First Day Of Onset Research Articles

NEONATAL SEIZURES: ETIOLOGY, TREATMENT AND PROGNOSIS

Introduction: Seizures are one of the most common pathologies in newborns. Their incidence is 1.5–3.5/1000 for term infants and 10–130/1000 for preterms. The most common causes of seizures in term infants are hypoxic-ischemic encephalopathy (HIE), cerebrovascular insult (CVI), cerebral malformations (CM), and metabolic disorders. For preterm infants: intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and infections. Clinical characteristics are diverse and subtle, and subclinical forms are common. The drug of the first choice is phenobarbitone. Newborns with seizures are more prone to developing neurological disturbances such as epilepsy and cerebral palsy.
 Methods: This is a clinical, observational research, one-year, retrospective, cross-sectional study conducted in the Department of neonatal intensive care and neonatology of the Clinic of Pediatrics KCUS. The study included 43 newborns who met the inclusion criteria.
 Results: We found that 7.19% of hospitalized newborns had seizures. A number of seizures were recorded in the group of term infants with an earlier time of seizures. The most common etiological causes were: HIE, IVH, infections, and CM. There was a frequent occurrence of metabolic disorders such as acidosis, blood sugar, and mineral (Ca, K, Na, and Mg) disorders. The median of the first day of onset of seizures in full-term infants is on the fourth day, while in premature infants it is on the sixth day of life. Phenobarbitone was mainly used to stop seizures, with great success. Overall mortality in children with seizures was 37.21%.
 Conclusions: Seizures are common in newborns, which, depending on the etiological cause, increase mortality, especially in preterm infants. Seizures in term infants occur earlier than in premature infants. The most common etiology of seizures in term infants are infections, hypoxemic-ischemic encephalopathy, intracranial hemorrhage, cerebral malformations, and cerebrovascular insult. In premature infants these are hypoxemic-ischemic encephalopathy, intracranial bleeding, and infections. In the initial treatment of neonatal convulsions, phenobarbitone is most often used, which has proven to be successful in the majority of cases.

Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease?

Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.

SQ house dust mite sublingual immunotherapy tablet subgroup efficacy and local application site reaction duration

BackgroundAllergic rhinitis with or without conjunctivitis (AR/C) is common, necessitating evaluation of SQ house dust mite (HDM) sublingual immunotherapy (SLIT)-tablet efficacy in various subgroups. ObjectiveTo evaluate 12 SQ-HDM efficacy and safety across subgroups, and the onset, duration, and recurrence of local application site reactions. MethodsSubgroup (age, sex, race, asthma status, and allergen sensitization) efficacy was assessed using pooled data from 2 previously described trials of daily 12 SQ-HDM vs placebo for AR/C (n = 2,138). Efficacy was measured by average total combined rhinitis score (TCRS; rhinitis daily symptom plus medication score) during the last 8 weeks of treatment. Safety in subgroups and local application site reaction onset, duration, and recurrence were evaluated using pooled data from 5 previously described trials of SQ HDM SLIT-tablet (n = 2,923). ResultsSignificant (based on 95% confidence intervals [CIs]) reduction in TCRS was seen with 12 SQ-HDM relative to placebo across all subgroups, with TCRS improvements ranging from 15% to 25%. The AE profile was generally similar within subgroups. Approximately 95% of local application site reactions were mild to moderate in severity. Median duration on day 1 of treatment for the most common local application site reactions (throat irritation, oral pruritus, ear pruritus, and lip swelling) ranged from 30 to 60 minutes; median first day of onset ranged from days 1 to 4 of treatment; median days that reactions recurred ranged from 3 to 12 days. ConclusionTreatment with 12 SQ-HDM consistently improved symptoms and was well tolerated in relevant subgroups of subjects with HDM AR/C. Local application site reactions to 12 SQ-HDM were typically mild to moderate and transient.

Perfusion-CT--Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

PurposeSevere acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis.Material and Methods79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4–6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared.ResultsStatistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests.ConclusionsCT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of developing pancreatic and/or peripancreatic necrosis already on the first day of the onset of symptoms and can be used for treatment planning and monitoring of therapy of acute pancreatitis. Early suspicion of possible pancreatic necrosis both on the basis of scores based on clinical status and laboratory tests have low predictive value.

The methods of evaluation of aggregative activity of blood corpuscles in norm and in patients with ischemic stroke.

The article presents comparative evaluation of aggregative activity of blood corpuscles in norm and in patients with ischemic stroke derived using flow cytofluorometry and light microscopy. It is noted that in patients with stroke in peripheral blood absolute content of leukocyte thrombocyte and erythrocyte thrombocyte aggregates is drastically increased as compared with healthy examined persons. Besides, more the number of aggregates is formed during the first day of onset of disease more the severe cerebral stroke progresses.

