Moderate Fever Research Articles

An assessment of a pediatric early warning system score in severe hand-foot-and-mouth disease children: To detect clinical deterioration in hospitalized children.

Identification of deteriorating severe hand, foot, and mouth disease (HFMD) children for referral to intensive care remains problematic.The medical records of 2382 hospitalized children with severe HFMD from May 2013 to September 2015 were retrospectively reviewed. A Pediatric Early Warning System (PEWS) score was designed based on study parameters on admission, evaluated in a logistic regression model, and subsequently validated with different cut-off scores, to predict the risk for clinical deterioration.After admission, 191 cases were transferred to the pediatric intensive care unit (PICU) and 2191 were admitted to the infectious disease department. Of which, 116 cases were subsequently transferred to PICU, with younger age, consciousness levels of sluggishness, lethargy or drowsiness, rashes with vesicles on the hands or feet, moderate or high fever, increased or disordered lung marking or pulmonary infiltration, abnormal heart rate, fasting plasma glucose, blood platelet, and C-reactive protein. A corresponding 10-component PEWS score >7 was significantly associated with subsequent transfer to PICU.A 10-component PEWS score >7 has good specificity but poor sensitivity for identifying severe HFMD children vulnerable to clinical deterioration.

Human brucellosis in Rio Grande do Norte, Brazil

Background: Brucellosis or Malta fever is a zoonotic disease caused by intracellular cocobacilli gram negative aerobic of the genus Brucella. Although it being transmitted to humans since 1859, the correct diagnosis and treatment are challenging. Brucellosis is prevalent in males, farmers and laboratories professionals. The human Brucellosis is most commonly transmitted by the consumption of raw dairy products, aerosol inhalation or direct contact with infected animal. Methods: Data were obtained through medical records review, physical examination findings and laboratory results. Case: A 64-year-old male farmer presented to the infectious disease department with a 30-day history of moderate fever, asthenia and appetite loss. Previously diagnosed with rheumatoid arthritis, he was in chronic use of prednisone (10 mg/day). In addition, he was using glibenclamide and losartan for diabetes mellitus and hypertension, respectively. Posterior to hospital admission, he had been unsuccessfully treated with empirical intravenous antibiotics (ceftriaxone, metronidazole, gentamicin, oxacillin). After three weeks of hospitalization, the patient reported dry cough and abdominal pain in the right upper quadrant. The clinical investigation turned to the suspicion of brucellosis when the patient detailed his daily cow's milk consumption and direct contact with goats. Therefore, serology revealed the presence of high level of antibody against Brucella, being positive for the IgM fraction. He initiated treatment with rifampicin and ciprofloxacin in the following 6 weeks. As his condition improved, he was discharged and referred to an outpatient clinic, remaining asymptomatic. Results: There are few academic publications focused in brucellosis in the medical field. Considered an occupational disease, human Brucellosis remains a common disease in rural areas. Due to the lack of specific symptoms, its diagnostic requires extensive knowledge in infectious diseases and epidemiology. Conclusion: This case highlights the importance of brucellosis serology, as well as preventive programs and educational interventions. The provision of diagnostic tests in endemic regions might enhance the probability of diagnosis and facilitate the effective treatment of human brucellosis worldwide.

Comparison of oral bioavailability of acetaminophen tablets, capsules and effervescent dosage forms in healthy volunteers

