Occurrence Of Syndromes Research Articles

Complications after thoracic surgery: don't (necessarily) blame it on the approach

Complications after thoracic surgery: don't (necessarily) blame it on the approach

Prevalence of Pain Syndromes, Mood Conditions, and Asthma in Adolescents and Young Women with Endometriosis

Study ObjectiveAdult women with endometriosis are often diagnosed with comorbid pain, mood, and autoimmune conditions. This study aims to describe the occurrence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis evaluated at our medical center. DesignRetrospective review of medical records. SettingDepartment of Obstetrics and Gynecology at a tertiary referral center. Participants138 adolescents/young women who were less than age 24 years at the time of their initial visit at our medical center, and whose surgical diagnosis of endometriosis was made at our institution or by outside institutions by the age of 21. InterventionsNone. Main Outcome MeasuresPrevalence of comorbid pain syndromes (defined as interstitial cystitis, irritable bowel syndrome, chronic headaches, chronic low back pain, vulvodynia, fibromyalgia, temporomandibular joint disease, and chronic fatigue syndrome), mood conditions (defined as depression and anxiety), and asthma. ResultsComorbid pain syndromes were found in 77 (56%) women, mood conditions in 66 (48%) women, and asthma in 31 (26%) women. Comparing endometriosis patients with and without comorbid pain syndromes, no differences were found in age at time of diagnosis, endometriosis symptoms, and endometriosis stage. Patients with comorbid pain syndromes were more likely to report mood conditions (62% vs 30% respectively, P < .001) and smoking (31% vs 10% respectively, P = .003), underwent more surgeries for endometriosis (median of 2 [range, 1–7] vs 1 [range, 1-5], P < .005), and were more likely to undergo appendectomy or cholecystectomy (30% vs 13%, P = .02). ConclusionsComorbid pain syndromes, mood conditions and asthma are common in adolescents and young women with endometriosis.

Serum levels of anti-apolipoprotein A-1 auto-antibodies and myeloperoxidase as predictors of major adverse cardiovascular events after carotid endarterectomy

We aimed at challenging the prognostic accuracies of myeloperoxidase (MPO) and antibodies anti-apolipoprotein A-1 (anti-apoA-1 IgG), alone or in combination, for major adverse cardiovascular events (MACE) prediction, one year after carotid endarterectomy (CEA). In this prospective single centre study, 178 patients undergoing elective CEA were included. Serum anti-apoA-1 IgG and MPO were assessed by enzyme-linked immunosorbent assay prior to the surgery. Post-hoc determination of the MPO cut-off was performed by receiver operating characteristics (ROC) analyses. MACE was defined by the occurrence of fatal or non-fatal acute coronary syndromes or stroke during one year follow-up. Prognostic accuracy of anti-apoA-1 IgG was assessed by ROC curve analyses, survival analyses and reclassification statistics. During follow-up, 5% (9/178) of patients presented a MACE, and 29% (52/178) were positive for anti-apoA-1 IgG. Patients with MACE had higher median MPO and anti-apoA-1 IgG levels at admission (p=0.01), but no difference for the 10-year global Framingham risk score (FRS) was observed (p=0.22). ROC analyses indicated that both MPO and anti-apoA-1 IgG were significant predictors of subsequent MACE (area under the curve [AUC]: 0.75, 95% confidence interval [95%CI]: 0.61-0.89, p=0.01; and 0.74, 95%CI: 0.59-90; p=0.01), but combining anti-apoA-1 IgG positivity and MPO>857 ng/ml displayed the best predictive accuracy (AUC: 0.78, 95%CI: 0.65-0.91; p=0.007). It was associated with a poorer MACE-free survival (98.2% vs. 57.1%; p<0.001, LogRank), with a positive likelihood ratio of 13.67, and provided incremental predictive ability over FRS. In conclusion, combining the assessment of anti-apoA-1 IgG and MPO appears as a promising risk stratification tool in patients with severe carotid stenosis.

Cerebral calcifications and schizophreniform disorder

OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.

