Risk Of Recurrent Episodes Research Articles

Complete Melkersson-Rosenthal syndrome: an exceptional cause of facial nerve palsy

Melkersson-Rosenthal syndrome (MRS) is a rare disease, with unknown etiology characterized by oro-facial oedema, fissuring tongue and peripheral facial palsy. The mainstay treatment is corticosteroids. We report the case of a 38-year old female, who presented six recurrent episodes of left peripheral facial palsy associated with simultaneous oedema of the median frontal area, treated successfully by short course oral corticosteroids with neuromuscular facial re-education. However, the recovery of the last episode was incomplete and the patient kept a left House-Brackmann grade II facial palsy at six months. The median frontal area was slightly inflammatory, being the location of simultaneous repetitive oedema and the tongue was fissured. These cardinal symptoms realise the complete triad of Melkersson-Rosenthal syndrome (MRS). The histopathological examination of the lip biopsy showed lymphocytic inflammation around the blood vessels. Since the residual facial palsy was graded as mild dysfunction, the frontal oedema fully recovered and the fissured tongue was not painful, the treatment consisted on appropriate neuromuscular re-education. The 6 months follow-up showed no recurrence with a stable grade II left facial palsy. We present this case to supplement the rare literature data concerning the management of this rare entity. Patients should be prepared to the risk of recurrent episodes with longer duration of symptoms and more incomplete recoveries, which may indicate other therapeutic options.

Optimizing medical management for diverticular disease: A systematic review and gap analysis

BackgroundResolution of acute diverticulitis is often associated with ongoing gastrointestinal symptoms and risk for recurrent episodes. Surgical guidelines recommend individualized treatment options but medical management strategies have been inconsistently implemented in surgical practice. This study reviews the evidence for medical management to reduce episodes or decrease gastrointestinal symptoms to inform shared decision-making discussions with patients and identifies key evidence gaps for the medical management of diverticular disease. MethodsPubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched to identify randomized clinical trials on recurrent acute diverticulitis and symptomatic uncomplicated diverticular disease that studied medical treatment strategies including fiber supplementation, probiotics, mesalamine, and rifaximin. Two independent researchers screened references and assessed articles for eligibility. Outcomes of interest included patient-reported symptom improvement and diverticulitis recurrence. Results27 of 485 unique articles identified in the electronic research met eligibility for inclusion. Three focused on fiber, three on probiotics, twelve on mesalamine, and nine on rifaximin with conflicting results. ConclusionMedical management options are available and may be helpful in some patients following resolution of acute diverticulitis to improve symptom burden and recurrent episodes of diverticulitis. Further investigation is needed to inform which subpopulation of patients are likely to benefit from different treatment strategies.

Trends and Predictors of Large Tuberculosis Episodes in Cattle Herds in Ireland.

Persistence of bovine tuberculosis (bTB) in cattle is an important feature of Mycobacterium bovis infection, presenting either as herd recurrence or local persistence. One risk factor associated with the risk of recurrent episodes is the severity of a previous bTB episode (severity reflecting the number of bTB reactors identified during the episode). In this study, we have sought to identify predictors that can distinguish between small (less severe) and large (more severe) bTB episodes, and to describe nationally the severity of bTB episodes over time. The study included descriptive statistics of the proportion of episodes by severity from 2004 to 2015 and a case-control study. The case-control study population included all herds with at least one episode beginning in 2014 or 2015, with at least two full herd tests during the episode and a minimum herd-size of 60 animals. Case herds included study herds with at least 13 reactors whereas control herds had between 2 to 4 (inclusive) reactors during the first 2 tests of the episode. A logistic regression model was developed to identify risk factors associated with a large episode. Although there has been a general trend towards less severe herd bTB episodes in Ireland over time (2004–2015), the proportion of large episodes has remained relatively consistent. From the case-control study, the main predictors of a large episode were the year the episode started, increasing herd-size, previous exposure to bTB, increasing bTB incidence in the local area, an animal with a bTB lesion and a bTB episode in an associated herd. Herds that introduced more animals were more likely to have a smaller bTB episode, reflecting the reduced risk of within-herd transmission when an episode was due to an introduced infected bTB animal. Some of the risk factors identified in this study such as reactors in previous bTB episodes, herds with an associated herd undergoing a bTB episode, herds in high incidence areas etc. may help to target future policy measures to specific herds or animals for additional surveillance measures. This information has important policy implications.

Analysis of molecular genetic study on the polymorphic C-159T locus of the CD14 gene in children with increased risk of recurrent episodes of acute obstructive bronchitis

A molecular genetic study of the polymorphic C-159T locus of the CD14 gene has been carried out in 31 children with recurrent episodes of acute obstructive bronchitis as well as in a cohort of 50 randomly sampled subjects forming the control group. As a result of the study, no higher statistically significant frequency of the CC, CT, and TT genotypes has been recorded at the polymorphic C-159T locus of the CD14 gene among children of the main group compared with the control. However, there is a trend towards a more frequent observation of the TT genotype among children with recurrent episodes of acute obstructive bronchitis compared with the control group (32.25 vs. 22.0%).

