Month Of Illness Research Articles

Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning

The frequent occurrence of cognitive symptoms in post-COVID-19 condition has been described, but the nature of these symptoms and their demographic and functional factors are not well characterized in generalizable populations. To investigate the prevalence of self-reported cognitive symptoms in post-COVID-19 condition, in comparison with individuals with prior acute SARS-CoV-2 infection who did not develop post-COVID-19 condition, and their association with other individual features, including depressive symptoms and functional status. Two waves of a 50-state nonprobability population-based internet survey conducted between December 22, 2022, and May 5, 2023. Participants included survey respondents aged 18 years and older. Post-COVID-19 condition, defined as self-report of symptoms attributed to COVID-19 beyond 2 months after the initial month of illness. Seven items from the Neuro-QoL cognition battery assessing the frequency of cognitive symptoms in the past week and patient Health Questionnaire-9. The 14 767 individuals reporting test-confirmed COVID-19 illness at least 2 months before the survey had a mean (SD) age of 44.6 (16.3) years; 568 (3.8%) were Asian, 1484 (10.0%) were Black, 1408 (9.5%) were Hispanic, and 10 811 (73.2%) were White. A total of 10 037 respondents (68.0%) were women and 4730 (32.0%) were men. Of the 1683 individuals reporting post-COVID-19 condition, 955 (56.7%) reported at least 1 cognitive symptom experienced daily, compared with 3552 of 13 084 (27.1%) of those who did not report post-COVID-19 condition. More daily cognitive symptoms were associated with a greater likelihood of reporting at least moderate interference with functioning (unadjusted odds ratio [OR], 1.31 [95% CI, 1.25-1.36]; adjusted [AOR], 1.30 [95% CI, 1.25-1.36]), lesser likelihood of full-time employment (unadjusted OR, 0.95 [95% CI, 0.91-0.99]; AOR, 0.92 [95% CI, 0.88-0.96]) and greater severity of depressive symptoms (unadjusted coefficient, 1.40 [95% CI, 1.29-1.51]; adjusted coefficient 1.27 [95% CI, 1.17-1.38). After including depressive symptoms in regression models, associations were also found between cognitive symptoms and at least moderate interference with everyday functioning (AOR, 1.27 [95% CI, 1.21-1.33]) and between cognitive symptoms and lower odds of full-time employment (AOR, 0.92 [95% CI, 0.88-0.97]). The findings of this survey study of US adults suggest that cognitive symptoms are common among individuals with post-COVID-19 condition and associated with greater self-reported functional impairment, lesser likelihood of full-time employment, and greater depressive symptom severity. Screening for and addressing cognitive symptoms is an important component of the public health response to post-COVID-19 condition.

Influenza Vaccine Effectiveness Against Influenza A(H3N2)-Related Illness in the United States During the 2021-2022 Influenza Season.

In the United States, influenza activity during the 2021-2022 season was modest and sufficient enough to estimate influenza vaccine effectiveness (VE) for the first time since the beginning of the coronavirus disease 2019 pandemic. We estimated influenza VE against laboratory-confirmed outpatient acute illness caused by predominant A(H3N2) viruses. Between October 2021 and April 2022, research staff across 7 sites enrolled patients aged ≥6 months seeking outpatient care for acute respiratory illness with cough. Using a test-negative design, we assessed VE against influenza A(H3N2). Due to strong correlation between influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, participants who tested positive for SARS-CoV-2 were excluded from VE estimations. Estimates were adjusted for site, age, month of illness, race/ethnicity, and general health status. Among 6260 participants, 468 (7%) tested positive for influenza only, including 440 (94%) for A(H3N2). All 206 sequenced A(H3N2) viruses were characterized as belonging to genetic group 3C.2a1b subclade 2a.2, which has antigenic differences from the 2021-2022 season A(H3N2) vaccine component that belongs to clade 3C.2a1b subclade 2a.1. After excluding 1948 SARS-CoV-2-positive patients, 4312 patients were included in analyses of influenza VE; 2463 (57%) were vaccinated against influenza. Effectiveness against A(H3N2) for all ages was 36% (95% confidence interval, 20%-49%) overall. Influenza vaccination in 2021-2022 provided protection against influenza A(H3N2)-related outpatient visits among young persons.

