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Background: Previous studies have investigated the influence of diabetes on alcoholic liver cirrhosis patients, leaving its impact unclear. Thus, we conducted a study to reveal the association of diabetes and clinical outcomes of such patients. Materials and methods: We prospectively collected data from multicenter pertaining to 965 patients diagnosed with alcoholic liver cirrhosis, all of whom were admitted due to acute decompensation between 2015 and 2019. Risk of major precipitating factors and incidences of death or liver transplantation in patients with and without diabetes was comparatively assessed. Propensity score (PS) matching was performed at a 1:2 ratio for accurate comparisons. Results: The mean age was 53.4 years, and 81.0% of the patients were male. Diabetes was prevalent in 23.6% of the cohort and was positively correlated with hepatic encephalopathy and upper gastrointestinal bleeding, although not statistically significant. During a median follow-up of 903.5 person-years (PYs), 64 patients with and 171 without diabetes died or underwent liver transplantation, with annual incidence of 33.6/100 PYs and 24.0/100 PYs, respectively. In the PS-matched cohort, the incidence of death or liver transplantation was 36.8/100 PYs and 18.6/100 PYs in the diabetes and matched control group, respectively. After adjusting for various factors, coexisting diabetes significantly heightened the risk of death or liver transplantation in the short and long term, in addition to prolonged prothrombin time, low serum albumin, elevated total bilirubin and creatinine, and decreased serum sodium levels. Conclusions: Diabetes increases the risk of death or liver transplantation in patients with alcoholic liver cirrhosis. [ABSTRACT FROM AUTHOR]

Introduction: Moyamoya angiopathy (MMA) has been known to manifest with myriad of neurological manifestations, often in association with various precipitating factors. This is the first study to systematically analyze the precipitating triggers to neurological symptoms done on the largest cohort of MMA in India. Methods: A single-centered, cross-sectional observational study, recruiting 160 patients with consecutive angiographically proven MMA over a period of 5 years (2016–2021), was undertaken to evaluate the profile of immediate precipitating factors in temporal association to the neurological symptoms, along with their clinical and radiological characteristics. SPSS 25 was used for statistical analysis. Results: Among the 160 patients (Adult-85, children-75), precipitating factors were seen in 41.3%, significantly higher in children (52%) than adults (31.8%) (p value: 0.011). The commonest triggers included fever (18.8%), emotional stress (8.1%), heavy exercise and diarrhea (6.3% each). Cold bath triggered MMA symptoms in 1.3%. Fever (p value: 0.008) and persistent crying (p value: 0.010) triggered neurological symptoms more commonly in children than in adults. Amongst MMA patients with precipitating factors, the commonest MMA presentation included cerebral infarction type (37.9%) and TIA (31.8%). The majority of precipitating factors that preceded an ischemic event were BP-lowing ones (54.7%). Conclusion: Neurological symptoms of MMA are commonly associated with several precipitating factors, including the lesser known triggers like cold bath. The frequency and profile precipitating factors varies with the age of presentation and type of MMA. It can serve as an early clue to the diagnosis of MMA and its careful avoidance can be largely beneficial in limiting the distressing transient neurological symptoms. [ABSTRACT FROM AUTHOR]

Background: Hypoglycemia is the most common complication and the most important obstacle to overcome to achieve good glycemic control in diabetic patients. It causes serious consequences, leading to increased morbidity and mortality. Objective: To identify the precipitating factors of hypoglycemia in diabetic patients undergoing treatment in Taksin hospital. Materials and Methods: A case-control study was conducted in 110 diabetic patients admitted due to hypoglycemia and 110 diabetic patients admitted for other reasons at Taksin Hospital, between October 2019 and September 2020. The sociodemographic information, clinical data, and precipitating causes of hypoglycemia were obtained from medical records. Logistic regression analysis was performed to identify the risk factor and reported as odds ratio (OR) with 95% confidence intervals (CI). Results: The multiple logistic regression analysis showed that the precipitating factors related to hypoglycemia among diabetic patients with a significant p-value (p<0.05) were poor self-care knowledge of hypoglycemia prevention (adjusted OR 14.37, 95% CI 5.75 to 35.89), insulin treatment in diabetic patients (adjusted OR 13.78, 95% CI 5.43 to 34.99), and intensive glycemic control HbA1c of less than 6% (adjusted OR 3.64, 95% CI 1.70 to 7.79). Furthermore, the result from the present study showed that individual factors were statistically significant and related to hypoglycemia. The factors included the age more than 60 years, low education level, functionally dependent patients, diabetes duration more than 10 years, hypertension, dyslipidemia, diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, and cognitive impairment. Conclusion: Poor self-care knowledge of hypoglycemia prevention, insulin treatment in diabetic patients, and intensive glycemic control were strong predictors of hypoglycemia in diabetic patients undergoing treatment in Taksin Hospital. Therefore, diabetes self-management education and tailoring diabetic therapy should be provided in diabetic patients to improve treatment and prevention of hospitalization due to hypoglycemia in diabetes. [ABSTRACT FROM AUTHOR]

