Presence Of Triggering Factors Research Articles

Evaluation of Etiology in Patients Who Admitted to Dermatology Outpatient Clinic with Acute Urticaria

Objective: The purpose of this review is to describe the causes of patients with acute urticaria who admitted dermatology outpatient clinic.
 
 Materials and Methods: Adult patients (age > 18 years) who were diagnosed with acute urticaria were included in our study. Our sample consisted of 159 patients with acute urticaria who applied to three different dermatology outpatient clinics between 2021-2022 years. Age, gender, duration of disease, history of angioedema, presence of triggering factor, history of chronic urticaria, and admission to the emergency department were collected retrospectively from records.
 Results: A total of 159 patients 102 (%64.1)were female and 57 (%35.8) were male. 82 (51.6%) patients had a triggering factor and no factor was detected in the remaining 77 (48.4%) patients. The total number of patients who admitted to the emergency department was 42 ( 26.4%). The most common triggering factor was drugs (n=31, 37.8%) followed by infections. The most commonly used drug type was Non-steroidal anti-inflammatory drugs and the most common infection was upper tract ınfections.
 Conclusion: Our study revealed that drugs and infections are common causative factors for acute urticaria consistent with the literature. When we examined patients with acute urticaria, especially in the emergency department or dermatology outpatient clinic, we need to keep in mind that detecting possible triggering factors can prevent the disease from recurring or the development of life-threatening symptoms.

Acute onset of diabetes and rapid cognitive decline in a patient with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome.

Mitochondrial diseases are a group of rare diseases presenting with heterogeneous clinical, biochemical, and genetic disorders caused by mutations in the mitochondrial or nuclear genome. Multiple organs can be affected, particularly those with high energy demand. Diabetes is a common endocrine manifestation of mitochondrial diseases. The onset of mitochondrial diabetes can be latent or acute, and the presenting phenotype can be type 1- or type 2-like. Studies show that diabetes ais associated with latent progression of cognitive decline in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Herein, we report a case of rapid cognitive decline after the acute onset of diabetes in a patient with MELAS syndrome. The patient was a 36-year-old woman who was hospitalized due to hyperglycemic crisis and seizures. She was diagnosed with MELAS syndrome two years previously, and had gradually progressing dementia and hearing loss. However, following the acute onset of diabetes, she developed rapid cognitive decline and loss of ability to perform daily activities. In conclusion, the acute onset of diabetes could be an associated risk factor for rapid cognitive decline in patients with MELAS syndrome. Thus, these patients as well as healthy carriers with related genetic mutations should undergo diabetes education and screening tests. Moreover, clinicians should be aware of the possibility for acute onset of hyperglycemic crisis, particularly in the presence of triggering factors. Diabetes is a common endocrine manifestation of mitochondrial diseases, presenting with a type 1- or type 2-like phenotype depending on the level of insulinopenia. Metformin should be avoided in patients with mitochondrial diseases to prevent metformin-induced lactic acidosis. Mitochondrial diabetes can manifest before or after the onset of MELAS syndrome. In patients with MELAS syndrome, diabetes can initially manifest with a life-threatening severe hyperglycemic crisis and can cause rapid cognitive decline. Diabetes screening tests (e.g. hemoglobin A1c, oral glucose tolerance test, or random blood glucose level measurement) should be performed either systematically or in the presence of symptoms, particularly after triggering events. Genetic testing and counseling should be provided to patients and their families for the purpose of better understanding the inheritance, progression, and possible outcomes of the disease.

