Number Of Clinical Signs Research Articles

Clinical and Parasitological Evaluation of Ivermectin and Ivermectin+Pyrantel Against Oxyuris Equi in Equines.

The equine pinworm could become an increasingly common problem, as there are reports of failure in the control of this parasite. The aim of this study was to evaluate the effects of ivermectin (IVM) and IVM combined with pyrantel pamoate (PYR). Thirteen parasitological positive equines were treated with oral IVM (200 µg/kg) and therapeutic efficacy, clinical recovery and the egg reappearance period (ERP) were evaluated. In cases for which ERP was shorter than the pre-patent period (PPP), a second treatment was performed with IVM (200 µg/kg)+PYR (6.6 mg/kg), followed by the same evaluation criteria described above. Therapeutic efficacy was 100% with IVM+PYR and 53.84% with IVM. The mean ERP was shorter than the PPP with both formulations, 77.55 days with IVM+PYR and 50 days with IVM. The presence of egg mass was always associated with a least one clinical sign. The reduction in the number of clinical signs per animal from Day 0 to Day 30 was greater in equines treated with IVM+PYR compared to those treated with IVM alone. The animals treated with IVM were 4.5-fold more likely to present clinical signs 30 days after treatment than those treated with IVM+PYR. A negative correlation was found between ERP and the number of clinical signs at 30 days in the animals treated with IVM. This clinical and parasitological evaluation demonstrated that the combination of IVM+PYR was more effective than IVM alone to control Oxyuris equi.

Retrospective analysis of maternal near miss and the applicability of previous caesarean section delivery as a predictor of risk at a tertiary level hospital of India

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Комплексний аналіз сироваткової концентрації матриксної металопротеїнази 1 та тканинного інгібітора металопротеїнази 1 у дітей дошкільного віку з рекурентними респіраторними інфекціями

Purpose - to systematically examine the state of interrelatedness between the serum concentration of matrix metalloproteinase 1 and the tissue inhibitor of metalloproteinase 1, the frequency of acute respiratory infections (ARIs), and a heterogeneous set of other clinical and laboratory parameters in preschool children. Materials and methods. Forty children (21 boy and 33 girls) aged 1 to 6 years old, undergoing inpatient treatment on acute respiratory infection, were involved in the clinical study. They were studied serum concentrations of MMP-1 and TIMP-1, C-reactive protein, certain blood leukocyte fractions, erythrocyte sedimentation rate, the content of several macro- and microbiological elements in their hair as well as a number of clinical signs. Also, two integral indicators of ARIs recurrence were calculated, namely, the infectious index (InI) and resistance index, as well as integral indices of inflammation and dolichostenomelia. The statistical processing of the primary digital material obtained was performed by IBM SPSS Statistics 27 licensed program. Results. The younger children had higher serum MMP-1 concentrations (p=0.007) and MMP-1/TIMP-1 ratio (p=0.008) compared to the older children. The girls showed higher values of MMP-1 (p=0.008) and MMP-1/TIMP-1 ratio (p=0.012) than the boys. The strong positive correlation between MMP-1 and InI in the children (ρ=0.514; p=0.001; 95% CI [0.232; 0.716]) was demonstrated. Using ordinal logistic regression method, a significant and simultaneously multidirectional dependence of InI categorical index on MMP-1 (B=1.078; p=0.013; 95% CI [0.223; 1.933]) and the age category of the examined children (B=-1.942; 95% CI [-3.757; -0.126]) was established. Conclusions. It is assumed that more frequent ARIs in children are accompanied by higher levels of serum MMP-1. It is not unlikely that there is differential «tuning» of MMP-1 activity in response to varying frequency of ARIs during the previous year. The degree of influence of the predictor, namely MMP-1, in ordinal regression models is determined by both the significance of this predictor and the variant of its combination with other studied covariates. The study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the local ethics committees of the institutions mentioned in the paper. An informed parental consent was obtained for the study in children. No conflict of interests was declared by the authors.

Imaging patterns in pediatric hypophosphatasia.