Copyright of China Surfactant Detergent & Cosmetics (1001-1803) is the property of China Surfactant Detergent & Cosmetics Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Acne vulgaris (AV) is an inflammatory disease of the pilosebaceous unit, which often causes stress and disrupts quality of life. Correctly identifying precipitating factors and preventing disease development will holistically increase the effectiveness of acne therapy, enabling better therapeutic outcomes to be achieved. Purpose: The objective of this study is to identify the clinical profile and precipitating factors of AV patients who visited Dr. Saiful Anwar Hospital between 2015 until 2017. Methods: This was a descriptive study, using a retrospective case study approach. The sample data was collected from medical records of AV patients from the period of 2015–2017 who met the following inclusion criteria: new AV cases with a complete medical record including gender, age, and precipitating factors. The dependent variable of this study was new AV patients, while the independent variables were the patient clinical profile and precipitating factors. Results: This study included 930 samples, with the number of female patients significantly higher (75.48%) than the number of males. The highest AV prevalence was found in the 15–24 years age group. The most common precipitating factors in females were hormonal issues, stress, and cosmetics; in males, these were stress, genetics, and dietary factors. Conclusion: The incidence of AV at Dr. Saiful Anwar Hospital mostly occurs in the 15–24 years age group, with varying trigger factors. The most frequent AV trigger factor in female patients was hormonal issues; in males, this was stress.

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Acute on chronic liver failure (ACLF) can be precipitated by several factors such as bacterial infection, alcohol intake, viral hepatitis, surgery, etc. Identification of precipitating factor is an important part of management of ACLF. A middle aged gentleman was presented with features of acute liver failure and after through history and investigations, he was diagnosed as acute on chronic liver failure. Chronic liver disease was first diagnosed after this event of acute insult. Precipitating factor of ACLF was dengue fever in this case report. Therefore, in endemic area of dengue infection, dengue serology tests which are not routinely done should be advised to identify dengue infection as an acute insult in ACLF.

Objectives: Piriformis tightness is one of the potential cause of pain, discomfort and dysfunction in community. However the ergonomic risk factors, pain (type, intensity, precipitating factors), physical anthropometrics specific to piriformis tightness were unclear. Hence the attempt was made to find the data and trends in piriformis tightness and it prevalence in bankers. Methodology: Study was conducted by approaching 36 banks in Karad taluka. Total 260 subjects (M:162;F:98) were included in the study who were assessed for there piriformis tightness by piriformis stretch test. There demographic data, no. of working years, pain (type, intensity, precipitating factor), chair height, chair width, cushion support were also documented. Result: Prevalence of piriformis tightness in bankers was 51.92%. Out of 135(M:93; F:42) bankers having tightness, 44 were having only right side involved, 22 were having left side involved and 69 were having bilateral tightness. Prevalence was more in people with BMI between 25-29kg/m² (pre-obese) and in fourth decade of life Conclusion: Out of 260 subjects 135(51.92%) bankers were having piriformis tightness. There is increasing risk of getting piriformis tightness with increasing BMI, Age. There is not significant relation between the chair height Chair weight and Cushion support on the chair and the piriformis tightness. There was increasing pain in sitting position(after maintaining for long time) and is relieved by rest. [ABSTRACT FROM AUTHOR]