Analysis of the epidemiology, coexisting skin diseases, and variables affecting seborrheic dermatitis severity

Seborrheic dermatitis (SD) is a common chronic skin disease that has a repeating future. SD affects between 1 and 3% of adults with normal immunity. Recent studies have shown that many cutaneous diseases, including SD, are associated with other skin conditions. In this current study, we aimed to assess the epidemiology, comorbid skin diseases accompanying the SD, and factors affecting the severity of the SD. This was a prospective study conducted in dermatology departments between January 2020 and December 2020. The baseline demographic data was recorded. Disease severity was assessed according to the Seborrheic Dermatitis Area and Severity Index (SDASI) scoring system. In this study, 211 patients with SD (92 men and 119 women) were included. The mean age of the patients was 32.51±15.31 years (range: 11–82). The mean disease duration was 38.59 months (range: 1–720 months). Emotional distress was the most common trigger, followed by seasons. The scalp, eyebrows, ears, nasolabial region, forehead, intermammary, postauricular area, and back were the body parts most frequently afflicted. 43 out of 211 patients had concomitant systemic diseases, and 64.5% of the patients had concomitant skin diseases. Also, almost half of the patients applied in the winter. The mean SDASI was 2.92±1.2 (range 0.3–8.1). In this study, SD was more commonly reported in females and the winter. Disease severity was higher in smokers and patients who applied in the summer. The severity of SD was unaffected by concomitant skin disease, gender, age, educational level, working status, skin type, alcohol consumption status, presence of trigger factors, comorbid skin and systemic diseases, and family history of SD or skin diseases. To improve the quality of life for SD patients, factors impacting disease severity should be carefully managed.

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits.

Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.

A case of post-splenectomy posterior reversible encephalopathy syndrome: a reversible event

Posterior reversible encephalopathy syndrome (PRES) is a disease characterized by features of clinical and neuroimaging findings. The basics of recognizing the entity include a combination of clinical features and radiological findings in the presence of triggering factors. Clinically the patient can have various presentations like nausea, vomiting, blurring of vision, seizures, altered consciousness, transient motor deficits, or cortical blindness. Radiologically the findings can be picked up by computed tomography (CT), magnetic resonance imaging (MRI), or diffusion-weighted imaging. The usual factors that can trigger the PRES include blood pressure fluctuations, eclampsia/preeclampsia, renal failure, cytotoxic agents, and autoimmune conditions. With vigilant suspicion and prompt treatment, patients can be saved from serious complications. Here we wish to report a case of a 22-year male patient who developed PRES syndrome after undergoing an emergency splenectomy and recovered with conservative medical management for the condition. This syndrome can be managed well with an early diagnosis which needs keen suspicion and prompt treatment.

ATP1A3-related disorders: An update.

Alternating Hemiplegia of Childhood (AHC), Rapid-onset Dystonia Parkinsonism (RDP) and CAPOS syndrome (cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss) are three distinct, yet partially overlapping clinical syndromes that have long been thought to be allelic disorders. From 2004 to 2012, both autosomal dominant and de novo mutations in ATP1A3 have been detected in patients affected by these three conditions. Growing evidence suggests that AHC, RDP and CAPOS syndrome are part of a large and continuously expanding clinical spectrum and share some recurrent clinical features, such as abrupt-onset, asymmetric anatomical distribution and the presence of triggering factors, which are highly suggestive of ATP1A3 mutations. In this review, we will highlight the main clinical and genetic features of ATP1A3-related disorders focussing on shared and distinct features that can be helpful in clinical practice to individuate mutation carriers.

Suicide attempts in emergency department

IntroductionThe suicide attempt is a real challenge for the clinician who works at the emergency department in order to identify and propose an adequate care.AimsTo estimate the prevalence of the suicide attempts, to describe the sociodemographic and clinical characteristics and to identify the predictors of recurrence.MethodsOur cross-sectional study was conducted at the medical emergency department of the university hospital of Mahdia and lasted for 12 months. Data were collected using a questionnaire of 51 items exploring the general and clinical characteristics and providing information of the treatment.ResultsAmong the 513 consultants, 90 had attempted suicide (17,5%). We found an average age of 26 years old, a sex-ratio (M/F) of 0,3, a secondary education level (53,3%), an unemployment and a single status (38,9% and 75,6%). The presence of psychiatric personal history and/or suicide attempts was found in 31,1% and 33,3% of cases. Suicide attempts were taken place in all cases at home, between 18 and midnight (43,3%), without premeditation (82,2%), in the presence of triggering factor (95,6%), during the last 3 months of the year (34,4%). In 70,2% of cases, the type of the suicide attempts was a drug intoxication. 67,8% of the suicide attempters regretted and criticized their acts.ConclusionA good assessment of the suicide risk determines the type of intervention that should be established and allows an adequate care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trigger factors in asthma and chronic obstructive pulmonary disease: a single-centre cross-sectional survey.