Hypophosphatasia is a rare genetic disorder of calcium and phosphate metabolism due to ALPL gene mutations, which leads to abnormal mineralization of the bones and teeth. Hypophosphatasia is characterized by low serum alkaline phosphatase activity and a number of clinical signs, including failure to thrive, bone pain and dental issues. The diagnosis is suspected based on clinical, laboratory and imaging findings and confirmed by genetic testing. Diagnosis in children is often delayed due to a lack of disease awareness, despite specific imaging findings that are a cornerstone of the diagnosis. The recent approval of enzyme replacement therapy (bone-targeted recombinant tissue nonspecific alkaline phosphatase) has given imaging an important role in monitoring treatment efficacy. The aim of this pictorial essay is to review the imaging features of hypophosphatasia at diagnosis and during follow-up, including whole-body magnetic resonance imaging patterns.

Tick paralysis in Australian birds caused by Ixodes holocyclus.

Tick paralysis is an uncommon cause of neuromuscular paralysis affecting 0.12% of wild birds presented to Currumbin Wildlife Sanctuary, Queensland, with a strong seasonal predilection towards spring and summer. Clinical signs and progression of paralysis showed similarities to companion animals and were consistent across 20 species. Tick location, number of engorged ticks and number of clinical signs did not affect the outcome; however, all mortalities occurred within 4 days of admission. Treatment with canine-derived tick antiserum resulted in clinical improvement within 24 h and a recovery rate of 73%. Average time to resolution of clinical signs was 4.3 days, with juvenile birds recovering more quickly than adults. The treatment and release of wild birds affected by tick paralysis are both achievable and rewarding, further research is required to establish treatment guidelines in birds.

Clinical safety of robenacoxib in cats with chronic musculoskeletal disease.

BackgroundEvaluate the clinical safety of robenacoxib in cats with chronic musculoskeletal disease (CMSD).AnimalsFour hundred forty‐nine client‐owned cats with CMSD.MethodsPooled analysis of safety variables from 4 prospective randomized blinded clinical trials of robenacoxib (n = 222) versus placebo (n = 227), administered orally once daily for 4 to 12 weeks. Safety was evaluated from reported adverse events (AEs) and abnormalities detected on hematology and serum and urine chemistry analyses.ResultsThe number of cats with at least 1 AE was not significantly different (P = .15) with robenacoxib (n = 106, 47.8%) compared to placebo (n = 93, 41.0%). The relative risk of at least 1 AE (incidence robenacoxib/placebo) was 1.15 (95% confidence interval 0.93‐1.43). There was no significant difference between groups in the number of clinical signs (range, 0‐9) per cat (P = .23). Serum creatinine concentrations were higher during robenacoxib administration compared to placebo (+4.36 μmol/L, 95% confidence interval 0.21‐8.50), but no related adverse clinical effects were detected. In the subgroup of 126 cats with evidence of chronic kidney disease, the relative risk of at least 1 AE (robenacoxib/placebo) was 1.09 (95% confidence interval 0.78‐1.52, P = .61).Conclusions and Clinical ImportanceRobenacoxib was not associated with increased risk of AEs compared to placebo when administered for 4 to 12 weeks to cats with CMSD. The generalizability of the results to general practice is limited by the fact that cases with severe and uncontrolled concomitant diseases were not included.

Feline lymphoplasmacytic rhinitis (FLPCR): Severity of inflammation correlates with reduced mucosal IgA expression