• Patients with HF of an ischemic etiology had the highest rate of death and/or HF hospitalization. • Patients with worsening HF precipitated by renal failure were associated with highest risk of death and/or HF hospitalization. • There was no interaction between HF etiologies and precipitating factors for worsening HF with regard to the study outcomes. • Treatment up-titration likely benefits patients irrespective of their etiology and/or precipitant factor. Knowledge on the association between heart failure (HF) etiologies, precipitant causes and clinical outcomes may help in ascertaining patient's risk and in selecting tailored therapeutic strategies. The prognostic value of both HF etiologies and precipitants for worsening HF were analyzed using the index cohort of BIOSTAT-CHF. The studied HF etiologies were: a) ischemic HF; b) dilated cardiomyopathy; c) hypertensive HF; d) valvular HF; and e) other/unknown. The precipitating factors for worsening HF were: a) atrial fibrillation; b) non-adherence; c) renal failure; d) acute coronary syndrome; e) hypertension; and f) Infection. The primary outcome was the composite of all-cause death or HF hospitalization. Among 2465 patients included in the study, 45% (N = =1102) had ischemic HF, 23% (N = =563) dilated cardiomyopathy, 15% (N = =379) other/unknown, 10% (N = =237) hypertensive and 7% (N = =184) valvular HF. Patients with ischemic HF had the worst prognosis, whereas patients with dilated cardiomyopathy had the best prognosis. From the precipitating factors for worsening HF, renal failure was the one independently associated with worse prognosis (adjusted HR (95%CI) = =1.48 (1.04–2.09), p < 0.001). We found no interaction between HF etiologies and precipitating factors for worsening HF with regard to the study outcomes (p interaction > 0.10 for all). Treatment up-titration benefited patients regardless of their underlying etiology or precipitating cause (p interaction > 0.10 for all). In BIOSTAT-CHF, patients with HF of an ischemic etiology, and those with worsening HF precipitated by renal failure (irrespective of the underlying HF etiology), had the highest rates of death and HF hospitalization, but still benefited equally from treatment up-titration. [ABSTRACT FROM AUTHOR]

ntroduction: The national incidence rate of the suicide attempts has grown year after year, where the department of Quindío is above the countries' rate, making it mandatory to have a characterization of the population as well as the identification of the factors related to the attempt of suicide in the region. Objective: Describe the attempt of suicide in the city of Armenia (Quindío) between 2016 and 2018. Methodology: A descriptive observational study was conducted with a first suicide attempted reported by SIVIGILA using descriptive statistics, Chi square tests and Mann Whitney. Results: A sample of 598 reported suicide attempted cases was analyzed, where more of the 50% were people under 29 years old, and according to their marital status, 68.9% did not have a partner at the moment, the predominant socioeconomic stratum was low and the most frequent mechanism was poisoning. There was a finding in the relation between previous suicide attempts and legal problems, psychiatric disorder backgrounds and consumption of psychoactive substances (SPA). According to the epidemiological period in the years analyzed, the tendency was increasing for the IX and XI periods. [ABSTRACT FROM AUTHOR]