The presence of trigger factors may help to distinguish asthma from chronic obstructive pulmonary disease (COPD). Knowing and avoiding trigger factors for both asthma and COPD can facilitate the design of comprehensive management programmes that can aid disease control. This study aimed to describe the relative frequency and range of various trigger factors in asthma and COPD. We conducted a telephone-based survey involving asthma and COPD patients on follow-up at a university hospital in Singapore. A total of 779 asthma patients and 129 COPD patients participated in this study. Among these patients, 93.8% of those with asthma and 42.6% of those with COPD had trigger factors (p < 0.001). The median number of trigger factors was greater among asthma patients than among those with COPD (3 vs. 0, p < 0.001). Trigger factors found to be significantly more prevalent among asthma patients compared to those with COPD include tobacco smoke, alcohol, upper respiratory tract infections, incense smoke, perfume, laughter, a dusty environment, air-conditioning, heavy rain, heavy traffic fumes, citrus fruits, gastro-oesophageal reflux, household pets, flowers/pollen, medications and psychological triggers. Trigger factors that were not previously described, such as bathing, fatigue, insufficient sleep, crowded places and overeating, were also reported. Trigger factors, although found in both groups of patients, were more common among asthma patients. Knowledge of these trigger factors may be useful in distinguishing between the two diseases and optimising disease management.

Prevalence of Triggering Factors in Acute Stroke: Hospital-based Observational Cross-sectional Study

Although chronic risk factors for stroke are reasonably well understood, the acute precipitants, or triggers, of stroke relatively remain understudied. Identification of particular time periods during which stroke risk is elevated could prove a valuable strategy to reduce stroke incidence through the introduction of appropriate prevention strategies during a period of vulnerability. The aim of this study was to determine the prevalence of trigger factors in acute stroke patients and to investigate the association of the presence of trigger factors with initial stroke severity at presentation (National Institutes of Health Stroke Scale (NIHSS) score in ischemic stroke patients and volume of hematoma in hemorrhagic stroke patients). This was a hospital-based observational cross-sectional study. All consecutive patients of recent stroke (reporting within 1 week of stroke onset) were included in the study. This study examined the prevalence of 11 predefined triggers (including both well-established and potential triggers) in predefined hazard periods. In total, 290 patients participated in the study. Presence of any trigger factor out of 11 trigger factors studied was seen in 128 (44.2%) of 290 patients, 104 (46.4%) of 224 ischemic stroke patients and 24 (36.4%) of 66 hemorrhagic stroke patients. Psychological stress was present in 51 (17.6%) patients, among psychological stress: stressful life event in 34 (11.7%), negative affect in 17 (5.9%), acute alcohol abuse in 31 (10.7%), clinical infections in 24 (8.3%), and anger and coffee intake in 12 (4.1%) each. Sexual activity, trauma, and surgery were present in 5 (1.7%), 4 (1.4%), and 5 (1.7%) patients, respectively. None of the patients reported exposure to recreational drug abuse, startling event, and unusual vigorous physical exertion in hazard periods. Two or more trigger factors were present in 16 (5.5%) patients. Clinical variables independently associated with the presence of trigger factors in acute stroke after multivariate analysis were younger age (<60 years) and stroke severity at initial presentation (ie, higher NIHSS score and higher hematoma volume). Trigger factors were present in 44.2% of acute stroke patients. Psychological stress (17.6%), acute alcohol abuse (10.7%), and clinical infections (8.3%) were the most common triggers. Younger age (<60 years) and stroke severity at initial presentation were independently associated with the presence of trigger factors in acute stroke patients. However, these associations need to be further explored in community-based studies.