Feline lymphoplasmacytic rhinitis (FLPCR) is a rare disease with an unclear pathogenesis characterized by lymphoplasmacytic (LPC) inflammation and progressive tissue destruction. Aims were to evaluate specific FLPCR clinical and pathological features to gain insights into disease pathogenesis. Signalment, clinical signs, serology and 47 pin. h biopsies were retrospectively collected from 33 FLPCR and 3 normal cats. Microscopical lesions and immunohistochemistry results utilizing anti-CD3, anti-CD20, anti-FOXP3, anti-feline-IgA, IgG, IgE and anti-FeLV (p27 and gp70), FIV, FCV and, FHV were scored and most were analyzed statistically. The majority of cats were domestic short haired (26/31) with median age of 11 years and a 0.35 F/M ratio. Serology evidenced 3/22 FIV and 1/22 FeLV positive cats. Immunohistochemistry evidenced 1/33 FeLV-p27 positive cats. Common clinical signs were sneezing (19/24 [79 %]), mucous discharge (13/24 [54 %]) and stertor (10/24 [42 %]). In normal tissues, IgAs were expressed in mucin, apical and lateral cell membrane of columnar cells and in periglandular plasma cells. IgGs were expressed in 20–30 % of columnar cells. Number of clinical signs was statistically significantly higher in female cats (p < 0.0001) and was significantly correlated with chronicity (p = 0.004), and IgG scores (p = 0.01). LPC severity scores correlated positively with infiltration of neutrophils (p = 0.015), gland destruction (p = 0.019) and angiogenesis (p = 0.016) and negatively with fibrosis (p < 0.0001). LPC severity scores were also significantly associated to female sex (p = 0.01) and to IgA (p = 0.03), with higher IgA scores associated to lower LPC scores.FLPCR associated to disruption of mucosal defense mechanisms generating cycles of tissue inflammation, tissue damage and repair with progressive loss of function independent from viral infections.

Frequency, active infection and load of Leishmania infantum and associated histological alterations in the genital tract of male and female dogs

Visceral leishmaniasis caused by the protozoan Leishmania infantum is a zoonosis. The domestic dog is the primary reservoir in urban areas. This study aimed to evaluate the frequency, active infection and load of L. infantum in the genital tract of male and female dogs seropositive for this parasite, as well as to identify histological genital alterations associated with this protozoan. We studied 45 male and 25 female L. infantum-seropositive noncastrated dogs from the same endemic area in Brazil. Tissue samples from the testis, epididymis, prostate, vulva, vagina, and uterus were examined by singleplex qPCR and parasitological tests (histopathology, immunohistochemistry, and parasitological culture). The latter were performed for the detection of active infection (parasites able to multiply and to induce lesions). Forty-four (98%) males and 25 (100%) females were positive for L. infantum in the genital tract (epididymis: 98%; vulva: 92%; vagina: 92%; testis: 91%; uterus: 84%; prostate: 66%). Active infection in the genital tract was confirmed in 69% of males and 64% of females (32% in the uterus). Parasite loads were similar in the testis, vulva, epididymis and vagina and lower in the prostate. Only the parasite load in the vagina was significantly associated with the number of clinical signs. Granulomatous inflammation predominated in all organs, except for the prostate. Only in the testis and epididymis was the inflammatory infiltrate significantly more intense among dogs with a higher parasite load in these organs. The high frequency, detection of active infection and similarity of L. infantum loads in the genital tract of infected males and females suggest the potential of venereal transmission of this parasite by both sexes and of vertical transmission by females in the area studied. Additionally, vertical transmission may be frequent since active L. infantum infection was a common observation in the uterus.

PCR for the detection of pathogens in neonatal early onset sepsis.

BackgroundA large proportion of neonates are treated for presumed bacterial sepsis with broad spectrum antibiotics even though their blood cultures subsequently show no growth. This study aimed to investigate PCR-based methods to identify pathogens not detected by conventional culture.MethodsWhole blood samples of 208 neonates with suspected early onset sepsis were tested using a panel of multiplexed bacterial PCRs targeting Streptococcus pneumoniae, Streptococcus agalactiae (GBS), Staphylococcus aureus, Streptococcus pyogenes (GAS), Enterobacteriaceae, Enterococcus faecalis, Enterococcus faecium, Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium, a 16S rRNA gene broad-range PCR and a multiplexed PCR for Candida spp.ResultsTwo-hundred and eight samples were processed. In five of those samples, organisms were detected by conventional culture; all of those were also identified by PCR. PCR detected bacteria in 91 (45%) of the 203 samples that did not show bacterial growth in culture. S. aureus, Enterobacteriaceae and S. pneumoniae were the most frequently detected pathogens. A higher bacterial load detected by PCR was correlated positively with the number of clinical signs at presentation.ConclusionReal-time PCR has the potential to be a valuable additional tool for the diagnosis of neonatal sepsis.

Mixed connective tissue disease, undifferentiated connective tissue disease and overlap syndromes

Systemic lupus erythematosus, systemic sclerosis, inflammatory myopathy and rheumatoid arthritis are systemic connective tissue disorders which are characterized by heterogeneous clinical symptoms and variable course. To date, updated diagnostic criteria for early diagnosis of each of the diseases of this group have been proposed. At the same time, a proportion of patients already have at the onset of the disease or over time, a combination of signs characteristic of different diseases. Such conditions are referred to as mixed connective tissue disease, undifferentiated connective tissue disease or overlap-syndrome, whose nosological identity remains the subject of discussion. Formerly there has been a kind of terminological confusion and similar conditions were described under different names, depending on the author's preferences. It was also believed that these conditions were an early stage or a clinically "incomplete" form of a connective tissue disease. However, as the observations of large patient groups have shown, whose disease was represented by a number of individual signs of several connective tissue diseases, the clinical manifestation remains unchanged for many years in the majority of them. To recognize the right for nosological independence, one should account for the fact that only for a mixed connective tissue disease various authors and research groups have proposed four variants of diagnostic criteria. These criteria have small differences in the number of clinical signs; however, all criteria include a mandatory sign, i.e. the presence of antibodies to U1-ribonucleoprotein in high titers. Clinical signs common to all these diagnostic criteria include the Raynaud's syndrome, arthritis, myositis and finger swelling or sclerodactyly. Another patient category includes those with mono- or oligosymptomatic manifestations characteristic of systemic connective tissue diseases, but without any specific immunological markers. Some of these patients in a fairly short time, usually from several months to 1–2 years, develop other clinical symptoms and signs corresponding to a reliable diagnosis of a connective tissue disease. At the same time, a significant part of patients with the oligosymptomatic course demonstrate a long-term stability without any further evolution of the disease. Such cases are defined as an undifferentiated connective tissue disease. To avoid the erroneous diagnosis of the transient form or an early stage of any connective tissue disease, the proposed classification criteria, along with the inclusion criteria, also embrace clinical and serological exclusion criteria. A separate category consists of patients with a combination of clinical signs sufficient for a definitive diagnosis of at least two systemic connective tissue diseases. These patients are diagnosed with the overlap-syndrome with indication of the components of connective tissue diseases in each individual case, as it largely determines the individual treatment and prognosis. The possibility of such clinical variants of systemic connective tissue diseases is becoming increasingly justified due to the concept of polyautoimmunity, which has attracted great interest of researchers in the last few years.

Parental and clinician agreement of illness severity in children with RTIs: secondary analysis of data from a prospective cohort study.

Severity assessments of respiratory tract infection (RTI) in children are known to differ between parents and clinicians, but determinants of perceived severity are unknown. To investigate the (dis)agreement between, and compare the determinants of, parent and clinician severity scores. Secondary analysis of data from a prospective cohort study of 8394 children presenting to primary care with acute (≤28 days) cough and RTI. Data on sociodemographic factors, parent-reported symptoms, clinician-reported findings, and severity assessments were used. Kappa (κ)-statistics were used to investigate (dis) agreement, whereas multivariable logistic regression was used to identify the factors associated with illness severity. Parents reported higher illness severity (mean 5.2 [standard deviation (SD) 1.8], median 5 [interquartile range (IQR) 4-7]), than clinicians (mean 3.1 [SD 1.7], median 3 [IQR 2-4], P<0.0001). There was low positive correlation between these scores (+0.43) and poor inter-rater agreement between parents and clinicians (κ 0.049). The number of clinical signs was highly correlated with clinician scores (+0.71). Parent-reported symptoms (in the previous 24 hours) that were independently associated with higher illness severity scores, in order of importance, were: severe fever, severe cough, rapid breathing, severe reduced eating, moderate-to-severe reduced fluid intake, severe disturbed sleep, and change in cry. Three of these symptoms (severe fever, rapid breathing, and change in cry) along with inter/subcostal recession, crackles/crepitations, nasal flaring, wheeze, and drowsiness/irritability were associated with higher clinician scores. Clinicians and parents use different factors and make different judgements about the severity of children's RTI. Improved understanding of the factors that concern parents could improve parent-clinician communication and consultation outcomes.

Clinical and Haematological Disorders in Cats with Natural and Progressive Infection by Feline Leukemia Virus (FeLV)

Background: Feline leukemia virus (FeLV) is an important infectious agent in cats, responsible for great health damages and a large death amount. Among the most common clinical disorders caused by FeLV, severe hematological changes are related at the progressive infection, ordinarily presented as cytopenias. Regarding its oncogenic potential, lymphoma and leukemia are the most observed illness originated by the agent. Therefore, this study has the goal of describing and comparing clinical and hematological disorders in FeLV positive cats from a selected population.Materials, Methods &amp; Results: Data of clinical evaluations of felines from a previously performed cross-sectional epidemiological study were compiled. This study obtained the prevalence of FeLV infected cats in Santa Catarina Plateau. Three groups were established from the original sample of 274 cats; Group 1 (control), FeLV negative and none clinical alterations (n = 80); Group 2, FeLV positive and none clinical changes (n = 9); Group 3, FeLV positive cats with clinical disorders (n = 29). Physical and hematological examination data were obtained from the medical records. The clinical changes at Group 3 were mucosal pallor (65.51% [19/29]), neurological disorders (20.69% [6/29]), lymphoma (20.69% [6/29]), coinfections (10.34% [3/29]) and leukemia (6.9% [2/29]). The most observed hematological disorders of Group 3 were anemia (65.51% [19/29]) and thrombocytopenia (62.7% [18/20]). At the complete blood count, the medium erythrocyte and eosinophil count, hemoglobin concentration and hematocrit were lower for Group 3 than the other two groups. The mean number of platelets count were higher for Group 1 than Group 2 and 3. The mean of the other variables remained between reference numbers. However, a descriptive analysis within the groups demonstrated that lymphopenia was observed in 34.48% (10/29) and neutropenia in 17.24% (5/29) at the Group 3. Discussion: The greater FeLV positive cats with clinical alterations number is a result of a sample obtained from a hospital population. In this scenario, cats are submitted to medical appointment in order to solve their clinical signs, not for purpose of infection screening. The frequency of non-neoplasic disease in FeLV positive cats was higher than neoplastic diseases. The mucosal pallor is the most important clinical change and it is an anemia consequence. A large number of clinical signs related in this study was non-specific. All the clinical changes are associated to FeLV infection, regardless the clinical syndrome observed. Neurological disorders frequency at this study was higher than other articles, being related to neoplastic lymphocytes in central nervous system at the resolved cases. Lymphoma and leukemia were the only neoplasms found in this FeLV study. Non-regenerative anemia was the main FeLV associated hematologic change. This disorder is originated by several mechanisms, such as the virus influence on bone marrow precursors and leukemic infiltration. Thrombocytopenia showed lower frequency than anemia and leukopenia, however, it was the second most common alteration in this study, which was observed in Group 2 and 3. The severe cytopenias related in Group 3 are probably due to the destruction or decrease of the production of these cells by the virus replication process. The clinical and hematological disorders found in this study, reveal the serious presentation and usually irreversible situation of this viral infection, originating important health harm to the affected cats.

IgG avidity index and complete blood count as biomarkers of clinical disease in naturally infected dogs with Leishmania infantum

Canine visceral leishmaniosis (CVL), a parasitic disease caused by Leishmania infantum, may evolve to a chronic condition and lead to death. Evaluation of infected dogs is important to establish the clinical and laboratory parameters involved in the evolution of the disease. The objectives of the present study were to discriminate a canine population (n = 52) into sub-clinical and clinically affected dogs based on signs and scores, to evaluate the hematological, biochemical, histopathological and parasitological parameters of the two dog groups, and to analyze the results by multivariate regression analysis with the aim of establishing biomarkers of CVL clinical disease. The most common signs observed in the clinically affected dogs (n = 29) were hyperkeratosis, weight loss, onychogryphosis, pale mucosa and lymphadenomegaly. In the multivariate analysis, animals presenting high IgG avidity index and low red blood, lymphocyte and eosinophil counts, and low serum urea concentration had an increased probability of being classified as clinically affected (p < 0.05). All five parameters were considered to be strong biomarkers for monitoring the clinical disease, while IgG avidity percentage was strongly correlated with the number of clinical signs and could function as an indicator of the duration of infection. This is the first report on the application of IgG avidity and of multivariate regression analysis in establishing associations between the clinical signs of CVL and host biomarkers. Since avidity index (AI) percentages were strongly correlated with the number of clinical signs, it could be useful in clinical practice for auxiliary diagnosis of CVL and monitoring disease progression. A limitation of this study is the lack of information on co-infections by Anaplasma platys, Babesia canis vogeli, Ehrlichia canis and Hepatozoon canis. Therefore future studies should evaluate the influence of such co-infections on the associations studied using multivariate methods with larger samples.

Влияние локального применения рекомбинантных цитокинов на течение и исход дентальной имплантации с закрытым синус-лифтингом

&lt;p class="p1"&gt;&lt;span class="s1"&gt;In order to increase the bone height in the distal portions of the maxilla during dental implantation the method of «closed» sinus lift is widely applied. Manipulation is considered to be a minimally invasive osteotomy but despite this fact, it is associated with a high complication rate that might lead to the loss of the dental implant. &lt;/span&gt;&lt;/p&gt;&lt;p class="p1"&gt;&lt;span class="s1"&gt;The purpose of the project is to analyze the evaluation of the effectiveness of immunomodulators local application during the "closed" sinus lift manipulation that is based on local in uence of «Betaleukin» and «Roncoleukin» drugs in the area of unexpected perforation of the mucous membrane of the maxillary sinus during the formation of the bone bed and close contact surface of the implant with a damaged part. A clinical randomized trial was held which of 105 patients aged 30 to 57, divided into three groups: comparison group, n = 35 (implants placed by the closed sinus lift standard method); betaleukin group, n = 35 (in addition to the surgery performed local recombinant IL-1β immunotherapy was conducted); roncoleukin group, n = 35 (the surgery done was combined with the local ronkoleukine immunomodulation). Within 10-12 days after the surgery hydrogel «Koleteks-Beta» and a gel containing recombinant IL-2 for a local effect on the oral mucous membrane around the installed implant were applied. During the study, all patients had a number of clinical signs that allow assessing the dynamics of post-operative course of the integration process of implants. Radiological control in the postoperative period was conducted to evaluate the position of the implant in relation to the maxillary sinus; the dynamics of bone tissue around it was observed. It was found out that the local treatment by immunomodulators improves the performance dynamics of clinical postoperative period; it reduces the risk of graft rejection and increases the ef ciency of integration process. &lt;/span&gt;&lt;/p&gt;

Accommodative and binocular dysfunctions: prevalence in a randomised sample of university students

BackgroundThe aim was to analyse the prevalence of symptomatic accommodative and non‐strabismic binocular dysfunctions in a randomised population of university subjects.MethodsA cross‐sectional study was conducted with a randomised sample of 175 university students aged between 18 and 35 years. All subjects were given a visual examination in which their symptoms were recorded, as well as performing objective and subjective refractive examinations and accommodative and binocular tests. Each subject was tested for the presence of uncorrected refractive error. Accommodative dysfunctions (AD) and binocular dysfunctions (BD) were diagnosed according to the number of clinical signs associated with each disorder, considering the signs that could be associated with each dysfunction as fundamental or complementary. An accommodative or binocular dysfunction was diagnosed when the subjects met two conditions: presenting with any kind of visual symptom in their clinical history and presenting the fundamental sign associated with each dysfunction as well as two or more complementary signs. Those subjects who presented with only an uncorrected refractive error were considered within the group called refractive dysfunction (RD).ResultsThe overall prevalence of accommodative and/or binocular dysfunctions was 13.15 per cent and for refractive dysfunction it was 45.14 per cent. Accommodative dysfunctions were present in 2.29 per cent of the population, binocular dysfunctions were observed in eight per cent and accommodative dysfunctions together were found in 2.86 per cent of the university students. Within the accommodative and binocular disorders, the most prevalent dysfunctions were convergence insufficiency, with a prevalence of 3.43 per cent and convergence excess and accommodation excess, both with a prevalence of 2.29 per cent.ConclusionBinocular dysfunctions were more prevalent than accommodative dysfunctions or accommodative and binocular dysfunctions together in a randomised population of university students.

Revisiting 'The Double malleoli' sign in nutritional rickets.

Sir, Nutritional rickets is a disease of high prevalence among children in India, with studies suggesting prevalence as high as 16.4% in the underprivileged children.1 To diagnose rickets, a number of clinical signs are routinely mentioned in text books. However the ‘Double malleoli’ sign a typical, easy to demonstrate clinical sign, lacks acknowledgement in literatures published over the last 50 years. The ‘Double malleoli’ sign is probably a handy tool for spot diagnosis of rickets in busy Outpatient Department (OPD) settings. We therefore would like to impress upon its importance with a clinical case example. We had a 6 year old male child presenting with complaints of deformity in bilateral legs and ankles along with difficulty in walking. As per usual practice, they elaborated complaints exposing only the child's legs to demonstrate leg deformities and knobbed ankles. Taking ‘Double Malleoli’ sign as a cue, complete exposure of the child was done to detect other clinical signs of rickets like widening of wrists, pot belly and gross genu valgum (Fig. 1A–C). Radiological and laboratory assessment were done to corroborate rachitic clinical findings. X-ray illustrated cupping and fraying of metaphysis and a widened physis (Fig. 1D and E). Laboratory parameters showed alkaline phosphatase of 797 IU/L, serum calcium 9.62 mg/dl and phosphorus 5.73 mg/dl. Treatment with vitamin D, calcium supplementation, necessary dietary and sun exposure advice resulted in clinical and radiological improvement demonstrable as early as 3 weeks with child walking more comfortably and white line evident in radiographs. Fig. 1 6 year old male child presented with deformity in bilateral legs; A: Knobbed ankle of the rachitic child (anterior view) takes appearance of two distinct medial prominences resembling a second malleoli (blocked arrows), one atop of the other – ... The ‘Double malleoli’ sign gets its name from the presence of two distinct medial bony prominences found in ankle of a rachitic child (Fig. 1A and B). The more proximal bony prominence, a metaphyseal ledge, formed by the enormous profusion of cartilage cells in rachitic maturation zone, mimics presence of a second medial malleoli atop of the true medial malleolus (formed by epiphysis)2 (Fig. 1D and E). This sign is frankly evident because of its anatomical location at ankle which has an ease of exposure in a busy OPD setting. Moreover, the subcutaneous location of the swelling allows a hard to miss palpatory finding to clinicians. Anxious parents of rachitic children often come up with chief complains of bow legs, and checking this sign in continuity to the bowed knees would readily give the clinician the first cue to a clinical diagnosis and help formulation of a detailed clinicoradiological and laboratory assessment.

Characterization of Visual Symptomatology Associated with Refractive, Accommodative, and Binocular Anomalies.