The present study is planned to assess etiologies, course, and outcome in patients with acute-on-chronic liver failure (ACLF). Two hundred and eight (182 males and 26 females) patients of ACLF fulfilling modified Asia Pacific Association For Study Of Liver Consensus criteria 2009 admitted to the gastroenterology department of SMS Medical College and hospital, Jaipur, between October 2015 and December 2017 were included. We evaluated etiology of underlying chronic disease and the acute event precipitating decompensation in ACLF. Most common etiology of chronic liver disease (CLD) was alcohol with 133 (63.94 %) patients. Viral hepatitis, cryptogenic cirrhosis, autoimmunity, nonalcoholic steatohepatitis, and Wilson disease as causes of CLD were present in 32 (15.4%), 29 (13.94%), 9 (4.3%), 3 (1.4%), and 2 (1%) cases, respectively. Alcohol, sepsis, bleeding, reactivation of hepatitis B, hepatitis E, antitubercular drugs, and autoimmune hepatitis as the causes of acute event were present in 100 (48.08%), 34 (16.35%), 19 (9.1%), 17 (8.2 %), 15 (7.2%), 13 (6.25%), and 2 (0.96%) patients, respectively. In 8 (3.85%) patients, the precipitating event could not be known. Mortality (in-hospital) in this study was 37.5%. Higher model for end-stage liver disease score and high Child-Turcotte-Pugh score score were significantly associated with mortality (P <0.001). Patients with higher ACLF grade were associated with higher mortality. Alcohol as a cause of CLD was significantly associated with mortality (p=0.0146, 95% confidence interval between 3.802 and 30.979). There was no significant difference regarding acute precipitating events between survivors and nonsurvivors. Alcohol was the most common cause for chronic etiology as well as acute precipitating event. Alcohol as a cause of CLD was significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Interest in clinical course preceding heart failure (HF) exacerbation has grown, with a greater emphasis placed on patients' clinical factors including precipitant factor (PF). Large-scale studies with precise PF documentation and temporal-outcome variation remain limited. We reviewed prospectively collected 2412 consecutive patient-level records from a multicenter Japanese registry of hospitalized patients with HF (West Tokyo Heart Failure2 Registry: 2018–2020). Patients were categorized based on PFs: behavioral (i.e., poor adherence to physical activity, medicine, or diet regimen), treatment-required (i.e., anemia, arrhythmia, ischemia, infection, thyroid dysfunction or other conditions as suggested exacerbating factors), and no-PF. The composite outcomes of HF rehospitalization and death within 1 year after discharge and HF rehospitalization were individually assessed. Median patient age was 78 years (interquartile range: 68–85 years), and 1468 (61%) patients had documented PFs, of which 356 (15%) were considered behavioral. The behavioral PF group were younger, more male and had past HF hospitalization history compared to those in the other groups (all p < 0.05). Although risk of in-hospital death was lower in the behavioral PF group, their risk of composite outcome was not significantly different from the treatment-required group (hazard ratio [HR] 1.19 [95% confidence interval {CI} 0.93–1.51]) and the no-PF group (HR 1.28 [95%CI 1.00–1.64]). Furthermore, the risk of HF rehospitalization was higher in the behavioral PF group than in the other two groups (HR 1.40 [95%CI 1.07–1.83] and HR 1.39 [95%CI 1.06–1.83], respectively). Despite a better in-hospital prognosis, patients with behavioral PFs were at significantly higher risk of HF rehospitalization. • Preventing rehospitalization for heart failure (HF) has been a major issue. • Identifying precipitants (PFs) for HF exacerbation would stratify risks for patient's prognosis. • Behavior PFs, defined as poor adherence to medication, exercise, or diet regimen needs investigation. • Patients with behavior PFs had a lower risk of in-hospital mortality. • Patients with behavior PFs had a higher risk of rehospitalization for HF. [ABSTRACT FROM AUTHOR]

The medical records of 186 patients diagnosed with Guillain-Barré syndrome (GBS) who had been followed up at the Research Center of Neurology, Russian Academy of Medical Sciences, in 2000 to 2011 were retrospectively analyzed. Most (65 %) of the patients had severe GBS; 19 % of the patients were on mechanical ventilation (MV) for an average of 21 (13; 48) days. The forms of GBS, such as acute inflammatory demyelinating polyneuropathy (AIDP) (n = 141; 78 %), and axonal variants, such as acute motor axonal neuropathy (AMAN), acute sensorimotor axonal neuropathy (AMSAN), i. e. AMAN / AMSAN (n = 39; 22 %), were studied separately. There was a significant difference in the seasonal revalence (p < 0.05). AIDP was encountered evenly throughout the year; AMAN / AMSAN occurred in 46 % of cases in summer. AIDP was followed by acute respiratory viral infection in 35 % of cases; diarrhea wasby the axonal forms in 36 % (p < 0.05). The axonal forms ran a severer course than AIDP: MV was performed twice more frequently (33 and 15 %, respectively); its duration was 6‑fold longer: 90 (46; 102) and 15 (10; 21) days (p < 0.05). AMAN / AMSAN was characterized by a severer neurological status and disability in the acute period, as shown by the NIS, MRCss, INCAT, R-ODS, and Barthel scales; these patients showed a poorer response to pathogenetic therapy (p < 0.05): 59 % with an insufficient effect; 15 % of those with AIDP. After six years, the majority (84 %) of the patients with AIDP walked alone and only 16 % were assisted. In the same period, less than half of the patients (40 %) with AMAN / AMSAN walked alone and a third (29 %) could move with assistance and almost the same percentage (31 %) could not walk.Thus, a number of specific features of GBS were found in a Russian population (equal age and sex distribution; a larger percentage of the axonal forms than in European countries and the United States); however, the most characteristics did not differ from the global data.