Effect of Type 2 Diabetes Mellitus on the Pharmacokinetics of Metformin in Obese Pregnant Women

The use of metformin throughout gestation by women with polycystic ovary syndrome (PCOS) and type 2 diabetes mellitus (T2DM) significantly reduces the number of first-trimester spontaneous abortions and the rate of occurrence of gestational diabetes and hypertensive syndromes. Metformin is taken up into renal tubular cells by organic cation transport 2 (OCT2) and eliminated unchanged into the urine. The objective of this study was to analyse the influence of T2DM on the pharmacokinetics of metformin in obese pregnant women and in a control group of non-diabetic obese pregnant women with PCOS. Eight non-diabetic obese pregnant women with PCOS and nine obese pregnant women with T2DM taking oral metformin 850mg every 12h were evaluated throughout gestation. Serial blood samples were collected over a 12-h period during the third trimester of pregnancy. Steady-state plasma concentrations of metformin were determined by high-performance liquid chromatography with a UV detector. The pharmacokinetic results of the two groups, reported as median and 25th and 75th percentile, were compared statistically using the Mann-Whitney test, with the level of significance set at p<0.05. The pharmacokinetic parameters detected for PCOS versus T2DM patients, reported as median, were, respectively: elimination half-life 3.75 versus 4.00h; time to maximum concentration 2.00 versus 3.00h; maximum concentration 1.42 versus 1.21μg/mL; mean concentration 0.53 versus 0.56μg/mL; area under the plasma concentration-time curve from time zero to 12h 6.42 versus 6.73μg·h/mL; apparent total oral clearance 105.39 versus 98.38L/h; apparent volume of distribution after oral administration 550.51 versus 490.98L; and fluctuation (maximum-minimum concentration variation) of 179.56 versus 181.73%. No significant differences in pharmacokinetic parameters were observed between the groups. T2DM in the presence of insulin use does not influence the pharmacokinetics of metformin in pregnant patients, demonstrating the absence of a need to increase the dose, and consequently does not influence the OCT2-mediated transport in pregnant women with PCOS.

Acute coronary syndromes related to bio-climate in a Mediterranean area. The case of Ierapetra, Crete Island, Greece

The occurrence of non-fatal acute coronary syndromes (ACS) is examined in relation with the local bioclimatic conditions in the Ierapetra area, in the southernmost part of Crete Island, Greece, during the period 2004–2007. Daily ACS counts and corresponding meteorological parameters, such as maximum and minimum air temperature, relative humidity, wind speed and cloudiness, were analyzed. Besides, the daily values of the human thermal index, physiologically equivalent temperature (PET) was evaluated. Pearson's χ2 test and generalized linear models (GLM) with Poisson distribution were applied. The ACS syndromes present a multiple variation within the year, with the primary maximum in August and the secondary in May, while relative high ACS frequencies exist in early winter time. The impact of the weather variability on the ACS incidence is not statistically significant (C.L. 95%).

Kounis syndrome

Kounis syndrome (KS) was described in 1991 by Kounis and Zavras as the coincidental occurrence of acute coronary syndromes (ACSs) with allergic reactions (anaphylactic or anaphylactoid).Today, allergic angina and allergic myocardial infarction are referred to as KS, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors.The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed.

Impact of lunar phase on the incidence of cardiac events

Objectives: Popular opinion holds that the phase of the moon influences human behavior, and several reports substantiate this claim; however, reports of correlation between the lunar cycle and cardiac events remain controversial. The purpose of the present study was to determine whether a relationship exists between lunar cycle and the occurrence of acute cardiac events. Methods: A retrospective review of cardiac events, including ST-elevated myocardial in-farction (STEMI), non-ST elevated myocardial infarction (NSTEMI), and unstable angina, over a 5- year period was performed. The dates of cardiac events were recorded and merged with the four phases of the lunar cycle (new moon, first quarter, full moon, and last quarter). Results: A total of 4751 cardiac events (578 STEMI, 1446 NSTEMI, 2727 unstable angina) occurred during the 5-year study period in 3935 unique patients. Cardiac events occurred equivalently during various phases of the lunar cycle. Conclusions: Despite popular opinion, our evidence suggests that the lunar cycle has no effect on the occurrence of acute coronary syndromes.