ASSOCIATION OF THYROID STATUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN A TERTIARY CARE HOSPITAL

INTRODUCTION: The concept of subclinical primary hypothyroidism has emerged over the past several decades, as our ability to detect subtle changes in thyroid function tests is progressively improved. Although it is recognized that patients with subclinical primary hypothyroidism may have subtle symptoms of thyroid dysfunction, the denition is purely a biochemical one, dened as elevated serum thyrotropin (TSH) levels but 1 normal free thyroxine (FT4) levels. AIMS AND OBJECTIVES: Proposed topic of research: Prevalence of Subclinical Hypothyroidism In Patients With Chronic Kidney Disease, Objective of Proposed Research: Prevalence of Subclinical Hypothyroidism In Patients With Chronic Kidney Disease, Broad objectives: To estimate TSH and Free T4 levels in Chronic Kidney Disease patients and calculate the eGFR using MDRD formula and classify the patients with CKD into 5 stages METHODOLOGY: This Cross sectional Observational Study was single-centre study, which was take place at NRS Hospital Kolkata total time take April 2017 to March 2018. RESULT AND ANALYSIS: We found 10(10.0%) patients had overt hypothyroidsm. 100(100.0%) patients had >3 month of illness. The mean TSH (mean± s.d.) of patients was 6.5200 ± 4.4210 micro IU/mL. The mean FT4 (mean± s.d.) of patients was 1.0509 ± .3960 ng/dL. The mean urea (mean± s.d.) of patients was 96.8830 ± 31.6749. The mean creatinine (mean± s.d.) of patients was 3.3010 ± 1.2648. The mean eGFR (MDRD) (mean± s.d.) of patients was 24.5080 ± 16.6236 ml/min /1#73m2. Association of age in years vs. subclinical hypothirodism was not statistically signicant (p=0.1486). CONCLUSION: We conclude that the prevalence of subclinical hypothyroidism is high among all the stages of CKD patients. Need for treatment depends on the patient's clinical scenario and decision of the clinician based on the presentation. There is an increasing trend of decreased thyroid functional status along with decrease of estimated GFR (eGFR). Chronic kidney disease impairs thyroid functional status in different ways. Thyroid functional status evaluation is recommended in each and every patient of CKD.

Effects of immunoglobulin plus prednisolone in reducing coronary artery lesions in patients with Kawasaki disease: study protocol for a phase III multicenter, open-label, blinded-endpoints randomized controlled trial

BackgroundKawasaki disease (KD) is an acute systemic vasculitis of unclear etiology that mainly affects infants and young children. Strategies to reduce the incidence and severity of coronary artery lesions (CALs), the determinant factor in the long-term prognosis of KD, are currently a focus of studies on KD. Corticosteroids, preferred in the treatment of the majority of vasculitides, are controversial in the treatment of acute KD. In this trial, we will evaluate whether the addition of prednisolone to standard intravenous immunoglobulin (IVIG) plus aspirin therapy can reduce the occurrence of CAL in Chinese patients with KD.MethodsThis is a multicenter, prospective, open-label, randomized controlled trial, which is expected to be conducted in more than 20 hospitals in China and aims to assess the efficacy and safety of IVIG + prednisolone treatment versus standard treatment. Patients with KD who fulfill the inclusion and exclusion criteria will be recruited and randomized (1:1) to receive either a large dose of IVIG (2 g/kg over 12–24 h with a maximum dose of 60 g) + aspirin 30 mg/kg/d or IVIG (2 g/kg over 12–24 h) + aspirin 30 mg/kg/d + prednisolone (2 mg/kg/d with a maximum dose of 60 mg tapered over 15 days after normalization of C-reactive protein concentration). The primary outcome will be the occurrence of CAL at 1 month of illness. The follow-up duration for each participant will be set as 1 year. Patients and treating physicians will be unmasked to group allocation.DiscussionThis will be the first multicenter randomized controlled trial to evaluate the efficacy of IVIG + aspirin + prednisolone in Chinese pediatric patients with KD, which may provide high-level evidence for improving the initial treatment for acute KD.Trial registrationClinicalTrials.govNCT04078568. Registered on 16 August 2018.