Background Development of infection-associated acute encephalopathy (AE) is precipitated by several factors, including viral agents, age, and genetic polymorphisms. In addition, children with prior underlying neurological disorders can also present with AE. Method We reviewed 55 children with AE who were referred to hospitals participating in the Status Epilepticus Study Group from 1988 to 2013. AE was classified into eight subtypes: acute encephalopathy with biphasic seizures and late reduced diffusion (AESD); hemiconvulsion–hemiplegia syndrome (HH); acute necrotizing encephalopathy; hemorrhagic shock and encephalopathy syndrome (HSES); clinically mild encephalitis/encephalopathy with a reversible splenial lesion; acute encephalitis with refractory, repetitive partial seizures; Reye-like syndrome; and unclassified. Result Of the 55 AE cases, 14 (25.4%) had underlying neurological disorders, including perinatal insults ( n = 6) and genetic syndrome and/or brain malformations ( n = 8). These preceding morbidities were relatively common in AESD (6/18, 33.3%), HH (3/9, 33.3%), and HSES (3/6, 50.0%). History of epilepsy or febrile seizures were frequent in HH cases (4/9, 44.4%), whereas they were rare in other AE subtypes. Conclusion Among the AE subgroups, HH, HSES, and AESD frequently emerged in preceding etiologies with augmented neuronal excitability. These subgroups may have distinct pathomechanism from the “cytokine storm” mediated AEs during childhood. [ABSTRACT FROM AUTHOR]

Aims: Several clinical conditions may precipitate acute heart failure (AHF) and influence clinical outcome. In this study we hypothesized that precipitating factors are independently associated with 90-day risk of death in AHF.Methods and Results: The study population consisted of 15 828 AHF patients from Europe and Asia. The primary outcome was 90-day all-cause mortality according to identified precipitating factors of AHF [acute coronary syndrome (ACS), infection, atrial fibrillation (AF), hypertension, and non-compliance]. Mortality at 90 days was 15.8%. AHF precipitated by ACS or by infection showed increased 90-day risk of death compared with AHF without identified precipitants [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.44-1.97, P < 0.001; and HR 1.51, 95% CI 1.18-1.92, P = 0.001), while AHF precipitated by AF showed lower 90-day risk of death (HR 0.56, 95% CI 0.42-0.75, P < 0.001), after multivariable adjustment. The risk of death in AHF precipitated by ACS was the highest during the first week after admission, while in AHF precipitated by infection the risk of death had a delayed peak at week 3. In AHF precipitated by AF, a trend toward reduced risk of death during the first weeks was shown. At weeks 5-6, AHF precipitated by ACS, infection, or AF showed similar risk of death to that of AHF without identified precipitants.Conclusions: Precipitating factors are independently associated with 90-day mortality in AHF. AHF precipitated by ACS or infection is independently associated with higher, while AHF precipitated by AF is associated with lower 90-day risk of death. [ABSTRACT FROM AUTHOR]

The present cross-sectional study was designed to assess the frequency of 36 possible triggering factors precipitating a migraine crisis (hormonal, environmental, and dietary) in adult outpatients suffering from migraine attacks. A group of 123 migraine sufferers, aged 43.2 ± 13.9 (mean ± SD) years, including 114 (92.7%) women, 68.3% having migraine without aura, 68.3% reporting pain severe enough to require drug prophylaxis, and 29.3% presenting with hypertension, were evaluated. The most common triggers were stress and fasting, and environmental and hormonal factors were frequently found to precipitate a crisis. More than 90% of the patients reported susceptibility to 5 or more factors, and only 2.4% did not complain about any dietary factor. The large number of triggers detected in the present study emphasises the importance of awareness and avoidance of these factors in the management of patients with migraine.El presente es un estudio transversal que fue diseñado para estimar la frecuencia de 36 posibles factores desencadenantes de iniciar una crisis de migraña (hormonales, ambientales y dietéticos) en pacientes adultos ambulatoriales que sufren ataques de migraña. Fue evaluado un grupo de 123 adultos que sufre de migraña, con edades entre 43,2 ± 13,9 (media ± DE), incluyendo 114 (92,7%) mujeres con migraña sin aura, 68,3% de las cuales informaron sentir dolor suficiente como para requerir profilaxis con fármacos y 29,3% con hipertensión. Los factores desencadenantes más comunes fueron el estrés y el ayuno; factores ambientales y hormonales fueron también desencadenantes frecuentes. Más del 90% de los pacientes informaron susceptibilidad a 5 o más factores, y sólo el 2,4% no informó de ningún factor dietético. El gran número de factores desencadenantes detectados en el presente estudio enfatiza la importancia del cuidado y la prevención de estos factores en el manejo de pacientes con migraña.