Clinical profile of patients with peritonitis due to hollow viscous perforation

Background: Peritonitis due to hollow viscous perforation has been documented by many historians. .Previously the disease was inevitably fatal due to lack of knowledge of surgical procedures, lack of availability of good quality post-operative care. Methods: After obtaining detailed history, complete general physical examination and systemic examination, the 52 patients will be subjected to relevant investigations. The complete data is collected in a specially designed case recording form. The data collected will be transferred into a master chart which is then subjected for statistical analysis. Results: 52 patients with diagnosis of secondary peritonitis were included. The mean age of patients was 45.72 (SD 14.26) years ranging from 15 to 75 and majority of patients (44%) belonged to age group of 46-60 years. There was male preponderance (70%). Conclusions: majority of patients presented to the hospital after 24 hrs of onset of symptoms and the mortality of those patients who presented within 2 to 5 days and after 5days was higher than as compared to mortality in patients who presented on the first day of onset of symptoms.

Platelet parameters and (1, 3)-β-D-glucan as a diagnostic and prognostic marker of invasive fungal disease in preterm infants.

The diagnosis of neonatal invasive fungal disease (IFD) is difficult and often delayed. The platelet parameters and (1, 3)-β-D-Glucan (BG) may be useful for diagnosing IFD, but their diagnostic performance are not well characterized in neonates. We studied 63 preterm infants with IFD, 160 preterm infants without sepsis (preterm control), and 41 preterm infants with bacterial sepsis. Platelet parameters at the first day of onset of IFD and at the fourteenth day after antifungal treatment were evaluated. Serum BG was measured. Platelet count (PC), plateletcrit (PCT), and platelet distribution width (PDW) values were significantly lower, and mean platelet volume (MPV) values significantly higher in the IFD versus preterm control infants. PC and PCT values were much lower in infants with IFD versus bacterial sepsis, and there were significant differences in BG value between the two groups. After 14 days of antifungal treatment, significant elevations in PC, PCT, PDW and reductions in MPV levels in IFD group were observed. Receiver operating characteristic (ROC) curves showed that PC and PCT were strong predictors of IFD. The PC and PCT cut-offs for predicting IFD were 119.5 (sensitivity 78%, specificity 95%) and 0.21 (sensitivity 83%, specificity 85%), respectively. There were significant differences in PC and PCT levels between deceased and survived patients. The PC and PCT cut-offs for predicting deceased IFD were 39 (sensitivity 62%, specificity 86%) and 0.04 (sensitivity 50%, specificity 95%), respectively. The sensitivity in diagnosing IFD by a BG cutoff of ≥10pg/ml was 68.3% and specificity was 75.6%. PC and PCT levels in the BG ≥400 pg/ml group were significantly lower compared to the BG<400 pg/ml group. Platelet parameters and BG could be useful biomarkers for the diagnosis and prognosis of neonatal IFD.

Comparison of early and late thrombolysis in patients with acute pulmonary embolism

Purpose: To compare the efficacy of thrombolytic therapy (TLT) in high risk patients with acute pulmonary embolism (APE) in the first day of onset of the disease and in patients with late hospitalization (3-10 days) Materials and methods: Retrospectively were processed 56 patients with a diagnosis of high risk APE (30 men, 26 women, age 60,43±3,03 years). Patients were divided into 2 groups: Group 1 includes 30 patients who were hospitalized for 1 day from an episode of APE. Group 2 includes 26 patients with APE from 3 to 10 day before hospitalization. Each group did not differ by sex, age, body weight, comorbidities. Patients of both groups after the diagnosis of high risk APE got TLT with Alteplaseof 100 mg (10 mg i/v bolus for 1 - 2 minutes, 90 mg i/v infusion over 2 hours). All patients received similar anticoagulant therapy. Patients of both groups were examined three times: before TLT (D 0), after infusion of Alteplase during 1st day (D 1) and at discharge (15±1,3 day, D 15). Results: In both groups increased SaO2, systolic blood pressure (SBP), and decreased pulmonary pressure (PP), right ventricular (RV) size and inferior vena cava (IVC) on D1 and D15 compared to D0 (all p<0,05). SaO2, RV, IVC, PP decreased significantly in Group 1 compared to patients in Group 2 on D1, this tendency continued to D15. All results see in the Table. View this table: Conclusion: The effectiveness of thrombolysis in patients of Group 1 was significantly better than in group 2. In the absence of clear criteria for the effectiveness of TLT in patients with high risk APE, the positive dynamics of RV function (size of RV, IVC, PP) and SaO2, remain simple and reliable criteria for evaluation of TLT in patients without invasive methods of treatment.