Effects of Covid-19 on the audio-vestibular system

PurposeIt was aimed to investigate the effects of COVID-19 infection on hearing and the vestibular system. MethodsTwenty-six patients whose treatment had been completed and who had no previous hearing or balance complaints were included in the study. Patients diagnosed with the disease by PCR were included in the study. Patients with at least one month of illness were included in the study. The hearing of patients was evaluated with transient evoked otoacoustic emissions (TEOAE) and pure-tone audiometry. Bedside tests, the European Evaluation of Vertigo scale (EEV), Video Head Impulse Test (vHIT), Ocular Vestibular Myogenic Evoked Potential (oVEMP), Cervical Vestibular Myogenic Evoked Potential (cVEMP) and Videonystagmography (VNG) tests were applied to evaluate the vestibular system. ResultsA statistically significant difference was found between the COVID-19 positive and control groups according to the mean values of the 4000 Hz and 8000 Hz in both the right and left ears (p < 0.05). No statistically significant difference was found in the other frequencies and TEOAE. No statistically significant difference was found between the COVID-19 positive and control groups in terms of their normal or pathological VNG saccade, optokinetic and spontaneous nystagmus values (p > 0.05). The normal and pathological VNG head shake values were found to be significantly different between the COVID-19 positive and control groups (p < 0.05). ConclusıonThe high frequencies in audiometry in the COVID-19 positive group were worse than those in the control group. In the vestibular system, especially in oVEMP and cVEMP, asymmetric findings were obtained in comparison to the control group, and a low gain in vHIT was shown. This study shows that the audiovestibular system of people with COVID-19 infection may be affected.

Frequency Distribution of Cutaneous Leishmaniasis in the Central Region of Iran

Cutaneous leishmaniasis is a zoonotic disease and one of the most widespread diseases in our country. This illness is a significant public health concern in most Iranian provinces. Therefore, it is necessary to study the prevalence and identification of new sources of this problem in many regions of Iran. The present study was intended to investigate the epidemiology of cutaneous leishmaniasis in Yazd city. This descriptive-analytical and cross-sectional study was performed on 121 patients with leishmaniasis in Nicopoor Center, Yazd in 2017. According to ethical and research standards, information about patients, including their gender, age, occupation, location and number of lesions and month of illness were collected and evaluated using SPSS Statistics, Version 21. The highest incidence of leishmaniasis occurred in adults over 50 years of age (28.9%) and in children under the age of 10 (23.1%). An incidence of 41.3% was observed for other occupations, including driver, farmer and child. In second place, the highest frequency was related to housewives (25.6%), and in third place, a higher frequency was observed in students (19%). The most common venereal sites were the hands (38.8%), in second place the feet (28.1%) and in third place the face (15.7%). The highest seasonal frequency of leishmaniasis occurred during the autumn. In light of the current study findings and the adverse effects of leishmaniasis, it is necessary to design strategies with the aim of controlling the disease and to implement appropriate actions with the intention of decreasing its prevalence nationally.

L. Kalischer. Ein Fall von (Influenza) Psychose im frühesten Kindesalter. —(Arch. f. Psych. Bd. 29. Heft 1. pg. 231—248)

Child 2 y. Ill 3 weeks later after influenza with acute delirium (Amentia) and recovered during the 3rd month of illness.