Objectives: The objective of the study is to identify the precipitating factors among the patients presenting with AHF (Acute Heart Failure). Study Design: Cross sectional study. Setting: Punjab Institute of Cardiology, Lahore. Duration of Study: 6 months. From 01-01-2007 to 30-06-2007. Methodology: The calculated sample size was 170 cases with 5% margin of error, 95% confidence level taking expected percentage of uncontrolled hypertension i.e. 12% (least percentage among all precipitating factors). Results: In the study group, mostly patients of AHF were young with mean age of 55 + 6.99 years, male (61.8%), Diabetic (53.5%) and have history of chronic Heart Failure (63.5%). In male the most common precipitating factor of AHF was ACS (39.04%) while in female uncontrolled hypertension (38.46%). Conclusion: In diabetic patients the most common precipitating factor of AHF was ACS (30.7%). In patients with acute decompensation of chronic heart failure the most common precipitating factor was non-compliance of medication (30.55%) while in patients with de novo Acute Heart Failure it was ACS (41.93%). ACS was the common precipitating factor of Acute Heart Failure (28.2%) among the study group irrespective of gender, diabetes and history of Heart Failure. [ABSTRACT FROM AUTHOR]

Objectives Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap. Method Narrative review based on a literature search of PubMed and Google Scholar. Results Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures. Conclusions The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research. [ABSTRACT FROM AUTHOR]

Background and aim Delirium is common and serious acute syndrome among older people precipitated by multiple external factors such as acute illnesses, trauma, surgery, and drugs. The aim of this study was to find possible stressors and causative triggers for acute delirium and compare patients with or without dementia in this respect. Methods 193 delirious patients from two separate delirium studies including settings of nursing homes and geriatric wards were thoroughly assessed for precipitating factors of delirium. Patients with and without dementia were compared for their clinical status, symptoms and signs, prognosis, and the profile of precipitating factors of delirium. Results The patients with dementia (n = 98) and without dementia (n = 95) did not differ in their demographic factors, mean number of drugs, or their psychiatric symptoms. The patients with dementia had higher number of comorbidities, poorer cognition, and they were more often restrained than those without dementia. The mean number of precipitators for delirium was 2.6 among those without dementia and 2.0 among those with dementia (p = 0.0019). Infections, metabolic conditions, trauma, and surgery were more common precipitating factors for delirium in those without than those with dementia. There was no difference in mortality between the groups. Conclusion Most patients had multiple precipitating factors for delirium irrespective of prior dementia. Those with dementia and decreased cognitive reserves needed lower number of etiologies to develop delirium. The profile of causative agents differed among patients with and without dementia. [ABSTRACT FROM AUTHOR]

Gout results from multifactor interactions between gender, age, genetic and environmental factors. Environmental factors underlying gout and precipitating factors triggering acute attacks might vary in different populations with different lifestyles. In this study, we aimed to collect data regarding the demographic and clinical features, comorbid factors, and precipitating factors associated with the initiation of acute attacks in gout patients in Turkey. A total of 312 patients were included in this study (mean age, 58.8 ± 13.8 years; female/male ratio, 55/257). The demographic features, alcohol intake, clinical and laboratory features, and comorbid conditions including obesity, diabetes mellitus, hyperlipidemia, hypertension, and coronary heart disease were noted in a standard questionnaire. Precipitating factors initiating acute attacks (if any) were also noted. The patients were divided into 4 groups according to the region of location as central Anatolian region, southeast Anatolian region, Aegean region, and Trakya region. Our results were compared according to the gender and the location of the patients. The mean age at the start of the symptoms was 10 years higher in women (60.4 ± 14.8 and 50.6 ± 13.5 years in women and men, respectively, p < 0.001).Obesity was present in 40.1 %, diabetes mellitus in 17.9 %, hyperlipidemia in 30.1 %, hypertension in 53.5 %, coronary artery disease in 17 %, and nephrolithiasis in 21.8 % of patients. Precipitating factors triggering gout flares were as follows: diet (high consumption of meat or fish) in 46.5 %, alcohol consumption in 15.7 %, diuretics in 8.3 %, diet or diuretics in 5.1 %, diet or alcohol in 4.5 %, diet or alcohol or diuretics in 1.6 %, others in 4.2 %, and none in 14.1 %. The presence of diabetes and diuretic use was more common among women. Use of diuretics is a more common trigger for gout flares among women. On the other hand, various comorbid conditions, such as obesity and hypertension, and triggers for gout flares may differ between patients living in different geographic regions. In summary, we reported the first data regarding clinical and demographic characteristics of gout in Turkey. The majority of our patients could describe at least one 'trigger' that initiated gout flare. Both comorbid conditions and triggers of attack might differ between men and women, and in different geographic areas. Better knowledge of the modifiable risk factors can be useful for the management strategy to optimize long-term patient outcomes in local clinics. [ABSTRACT FROM AUTHOR]