THU0381 Clinical determinants of attack prodrome in patients wiht familial mediterranean fever

BackgroundFamilial Mediterranean fever (FMF) is the most frequent form of periodic fever syndromes which is characterized by recurrent febrile inflammatory attacks of serosal and synovial membranes. Attacks are usually preceded...

Cranial neuralgias: from physiopathology to pharmacological treatment

Cranial neuralgias are paroxysmal painful disorders of the head characterised by some shared features such as unilaterality of symptoms, transience and recurrence of attacks, superficial and "shock-like" quality of pain and the presence of triggering factors. Although rare, these disorders must be promptly recognised as they harbour a relatively high risk for underlying compressive or inflammatory disease. Nevertheless, misdiagnosis is frequent. Trigeminal and glossopharyngeal neuralgias are sustained in most cases by a neurovascular conflict in the posterior fossa resulting in a hyperexcitability state of the trigeminal circuitry. If the aetiology of trigeminal neuralgia (TN) and other typical neuralgias must be brought back to the peripheral injury, their pathogenesis could involve central allodynic mechanisms, which, in patients with inter-critical pain, also engage the nociceptive neurons at the thalamic-cortical level. Currently available medical treatments for TN and other cranial neuralgias are reviewed.

Benign Paroxysmal Vertigo of Childhood: Categorization and Comparison With Benign Positional Paroxysmal Vertigo in Adult

IntroductionThe differential diagnosis of vertigo in children is extensive. This implies an additional difficulty in diagnosing dizziness in paediatric population. Patients and methodTwenty-three children consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks entered our study, and were compared to a 15 adults group with benign positional paroxysmal vertigo. Fifteen healthy paediatric subjects and 18 adults were selected as control groups. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine, and other accompañying symptoms were considered. Neurological, vestibular, and auditory functions were assessed includinf the performance of a posturography in every group of patients. ResultsThe presence of migraine, physical activity prior to vertigo, and the positional trigger of vertigo were the clinical elements wich differentiated both populations of patients with vertigo. There were significant differences in adult posturography between vertigo and control groups. In paediatric population, there were no differences between vertigo and control group in the posturography study. ConclusionsThe benign paroxysmal vertigo of childhood complex is the most frequent aetiology of paediatric dizziness. The duration and triggers of vertigo in children are quite similar to those found in VPPB adults. The instability posterior to vertigo, measured by posturography, were less intense in children than in adult population.

Genetic Polymorphisms and Arrhythmia Susceptibility

Over the past 10 years, remarkable advances have been made in identifying the genes responsible for primary electrical heart diseases, such as congenital long QT syndrome and Brugada syndrome. Basic and clinical studies on these inherited arrhythmias have provided significant insight into the molecular basis of cardiac electrophysiology and the mechanisms of arrhythmias. However, many studies of genotype - phenotype relationships in these diseases have revealed considerable phenotypic variability in individuals from the same kindred carrying the identical disease-associated DNA variant, as is commonly observed in other polygenic disorders. Furthermore, despite rapid progress in understanding the molecular basis of primary electrical heart diseases, there is little insight into the genetics of acquired arrhythmias. Recently, it has been recognized that common genetic polymorphisms in cardiac ion channel and other genes may modify cardiac excitability, which in turn predisposes affected individuals to arrhythmias in the presence of triggering factors, such as electrolyte abnormalities or drugs. This paper reviews the current understanding of the contribution of genetic polymorphisms to the pathophysiology of cardiac arrhythmias.