Síndrome de Kounis

Kounis syndrome was described in 1991 by Kounis and Zavras as the coincidental occurrence of acute coronary syndromes with allergic reactions (anaphylactic or anaphylactoid).Today, allergic angina and allergic myocardial infarction are referred to as Kounis syndrome, and the latter has been reported in association with a variety of drugs, insect stings, food, environmental exposures and medical conditions, among other factors.The incidence is not known, as most of the available information comes from case reports or small case series. In this article, the clinical aspects, diagnosis, pathogenesis, related conditions and therapeutic management of the syndrome are discussed.

Musculoskeletal Pain and Overuse Syndromes in Adult Acquired Major Upper-Limb Amputees

Østlie K, Franklin RJ, Skjeldal OH, Skrondal A, Magnus P. Musculoskeletal pain and overuse syndromes in adult acquired major upper-limb amputees. Objectives (1) To compare the prevalence of self-reported musculoskeletal pain in upper-limb amputees (ULAs) in Norway with that of a control group drawn from the Norwegian general population; (2) to describe musculoskeletal pain bothersomeness in ULAs; (3) to estimate the association between prosthesis wear and self-reported musculoskeletal pain in ULAs; and (4) to describe the occurrence of musculoskeletal overuse syndromes in a sample of ULAs. Design Cross-sectional study: postal questionnaires and clinical examinations. Setting Norwegian ULA population. Clinical examinations performed at 3 clinics. Participants Questionnaires: population-based amputee sample (n=224; 57.4% response rate). Random control sample (n=318; 33.1% response rate). Clinical examinations: combined referred sample and convenience sample (n=70; 83.3% of those invited). Survey inclusion criteria: adult, resident in Norway and mastering Norwegian (amputees and controls), acquired major upper-limb amputation (amputees only). Interventions Not applicable. Main Outcome Measures Self-reported musculoskeletal pain and pain bothersomeness. Self-reported pain in prosthesis wearers and nonwearers. Clinically assessed diagnoses of musculoskeletal overuse syndromes. Results Self-reported musculoskeletal pain was more frequent in ULAs than in the control group except for lower back pain. In ULAs, 57.0% reported neck/upper back pain (odds ratio [OR]=2.56; 95% confidence interval [CI], 1.64–3.98), and 58.9% reported shoulder pain (OR=4.00; 95% CI, 2.51–6.36). The percentage difference for arm pain was 24.8% ( P<.001). All pain was reported as bothersome. We found no difference in pain prevalence between prosthesis wearers and nonwearers. Musculoskeletal overuse syndromes were found in 6.1% to 24.2% of ULAs, depending on diagnosis and case-definition criteria. Conclusions Upper-limb loss increases the risk of self-reported musculoskeletal pain in the neck/upper back, shoulders, and in the remaining arm. Prosthesis wear does not prevent musculoskeletal pain. Further studies should be conducted to investigate the effects of prosthesis wear and possible preventive measures, and to ascertain our preliminary prevalence estimates of overuse syndromes.

Transcoronary Th-17 lymphocytes and acute coronary syndromes: new evidence from the crime scene?

During the last two decades, a new perspective on atherosclerosis has prevailed based on accumulating evidence on the role of inflammatory and immune-competent cells, such as monocytes and T-lymphocytes, in contributing to the development of this disease. It is now generally accepted that a specific T-cell response is crucial in determining not only the development and growth of the atherosclerotic lesion, but also its fate toward a stable or an unstable pattern of evolution (i.e., rupture or ulceration), eventually leading to the clinical occurrence of acute coronary syndromes (ACS) [1]. In this respect, a complex interplay between T-cell subsets seems to regulate the fate of atherosclerotic lesions [2]. The adaptive effector CD4+ T helper (Th)-mediated immune response can be very heterogeneous, because of the existence of distinct cell subsets characterized by different profiles of cytokine production. Two polarized types of Th effectors, type 1 (Th-1) and type 2 (Th-2), were initially identified in bothmice and humans. Th-1 cells produce large amounts of interferon (IFN)-γ, while Th-2 cells are characterized by the production of IL-4, IL-5, and IL-13, but not IFN-γ. Our group has previously shown that Th-1 cells, by producing large amounts of γ-IFN, may contribute to