Abstract A wide variety of acetaminophen dosage forms have been administered to relieve mild to moderate pain and fever, so far. The purpose of this study was to compare the oral bioavailability in healthy volunteers, of three of these dosage forms. We included healthy volunteers in our study and divided replace with placed them into three groups: tablet, capsule and effervescent. Each dosage form contained 500 mg of acetaminophen as active material. Blood samples were taken at 0.5, 1, 2, 4 and 8-hour intervals after receiving the dose. Acetaminophen blood levels were measured using HPLC method. Data were fit in a “one-compartment PK model”, using P-Pharm 1.5 software and analyzed under statistical tests. The maximum concentrations of acetaminophen in blood samples were measured at 1h after taking the drug (6.61±3.19 μg/ml, 11.29±3.94 μg/ml and 15.25±2.54 μg/ml in groups receiving capsule, tablet and effervescent, respectively). Pharmacokinetic (PK) data analysis & modeling from the three groups showed that the half-life of acetaminophen was 140.72 min in the tablet group, 140.29 min in capsule and 132.08 min in effervescent. The area under the blood levels curve were 47.04, 40.62 and 53.11 μgmin/ml, in tablet, capsule, and effervescent groups, respectively. Statistically significant differences in PK parameters were recorded as the study replace with we compared effervescent with tablets and capsule dosage forms (p < 0.05). According to the results, the effervescent form creates better PK parameters compared with tablet and capsule forms, therefore, it is suggested replace with we suggested that this form should be administer in cases of pain and fever to achieve quick drug efficacy.

PERFORATION PERITONITIS: A CASE STUDY.

Peritonitis is an emergency health condition that is life-threatening and requires urgent surgery. here we presented a case of perforation peritonitis for a 21 years old male. The patient suffered severe abdominal pain constant vomiting of what he eat, not bloody diarrhoea and he had moderate fever. Abdomen examination showed peritonitis. And the CT.abdomen examination showed a presence of peritonitis and few air pocket in rectosigmoid region and posterior to pancrease which mean that patient had peritonitis with pneumoperitoneum. The patient underwent surgery and stayed in the hospital for 7 days during which the patient\\\'s health improved and became healthy. Pavlidis, T. E. "Cellular changes in association with defense mechanisms in intra-abdominal sepsis."?Minerva chirurgica6 (2003): 777-781.‏ Meena, Laxmi Narayan, Sanchit Jain, and Prahlad Bajiya. "Gastrointestinal perforation peritonitis in India: A study of 442 cases."?Saudi Surgical Journal3 (2017): 116.‏ Ch, Biram, et al. "A Clinical Study of the Spectrum of Gastro Intestinal Perforation Peritonitis in Rural Southern East Rajasthan."?Journal of Universal Surgery2 (2017).‏ Prasad, N. Baba Guru, and KV Bhaskar Reddy. "A study of acute peritonitis: evaluation of its mortality and morbidity."?International Surgery Journal2 (2016): 663-668.‏ Bali, Rajandeep Singh, et al. "Perforation peritonitis and the developing world."?ISRN surgery2014 (2014).‏ Chakma, Sujit M., et al. "Spectrum of perforation peritonitis."?Journal of clinical and diagnostic research: JCDR11 (2013): 2518.‏ Coppolino, F. F., et al. "Gastrointestinal perforation: ultrasonographic diagnosis."?Critical ultrasound journalS1 (2013): S4.‏ Kolar, Mila, et al. "Free intestinal perforation in children with Crohn's disease systematic literature review and case report."?Journal of Pediatric Surgery Case Reports(2018).‏ Rohit, Dushyant Kumar, R. S. Verma, and Grishmraj Pandey. "Clinical study and management of peritonitis secondary to perforated peptic ulcer."?International Surgery Journal8 (2017): 2721-2726.‏ Ordonez, Carlos A., and Juan Carlos Puyana. "Management of peritonitis in the critically ill patient."?Surgical Clinics6 (2006): 1323-1349.‏ [Ameen Abdulrahman A kamal. (2018); PERFORATION PERITONITIS: A CASE STUDY. Int. J. of Adv. Res. 6 (Feb). 1527-1530] (ISSN 2320-5407). www.journalijar.com Ameen Abdulrahman A kamal

A single session of laser ablation for toxic thyroid nodules: three-year follow-up results