Factors Related to Temporal Incapacity in Patients With Fibromyalgia

To know the sociodemographic, clinical and working conditions characteristics related with temporary disability (TWD) in patients with fibromyalgia syndrome (FS).Patients diagnosed with FS who met the American College of Rheumatology's criteria, attending an outpatient clinic for at least three months prior were included. We performed a standard clinical protocol with sociodemographic, clinical and working conditions, dates and number of TWD during the last year. All patients were asked to complete a questionnaire with 40 items [Fibromyalgia impact questionnaire (FIQ) inclusive].The participants were 51 women with FS, 32 of whom needed one or more TWD during the last year. The mean TWD was 83.73 days (DS 98). There was not a statistically significant relationship between the TWD and sociodemographic characteristics in a bivariate analysis. There is a significant trend with hard physical work and with the presence of triggering factors. There was evidence of a significant statistical relationship between TWD with a lack of response to selective serotonin re-uptake inhibitors (SSRIs). We noticed that the highest marks in the FIQ have a direct relationship with patients in a TWD situation.The lack of response to SSRIs was related with TWD process. The patients in TWD situation scored the highest FIQ. There is a trend towards an increase in the TWD with jobs that required physical effort.

Trigger Factor Forms a Protective Shield for Nascent Polypeptides at the Ribosome

In prokaryotes, the ribosome-associated Trigger Factor is the first chaperone newly synthesized polypeptides encounter when they emerge from the ribosomal exit tunnel. The effects that Trigger Factor exerts on nascent polypeptides, however, remain unclear. Here we analyzed the potential of the Trigger Factor to shield nascent polypeptides at the ribosome. A set of arrested nascent polypeptides differing in origin, size, and folding status were synthesized in an Escherichia coli-based in vitro transcription/translation system and tested for sensitivity to degradation by the unspecific protease proteinase K. In the absence of Trigger Factor, nascent polypeptides exposed outside the ribosomal exit tunnel were rapidly degraded unless they were folded into a compact domain. The presence of Trigger Factor, as well as a Trigger Factor fragment lacking its peptidyl-prolyl isomerase domain, counteracted degradation of all unfolded nascent polypeptides tested. This protective function was specific for ribosome-tethered Trigger Factor, since neither non-ribosomal Trigger Factor nor the DnaK system, which cooperates with Trigger Factor in the folding process in vivo, revealed a comparable efficiency in protection. Furthermore, shielding by Trigger Factor was not restricted to short stretches of nascent chains but was evident for large, non-native nascent polypeptides exposing up to 41 kDa outside the ribosome. We suggest that Trigger Factor supports productive de novo folding by shielding nascent polypeptides on the ribosome thereby preventing untimely degradation or aggregation processes. This protected environment provided by Trigger Factor might be particularly important for large multidomain proteins to fold productively into their native states.

Neuro-otological features of Benign Paroxysmal Vertigo and Benign Paroxysmal Positioning Vertigo in children: A follow-up study

Background: Causes of benign episodic vertigo in paediatric age include benign paroxysmal vertigo of childhood (BPV) and benign paroxysmal positional vertigo (BPPV). Objective: The aim is to review the clinical, audiological and vestibular findings in a cohort of children with BPV and in a group of children with BPPV and to highlight the differences useful to formulating a differential diagnosis. Methods: Eighteen children, aged 4–9 years, consecutively examined for paroxysmal attacks of dizziness and/or vertigo attacks between January 2002 and December 2002 entered our study. The clinical characteristics of vertigo, presence of triggering factors, family history of migraine, presence of motion sickness, migraine and other accompanying symptoms were considered. Neurological, ophthalmologic, vestibular and auditory functions were assessed. Results: Eight children suffered from BPPV and ten children from BPV. In the BPPV group, the vestibular examination was normal except for the Dix–Hallpike maneuver. Liberatory maneuvers were immediately effective in all patients and all remained symptom-free during the follow-up. In the BPV group, the vestibular examination was positive in 3 patients but none had positive Dix–Hallpike maneuver. All patients with BPV have a positive family history of migraine and seven had a history of motion sickness. In all, migraine was present one year before the vertigo symptoms, with a frequency of at least two migraine episodes a month. Conclusion: BPV differs from BPPV in terms of family history, clinical symptoms, otoneurological signs, therapy and clinical evolution. BPPV is characterized by specific otoneurological signs, and must be treated with liberatory maneuvers: neither medical therapy nor strict follow-up is needed.