Evaluating the effectiveness of the influenza vaccine during respiratory outbreaks in Singapore’s long term care facilities, 2017

Influenza outbreaks occur periodically in Long Term Care Facilities (LTCFs) and vaccination is critical in preventing influenza infections. We evaluated the influenza vaccine effectiveness (VE) during respiratory outbreaks in LTCFs reported to the Ministry of Health, Singapore in 2017.A test-negative design was used to estimate the ratio of the odds of testing positive for influenza among vaccinated individuals to the odds among unvaccinated individuals. The VE was calculated as (1-odds ratio) × 100%. For adjusted VE, the estimates were derived using logistic regression adjusted for age group, gender, month of illness, and number of days from date of illness onset till to swab collection date. Estimates by influenza subtypes and post-vaccination time periods (15–180 days & 181–365 days) were also calculated using stratified data.264 individuals, with 118 laboratory-confirmed influenza cases [32 A(H1N1)pdm09, 75 A(H3N2), 11 A(untypable)], were included in the analysis. No one was identified to be infected with influenza B. The overall adjusted VE estimate was 40.5% (95% CI: −12.2–68.5%), while the subtype-specific adjusted VE estimates were −43.4% (95% CI: −312.4–50.2%) against A(H1N1)pdm09 and 57.1% (95% CI: 5.7–80.5%) against A(H3N2). At 15–180 days post-vaccination period, the adjusted VEs were 59.3% (95% CI: 18.0–79.8%) against all influenza, 35.4% (95% CI: −123.5–81.3%) against A(H1N1)pdm09 and 67.9% (95% CI: 22.5–86.7%) against A(H3N2). Estimates were not significant at 181–365 days post-vaccination.The influenza vaccine showed varying effectiveness among individuals in Singapore’s LTCFs in 2017, with a higher effectiveness among those who were more recently vaccinated. It remains an important tool in preventing influenza infections, especially for those who are at high risk of influenza-related complications.

The economic impact of childhood acute gastroenteritis on Malawian families and the healthcare system

ObjectivesThis prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi.SettingData were collected in two Malawian settings: a rural health centre in...

The natural history of acute Q fever: a prospective Australian cohort.

A detailed description of the natural history of acute Q fever, caused by infection with Coxiella burnetii, AIM: : To significantly increase understanding of the illness. Subjects with provisional acute Q fever (n = 115) were recruited from primary care in rural Australia, and followed prospectively by interview and blood collection including for serological confirmation. A nested series of subjects with prolonged illness (cases), and those without (controls), were investigated in detail. Total phase I and phase II anti-C. burnetii antibodies were detected by complement fixation test; and IgG, IgM and IgA phase I and phase II titres by immunofluorescence. Flow cytometric analysis was conducted to enumerate circulating T cells subsets, B cells, monocytes and natural killer cells. Serological testing confirmed acute Q fever in 73 subjects (63%). The acute illness featured fever, headache, sweats, fatigue and anorexia; and varied widely in severity, causing an average of 8 days in bed and 15 days out of work or other role in the first month of illness. The illness course varied from 2 days to greater than a year. No cases of chronic, localized Q fever infection, such as endocarditis, were identified. Neither severe nor prolonged illness were associated with persistence of C. burnetii DNA, altered patterns of C. burnetii-specific IgG, IgM or IgA antibody production, or altered leucocyte subsets. The severity of acute Q fever alone predicted prolonged duration. Further studies are warranted to better understand the pathophysiology of prolonged illness after acute Q fever.

Concurrent occurrence of haemangioma and hepatocellular carcinoma in layer chicken-A case report

Post mortem examination was carried out of a commercial layer bird which died after about a month of illness. Grossly, a large lobulated growth on liver was observed. Microscopic examination revealed the histopathological features characteristic to the hepatocellular carcinoma and haemangioma. Concurrent occurrence of both the entity of tumours was considered a rare finding in the layer chicken.

Fulminant subacute sclerosing panencephalitis: Report of a case and review of literature

An 11-year-girl presented with rapidly progressive visual loss, which partially improved following prednisolone therapy. One month later, she developed mental changes and incontinence. She was confused, had bilateral cortical blindness and pyramidal signs. Electroencephalography revealed slowing and T2-weighted magnetic resonance imaging hyperintensity in the frontal and parieto-occipital regions. Cerebrospinal fluid was positive for measles antibody. She died on the third month of illness. Postmortem brain biopsy was positive for measles antigen. She did not have myoclonus or periodic discharges in electroencephalography during the entire course of illness. In children with visual impairment and rapidly deteriorating neurological status, subacute sclerosing panencephalitis should be considered. Cerebrospinal fluid measles antibody may clinch the diagnosis.