Purpose: To confirm the effectiveness of laser ablation on toxic nodules in a large population with three years of follow-up.Material and methods: Between 2009 and 2014, we treated 82 patients with hyperthyroidism related to the presence of a toxic nodular goitre. Patients were pre-treated pharmacologically with methimazole prior to single session of laser ablation (LA) and then followed up every 3 months with FT4 and TSH blood tests as well as ultrasound examination of the nodules treated.Results: All patients responded to the treatment. The median nodule volume decreased from 12 ml (range 5–118 ml) to 5 ml (range 1.2–40 ml) after three years (p < 0.001). The percentage of patients who discontinued methimazole therapy was reduced by increasing the initial volume of the toxic nodule. In nodules with a volume less than 5 ml, all patients were able to suspend methimazole; this percentage was reduced to 90.2% in nodules with a volume between 5 and 15 ml, 61.1% in those with volume 15–25 ml and only 28.5% in nodules larger than 25 ml. We had no major complications but only moderate pain and fever in the evening, a few hours after ablation therapy in 10% of treated patients.Conclusions: Single session of LA of toxic thyroid nodules is effective and safe, especially in nodules with a volume under 15 ml.

The concomitant use of lapatinib and paracetamol - the risk of interaction

SummaryLapatinib is a tyrosine kinase inhibitor used for the treatment of breast cancer. Paracetamol is an analgesic commonly applied to patients with mild or moderate pain and fever. Cancer patients are polymedicated, which involves high risk of drug interactions during therapy. The aim of the study was to assess the interaction between lapatinib and paracetamol in rats. The rats were divided into three groups of eight animals in each. One group received lapatinib + paracetamol (IL + PA), another group received lapatinib (IIL), whereas the last group received paracetamol (IIIPA). A single dose of lapatinib (100 mg/kg b.w.) and paracetamol (100 mg/kg b.w.) was administered orally. Plasma concentrations of lapatinib, paracetamol and its metabolites – glucuronide and sulphate, were measured with the validated HPLC-MS/MS method and HPLC-UV method, respectively. The pharmacokinetic parameters of both drugs were calculated using non-compartmental methods. The co-administration of lapatinib and paracetamol increased the area under the plasma concentration-time curve (AUC) and the maximum concentration (Cmax) of lapatinib by 239.6% (p = 0.0030) and 184% (p = 0.0011), respectively. Lapatinib decreased the paracetamol AUC0-∞ by 48.8% and Cmax by 55.7%. In the IL + PA group the Cmax of paracetamol glucuronide was reduced, whereas the Cmax of paracetamol sulphate was higher than in the IIIPA group. Paracetamol significantly affected the enhanced plasma exposure of lapatinib. Additionally, lapatinib reduced the concentrations of paracetamol. The co-administration of lapatinib decreased the paracetamol glucuronidation but increased the sulphation. The findings of this study may be of clinical relevance to patients requiring analgesic therapy.

Randomized controlled trial to test the effect of on- arrival vaccination and deworming on Stocker cattle health and growth performance

Our objective was to determine the effect of vaccination and deworming at arrival (d 0) on bovine respiratory disease (BRD) incidence, mortality, and growth of stocker calves. Calves (n=80) were stratified by d -3 weight and fecal egg count (FEC) into 20 pens of 4 calves. Pens were randomly assigned to treatments in a 2×2 factorial design, testing d 0 vaccination (modified-live respiratory virus and clostridial vaccine, or not) and deworming (oral fenbendazole and levamisole, or not). Body weights were measured on days 0, 14, 28, 42, 56, 70, and 85, and FEC were measured on days -3, 28, 56, and 85. Incidence of BRD was greater for d 0 vaccination (RR=3.2), high fever (≥104°F, ≥40°C) at d 0 (RR=6), and higher d -3 FEC (RR=1.2 per 100 epg). Mortality was greater for d 0 vaccination (OR=8.3) and high fever (OR=41.6). Growth was 10.3 lb (4.7 kg) lower for d 0 vaccination, 24 lb (11 kg) and 16 lb (7.3 kg) lower for moderate (103°F to 103.9°F; 39.4°C to 39.9°C) and high fever, respectively, and 17.6 lb (8 kg) lower for each additional BRD treatment a calf received. Deworming was neither beneficial nor detrimental to any health or performance factors. Health and growth performance of stocker calves may be adversely affected by vaccination at arrival, higher arrival FEC, and fever at arrival.