Objectives: To observe the effects of hyponatraemia on the complications of liver cirrhosis Study design: Descriptive case series study. Setting: Department of Medicine, Isra University Hospital and Department of Medicine, Liaquat University Hospital Hyderabad / Jamshoro Duration of Study: August 2010 to February 2011. Subjects & Methods: This study comprised of 100 cases of cirrhosis of liver who were admitted in Department of Medicine, Isra University, and Department of Medicine, LUMHS, Jamshoro/Hyderabad. The presenting complaints were presence of distention of abdomen, stupor, irritability, altered sleep pattern, coma and hematemesis. After giving immediate treatment adequate historical information, physical examination and specific pertinent laboratory test results were recorded to the specifically designed proforma after obtaining the informed consent. The main variables studied were frequency of hyponatremia, assessment of degrees of hyponatremia and its effects on the complications of cirrhosis of liver. Results: Out of 100 cases, 67(67%) were male and 33(33%) were female. Hyponatremia was present in 35% patients (n=35/100, total 100). Out of these 20% (n=20) were having mild hyponatremia (Na 135-130 mEq/L), 14% (n=14) moderate hyponatremia (Na 130-125 mEq/L) and only 1% (n=1) severe hyponatremia (Na <125 mEq/L). Twenty eight percent (28%) patients were suffering from hepatic encephalopathy, 23% from bleeding esophageal varices and 9% from spontaneous bacterial peritonitis respectively. Primary outcome was: 63 patients improved and were discharged, 27 patients didn't improved and were still being managed, and lastly 10% patients expired while on treatment. Conclusions: Among hepatic encephalopathy and spontaneous bacterial peritonitis, moderate and severe hyponatremia is one of the major risk factor of mortality and morbidity while normal serum sodium and mild hyponatremia had no effect. [ABSTRACT FROM AUTHOR]

The present cross-sectional study was designed to assess the frequency of 36 possible triggering factors precipitating a migraine crisis (hormonal, environ- mental, and dietary) in adult outpatients suffering from migraine attacks. A group of 123 migraine sufferers, aged 43.2 ± 13.9 (mean ± SD) years, including 114 (92.7%) women, 68.3% having migraine without aura, 68.3% reporting pain severe enough to require drug prophylaxis, and 29.3% presenting with hypertension, were evaluated. The most common triggers were stress and fasting, and environmental and hormonal factors were frequently found to precipitate a crisis. More than 90% of the patients reported susceptibility to 5 or more factors, and only 2.4% did not complain about any dietary factor. The large number of triggers detected in the present study emphasises the importance of awareness and avoidance of these factors in the management of patients with migraine. [ABSTRACT FROM AUTHOR]

The objective of this study was to update the clinical issues of acute intermittent porphyria (AIP), as they have not been in focus for years, and to be aware of potentially associated disorders and social consequences. A total of 356 gene carriers of AIP from northern Sweden participated in this retrospective population-based study. Eight mutations were found with a predominance of W198X (89%). Clinical manifestations of AIP (manifest AIP) were identified in 42%, 65% were women. Women were more severely stricken by AIP attacks concerning number and duration, hospital admission and early onset. Men reporting most attacks were >40 years of age. In addition to traditional symptoms during attacks, fatigue was commonly described. Chronic AIP symptoms and disability pension due to AIP were reported in about 20% of subjects. Precipitating factors were reported with evident sex differences. Half of the gene carriers who were on medications used drugs considered not safe (in 1999), mainly antihypertensive drugs. Smoking was associated with high AIP attack frequency. Elevated levels of ALT, bile acids, creatinine, U-ALA and U-PBG and decreased levels of creatinine clearance were associated with manifest AIP. The same was true for hypertension and myalgia in the legs. Hepatoma was strikingly overrepresented. The high prevalence of manifest AIP in this study could be explained by a mutation-dependent penetrance. Our results emphasize the importance of early diagnosis, counselling and treatment of attacks, screening and treatment of associated disorders. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to assess the possible predisposing aetiologic and short-term precipitating factors for delirium in acutely ill hospital patients with a heavy burden of comorbidities and medications. Methods: Eighty-seven consecutive patients with acute delirium admitted to a general medicine unit were thoroughly examined, and the predisposing and precipitating factors of their delirium were assessed. Results: In this population, an average of 5.2 predisposing factors and 3.0 potential precipitating factors for delirium was revealed, meaning an average of over eight possible aetiological causes for each patient. The most common precipitating factors were infections (n=72), metabolic abnormalities (n=52), adverse drug effects (n=41), and cardiovascular events (n=38). In addition, a number of very rare conditions were diagnosed after thorough assessments. Conclusion: Geriatric patients with acute delirium typically present with several concomitant predisposing factors for delirium exposing them to high vulnerability for the syndrome. In most patients, a number of possible etiological causes for delirium can be identified after a careful assessment, but their true pathogenetic pathway to the syndrome is unclear. [Copyright &y& Elsevier]