Purpose. To characterize the symptomatology of refractive, accommodative, and nonstrabismic binocular dysfunctions and to assess the association between dysfunctions and symptoms. Methods. 175 randomised university students were examined. Subjects were given a subjective visual examination with accommodative and binocular tests, evaluating their symptomatology. Accommodative and binocular dysfunctions (AD, BD) were diagnosed according to the number of existing clinical signs: suspect AD or BD (one fundamental clinical sign), high suspect (one fundamental + 1 complementary clinical sign), and definite (one fundamental + 2 or more complementary clinical signs). A logistic regression was conducted in order to determine whether there was an association between dysfunctions and symptoms. Results. 78 subjects (44.6%) reported any kind of symptoms which were grouped into 18 categories, with “visual fatigue” being the most frequent (20% of the overall complaints). Logistic regression adjusted by the presence of an uncorrected refractive error showed no association between any grade of AD and symptoms. Subjects with BD had more likelihood of having symptoms than without dysfunction group (OR = 3.35), being greater when only definite BD were considered (OR = 8.79). Conclusions. An uncorrected refractive error is a confusion factor when considering AD symptomatology. For BD, the more the number of clinical signs used the greater the likelihood suffering symptoms.

Less Common Clinical Manifestations of Atopic Dermatitis: Prevalence by Age

The common manifestations of atopic dermatitis (AD) appear sequentially with involvement of the cheeks in infancy, flexural extremities in childhood, and hands in adulthood. Although less common clinical manifestations are well described, they have not been the subject of epidemiologic studies to describe their prevalence in specific age groups. This observational, cross-sectional, comparative study included 131 children younger than 18 of both sexes with AD who attended the clinics of the Dermatology Department of the National Institute of Pediatrics in Mexico City. Patients were examined to determine the presence of infrequent clinical manifestations of AD during infancy, preschool and school age, and adolescence and stratified according to sex, age, and number of clinical signs. A chi-square test was used to detect differences according to age and sex. Logistic regression analysis was also performed. The main findings according to age were genital dermatitis and papular-lichenoid dermatitis variant in infants; atopic feet, prurigo-like, nummular pattern, and erythroderma in preschool and school-aged children; and eyelid eczema and nipple dermatitis in adolescents. The risk of development of nipple dermatitis and eyelid eczema increased with age, and the development of genital dermatitis decreased with age. The knowledge of the prevalence of less common clinical manifestations of AD according to age in different populations might be helpful in diagnosing incipient cases of AD.

Dental postoperative bleeding complications in patients with suspected and documented liver disease

The aims of this study were to determine the frequency of bleeding complications following dental procedures in patients with known or suspected chronic liver disease and whether international normalized ratio (INR) determination could aid in predicting bleeding complications in these patients. We identified 90 patients (mean age: 51 ± 9 years) in this retrospective chart review. Sixty-nine patients had a known history of chronic liver disease and 21 had suspected chronic liver disease. Descriptive statistics were determined. Independent sample t-test and one-way variance test were utilized for continuous variables and chi-square test for dichotomous variables. The mean INR value for all patients was 1.2 ± 0.3. The INR value was significantly associated with the diagnosis of liver cirrhosis, the diagnoses of Hepatitis B and C together, the presence of ascites alone, and the number of clinical signs and symptoms (i.e. ascites, jaundice and encephalopathy) present. Nine patients with INR values between 1.5 and 2 underwent invasive dental procedures without postoperative bleeding complications. There were no episodes of postoperative bleeding in patients. The findings suggest that clinicians should not rely solely on an INR value to predict post-procedure bleeding in patients with liver disease.

Chiari I malformation presenting with hearing loss: surgical treatment and literature review

Chiari I malformations can present with a number of clinical signs and symptoms. We present a case of an 11-year-old girl that presented with significant sensorineural hearing loss as her only Chiari-related symptom. The patient had four audiograms that all demonstrated progressive bilateral hearing loss between 10 and 30 dB. On magnetic resonance scan, the patient was found to have a Chiari I malformation. The patient had 9 mm of tonsillar herniation but no syrinx or hydrocephalus was present. On exam, the patient did not exhibit any other symptoms of her Chiari malformation or cranial nerve abnormalities other than sensorineural hearing loss. The patient underwent a suboccipital craniotomy, C1 laminectomy, and duraplasty. The patient noted a subjective improvement in hearing and an audiogram performed at 3 months postoperatively demonstrated normal hearing bilaterally. Sensorineural hearing loss may be caused by Chiari I malformations. This symptom may improve following decompression.