Declining Maternally-Derived Measles Antibodies in Infants and Nursing Mothers in Nigeria: A Review

Measles, also reffered to as rubeolais an endemic respiratory disease caused by a virus. It is a highly contagious infection which typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, conjunctivitis and sore throat. Today, despite the availability of a safe, effective and relatively inexpensive vaccine for more than 40 years, measles still kills more than any other vaccines preventable disease among children. In Pregnant women, IgG immunoglobulin antibody is produced and crosses the placenta to developing fetus’ blood circulation; thereby conferring primary protection against infections in the early life of newborns. The presence or absence of Maternal Measles Antibody (MMA) in infants is therefore a factor to be considered in immunization of infants against measles. In Nigeria, the recommended age for routine measles vaccination for infants is at 9 month of age. However, it has been severely reported that the present-day civilized mothers are more measles vaccine-immuned contrary to been natural measles virus-immuned and as such, produce low titer anti-measles virus antibody which consequently decays or clears from their respective infants earlier than 9 months of age when measles vaccine is routinely administered. Early immunization against measles may potentially minimize the duration of the period between the loss of maternal antibodies transferred via the placenta and the administration of the recommended measles vaccination for infants, hence the need for the re-evaluation of the measles immunization schedule. Keywords: Vaccination; Maternal Measles Antibody; Infant, Virus;

Safety of intravenously applied mistletoe extract \u2013 results from a phase I dose escalation study in patients with advanced cancer

BackgroundMistletoe extracts have anti-tumor properties and are approved for subcutaneous use in cancer patients. Data on Intravenous application are limited.MethodsAn aqueous extract from pine-mistletoe was used to investigate maximum tolerable dose (MTD) and safety of intravenous application. It was infused once weekly for 3 weeks in patients with advanced cancer. Any type of cancer was included; relevant exclusion criteria were concurrent chemo- or radiation therapy. The classical phase I 3 + 3 dose escalation scheme was followed. Predefined dose groups were 200, 400, 700, 1200 and 2000 mg. Maximum planned dose was 2000 mg. With the MTD three more patients should be treated for 9 weeks in order to evaluate intermediate term tolerability. Weekly during the treatment and 1 week later tolerability, clinical status, safety laboratory parameters and adverse events were documented.ResultsTwenty-one patients (3 in the dose groups 200, 400, 700 and 1200 mg, respectively, 9 in the dose group 2000 mg) were included. MTD was not reached. Because one dose-limiting toxicity (DLT), an allergic reaction, occurred during infusion of 2000 mg, three more patients had to be included in this dose group and tolerated it, as well as the three patients who received 2000 mg for 9 weeks. Occasionally in the dose group 2000 mg mild to moderate fever occurred.ConclusionWeekly infusions of 2000 mg of the pine-mistletoe extract were tolerated and can be used in further studies but had a risk for allergic reactions and fever. German Clinical Trials Register (Trial registration number DRKS00005028).

Innate Immune Basis for Rift Valley Fever Susceptibility in Mouse Models

Rift Valley fever virus (RVFV) leads to varied clinical manifestations in animals and in humans that range from moderate fever to fatal illness, suggesting that host immune responses are important determinants of the disease severity. We investigated the immune basis for the extreme susceptibility of MBT/Pas mice that die with mild to acute hepatitis by day 3 post-infection compared to more resistant BALB/cByJ mice that survive up to a week longer. Lower levels of neutrophils observed in the bone marrow and blood of infected MBT/Pas mice are unlikely to be causative of increased RVFV susceptibility as constitutive neutropenia in specific mutant mice did not change survival outcome. However, whereas MBT/Pas mice mounted an earlier inflammatory response accompanied by higher amounts of interferon (IFN)-α in the serum compared to BALB/cByJ mice, they failed to prevent high viral antigen load. Several immunological alterations were uncovered in infected MBT/Pas mice compared to BALB/cByJ mice, including low levels of leukocytes that expressed type I IFN receptor subunit 1 (IFNAR1) in the blood, spleen and liver, delayed leukocyte activation and decreased percentage of IFN-γ-producing leukocytes in the blood. These observations are consistent with the complex mode of inheritance of RVFV susceptibility in genetic studies.