Cytokines in acute chikungunya.

IntroductionAcute chikungunya (CHIKV) is predominantly an acute onset of excruciatingly painful, self-limiting musculoskeletal (MSK) arbovirus illness and this was further reported by us during the 2006 Indian epidemic [Chopra et al. Epidemiol Infect 2012]. Selected serum cytokines profile in subjects within one month of onset of illness is being presented.MethodsOut of 509 clinical CHIKV cases (43% population) identified during a rural population survey, 225 subjects consented blood investigations. 132 examined within 30 days of febrile onset are the study cohort. Anti-CHIKV IgM and IgG antibodies tested by immunochromatography and indirect immunofluorescence respectively. Interferons (IFN)-α, -β and -γ, Interferon Gamma-Induced Protein-10 (CXCL-10/IP-10), Tumor Necrosis Factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Interleukin-13 (IL-13), Monocyte Chemoattractant Protein-1 (MCP-1), Interleukin–4 (IL-4) and Interleukin–10 (IL-10) performed by ELISA. Samples collected from neighboring community a year prior to the epidemic used as healthy controls.ResultsSeropositivity for anti-CHIKV IgM and IgG was 65% and 52% respectively. IFN-α, IFN-β, IFN-γ, CXCL10/IP-10 and IL-1β showed intense response in early acute phase. Cytokines (particularly TNF-α, MCP-1, IL-4, IL-6 and IL-10) was maximum in extended symptomatic phase and remained elevated in recovered subjects. Higher (p<0.05) IFN and IL-4 seen in patients seropositive for anti-CHIKV IgG. Elderly cases (≥65 years) showed elevated cytokines (except IFN) and anti-CHIKV antibodies near similar to younger subjects. Significant correlations (p<0.05) found between cytokines and clinical features (fatigue, low back ache, myalgia) and anti-CHIKV antibodies.ConclusionAn intense cytokine milieu was evident in the early and immediate persistent symptomatic phase and in recovered subjects. Early persistent IgM and lower IgG to anti-CHKV and intense Th2 cytokine phenotype seem to be associated with delay in resolution of MSK symptoms. Intriguingly, maximum TNF-α, IL-6 and IL-13 with low anti-CHIKV IgM response found in subjects recovered from CHIKV within one month of illness.

Clinical presentation of various thyroid lesions in a study population attending a teaching hospital in North India

Background: The present study is undertaken to evaluate the different clinical presentations of thyroid lesions in Northern Indian population. Clinical examination, although very accurate in most cases of thyroid lesion, is inadequate in some areas especially, in staging of thyroid malignancies and in detecting the multi-nodularity of the gland. Methods: The study was conducted in the postgraduate department of pathology of a teaching hospital for a period of 1 year. It was a prospective hospital based Study. In each case, a brief clinical history and physical examination along with evaluation of relevant investigation was carried out. Patient was explained about whole of the procedure &amp; the consent for the procedure was taken in all patients. FNAC of thyroid gland was done and the results of FNAC were correlated with histopathology, wherever available. The final results were correlated with different clinical presentations using SPSS 11.5 software. Results: Out of the 139 patients, 134 presented with swelling in the neck, 3 patients presented with pain in the neck while as 2 patients came with discomfort in the neck. 74 patients have duration of swelling more than 2 years, 51 patients have duration upto 1 year, 10 patients have duration between 1 to 2 years and 4 patients have less than one month. Out of 139 patients, 110 patients have solitary swelling, 87 have swelling on right side, 119 presented with regular margins, 91 presented with firm consistency, 130 were mobile and 135 presented with non-tender. Conclusion: Majority of the patients presented after 2 years of illness i.e. 74. Only 4 patients presently acutely within 1 month of illness. The major complaint was swelling in neck i.e. in 134, rest presented with local pain and discomfort .

Hereditary coproporphyria from clinician’s point of view: A case report

Acute hepatic porphyrias can mimic a range of unrelated diseases and conditions that may occur independently of porphyria and trigger their initial manifestations and further attacks. A 46-year-old female patient was subjected to cholecystectomy for biliary colic. Histopathological analysis revealed acute purulent exacerbation of chronic cholecystitis. On the 8th day post surgery, the patient was rehospitalized for nausea, abdominal pain, weakness and faintness, poor general condition, hypertension, tachycardia, apathy and profuse sweating. Laboratory findings revealed hyponatremia, hypokalemia, and metabolic alkalosis. Exploratory laparotomy did not detect a pathomorphological substrate. The patient was transferred to surgery department of the tertiary care institution. Due to metabolic imbalance, she was transferred to the Department of Endocrinology with signs of paleness, profuse sweating, tachycardia, and tachydyspnoea. The cardiologist performed echocardiography. The patient was diagnosed to have acute left ventricular failure and sub-acute myocardial infarction and transferred to the Department of Cardiology. Coronarography findings were normal. Cramps and pain in the legs with sensory loss, general weakness, apathy and mental confusion suggested acute hepatic porphyria. Thus, hereditary coproporphyria was diagnosed in the second month of illness. The treatment was continued at the Department of Gastroenterology. Clinical manifestations included polyneuropathy, flaccid paraparesis and acute brain syndrome, precordial oppressions and tachycardia. Haem arginate and hypertonic glucose were applied. The condition of the patient gradually improved. Porphyrias should always be taken into consideration in doubtful, frequently dramatic clinical pictures characterized by neurovisceral symptoms and precipitating factors of acute porphyria attacks must never be neglected.

Human rhinovirus C: Age, season, and lower respiratory illness over the past 3 decades

BackgroundHuman rhinoviruses (HRVs) cause common colds, and the recently discovered HRV-C is increasingly associated with lower respiratory illness among populations such as children and asthmatic patients.ObjectiveTo determine how HRV-C is associated with respiratory illness and to evaluate changes in prevalence and species over 2 decades.MethodsA prospective study of children younger than 5 years was performed at the Vanderbilt Vaccine Clinic over a 21-year period. Nasal-wash specimens from children presenting with upper or lower respiratory illness at acute care visits were tested for HRV and HRV-positives genotyped. Demographic and clinical features were compared between children with or without HRV, and with different HRV species.ResultsHRV was detected in 190 of 527 (36%) specimens from a population of 2009 children from 1982 through 2003. Of these, 36% were HRV-C. Age (P = .039) and month of illness (P < .001) were associated with HRV infection and HRV species. HRV-C was significantly associated with lower respiratory illness, compared with HRV-A (P = .014). HRV-A and HRV-C prevalence fluctuated throughout the 21-year period; HRV-C was more prevalent during winter (P = .058).ConclusionsHRV-C is not a new virus but has been significantly associated with childhood lower respiratory illness in this population for several decades. Temporal changes in virus prevalence occur, and season may predict virus species. Our findings have implications for diagnostic, preventive, and treatment strategies due to the variation in disease season and severity based on species of HRV infection.

Clinical profile of chikungunya patients during the epidemic of 2007 in Kerala, India