Gene-environment interaction: a central concept in multifactorial diseases.

Unlike the rare and severe genetic defects that cause monogenic diseases, the genetic factors that modulate the individual susceptibility to multifactorial diseases (cardiovascular diseases, cancers, diabetes, etc.) are common, functionally different, forms of genes (polymorphisms), which generally have a modest effect at an individual level but, because of their high frequency in the population, can be associated with a high attributable risk. Environmental factors can reveal or facilitate the phenotypic expression of such susceptibility genes. Indeed, in common diseases genetic effects can be considerably amplified in the presence of triggering factors. There is now accumulating evidence that most of the susceptibility genes for common diseases do not have a primary aetiological role in predisposition to disease, but rather act as response modifiers to exogenous factors such as stress, environment, disease, drug intake. A better characterisation of the interactions between environmental and genetic factors constitute a key issue in the understanding of the pathogenesis of multifactorial diseases. The present paper will review three examples of gene-environment interactions in the field of CHD.

Assisted folding of D-glyceraldehyde-3-phosphate dehydrogenase by trigger factor.

The Escherichia coli trigger factor is a peptidyl-prolyl cis-trans isomerase that catalyzes proline-limited protein folding extremely well. Here, refolding of D-glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in the presence of trigger factor was investigated. The regain of activity of GAPDH was markedly increased by trigger factor after either long- or short-term denaturation, and detectable aggregation of GAPDH intermediates was prevented. In both cases, time courses of refolding of GAPDH were decelerated by trigger factor. The reactivation yield of GAPDH showed a slow down-turn when molar ratios of trigger factor to GAPDH were above 5, due to tight binding between trigger factor and GAPDH intermediates. Such inactive bound GAPDH could be partially rescued from trigger factor by addition of reduced alphaLA as competitor, by further diluting the refolding mixture, or by disrupting hydrophobic interactions in the complexes. A model for trigger factor assisted refolding of GAPDH is proposed. We also suggest that assisted refolding of GAPDH is due mainly to the chaperone function of trigger factor.

Prognostic factors for recurrence of a first seizure during childhood.

This study was designed with the objective of evaluating the chance of recurrence in our area and to answer questions regarding prognostic factors capable of helping in the management of the first seizure in childhood. One hundred and thirty six children from 1 month to 12 years of age seen at the Pediatric Emergency Division of Hospital de Clínicas de Porto Alegre because of a first seizure with or without triggering factors were included in the study. The follow-up included 121 children. We concluded that family history of seizures, presence of triggering factors at first event, seizure type, seizure duration and paroxysmal electroencephalographic abnormalities were predictive factors for seizure recurrence. The recurrence in this sample was 36.36% during the study. Cumulative recurrence risks were 14.88%, 23.14%, 28.93%, 33.06% and 35.54% to 3, 6, 9, 12 and 15 months, respectively.

Hepatic cytochrome P450-mediated oxidation function in migraine.

Hepatic cytochrome P450-dependent oxidation is deficient in 5% to 10% of the Caucasian population. A similar percentage seems to suffer from migraine. The hypothesis was tested that an oxidation deficiency possibly relevant to potential dietary triggers plays a role in the pathogenesis of migraine. In 37 migraine sufferers and 26 controls age- and sex-matched to 26 of these patients, debrisoquine hydroxylation following an oral dose of 10 mg was employed as a marker of oxidation status, determined by calculating the metabolic ratio (MR): urinary debrisoquine/urinary 4-hydroxydebrisoquine. MR was similarly distributed in migraineurs and controls. Three subjects in each group were poor metabolizers (MR greater than 30, versus normal range, 0.1-12). MR in patients did not depend on type of migraine (common versus classic), attack frequency, the presence of trigger factors, smoking or a history of adverse reactions or sensitivity to medicines.