Fear avoidance model – review of selected reports

SUMMARY: Based on the bio-psycho-social approach, fear-avoidance model can be used in situations when somebody avoids movement because of fear of pain. This model can be applied in groups of patients with low back pain and musculoskeletal pain and explains how acute pain becomes chronic. A simple behavioral model of classical and operant conditioning that explains activity avoidance was developed into a more sophisticated, cognitive-behavioral fear-avoidance model, postulating the existence of a vicious circle that causes increasing disability of patients in chronic pain. The variables involved in this mechanism are catastrophizing, fear of activity, avoiding movement, increased distress and fear-avoidance beliefs. This article also presents some further improvements to the model that include pain intensity and motivational theory. A brief overview of tools used in research on fear-avoidance is also presented. It is recommended to take Fear Avoidance Model in to consideration when working with patients with no improvement and the risk of recurrent episodes of pain. Further studies are needed to empirically verify the fear-avoidance model.

Allelic polymorphism C-590T of the IL4 gene as a probable genetic marker for the increased predisposition to the development of recurrent episodes of acute obstructive bronchitis in children

Acute respiratory infections (ARIs) hold the first place among all infections throughout the world. ARIs are frequently complicated by the development of acute obstructive bronchitis (AOB). According to different authors, the frequency of developing AOB due to ARIs in children ranges from 5 to 40%. The growing occurrences of ARIs in children and the formation of bronchoobstructive syndrome that frequently ends up in the development of bronchial asthma, leading children to invalidity, specify a new priority research area—molecular genetic markers sought for to identify an increased predisposition to certain socially important illnesses. The molecular-genetic testing of the polymorphic C-590T locus of the IL4 gene as the marker of increased predisposition to the development of recurrent episodes of AOB were conducted in 31 children with frequent ARIs and recurrent episodes of AOB and in 50 general-population control subjects. The level of IgE in the blood serum was studied in 31 children with frequent recurrent episodes of AOB and compared with the data of 35 control children with acute bronchitis. The comparative molecular genetic analysis of the results in children with recurrent episodes of AOB and the data obtained from the subjects of a general population control group has shown that the frequency of the CT genotype at the polymorphic C-590T locus of the IL4 gene was noticeably higher in children with recurrent AOB episodes. The markedly higher frequency of the CC genotype at the polymorphic C-590T locus of the IL4 gene was recorded in the control group subjects and compared to the data of children from the main group. It was established that carrying the 590 CT genotype with the allelic polymorphism of the IL4 gene increases the risk of recurrent episodes of AOB in children by three times. The level of IgE in the blood serum in the majority of sick children from the main group was four times higher than in the control children.

Can we make sense of takotsubo cardiomyopathy? An update on pathogenesis, diagnosis and natural history

Takotsubo cardiomyopathy (TTC) is a form of reversible acute cardiac dysfunction of uncertain pathogenesis, which occurs predominantly in postmenopausal women, often with antecedent severe stress. Systolic dysfunction most commonly affects the apex of the left ventricle. There is considerable uncertainty regarding the pathogenesis of TTC and the optimal diagnostic methodology. Acute catecholamine release may play a component role, but the regional hypokinesis is associated with an acute inflammatory process, with resultant early release of brain natriuretic peptide (BNP) and N-terminal pro-BNP. As the diagnosis of TTC has largely been a process of exclusion, there has been considerable underdiagnosis. The combination of demographics, preceding history, ECG appearances and N-terminal pro-BNP elevation may provide the basis for improved early diagnosis. Complete recovery takes at least several months, with a risk of recurrent episodes. Efforts to delineate pathogenesis, expedite diagnosis and evaluate residual disability may assist in the development of appropriate treatment regimens.

Impact of Returning First-time Renal Stone Formers to Duty on United States Navy Submarines

Until 1991 most submariners were automatically disqualifed from submarine service after their first kidney stone. The basis for disqualification was the belief that these individuals would be at risk for recurrent episodes, which could result in mission compromising hazardous medical evacuations from deployed submarines. The purpose of this study is to examine the ramifications of returning submariners back to submarine duty following diagnosis of a renal stone.

Prognostic factors in major depression: A long-term follow-up study of 323 patients

Background: Optimal long-term treatment of major depression should assess the background factors affecting remission and recurrent episodes. The duration and number of previous depressive episodes has been shown to be important for recurrence. This long-term prospective study of patients with major depression assessed the prognostic effect of variables related to childhood, social life and occupation. Methods: The study examined 323 patients in two follow-up examinations 12–25 years from the initial examination to the second follow-up. Stepwise logistic regression was used to evaluate the prognostic effect for depression at the second follow-up. Results: The risk of depression at the second follow-up was associated with several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one’s own occupation. Limitations: The patient group was selected from the practice of only one psychiatrist. Conclusions: Several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one’s own occupation have previously been shown to be associated with the risk of depression. The results in this study suggest that these factors are also important in predicting the outcome of a major depressive episode and the risk of recurrent episodes.