Background:The association of the present Chikungunya pandemic with a mutation in the Chik virus is already established in many parts of the world, including Kerala. Kerala was one of the worst-affected states of India in the Chikungunya epidemic of 2006–2007. It is important to discuss the clinical features of patients affected by Chikungunya fever in the context of this change in the epidemiology of the disease.Aim:This study tries to analyze the clinical picture of the Chikungunya patients in Kerala during the epidemic of 2007.Setting and Design:A cross-sectional survey was carried out in five of the most affected districts in Kerala, India.Materials and Methods:A two-stage cluster sampling technique was used to collect the information. Ten clusters each were selected from all the five districts, and the size of the clusters were 18 houses each. A structured interview schedule was used for data collection. Diagnosis based on clinical signs and symptoms was the major case-finding strategy.Results and Conclusion:Of the 3623 residents in the surveyed households, 1913 (52.8%) had Chikungunya clinically. Most of the affected were in the adult age group (73.4%). Swelling of the joints was seen in 69.9% of the patients, followed by headache (64.1%) and itching (50.3%). The knee joint was the most common joint affected (52%). The number of patients with persistence of any of the symptoms even after 1 month of illness was 1388 (72.6%). Taking bed rest till the relief of joint pain was found to be a protective factor for the persistence of the symptoms. Recurrence of symptoms with a period of disease-free interval was complained by 669 (35.0%) people. Older age (>40 years), a presentation of high-grade fever with shivering, involvement of the small joints of the hand, presence of rashes or joint swelling during the first week of fever and fever lasting for more than 1 week were the significant risk factors for recurrence of symptoms predicted by a binary logistic regression model. In conclusion, we found that there is substantial acute and chronic morbidity associated with the Chikungunya epidemic of 2007.

A young man with a cough, an abnormal chest radiograph, and multiple skin lesions.

His chest infiltrates have not resolved after 1 month of illness and two antibiotic courses. What is the diagnosis?

Factores que influyen en el pronóstico del síndrome de Guillain-Barré infantil

Guillain Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis in children. The factors that come to bear on its prognosis have not been properly determined in Latin America.Our aim was to establish the clinical and electrophysiological indicators of GBS in a group of paediatric patients attended in a tertiary care hospital. Patients and methods. We conducted a prospective study involving 67 patients who were hospitalised in the Instituto de Ortopedia Infantil Roosevelt between 1999 and 2002 after having been diagnosed as suffering from GBS. The clinical and electrophysiological characteristics were evaluated during the first month of illness and a clinical follow up was carried out until the patients reached stage III on Hughes' functional disability scale.Initially, it was observed that the protracted plateau time, the quadriplegia on day 10 of the disease and the electrical non excitability demonstrated by means of neuroconduction studies were variables linked to a protracted recovery time. Patients with a protracted recovery time required respiratory assistance more often, but this association was not statistically significant. In the Kaplan Meier survival analysis and the Cox analysis employed to determine the effects of covariance, the presence of quadriplegia associated to electrical non excitability were identified as significant variables in nine patients who required a longer time to reach Hughes stage III (mean: 172.7 days, 95% confidence intervals: 143.51 202.05). Patients with excitable motor nerves (EMN) and without quadriplegia reached functional stage III more quickly (mean: 39.51 days, 95% confidence intervals: 25.79 53.24).Children with GBS who display EMN and quadriplegia on day 10 of the illness are the group with the poorest prognosis and have a very long motor recovery time.

Serial changes of plasma nitrate in the acute phase of Kawasaki disease.

Endogenous nitric oxide (NO) production increases with clinical conditions associated with immune stimulation. In Kawasaki disease (KD), various cytokines play a role in inflammatory reactions in the cardiovascular system. The authors hypothesized that elevated concentrations of nitrate was related to the severity of vasculitis. The aim of the present study was to evaluate serial changes of plasma nitrate concentrations in the acute phase of KD and to consider how NO is related to the inflammatory process of KD and to the coronary artery lesion (CAL). Thirty patients with KD and 20 age-matched healthy controls were enrolled in the present study. Blood samples were obtained weekly for the first and second months. The patients were divided into two groups: one with CAL (n = 11) and another without CAL (n = 19). Plasma nitrate was measured by high-performance liquid chromatography. In both groups, plasma nitrate increased remarkably from the first week to the third week. Peak concentrations of nitrate (mean +/- SD, micro mol/L) in each group were as follows: 56.9 +/- 23.8 in the CAL(+) group and 68.2 +/- 33.8 in the CAL(-) group. Plasma nitrate decreased from the third week to the second month but was still elevated in both groups in comparison with the age-matched healthy controls. There was no correlation between plasma nitrates and white blood cell count or C-reactive protein, respectively (r = 0.013, 0.075). The results suggest that NO production may not be related to the severity of vascular inflammation and that elevated nitrate during the first month of illness may not be associated with a higher risk of CAL.