Association between cocaine abuse in pregnancy and placenta-associated syndromes using propensity score matching approach

AimsWe used propensity scores matching techniques to assess the association between maternal cocaine abuse in pregnancy and the occurrence of placenta-associated syndromes (PAS). Study designMothers who abused cocaine (n=5026) were matched to controls (n=5026) from a sample of 1,693,197, unexposed mothers in Florida from 1998 to 2007. Cocaine abuse was identified using the ICD-9 principal and secondary diagnosis codes (304.2 for cocaine dependence and 305.6 for cocaine abuse). The outcome of interest, PAS, was identified as any indication in diagnosis field of ICD-9-CM codes for: placental abruption (641.2), oligohydramnios (658.0), placental infarction (656.7, 656.8, 656.9), gestational hypertension (642.3, 642.9), preeclampsia (642.4, 642.5, and 642.7) or eclampsia (642.6). ResultsNearly 6% of mothers in the study sample experienced a condition associated with PAS prior to matching. Women who abused cocaine were 58% more likely to have PAS when compared to women who did not (OR=1.48, 95% confidence interval: 1.33, 1.66). Women who abused cocaine were at elevated odds for placental abruption, placenta infarction and preeclampsia with the most pronounced odds noted for placental abruption (OR=2.79, 95% confidence interval: 2.19, 3.55). ConclusionsThese findings indicate that cocaine abuse during pregnancy is associated with more placenta-related disorders than previously reported.

Microvascular Dysfunction in the Spectrum of Coronary Instability

The term "coronary instability" commonly refers to the sequence of events that lead from plaque erosion or rupture to the occurrence of acute coronary syndromes (ACS). However, evidence indicates that coronary microvascular dysfunction plays a relevant pathophysiologic and prognostic role in the setting of ACS, both in ST-segment elevation myocardial infarction and in non-ST-segment elevation ACS. Our group have recently demonstrated that Tako-Tsubo syndrome, which clinically mimics ACS, is sustained by a common pathophysiologic mechanism represented by reversible coronary microvascular dysfunction. Given this evidence, we propose a reappraisal of the concept of coronary instability, extending this notion from the dramatic event represented by plaque erosion or rupture to a more diffuse process that can acutely affect each segment of the coronary circulation.

Effects of insulin-like growth factor 1 in preventing acute coronary syndromes: The PRIME study

ObjectiveInsulin-like growth factor-1 (IGF-1) has been associated with cardiovascular risk factors and atherosclerosis. The aim of the present study was to evaluate the prognostic value of IGF-1 concentrations with respect to occurrence of well-defined coronary syndromes. MethodsThe PRIME study is a prospective cohort having included 10,600 subjects from Northern Ireland and France. Detailed information on cardiovascular risk factors, socioeconomic and behavioural variables were collected and a cardiologic examination was performed. At 5-year follow-up, 317 incident cases of coronary events were recorded according to strict protocols. They were matched to 634 age- and centre-paired controls from the same cohort, free of coronary disease. Baseline IGF-1 concentrations were measured, together with variables of lipid and glucose metabolism and markers of vascular and systemic inflammation. ResultsBaseline IGF-1 concentration was lower in subjects developing an acute coronary syndrome than in unaffected controls. IGF-1 levels correlated negatively with age, waist circumference, tobacco consumption and markers of inflammation. Subjects in the highest quartile of IGF-1 distribution had a 55% reduction in the relative risk of developing myocardial infarction and a 45% decrease for all-combined acute coronary syndromes. A similar trend, although non-significant, was noted for angina pectoris. Multiple adjustments on classical risk factors and inflammation markers did not affect IGF-1 results. Elevated levels of both IGF-1 and apo A-I conferred a significantly greater risk reduction than either one alone. However, interaction between the two markers was not significant. ConclusionLike HDL markers, high levels of IGF-1 confer protection against coronary artery disease.