Flavonoids of puerarin versus tanshinone ⅡA for ischemic stroke: a randomized controlled trial

Flavonoids are widely used today in the treatment of ischemic stroke. The therapeutic effects and functions of flavonoids are, therefore, generating more and more interest. To investigate the therapeutic effects and functions of flavonoids of puerarin in treating patients with ischemic stroke. A total of 67 inpatients suffering from ischemic stroke from the Department of Neurology, Changhai Hospital in China were divided into two groups randomly, the treatment group, which was treated with flavonoids of puerarin, and the control group, administered with tanshinone II A sulfate instead. Defects in neurological function were evaluated according to the National Institutes of Health Stroke Scale (NIHSS) on the first day of onset. Lactate dehydrogenase (LDH), serum interleukin-6 (IL-6) and brain-derived neurotrophic factor (BDNF) levels were determined by radioimmunoassay on the second trial day. After a 14-day treatment, LDH, serum IL-6 and BDNF levels and NIHSS score were also detected, and CT perfusion imaging was used to measure and analyze the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV) and mean transit time (MTT). On the first day, NIHSS scores of the two groups were similar. On the second day there was no significant difference in LDH and IL-6 levels between the treatment group and the control group. After a 14-day treatment, LDH and IL-6 levels and the NIHSS score in the treatment group were lower than those in the control group (P<0.05). There was no significant difference in BDNF levels in the two groups. After 14 d, the CT perfusion imaging demonstrated that the treatment group showed more effective blood perfusion than the control group. Flavonoids of puerarin can restrain the increase of IL-6 after acute ischemic stroke, and depress the LDH raised by reperfusion after cerebral ischemia. It can also enhance blood perfusion of the ischemic region.

Clinical spectrum of acute otitis media complicating upper respiratory tract viral infection.

acute otitis media (AOM) often occurs as a complication of upper respiratory tract infection (URI). to describe otoscopic findings during URI, the full clinical spectrum of AOM, and outcome of cases managed with watchful waiting. : In a prospective study of 294 healthy children (6 months-3 years), characteristics of AOM complicating URI were studied. Otoscopic findings were categorized by tympanic membrane (TM) position, color, translucency, and mobility. Otoscopic score was assigned based on McCormick otoscopy scale (OS)-8 scale. during days 1 to 7 of URI, otoscopic findings at 1114 visits were consistent with AOM in 22%; myringitis (inflamed TM, no fluid) was diagnosed in 7%. In AOM episodes diagnosed within 28 days of URI onset, TM position was described as: nonbulging (19%), mild bulging (45%), bulging (29%), and TM perforation occurred in (6%). OS-8 scale showed mild TM inflammation (OS, 2-3) in 6%, moderate (OS, 4-5) in 59%, and severe (OS, 6-8) in 35%. In 54% of 126 bilateral AOM episodes, inflammation of both TMs was at different stages. Of 28 cases of nonsevere AOM managed with watchful waiting, 4 progressed and 3 later required an antibiotic. AOM is a spectrum of infection that may present at various stages, even in the same child with bilateral disease. During URI, otoscopic changes are observed from the first day of onset. Understanding the wide clinical spectrum of AOM is needed to help with future clinical trial design and development of a scoring system to establish treatment criteria that will minimize antibiotic use.

The surgical treatment of acute spinal paralysed patients

Following the basic principles of Sir Ludwig Guttmann in respect of the comprehensive care and management of spinal cord injured patients, the German SCI centers try to admit those freshly injured preferably on the first day of onset, providing spinal surgery and intensive care. In our series of recent comprehensive spinal paralysed patients admitted from Jan 1st 1993 to Dec 31st 1995 178 patients requested operative decompression and stabilization out of a total of 255 patients. 51.4% of the patients had been operated within the first 24 h, but 10.5% later than 2 weeks. A high incidence of reoperations (45.2%) must be noted in cases operated prior to the admittance to the SCI center due to failures of instrumentation or lack of anterior reconstruction. Nineteen patients with various spinal tumors underwent surgical treatment, and seven patients with spondylitis and severe neurological deficit. Only 64.4% of the 1st day admissions came in time for administration of high dose methylprednisolone according to the NASCIS II study. The additional pelvic and long bone fractures were operated on following the principles of the Swiss AO, thus achieving immediate mobilization as was also possible after surgical spine stabilization. Neurological recovery could only be found in those with incomplete lesions in more than 50% but also two with neurological deterioration had to be accepted in the paraplegic cohort. Eight who were tetraplegic and 14 with paraplegia died within the first 3 months, but nine with paraplegia had a tumor or spondylitis.

Prevention and treatment of relapsing autoimmune encephalomyelitis with myelin peptide-coupled splenocytes.

Injection of antigen cross-linked accessory cells has proven to be an efficient and highly selective approach for inducing epitope-specific peripheral tolerance. This approach has been used successfully to inhibit induction of experimental autoimmune encephalomyelitis (EAE) and to dissect the relative dominance of component encephalitogenic determinants that contribute to both acute and relapsing EAE. In this study, we evaluated the tolerogenic effect of the dominant encephalitogenic epitope for SJL/J mice, residues 139-151 of myelin proteolipid protein (PLP), on the induction and relapses of EAE induced actively with PLP139-151/CFA. Our results demonstrate the powerful protective effect of treating mice before induction of EASE with PLP139-151-conjugated splenocytes (SPL) on the incidence and severity of both the initial episode and the first relapse of EAE. Moreover, treatment of mice on the first day of onset of clinical signs of EAE reduced the severity of the first relapse, apparently by reducing T cell recognition of PLP139-151, although no significant therapeutic effect was observed during the initial treated clinical episode. These data demonstrate the utility of using neuroantigen-coupled accessory cells to prevent and treat relapsing EAE.