A prospective study on the safety and effectiveness of using lauromacrogol for ablation of pancreatic cystic neoplasms with the aid of EUS

With the development of imaging techniques, the detection rate of pancreatic cystic neoplasms (PCNs) has increased. The surgical morbidity and mortality rates of PCNs are quite high. This study is intended to evaluate the safety and effectiveness of a minimally invasive treatment, EUS-guided PCN ablation with lauromacrogol. From April 2015 to May 2016, 120 patients with PCNs were enrolled to undergo EUS. We prospectively studied 29 of the 120 patients who underwent EUS-guided ablation with lauromacrogol. The follow-up contrast-enhanced CT or magnetic resonance image was conducted at 3 months and then 6 months after ablation. We determined the effectiveness of ablation by the changes in the volume of the cysts. Twenty-nine patients were enrolled in the study, and 7 of them underwent a second ablation; therefore, there were 36 treatments. The mean tumor diameter was 28.6 ± 14.5mm preoperation, whereas the diameter postoperation was 13.4 ± 10.5mm. Mild pancreatitis occurred in 2 patients and moderate fever in 1; they occurred in the cysts located in the head/uncinate. Among the 29 treatments with complete follow-up of 9 months (range, 3-15), 11 had complete response and 9 had partial response. The resolution rate was 37.9% (11/29) with 36.4% (8/22) in the cysts of the head/uncinate and 42.9% (3/7) in the body/tail (P > .05). EUS-guided PCN ablation with lauromacrogol is safe and efficient. Adverse event rates seem to be higher in the head/uncinate than in the body/tail, but their resolution rates are similar. Further studies involving larger populations and longer follow-ups are warranted.

Clinical Profile, Outcome, and Atypical Presentations of Scrub Typhus: Experience from a Tertiary Care Center in South India

<b>Background</b> The aim of this study was to describe the clinical profile and atypical presentations of scrub typhus in children aged younger than 12 years admitted to a tertiary care center in south India. <b>Materials and Methods</b> A retrospective chart review of children diagnosed with scrub typhus from January 2014 to January 2015 was performed; the clinical features (including atypical presentations), laboratory parameters, and response to treatment were analyzed. <b>Results</b> The majority of the cases was from urban areas and presented with gastrointestinal manifestations (25/31). Eschar was noted in 23 children (74%) and was typically found above the level of the umbilicus. All cases showed a rapid resolution with doxycycline. Atypical presentations included massive lung consolidation, epididymo-orchitis, secondary hemophagocytic lymphohistiocytosis, and “Kawasaki-like” disease. Infants in the group presented with low to moderate grade fever, significant hepatosplenomegaly, high C-reactive protein, and leukocytosis with lymphocytic preponderance. We propose that this tetrad of features, even in the absence of an eschar, should point to a possible diagnosis of scrub typhus in infants. <b>Conclusion</b> Changes in typical presentation of pediatric scrub typhus present a continuing diagnostic challenge.

How to Diagnose Early 5-Azacytidine-Induced Pneumonitis: A Case Report.

Interstitial pneumonitis is a classical complication of many drugs. Pulmonary toxicity due to 5-azacytidine, a deoxyribonucleic acid methyltransferase inhibitor and cytotoxic drug, has rarely been reported. We report a 67-year-old female myelodysplastic syndrome patient treated with 5-azacytidine at the conventional dosage of 75 mg/m2 for 7 days. One week after starting she developed moderate fever along with dry cough and subsequently her temperature rose to 39.5 °C. She was placed under broad-spectrum antibiotics based on the protocol for febrile neutropenia, including ciprofloxacin 750 mg twice daily, ceftazidime 1 g three times daily (tid), and sulfamethoxazole/trimethoprim 400 mg/80 mg tid. High-resolution computed tomography of the chest disclosed diffuse bilateral opacities with ground-glass shadowing and pleural effusion bilaterally. Mediastinal and hilar lymph nodes were moderately enlarged. polymerase chain reaction for Mycobacterium tuberculosis, Pneumocystis jiroveci, and cytomegalovirus were negative. Cultures including viral and fungal were all negative. A diagnosis of drug-induced pneumonitis was considered and, given the negative bronchoalveolar lavage in terms of an infection, corticosteroid therapy was given at a dose of 1 mg/kg body weight. Within 4 weeks, the patient became afebrile and was discharged from hospital. Development of symptoms with respect to drug administration, unexplained fever, negative workup for an infection, and marked response to corticosteroid therapy were found in our case. An explanation could be a delayed type of hypersensitivity (type IV) with activation of CD8 T cell which could possibly explain most of the symptoms. We have developed a decision algorithm in order to anticipate timely diagnosis of 5-azacitidine-induced pneumonitis, and with the aim to limit antibiotics abuse and to set up emergency treatment.

Safety and immunogenicity of the novel H4:IC31 tuberculosis vaccine candidate in BCG-vaccinated adults: Two phase I dose escalation trials

BackgroundNovel vaccine strategies are required to provide protective immunity in tuberculosis (TB) and prevent development of active disease. We investigated the safety and immunogenicity of a novel TB vaccine candidate, H4:IC31 (AERAS-404) that is composed of a fusion protein of M. tuberculosis antigens Ag85B and TB10.4 combined with an IC31® adjuvant. MethodsBCG-vaccinated healthy subjects were immunized with various antigen (5, 15, 50, 150μg) and adjuvant (0, 100, 500nmol) doses of the H4:IC31 vaccine (n=106) or placebo (n=18) in two randomized, double-blind, placebo-controlled phase I studies conducted in a low TB endemic setting in Sweden and Finland. The subjects were followed for adverse events and CD4+ T cell responses. ResultsH4:IC31 vaccination was well tolerated with a safety profile consisting of mostly mild to moderate self-limited injection site pain, myalgia, arthralgia, fever and post-vaccination inflammatory reaction at the screening tuberculin skin test injection site. The H4:IC31 vaccine elicited antigen-specific CD4+ T cell proliferation and cytokine production that persisted 18weeks after the last vaccination. CD4+ T cell expansion, IFN-γ production and multifunctional CD4+ Th1 responses were most prominent after two doses of H4:IC31 containing 5, 15, or 50μg of H4 in combination with the 500nmol IC31 adjuvant dose. ConclusionsThe novel TB vaccine candidate, H4:IC31, demonstrated an acceptable safety profile and was immunogenic, capable of triggering multifunctional CD4+ T cell responses in previously BCG-vaccinated healthy individuals. These dose-escalation trials provided evidence that the optimal antigen-adjuvant dose combinations are 5, 15, or 50μg of H4 and 500nmol of IC31.Trial registration: ClinicalTrials.gov, NCT02066428 and NCT02074956.

Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases.

Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD.

Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy in Benign Cystic Thyroid Nodules: Preliminary Results.

Objective To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI) in treating cystic thyroid nodules. Materials and Methods A total of 158 cystic or predominantly cystic thyroid nodules (>80% cystic component) in 143 patients were evaluated. 114 patients with compressive symptoms or aesthetic complaints were offered PPI. 44 individuals without compressive symptoms and aesthetic complaints who were only followed up clinically were used as the control group. The efficacy and safety of PPI were evaluated for 1 month, 3 months, 6 months, 9 months, and 12 months of follow-up. Results In the PPI group, the mean baseline volume of 15.6 ± 18.9 cm3 reduced at the 1-month follow-up to 5.1 ± 5.6 cm3 (p < 0.001) and 0.6 ± 0.9 (p < 0.001), and nodules shrunk according to the time after PPI (p < 0.001). A complete response (if ≥70% decrease) to PPI at the 12-month follow-up occurred in 100% of the cystic or predominant cystic nodules. None of the nodules recurred at the 12-month follow-up after PPI. The side effects were mild. Twenty patients (17.5%) developed mild localized pain, and fourteen cases (12.3%) experienced mild or moderate fever after PPI. Conclusions PPI is a safe and effective alternative to treat benign cystic or predominant cystic thyroid nodules.

春季花粉症患者のいびきと日中の眠気に関する質問票調査

Bothersome symptoms of hay fever impair not only patients' quality of life but also their labor productivity and learning efficiency. Excessive daytime sleepiness (EDS) caused by hay fever is thought to be one of the reasons for these impairments. The purpose of this study was to investigate the relationship between the severity of springtime hay fever and EDS by using a questionnaire. The questionnaire included information about age, sex, height, weight, severity of hay fever, treatment for hay fever, smoking and alcohol consumption habit, history of drug use for sleeping, existence of snoring, and Japanese version of the Epworth Sleepiness Scale. After excluding responses containing insufficient data, responses from 1,734 patients were considered as eligible. By performing logistic regression analysis, we analyzed the effect of the aforementioned parameters on the comorbidity of EDS and snoring. The odds ratio (OR) to comorbid EDS was significantly higher in the moderate and severe hay fever groups than in the asymptomatic hay fever group (moderate: OR=1.76, p=0.014, severe: OR=2.53, p<0.001). Also, OR to comorbid snoring was significantly higher in the severe hay fever group than in the asymptomatic hay fever group (severe: OR=1.90, p=0.001).

Spondylodiscitis: a rare complication following percutaneous nephrostomy.

Spondylodiscitis is an inflammation of the intervertebral disc and the adjacent vertebral bodies. The spondylodiscitis can not only be a complication of medical interventions such as an operation near spinal column but also urogenital and vascular interventions and intravenous catheter use. A 71-year-old man was admitted to our emergency department with fever and severe abdominal pain. Antibiotic therapy had been performed with intravenous administration of 2 g of ceftriaxone and the patient underwent the placement of a percutaneous nephrostomy according to Seldinger technique. After 1 week, the patient experienced a severe pain at the lumbar tract of the vertebral column associated with a moderate abdominal pain and septic fever. A magnetic resonance imaging (MRI) of the lumbar spine showed widespread impregnation of the upper portion of L3 and the lower portion of L2 compressing the spinal roots as well as the ileopsoas muscle such as a spondylodiscitis. Liquor culture showed an increase of liquor immunoglobulin G, total liquor protein and was positive for Extended-spectrum beta-lactamases (ESBL) - producing Escherichia coli. After the antibiotic therapy, the spondylodiscitis resolves without important sequelae. In the present case report, we describe a very rare complication of percutaneous nephrostomy tube placement, despite of the prophylactic antibiotic therapy according to the most recent guidelines. Predisposing factors to spondylodiscitis include the very young and elderly, the immunosuppressed, diabetic individuals and a general debilitating disease such as renal failure. This case suggests the importance of remembering spondylodiscitis when septic fever and back pain occurs following the placement of a percutaneous nephrostomy in a septic patient.

Unusual Presentation of a Common Disease

Introduction: High fever and toxemia, complicated by encephalopathy, during third week of fever is typical manifestations of typhoid fever. Here we report a case of young male, who presented with extrapyramidal symptoms (EPS) in first week of Enteric fever. Case report: A thirty two year old male presented with complaints of moderate grade fever without chills and rigors and generalized body weakness for seven days. On fourth day of his illness, he developed abnormal body movements in the form of coarse tremors of bilateral upper limbs. He had chronic hepatitis C infection, for which he was on DAAs since one month. His examination revealed coarse tremors in bilateral upper limbs with bradykinesia and cogwheel rigidity. There were no cerebellar signs or signs of meningeal irritation. On evaluation, he had mild anaemia and his renal function tests, thyroid function test, serum electrolytes were normal. Liver function test revealed normal bilirubin with elevated AST (184 U/L) and ALT (143 U/L). ALP was normal. Blood culture was sterile. MRI brain was normal. H.C.V R.N.A was not detectable. Widal test was positive with TO titre of 1:320. He was treated with injection ceftriaxone 2g given I/V every 12 hourly and tablet azithromycin 500 mg twice daily. He was continued with antivirals (sofosbuvir and daclatasvir). His EPS started improving by Day 10 of treatment and disappeared at 2 months of follow up. Discussion: Neuropsychiatric manifestations are common in enteric fever. Headache is the most frequently reported symptom. Other neurological manifestations including disordered sleep patterns, acute psychosis, myelitis, and rigidity have been observed. Neurological findings in the absence of encephalopathy may occur, indicating a focal, as well as a generalized, neuronal dysfunction. EPS have been reported in the varied neurological presentations of Enteric fever, mostly in the third week of illness. But to the best of knowledge of the authors, this is first case of Enteric fever reported in literature presenting as EPS in the first week illness. It remains a challenge to the physicians to diagnose such patients at an early stage.

Prospective Study of Safety and Effectiveness of Lauromacrogol for Ablation of Small Pancreatic Cystic Neoplasms Under EUS: 2016 ACG International Award

Introduction: With the development of imaging techniques, small pancreatic cystic neoplasms some of which exist possibility of malignancy are becoming more and more prevelant. Surgical morbidity and mortality rates for pancreatic cystic tumors are quitely high. There have been some studies on EUS-guided ethanol lavage therapy with or without paclitaxel injection for pancreatic cystic neoplasms, but lauromacrogol ablation have not been reported.We aim to evaluate the safety and effectiveness of EUSguided small pancreatic cystic neoplasms ablation with lauromacrogol. Methods: From April 2015 to may 2016,120 patients of small pancreatic cystic neoplasms were enrolled to perform EUS,among whom 59 patients finally received surgery.We prospectively studied 29 patients undergoing EUS-guided ablation with lauromacrogol among 120 patients. The follow-up pancreatic enhanced CT or MRI was taken at 3 months and then 6 months after frist ablation. We determined the efficiency of ablation by RECIST criteria. Results: Twenty women and nine men were enrolled in study and 7 of 29 patients underwent the second ablation so there are 36 cases of ablation. Twenty-one cases were located in the head/uncinate of the pancreas while 8 in the body/tail. Mean tumor diameter was 30mm(rang 11-72mm) pre operation while 14.1mm(rang 0-35mm) post. The mean volume of injected polidocanol was 10.9ml(rang 1.5-30ml). Mild pancreatitis occurred in 2 cases and moderate fever occurred in 1 case among 36 cases and all of these complications occurred in the cysts located in the head/uncinate.None of the patients reported any severe complications. Of the 23 cases with complete followed-up of 3.9 months(rang 1.5-12months),4 cases had complete resolution and 13 cases had partial resolution and the resolution rate is 73.9%. Complete resolution was achieved in 3 cases and partial resolution in 9 in the cysts of the head/uncinate, while 1 patient achieved complete resolution and 4 achieved partial resolution in the cysts of the body/tail. No statistically significant difference in resolution rate of the cysts was found between he head/uncinate and the body/tail(12/17vs5/6:P>0.05). Conclusion: EUS-guided small pancreatic cystic neoplasms ablation with lauromacrogol is safe and efficient. Complication rates were higher in the cysts of the head/uncinate than body/tail, but their resolution rates were similar. Further studies involving larger populations and longer follow-ups are warranted.Figure 1Figure 2