Risk Factors for Crop Health Under Global Change and Agricultural Shifts: A Framework of Analyses Using Rice in Tropical and Subtropical Asia as a Model

Plant disease epidemiology requires expansion of its current methodological and theoretical underpinnings in order to produce full contributions to global food security and global changes. Here, we outline a framework which we applied to farmers' field survey data set on rice diseases in the tropical and subtropical lowlands of Asia. Crop health risks arise from individual diseases, as well as their combinations in syndromes. Four key drivers of agricultural change were examined: labor, water, fertilizer, and land availability that translate into crop establishment method, water shortage, fertilizer input, and fallow period duration, respectively, as well as their combinations in production situations. Various statistical approaches, within a hierarchical structure, proceeding from higher levels of hierarchy (production situations and disease syndromes) to lower ones (individual components of production situations and individual diseases) were used. These analyses showed that (i) production situations, as wholes, represent very large risk factors (positive or negative) for occurrence of disease syndromes; (ii) production situations are strong risk factors for individual diseases; (iii) drivers of agricultural change represent strong risk factors of disease syndromes; and (iv) drivers of change, taken individually, represent small but significant risk factors for individual diseases. The latter analysis indicates that different diseases are positively or negatively associated with shifts in these drivers. We also report scenario analyses, in which drivers of agricultural change are varied in response to possible climate and global changes, generating predictions of shifts in rice health risks. The overall set of analyses emphasizes the need for large-scale ground data to define research priorities for plant protection in rapidly evolving contexts. They illustrate how a structured theoretical framework can be used to analyze emergent features of agronomic and socioecological systems. We suggest that the concept of "disease syndrome" can be borrowed in botanical epidemiology from public health to emphasize a holistic view of disease in shifting production situations in combination with the conventional, individual disease-centered perspective.

Treatment and survival patterns in relation to multimorbidity in patients with locoregional breast and colorectal cancer

PURPOSE: To examine the effects of the occurrence and co-occurrence of comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS) on treatment and outcomes in older cancer patients. MATERIALS AND METHODS: We used records from the Ohio Cancer Incidence Surveillance System linked with Medicare data, clinical assessment data from the home health care Outcomes and Assessment Information Set, and death certificate data. Our patient population included fee-for-service HHC Medicare beneficiaries diagnosed with incident loco-regional breast or colorectal cancer in years 1999-2001 (n=1236). We grouped patients according to the presence of multimorbidity: (0): none of COM, FL, or GS; (1): occurrence - but no co-occurrence - of COM, FL, or GS; (2): co-occurrence of any two of COM, FL, and GS; and (3): co-occurrence of all three of COM, FL, and GS. Our outcomes were receipt of standard treatment, as well as overall survival (OS) and disease-specific survival (DSS) through 2005. Multivariable regression models were developed to analyze the independent association between multimorbidity and the outcomes, before and after adjusting for age. RESULTS: The effect of multimorbidity on our outcomes was attenuated considerably by age. Adjusting for age and compared with no multimorbidity (0), high multimorbidity (3) remained significantly and negatively associated with receipt of standard treatment (adjusted odds ratio: 0.57, 95% Confidence Interval (CI): 0.33, 0.97). Furthermore, high multimorbidity (3) was associated with increased hazard for OS, but not for DSS (adjusted hazard ratio and 95% CI: 2.15 (1.58, 2.93) for three entities). CONCLUSION: Multimorbidity is significantly and independently associated with cancer treatment and OS, but not DSS.

Genetics of monegenic forms of diabetes mellitus

It is universally recognized that autoimmune type 1 diabetes mellitus (DM) is not the only form of this disease in children. Increasingly more children andadolescents present with DM2, MODY, and rarer syndromal forms of DM. The actual prevalence of DM other than DM1 in children and adolescentsis unknown but may be estimated at 10%. Despite rare occurrence of genetic syndromes, they collectively account for almost 5% of DM cases amongchildren. The rapid upgrowth of molecular biology opens up a wide range of possibilities for designating various symptom complexes as nosologically selfconsistentforms. New genetic syndromes associated with DM are annually described. It is important both to adequately identify and treat manifestationsand complications of these syndromes in children and to provide relevant medico-genetic counseling and recommendations to the parents.Key words: non-immune diabetes mellitus, MODY, Wolfram syndrome, neonatal, syndromal forms

