of symptoms, require differentiation from the more common neurogenetic syndromes with different pathomechanisms of the disease, but also related to intellectual disability, autism, epilepsy or neurodegenerative processes. The design of innovative drugs based on selective effects on membrane trafficking processes creates wide opportunities for precise, targeted therapeutic intervention, with a significantly minimized risk of its ineffectiveness or side effects.

Post-polio syndrome is not a dysimmune condition.

Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. Cross-sectional study. Montpellier University Hospital. Forty-seven PPS and 27 healthy controls. PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1β, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-β, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. Our results suggest that PPS is not a dysimmune disease. Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.

Characteristics of Respiration Symptoms and Lung Function of Rice Milling Workers in Suwug Village, Sawan District, Buleleng Regency

Background: Rice milling is an important industry in the agricultural sector, but during the process can affect the health of workers. Method: This research is an observational analytical study using a cross-sectional design, which was conducted in Suwug Village, Sawan District, Buleleng Regency in August 2023. Results: There were 106 samples that met the inclusion criteria. Cough is the dominant respiratory symptom found in rice mill workers. The average FEV1 was 1.59 ± 0.64 liters and 74.34 ±24.21%, the average FVC was 2.04 ± 0.73 and 77.82 ± 38.73%, the median FEV1/FVC value was 76.59 (22.25) and the median FEF25-75 was 68.11 (58.50). Cough was found to be more common in female samples (p = 0.048). Wheezing was found more in samples that did not use PPE (p = 0.026). FEV1/FVC values were lower in active smokers 71.80 ± 16.33 (p = 0.043). FEV1(%), FEV1/FVC (%), and FEF25-75 were significantly lower in more than 20 years old workers with values respectively 64.06±24.42; 67.93±15.44; and 46.65 ± 31.73 (p = 0.00). The mean FEF25-75 was lower in samples &lt;63.94 years old (p = 0.028). Airway obstruction was predominantly in workers for more than 20 years. Conclusion: There was no correlation between all respiratory symptoms including coughing, hemoptysis, shortness of breath, chest pain, sputum, purulent sputum, and wheezing based on age, smoking status, and length of work. There were no significant differences in spirometry results based on age, gender, smoking status, and use of PPE.

Reflux Symptoms Increase Following Sleeve Gastrectomy Despite Triage of Symptomatic Patients to Roux-en-Y Gastric Bypass.

Bariatric surgical options in obese patients include sleeve gastrectomy (SG) and roux-en-Y gastric bypass (RYGB), which may not be equivalent in risk of postoperative reflux symptoms. We evaluated risk and predictive factors for postbariatric surgery reflux symptoms. Patients with obesity evaluated for bariatric surgery over a 15-month period were prospectively followed with validated symptom questionnaires (GERDQ, dominant symptom index: product of symptom frequency and intensity from 5-point Likert scores) administered before and after SG and RYGB. Esophageal testing included high-resolution manometry in all patients, and ambulatory reflux monitoring off therapy in those with abnormal GERDQ or prior reflux history. Univariate comparisons and multivariable analysis were performed to determine if preoperative factors predicted postoperative reflux symptoms. Sixty-four patients (median age 49.0 years, 84% female, median BMI 46.5kg/m2) fulfilled inclusion criteria and underwent follow-up assessment 4.4 years after bariatric surgery. Baseline GERDQ and dominant symptom index for heartburn were significantly higher in RYGB patients (P≤0.04). Despite this, median GERDQ increased by 2 (0.0 to 4.8) following SG and decreased by 0.5 (-1.0 to 5.0) following RYGB (P=0.02). GERDQ became abnormal in 43.8% after SG and 18.8% after RYGB (P=0.058); abnormal GERDQ improved in 12.5% and 37.5%, respectively (P=0.041). In a model that included age, gender, BMI, acid exposure time, and type of surgery, multivariable analysis identified SG as an independent predictor of postoperative heartburn (odds ratio 16.61, P=0.024). Despite preferential RYGB when preoperative GERD was identified, SG independently predicted worsening heartburn symptoms after bariatric surgery.

Diagnostics of COVID-19 Post-Traumatic Anxiety in Students

Post-traumatic anxiety COVID-19 is a state of students after experiencing a pandemic. Post-traumatic anxiety is classified and analyzed based on physical symptoms, emotional symptoms, mental symptoms, behavioral symptoms, spiritual symptoms, and several statements containing conditions that are the condition of post-traumatic COVID-19 students. This study aims to know and find symptoms experienced by students regarding post-traumatic anxiety due to COVID-19. The method used in this study is to use the observation method through data collection by filling out a questionnaire. The sample for this research consisted of 68 students at Anaka State Elementary School, Kawalu sub-district, Tasikmalaya city, Indonesia. Based on the observation results, data was obtained with the most dominant physical symptoms being dizziness, the most dominant emotional symptoms being feeling shaken, the most predominant mental symptoms being forgetfulness, the most dominant behavioral symptoms being crying, and the most dominant spiritual symptoms being grumbling. This research contributes as an overview for teachers and prospective teachers about the condition of students post-COVID and recommends strengthening psychology education to overcome this problem.

Membrane trafficking in neurodevelopmental disorders – new insight and therapeutic implications

Introduction: Membrane trafficking processes are essential for cell viability and basic functions, as well as for interactions between the cell interior and the surrounding environment.&#x0D; Purpose: This article focuses on the review of specific subgroup of inherited neurodevelopmental disorders caused by membrane trafficking dysfunction. The possibility of innovative therapeutic approaches based on selective effects on membrane trafficking processes is also discussed.&#x0D; State of knowledge: Most previously published reviews are lists of multi-organ diseases related to membrane trafficking dysfunction that are grouped by damaged genes/proteins or by single dominant clinical symptom. No review that focused exclusively on the subgroup of neurodevelopmental diseases related to membrane trafficking defects and their differential diagnosis useful in clinical practice, could be identified.&#x0D; Conclusions: Neurodevelopmental diseases related to membrane trafficking defects constitute a significant still growing group of rare/ultra-rare disorders which, due to the spectrum of symptoms, require differentiation from the more common neurogenetic syndromes with different pathomechanisms of the disease, but also related to intellectual disability, autism, epilepsy or neurodegenerative processes. The design of innovative drugs based on selective effects on membrane trafficking processes creates wide opportunities for precise, targeted therapeutic intervention, with a significantly minimized risk of its ineffectiveness or side effects.

Assessment of the health status and pharmacological treatment of neonates with osteogenesis imperfecta – 20-year single-centre observations

Introduction and objective: Osteogenesis imperfecta is a heritable bone dysplasia resulting in reduced bone mineral density. Fractures of long bones, which are the dominant symptom of osteogenesis imperfecta, can be diagnosed already in foetal life. Multiple fractures are associated with severe pain, which may cause deterioration of the newborn’s general condition, respiratory and circulatory disorders, and reduced general motor activity. The aim of the study was to summarise the experience resulting from many years of care and treatment of neonates with osteogenesis imperfecta types II and III. Materials and methods: The study included 53 newborns with osteogenesis imperfecta hospitalised at the Department of Paediatrics, Newborn Pathology and Bone Metabolic Diseases in the years 2001–2021. All children underwent a babygram and an assessment of their health status, including calcium and phosphorus metabolism parameters. Results: In 67.3% of cases, the mother was informed before delivery that she would give birth to a sick child. The general condition of the newborns was moderately severe to severe in 43.4%. Physical examination revealed abnormal body proportions related to previous fractures in 98.1% of patients, including long bones of limbs. More than 10 fresh bone fractures were diagnosed in 34% of children. Conclusions: Prenatal diagnosis of osteogenesis imperfecta indicates its severe course (multiple fractures) in the neonatal period. Therefore, it requires care in a specialised centre that will provide safe, symptomatic pharmacological treatment (bisphosphonates) to reduce both pain and the risk of further bone fractures.

The Effectiveness of Massage Therapy on Pain Reduction in Rheumatoid Arthritis Patients: Literature Review

Rheumatoid Arthritis is a chronic inflammatory disease that can cause bone damage and cause disability. The most common and dominant symptom is pain, especially swelling in the morning. There is a way to treat pain in rheumatoid arthritis patients with massage. Massage has the effect of reducing anxiety and muscle tension. This muscle massage stimulation is enriched to stimulate delta-A nerve fibers and C fibers and releases substance P in the afferent nerves, where there are mechanoreceptors (tactile apparatus: skin) as a defense mechanism, and in the central cortex, the descending nerves release endogenous. opiates, namely endorphins produced by the pituitary as a pain reliever. So, it can block or reduce pain impulses. This study aims to determine the effect of massage on reducing pain intensity in rheumatoid arthritis patients. This research uses a literature review design using 2 databases, namely PubMed and Scopus. The results showed that in journal research, giving massage for ± 15 minutes every day resulted in reduced pain and anxiety. In the journal, rheumatoid arthritis sufferers had a decrease in the quality of pain using back massage therapy with p=0.05. The conclusion of this study shows that the use of massage therapy is effective for patients with rheumatoid arthritis who experience pain.

Low Post-Treatment Quality of Life and the High Incidence of Pain Are Common and Significantly Exacerbated in Depressed Head and Neck Patients Treated with Definitive Accelerated Radiotherapy.

(1) Background: The goal of this study is to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART). (2) Methods: 76 recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up = 47 months), completed EORTC QLQ-C30 with the H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual-Analog Scales (VAS) of pain in HN and the neck/arm areas. (3) Results: The most dominant symptoms measured with QLQ-C30 were as follows: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within the H&N35, the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder area) of the patients, with a mean score of 3/10. One-third of the patients reported depressive moods (HADS ≥ 15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to the non-depressed group before DART (96% vs. 78%) and required steroids treatment (85% vs. 58%) during DART, also scored significantly worse on 23 of the 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women and less-advanced patients scored better in several aspects of quality of life. (4) Conclusions: Patients treated with DART struggle with low quality of life and persistent treatment-related symptoms including constant pain. HNC survivors, especially those who are depressed, may require additional psychosocial, rehabilitation and medical intervention programmes.

The presenting symptom signatures of incident cancer: evidence from the English 2018 National Cancer Diagnosis Audit

BackgroundUnderstanding relationships between presenting symptoms and subsequently diagnosed cancers can inform symptom awareness campaigns and investigation strategies.MethodsWe used English National Cancer Diagnosis Audit 2018 data for 55,122 newly diagnosed patients, and examined the relative frequency of presenting symptoms by cancer site, and of cancer sites by presenting symptom.ResultsAmong 38 cancer sites (16 cancer groups), three classes were apparent: cancers with a dominant single presenting symptom (e.g. melanoma); cancers with diverse presenting symptoms (e.g. pancreatic); and cancers that are often asymptomatically detected (e.g. chronic lymphocytic leukaemia). Among 83 symptoms (13 symptom groups), two classes were apparent: symptoms chiefly relating to cancers of the same body system (e.g. certain respiratory symptoms mostly relating to respiratory cancers); and symptoms with a diverse cancer site case-mix (e.g. fatigue). The cancer site case-mix of certain symptoms varied by sex.ConclusionWe detailed associations between presenting symptoms and cancer sites in a large, representative population-based sample of cancer patients. The findings can guide choice of symptoms for inclusion in awareness campaigns, and diagnostic investigation strategies post-presentation when cancer is suspected. They can inform the updating of clinical practice recommendations for specialist referral encompassing a broader range of cancer sites per symptom.

Herbal medicine Eunkyo-san (Yinqiao-san) for COVID-19: A telemedicine case series

Coronavirus disease 2019 (COVID-19) cases surged across South Korea during the omicron-variant wave. We aimed to report the effectiveness of herbal medicine administered through telemedicine consultations as an adjunctive therapy for COVID-19. Patients with confirmed COVID-19 who were self-isolating at home were provided telephone consultations through a Korean Medicine clinic between January and March 2022. On the basis of their dominant symptoms, the patients were prescribed Eunkyo-san for seven days. Patients were asked to evaluate the severity of their COVID-19 symptoms before and after treatment by numeric rating scale. Of ten patients, more than half of them reported cough, fever, headache, and sore throat on the first telephone consultation. Patients reported that all symptoms related to COVID-19 disappeared completely on the second consultation. No severe adverse events were identified. The results of this case series suggest that Eunkyo-san administration can be a beneficial adjunctive therapy for patients with COVID-19.

Pill Esophagitis: Clinical and Endoscopic Profile

Abstract Background Medications can rarely cause esophageal injury and present with acute symptoms. Multiple factors, including the type of medication, comorbidity, and method of ingestion play a role in causing drug-induced or pill esophagitis (PE). We analyzed the clinical, endoscopic, and histopathological profiles of PE cases at our gastroenterology outpatient clinic. Methods Medical records of PE cases were reviewed retrospectively over a period of 5 years at a tertiary care hospital in India from May 2017 to May 2022. The data were collected and analyzed using descriptive statistical analysis. Results A total of 30 patients diagnosed with PE were involved in the study. A slight male preponderance of 56.7% was noted with a mean age of 40.7 years. Odynophagia was the dominant symptom (70%) with a mean duration of symptoms of 5.63 days. The most common location was at the mid-esophagus (80%) followed by the lower esophagus (10%). The majority (56.7%; 17/30) had over-the-counter (OTC) drug consumption, followed by doxycycline (33.3%; 10/30). Kissing ulcers were seen in 30% of the subjects; 90% of the patients received a combination of proton pump inhibitors and sucralfate suspension for 2 weeks along with discontinuation of the causative drug, with a 96.7% resolution rate. Conclusion OTC medication and antibiotics such as doxycycline are the leading cause of PE. Prompt recognition and discontinuation of the causative drug are crucial in preventing complications. Patient education is vital in preventing PE regarding the usage of OTC medicines in developing countries.

Efficacy of Regular Prophylaxis with a Plasma-Derived Von Willebrand Factor/Factor VIII Concentrate in Reducing Heavy Menstrual Bleeding in Females with Von Willebrand Disease

Background: Heavy menstrual bleeding (HMB) is the dominant symptom affecting ~80-90% of women with VWD and is a common cause of outpatient visits and hospitalizations. Long-term prophylaxis with a von Willebrand factor (VWF) concentrate is recommended in von Willebrand disease (VWD) patients with a history of severe, frequent bleeds, and for women with VWD who experience HMB. A recent prospective study found that recombinant VWF was not superior to tranexamic acid at reducing HMB in women with VWD. The WIL-31 study demonstrated the efficacy of prophylaxis with a plasma-derived VWF/factor VIII (pdVWF/FVIII) concentrate containing VWF and FVIII in a 1:1 activity ratio (wilate ®) in adults and children with VWD of all types. The primary endpoint was met, showing a decrease of 84% in the mean total annualized bleeding rate (ABR) compared with prior on-demand treatment. The impact of pdVWF/FVIII prophylaxis on HMB was evaluated as a secondary endpoint of the WIL-31 study. Aims: To investigate the efficacy of regular prophylaxis with a pdVWF/FVIII concentrate in reducing the incidence of HMB in females with VWD who had previously been treated on demand. Methods: WIL-31 (NCT04052698) was a prospective, non-controlled, international, multicenter phase 3 trial that enrolled male/female patients, aged ≥6 years old with VWD type 1 (VWF:RCo &amp;lt;30 IU/dL), type 2 (except 2N) or type 3. Prior to entering the WIL-31 study, all patients had received on-demand treatment with a VWF-containing product during a 6-month, prospective, observational, run-in study (WIL-29). Patients in WIL-31 received regular pdVWF/FVIII prophylaxis 2-3 times per week at a dose of 20-40 IU/kg for 12 months. Exploratory analyses included comparison of heavy menstrual ABR (HMABR). HMB was defined as any menstrual bleed that impeded the ability to perform daily activities (such as work, housework, exercise, or social activities) during menstrual periods. Criteria for HMB included changing pads more frequently than hourly, menstrual bleeding lasting 7 or more days, or the presence of clots &amp;gt;1 cm combined with a history of flooding or a Pictorial Blood Assessment Chart (PBAC) score ≥185. PBAC scores were reviewed from patient diaries at each study visit. Results: Of the 33 patients included in the overall population, 14 (42%) were female and half (n=7; 13-43 years old) were of childbearing age. In these females, all VWD types were represented: type 1 (n=2), type 2 (n=1); and type 3 (n=4). Six (86%) females were on hormonal birth control during WIL-31. Prophylaxis with pdVWF/FVIII reduced the mean HMABR by 64% compared with on-demand treatment (3.0 vs 8.3 in WIL-31 and WIL-29, respectively). During on-demand treatment, 86% (6/7) of females experienced ≥1 HMB episode, which was reduced to 29% (2/7) during prophylaxis with four patients experiencing no HMB (Figure 1). During on-demand treatment, 6 females experienced 32 HMB episodes; of these, 7 (22%) required further treatment with pdVWF/FVIII and 2 (6%) required concomitant medication. Under prophylaxis, two patients (aged ≥17 years), experienced 12 HMBEs; of these, only one (8%) impeded daily activity and none required additional pdVWF/FVIII treatment, hospitalization, or concomitant medication. Mean (SD) intra-individual median PBAC scores (N=4) decreased by 43% from 227 (91.7) during on-demand treatment to 131 (59.9) with prophylaxis, a 96-point reduction. Conclusion: Prophylaxis with pdVWF/FVIII was efficacious in reducing HMB compared with on-demand treatment in 7 female patients with VWD. None of the cases of HMB during prophylaxis was severe enough to require additional treatment. Among women with VWD, HMB remains a major burden and further research is required.

Identifikasi Gejala Dan Faktor Risiko Kejadian Penyakit Mirip African Swine Fever Di Kota Kupang

Pigs as livestock are playing role as providers and contributors of animal protein sources other than poultry and cattle. African swine fever (ASF) is a double-stranded DNA virus, in the family Asfarviridae and genus Asfivirus. ASF is an infectious disease in pigs with a mortality rate of 100%. The purpose of this study was to identify symptoms and risk factors that were similar to African swine fever (ASF) in Kupang City and to examine the dominant clinical symptoms of African swine fever (ASF)-like disease in Kupang City. Data were obtained from filling out questionnaires by 250 respondents as pig farmers. Primary data were processed and analyzed using SPSS and then presented in the form of graphs and tables. The results showed that ASF-like disease had general and specific clinical symptoms. However, the incidence of abortion in pregnant sows is rarely found, this is based on the number of farmers whose sows experienced abortions as much as 41.6%. Risk factors that can cause ASF-like diseases in Kupang City, namely the lack of public knowledge about livestock systems and management, poor application of biosecurity, feeding contaminated with ASF virus (swill feeding), frequent cross-breeding of livestock. In addition, there also risk factors for ASF-like diseases originating from human activities (anthropogenic) such as visiting.

Sequential activation of DNA viruses by the RNA virus SARS-CoV-2 in patients with long COVID syndrome

Abstract Background Reactivation of Epstein-Barr virus (EBV) has been suggested to play role in long lasting multiorgan symptoms several months after the initial COVID-19 illness. Purpose The aim of our prospective study was to 1) to evaluate the reactivation of DNA viruses of EBV, Cytomegalovirus, Herpes simplex, Varicella zoster and Parvovirus-B19 by SARS-CoV-2 in patients with the diagnosis of long-COVID syndrome, 2) to investigate the effect of supposed virus reactivation on clinical conditions and long COVID syndromes. Methods Patients with long COVID syndrome were prospectively included into the Vienna PostCoV Registry between March 15th 2021 and September 30th 2021. - The time between COVID-19 infection and first clinical visit was 219±98 days (7±3 months). Clinical symptoms were documented and patients were divided into symptoms-oriented subgroups with dominantly respiratory, cardiovascular or neuropsychologic complaints. Qualitative and quantitative viral IgG and IgM titer of the selected DNA viruses of n=105 patients were compared with age and sex-matched healthy (non-infected, non-vaccinated, n=105) controls, who had neither spike- nor nucleocapsid antibodies, nor clinical history of COVID-19 disease. Results Long Covid patients had significantly higher cumulative number of IgM positivity of the DNA viruses (18.1% vs 6.7%, p=0.02), and significantly elevated quantitative EBV IgG (420±296 vs 339±282 mg/dL, p=0.033) and Parvo-B19 IgM (0.28±0.29 vs 0.03±0.12 mg/dL, p&amp;lt;0.001) titer as compared to healthy controls. Significantly more patients with long COVID symptoms had an EBV IgG titer above the detection limit as compared with healthy controls (40% vs 28%, p=0.018), suggesting EBV virus reactivation and chronic EBV infection. EBV IgG titer was significantly higher in patients with dominant respiratory symptoms, while elevated Parvo-B19 IgM titer was observed in patients with dominant cardiovascular complaints. In patients with long-COVID syndrome the quantitative EBV IgG titer increased with the time between infection and blood sampling (logarithmic correlation, p=0.011), suggesting the subclinical continuous EBV activation by the SARS-CoV2 RNA virus, while the quantitative Parvo-B19 IgM titer decreased linearly during the observation period. Conclusions In this study of patients with long-COVID syndrome, SARS-CoV-2 infection apparently activated certain types of DNA viruses (EBV, and Parvo-B19), as demonstrated by the significantly higher incidence of cumulative IgM positivity, and elevated EBV IgG and parvovirus-B19 IgM titers, in long-COVID patients compared to healthy controls.