Medical records of 513 patients with aneurysmal subarachnoid hemorrhage were reviewed to analyze the factors precipitating aneurysmal rupture. There was no seasonal difference in incidence. A significantly higher incidence was observed during 6:00 AM to 9:00 AM and 6:00 PM to 9:00 PM when engaging in daily routines such as defecation/micturition, brushing teeth/washing face/dressing, eating/drinking, and taking a bath. These activities are associated with a Valsalva maneuver that results in sudden pressure changes across the aneurysmal wall precipitating aneurysmal rupture. Aneurysmal rupture occurred most frequently during talking, chatting, watching television, or staying home without any strenuous physical activity. Considering the time spent, the highest incidence rate was found during defecation/micturition. There was no significant difference between men and women or between younger and older age groups regarding activities or events preceding aneurysmal rupture. Hypertension was the most common pre-existing medical problem. The main results are the same as those of the previous study except for aging of the patients. [Copyright &y& Elsevier]

Introduction: Acute heart failure syndromes are the most common cause of hospitalization in patients over 65 year. The number of hospitalizations for heart failure has tripled over the last three decades and it is expected to grow further. Matherials and methods: We followed 390 patients, with an average age of 69.2 yrs, admitted in the Cardiology Department of Internal Medicine Clinic IV of Târgu Mureș, from January 2009 till January 2010 for treatment of the acute heart failure. The aim of this study was the analization of the clinical presentation and the precipitating factors of the heart failure at these patients. Results and discussions: The most common clinical presentation at this category of patients is decompensated heart failure (peripherial oedema/congestion). In this particular case over two thirds of patients have history of heart failure (p < 0.0001). Hypertensive heart failure is a common finding in the novo cases (p = 0.0004). Cardiogenic shock is relatively rare form at this group but with very high hospital mortality. The most common trigger is infection, that frequently causes acute heart failure syndromes, mostly right heart failure in patients with pulmonary cardiopathy (p < 0.003). It is the most frequently identified trigger, both, in worsening chronic heart failure (p = 0.0002) and de novo heart failure group (p = 0.251). Conclusions: The prevalence of triggers varies considerably depending on the target population, but infections, arrhythmias, elevated blood pressure and non-compliance remain frequent causes of acute heart failure syndromes. [ABSTRACT FROM AUTHOR]

Aim: To study the clinical presentations and relationship of socio-demographic variables with conversion disorder. Methods: Forty patients admitted to the department of psychiatry, Assam Medical College and Hospital, Dibrugarh, during November 2004 to August 2005 who fulfilled the inclusion criteria of the study were evaluated for socio-demographic variables and clinical presentations on a semi-structured pro forma. Results: Conversion disorder is more common in young adults (57.5%), females (92.5%) and among students belonging to nuclear family of lower socioeconomic status. A majority of the patients had an obvious precipitating factor, of which family-related (40%) and school-related (30%) problems accounted for the major types. Motor symptoms were the predominant presentation (87.5%) with pseudo seizure being the commonest. [ABSTRACT FROM AUTHOR]

Acute on chronic liver failure (ACLF) can be precipitated by several factors such as bacterial infection, alcohol intake, viral hepatitis, surgery, etc. Identification of precipitating factor is an important part of management of ACLF. A middle aged gentleman was presented with features of acute liver failure and after through history and investigations, he was diagnosed as acute on chronic liver failure. Chronic liver disease was first diagnosed after this event of acute insult. Precipitating factor of ACLF was dengue fever in this case report. Therefore, in endemic area of dengue infection, dengue serology tests which are not routinely done should be advised to identify dengue infection as an acute insult in ACLF.