Acute Bacterial Pneumonia is Associated With the Occurrence of Acute Coronary Syndromes

Acute Bacterial Pneumonia is Associated With the Occurrence of Acute Coronary Syndromes

Association between tobacco use in pregnancy and placenta-associated syndromes: a population-based study

Cigarette smoking is an established risk factor for adverse perinatal outcomes. The purpose of this study is to examine the association between maternal smoking in pregnancy and the occurrence of placental-associated syndromes (PAS). We analyzed data from a population-based retrospective cohort of singleton deliveries that occurred in the state of Missouri from 1989 through 2005 (N = 1,224,133). The main outcome was PAS, a composite outcome defined as the occurrence of placental abruption, placenta previa, preeclampsia, small for gestational age, preterm or stillbirth. We used logistic regression models to generate adjusted odd ratios and their 95 percent confidence intervals. Non-smoking gravidas served as the referent category. The overall prevalence of prenatal smoking was 19.6%. Cigarette smoking in pregnancy was associated with the composite outcome of placental syndromes (odds ratio, 95% confidence interval = 1.59, 1.57-1.60). This association showed a dose-response relationship, with the risk of PAS increasing with increased quantity of cigarettes smoked. Similar results were observed between smoking in pregnancy and independent risks for abruption, previa, SGA, stillbirth, and preterm delivery. Maternal smoking in pregnancy is a risk factor for the development of placenta-associated syndrome. Smoking cessation interventions in pregnancy should continue to be encouraged in all maternity care settings.

Multifocal cerebral hemorrhages in H1N1 SOIV influenza patients: Report of 2 cases

Background: Neurological complications of influenza have been scarcely reported possible under-recognized. The full description of clinical forms of the current pandemic influenza is currently underway. Several different neurological syndromes have been associated with influenza but no cases of multi-focal cerebral hemorrhages have been reported so far. The aim of this report is to present 2 cases of multiple focal cerebral hemorrhages in patients with influenza H1N1 pandemic. Methods: Clinical, laboratorial and imaging data of 2 cases of influenza and serious neurological symptoms are presented. Cranial CT scan was performed in both cases. Influenza virus identification in upper respiratory secretion (UPS) was performed by real-timereversetranscriptase-polymerase-chain-reaction assay. Cerebrospinal fluid (CSF) was analized. No necropsy or brain biopsy were performed Results: Case n° 1: 32 years old pregnant woman with flu like symptoms, evolved to severe pneumonia and ARDS requiring mechanical ventilation. She developed comma and cranial CT scan has shown multiple hemorrhagic foci scattered throughout the brain and subaracnoid hemorrhage (SAH) (Figure 1). CSF was hemorrhagic. No hemorrhagic disorder was found and eclampsia was ruled-out. Despite oseltamivir therapy she eventually died. H1N1 SOIV was isolated from UPS. Case n° 2: 51 years old male with flu like symptoms evolved to ARDS and respiratory insufficiency demanding ICU and mechanical ventilation. He developed status epilepticus. Cranial CT scan showed multifocal hemorrhages. Lumbar CSF was hemorrhagic. H1N1 SOIV was isolated from UPS. Despite therapy with oseltamivir he eventually died. Figure 1: Cranial CT scan showing multifocal hemorrhage in frontal, parietal, temporal and occipital lobes, as well as SAH and intraventricular hemorrhage Conclusion: Influenza has imposed an under-recognized burden of central nervous system disease so far. Well known neurological syndromes associated with influenza virus in humans have been febrile convulsions, acute encephalitis, acute encephalopathy, Reye's syndrome, Guillain-Barré syndrome, Kleine-Levin syndrome and post encephalitic Parkinson's disease. Some encephalitis cases with petechial lesions in the brain have also been reported. The highly pathogenic H5N1 influenza virus has shown neurological damage in both birds and humans. Current medical literature, including some up-to-date publications of H1N1 pandemic haven’t shown the occurrence of multifocal hemorrhagic neurological syndromes. The cases here presented should aware practitioners for such possibility especially because many seriously ill influenza patients in ICU have been kept under sedation so hiding several neurological symptoms. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive