Duration Of Prodromal Symptoms Research Articles

Acute Pelvic and Hip Apophyseal Avulsion Fractures in Adolescents: A Summary of 719 Cases.

Apophyseal avulsion fractures of the pelvis and hip are common injuries in adolescent athletes. However, high volume comparative studies elucidating the spectrum of injuries are largely absent from the literature. The current study provides a comprehensive analysis of demographic, anatomic, pathophysiological, clinical, and athletic-related variables associated with such injuries in an extensive population of affected adolescents. A retrospective review was performed of records of patients presenting to a single tertiary care pediatric hospital between January 1, 2005, and July 31, 2020, collecting variables including patient sex, age, body mass index, fracture location, injury mechanism, sport at the time of injury, and duration of prodromal symptoms. Seven hundred nineteen fractures were identified in 709 patients. The average patient age was 14.6, and 78% of the fractures occurred in male patients. The anterior inferior iliac spine (33.4%), anterior superior iliac spine (30.5%), and ischial tuberosity (19.4%) were the most common fracture sites. The most common injury mechanisms were running (27.8%), kicking (26.7%), and falls (8.8%). The most common sports at the time of injury were soccer (38.1%), football (11.2%), and baseball (10.5%). Fracture site was significantly associated with patient sex, age, body mass index, laterality, mechanism, sport, time from injury, and presence of prodromal symptoms. The annual volume of pelvic avulsion fractures treated at the institution increased significantly from n=17 in 2005 to n=75 in 2019. Adolescent pelvic and hip avulsion fractures occur during a narrow window of age and skeletal maturation and are frequently sustained during sporting activities. Each fracture location is associated with certain demographic, mechanistic, and patient-specific characteristics. The associations between fracture site and patient-specific or injury-specific variables offer insights into the pathophysiology and possible underlying biomechanical risk factors that contribute to these injuries. This is a level III retrospective study.

Prodromal symptoms, health care seeking in response to symptoms and associated factors in eclamptic patients

BackgroundEclampsia is one of the leading causes of maternal death worldwide. Maternal catastrophe is made worse in developing countries by the high incidence coupled with delayed presentation of patients and health facility constraints in effective management of eclampsia and its complications.MethodsA prospective study of all 93 eclamptic women admitted to a general hospital in Somali regional state, Ethiopia was conducted between May 1, 2014 and April 30, 2015 using a structured questionnaire which included socio-demographic data, antenatal visit status, distance of nearest maternal health facility, timing of convulsions, questions related to symptoms preceding seizures; health care seeking for the symptoms and time interval from prodromal symptoms to the diagnosis of eclampsia. Descriptive statistics and multivariable logistic regression analyses were conducted. Statistical tests were done at a level of significance of P < 0.05.ResultsThere were 93 cases of eclampsia among 3500 deliveries with an incidence of 2.7%. The timing of Eclampsia was antepartum in 57 (61.3%); intrapartum in 26 (28.0%) and postpartum in 10 (10.7%). Most (63%) were not having any antenatal care (ANC) follow up. Precedent symptoms were reported in 73 (79.0%) of the mothers with severe head ache in 70 (75.0%); visual disturbance in 44 (47%) and epigastric pain in 17 (18.0%). The frequency of symptoms was not influenced by the timing of eclampsia and degree of hypertension and prodromal symptoms were reported in 80% of the patients with severe hypertension. The mean duration of prodromal symptoms before patients were diagnosed with eclampsia was 5.5 days. Only 19/73 (26.0%) of the patients with prodromal symptoms visited a health facility for their complaints prior to developing eclampsia. The diagnosis of hypertensive disorder of pregnancy was made in 8 (42.0%) of these patients. Independent predictors of failure to seek health care in response to preceding symptoms were: rural residence (p-value < 0.001) and distance of maternal health facility of > 5km (p-value < 0.01).ConclusionsPrecedent symptoms were reported in most women. But many patients present late in response to these warning signs of eclampsia. Improving awareness of prodromal symptoms of eclampsia and timely health care seeking; providing ANC advises on danger signs of eclampsia in the socio-cultural context of the community; ensuring access to ANC services for rural mothers, and administration of anticonvulsants for all women with prodromal symptoms are recommended.

Social Functioning Deficits in Young People at Risk for Schizophrenia

Impairment in social functioning is a central feature of schizophrenia and is known to be evident before the onset of psychosis, acting as a potential vulnerability marker. The aim of the present study was to test the hypothesis that social impairment is simultaneously a state and trait marker of risk for schizophrenia and schizophrenia-related disorder. Social functioning was examined in three groups: ultra-high-risk subjects (UHR, n =32), genetic high-risk subjects (GHR, n =32), and age- and IQ-matched healthy controls (HC, n =30). Social functioning was assessed using the Social Functioning Scale (SFS), and prodromal symptoms were assessed in high-risk subjects using the Comprehensive Assessment of At-Risk Mental States (CAARMS). Both the UHR and GHR groups exhibited significantly impaired social functioning compared with the HC group, and the UHR group was more impaired than the GHR group. In the UHR group, duration of prodromal symptoms was related to impaired 'interpersonal behaviour'. Positive and negative symptoms were not significantly associated with social functioning, whereas disorganized and general symptoms were significantly correlated with poor 'independence-competence' in UHR individuals. The findings support the hypothesis that impairment in social functioning is both a trait and state marker of risk for schizophrenia and other psychotic disorders, implying that social impairment constitutes a mediating vulnerability indicator of psychotic disorders including schizophrenia.

Current treatment of recurrent vasovagal syncope: between evidence-based therapy and common sense

Vasovagal syncope is very frequent and benign and the vast majority of subjects do not need any specific treatment, but only reassurance and education. An unknown but small percentage of patients require specific treatment when syncope is very frequent or is responsible for major trauma. For these patients, there are some evidence-based therapies available and some first-line treatments appear to be established. The therapeutic choice mainly depends on the presence and duration of prodromal symptoms. In subjects aged < 70 years with well recognizable prodromes, the first-line treatment is counterpressure manoeuvres. In patients with no or minimal prodromes, but with tilt testing and carotid sinus massage (CSM) both positive, cardiac pacing appear to be the first-line therapy. However, an area of uncertainty remains, represented by patients with no or minimal prodromes and negative CSM. For these patients, appropriate treatment (drugs, tilt training, cardiac pacing, relaxation-based treatment) can be chosen by considering the clinical context, the risk of trauma and possible comorbidities, in addition to utilizing the little or controversial knowledge available, as well as common sense.

Duration of untreated psychosis vs. N-acetylaspartate and choline in first episode schizophrenia: a 1H magnetic resonance spectroscopy study at 4.0 Tesla

N-acetylaspartate (NAA) has been associated with neuronal integrity and function, and choline-containing compounds have been linked to neuronal membrane integrity. This study examined the influence of the duration of untreated psychosis, duration of prodromal symptoms and total length of untreated illness on these markers of neuronal loss or damage. In vivo 1H magnetic resonance spectroscopy data were acquired from 1.5-cc volumes in the left anterior cingulate and left thalamus of 19 never-treated first episode schizophrenic subjects using STEAM20 at 4.0 Tesla. Duration of untreated psychosis, prodrome and total length of untreated illness were correlated with levels of NAA and choline. No significant correlation was observed between NAA and duration of untreated psychosis and untreated illness in both regions examined. Thalamic NAA negatively correlated with duration of prodromal symptoms. A positive correlation between choline and duration of untreated psychosis was identified in both regions studied. Delays in treatment of psychotic symptoms of schizophrenia were not associated with a reduction in markers of neuronal integrity or function in contrast to longer prodromal periods, which were associated with lower NAA. Neuronal damage, potentially detectable via lower NAA, may be occurring before the onset of psychosis. Increased choline is associated with longer duration of untreated psychosis and could indicate that psychosis-related membrane alterations precede the appearance of NAA reductions observed by studies of chronic schizophrenia.

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain.

To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long DUP was associated with insidious onset, poor global functioning, and laboral incapability. Among the Finnish patients exclusively, long DUP correlated with a weak earlier social network, instability of professional identity, long duration of prodromal symptoms, psychological dependency on the family, and criticism by the parents of the patient. Among the Spanish patients only, longer DUP was associated with more severe positive symptoms at admission. There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.

Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group

Intervention in the prodromal phase of schizophrenia and related psychoses may result in attenuation, delay or even prevention of the onset of psychosis in some individuals. However, a “prodrome” is difficult to recognise prospectively because of its nonspecific symptoms. This study set out to recruit and follow up subjects at high risk of transition to psychosis with the aim of examining the predictive power for psychosis onset of certain mental state and illness variables. Symptomatic individuals with either a family history of psychotic disorder, schizotypal personality disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were assessed and followed up monthly for 12 months or until psychosis onset. Twenty of 49 subjects (40.8%) developed a psychotic disorder within 12 months. Some highly significant predictors of psychosis were found: long duration of prodromal symptoms, poor functioning at intake, low-grade psychotic symptoms, depression and disorganization. Combining some predictive variables yielded a strategy for psychosis prediction with good sensitivity (86%), specificity (91%) positive predictive value (80%) and negative predictive value (94%) within 6 months. This study illustrates that it is possible to recruit and follow up individuals at ultra high risk of developing psychosis within a relatively brief follow-up period. Despite low numbers some highly significant predictors of psychosis were found. The findings support the development of more specific preventive strategies targeting the prodromal phase for some individuals at ultra high risk of schizophrenia.

The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope

The present study was undertaken to identify and quantitate the symptoms associated with neurocardiogenic syncope, syncope due to ventricular tachycardia, and syncope resulting from atrioventricular block. Eighty patients referred for evaluation of syncope in whom a diagnosis of neurocardiogenic syncope, atrioventricular block, or ventricular tachycardia was established were studied. Each patient was interviewed using a standard questionnaire. The clinical histories were then compared to identify which variables best differentiated the cause of syncope. The clinical histories of patients with syncope due to ventricular tachycardia and atrioventricular block were similar. Only age, the duration of prodromal symptoms, diaphoresis prior to syncope, and fatigue following syncope differed. In contrast, the clinical history in patients with neurocardiogenic syncope differed greatly from that obtained in patients with syncope due to atrioventricular block or ventricular tachycardia. Features of the clinical history that were predictive of syncope due to atrioventricular block or ventricular tachycardia were male sex, age > 54 years, < or = 2 episodes of syncope, and a duration of warning of < or = 5 seconds. Features of the clinical history predictive of syncope not due to ventricular tachycardia or atrioventricular block were palpitations, blurred vision, nausea, warmth, diaphoresis, or lightheadedness prior to syncope, and nausea, warmth, diaphoresis, or fatigue following syncope. The results of this study identify and compare the features of the clinical history obtained in patients with syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope and demonstrate that the clinical history is of value in distinguishing patients with these three causes of syncope.

Increased Incidence of Anti-glomerular Basement Membrane Antibody (anti-GBM) Nephritis in the Mersey Region, September 1984–October 1985

We report an increase in the incidence of anti-glomerular basement membrane antibody nephritis in the Mersey Region over the 13 months from September 1984 to October 1985. During this period anti-glomerular basement membrane antibody nephritis was diagnosed in 10 patients: seven cases occurred between 1 June and 31 October 1985. We could identify no common infective agent or history of toxic exposure. Although outbreaks of parvovirus infection were reported in the region during this period, no patient had serological evidence of recent infection with parvo- or other virus. The only atypical feature was the high incidence of allergic rash which was seen in four of six patients treated with antibiotics before admission. Only two patients recovered sufficient renal function to make dialysis unnecessary. Both had a longer duration of prodromal symptoms, lower levels of circulating anti-glomerular basement membrane antibody antibodies and histological evidence of less aggressive disease.

Clinical variations in bullous pemphigoid with respect to early symptoms

We report the clinical variations and the duration of prodromal symptoms in 20 patients with bullous pemphigoid. Nearly two-thirds of the patients had prodromal symptoms. THe duration of the prodromal eruptions was up to 6 weeks if papular and/or urticarial and up to 2 years if eczematous, before the blisters appeared. Evidently longer prodromal periods were found in the present study than in earlier investigations. It is not known when in the course of the disease the direct immunofluorescence will be positive. Two of our patients were immunofluorescence-positive 1 and 2 weeks respectively before the blisters appeared. A common clinical manifestation in this study was vesicles on palms and/or soles. These eruptions, particularly as an early symptom, may cause misinterpretation in patients with bullous pemphigoid.