Search

BACKGROUND: Patients presenting to the emergency department with recent palpitations are a diagnostic challenge when the arrhythmia and its symptoms have resolved prior to arrival. Newer smart watch technology, adept at detecting atrial fibrillation, can assist in the diagnostic evaluation of transitory palpitations. We report a case of cold drink-triggered atrial fibrillation whose diagnosis would not have been possible without the assistance of the patients smart watch. CASE PRESENTATION: A middle-aged man without cardiac history developed sudden rapid, irregular palpitations with shortness of breath while drinking a glass of cold juice. He activated his smart watch with 1-lead electrocardiography technology which detected rapid atrial fibrillation. He sought medical care, but while waiting, his symptoms-then 90 min in duration-spontaneously resolved. His initial diagnostic evaluation documented only sinus rhythm, as did several follow-up evaluations with cardiology the next several weeks. Had it not been for his smart watch, the etiology of his transitory palpitations would have remained undiagnosed. His physicians encouraged trigger avoidance. In the following months, he avoided rapid ingestion of cold drink, taking instead small sips. The atrial fibrillation has not recurred. CONCLUSIONS: The case illustrates the valuable contribution of smart watch technology in the diagnostic evaluation of patients with short-lived palpitations. The case also educates clinicians about cold drink and food as a trigger of paroxysmal atrial fibrillation. This trigger, like alcohol, can be modified. Cold drink trigger avoidance has been reported by patients to reduce atrial fibrillation recurrence and is a low-risk, cost-effective strategy that is often successful.

Background The recognition of food as the trigger of attacks occurs in approximately 25% of individuals with migraine. However, differentiating migraine food triggers and prodrome symptoms is still a challenge.

Abstract Background Patients presenting to the emergency department with recent palpitations are a diagnostic challenge when the arrhythmia and its symptoms have resolved prior to arrival. Newer smart watch technology, adept at detecting atrial fibrillation, can assist in the diagnostic evaluation of transitory palpitations. We report a case of cold drink-triggered atrial fibrillation whose diagnosis would not have been possible without the assistance of the patient’s smart watch. Case presentation A middle-aged man without cardiac history developed sudden rapid, irregular palpitations with shortness of breath while drinking a glass of cold juice. He activated his smart watch with 1-lead electrocardiography technology which detected rapid atrial fibrillation. He sought medical care, but while waiting, his symptoms—then 90 min in duration—spontaneously resolved. His initial diagnostic evaluation documented only sinus rhythm, as did several follow-up evaluations with cardiology the next several weeks. Had it not been for his smart watch, the etiology of his transitory palpitations would have remained undiagnosed. His physicians encouraged trigger avoidance. In the following months, he avoided rapid ingestion of cold drink, taking instead small sips. The atrial fibrillation has not recurred. Conclusions The case illustrates the valuable contribution of smart watch technology in the diagnostic evaluation of patients with short-lived palpitations. The case also educates clinicians about cold drink and food as a trigger of paroxysmal atrial fibrillation. This trigger, like alcohol, can be modified. Cold drink trigger avoidance has been reported by patients to reduce atrial fibrillation recurrence and is a low-risk, cost-effective strategy that is often successful.

Background Diabetic ketoacidosis (DKA), a critical and potentially fatal complication resulting from a lack of insulin, presents with elevated blood sugar, acid-base imbalance, and increased ketone bodies. Objectives Our research was designed to assess the clinical manifestations, laboratory findings, and outcomes of treatment in children diagnosed with DKA over a span of five years in the Mekong Delta region of Vietnam. Methods This study retrospectively analyzed pediatric cases of diabetic ketoacidosis treated at a major pediatric center in the Mekong Delta between 2017 and 2021. Results Diabetic ketoacidosis was more common in older children aged 11 - 16 years (66.7%), and females (70%). The majority of cases had not been diagnosed with previous diabetes (60%) and no history of diabetic ketoacidosis (90%). In univariate analysis, female gender (OR, 13.0; 95% CI, 1.4 - 124.3; p=0.026), previous diabetes diagnosis (OR, 7.8; 95% CI, 1.5 - 41.2; p=0.016), precipitating factors (OR, 10.1; 95% CI, 1.1 - 97.0; p=0.045), tachypnea (OR, 5.5; 95% CI, 1.1 - 26.4; p=0.033), Kussmaul breathing (OR, 5.4; 95% CI, 1.1 - 26.0; p=0.036), serum potassium level (OR, 3.5; 95% CI, 1.2 - 10.4; p=0.027), and anion gap (OR, 1.6; 95% CI, 1.8 - 2.3; p=0.003) were associated factors with severe DKA. All cases in our study had a 100% survival rate. Anion gap was an independent factor associated with severe diabetic ketoacidosis after adjustment multivariate analysis. Conclusion: Female, younger age, precipitating factors, tachypnea, Kussmaul's breathing, and relevant laboratory findings, including increased anion gap, should be considered to ensure successful management in pediatric diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

Background Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure. Methods All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used. Results Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment. Conclusion This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy. [ABSTRACT FROM AUTHOR]

Introduction Variability in return-to-duty (RTD) decision-making following mild traumatic brain injury (mTBI) is a threat to troop readiness. Current RTD assessments lack military-specific tasks and quantitative outcomes to inform stakeholders of a service member's (SM) capacity to successfully perform military duties. Augmented reality (AR), which places digital assets in a user's physical environment, provides a technological vehicle to deliver military-relevant tasks to a SM to be used in the RTD decision-making process. In addition to delivering digital content, AR headsets provide biomechanical data that can be used to assess the integrity of the central nervous system in movement control following mTBI. The objective of this study was to quantify cognitive and motor performance on an AR rifle qualification test (RQT) in a group of neurologically healthy military SMs. Materials and Methods Data were collected from 111 healthy SMs who completed a basic (single-task) and complex (dual-task) RQT with a simulated M4 rifle. The complex scenario required the SM to perform the RQT while simultaneously answering arithmetic problems. Position data from the AR headset were used to capture postural sway, and the built-in microphone gathered responses to the arithmetic problems. Results There were no differences in the number of targets hit, trigger pull reaction time, and transition time from kneeling to standing between the basic and complex scenarios. A significant worsening in postural sway following kneel-to-stand transition was observed in the complex scenario. The average reaction time to answer the arithmetic problems was nearly 2 times slower than the average reaction time to pull the trigger to a displayed target in the complex scenario. Conclusion The complex scenario provoked dual-task interference in SMs as evidenced by worsening postural sway and reaction time differences between the cognitive and motor tasks. An AR RQT provides objective and quantitative outcomes during a military-specific task. Greater precision in evaluating cognitive and motor performance during a military-relevant task has the potential to aid in the detection and management of SMs and their RTD following MTBI. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to identify factors associated with nursing performance, classify potential profiles of nursing performance-related variables, and explain their effects on nursing performance. Methods: The study involved 245 nurses at a University Hospital in South Korea from September 1 to 14, 2021. The participants were nurses in a ward who operated within a team and had at least 6 months of clinical experience. Structured questionnaires were used to measure variables, and data were collected online using Google Forms. Using latent profile analysis, the participants were classified into four human resource and job attitude profiles. Linear regression was used to identify relevant factors, and one-way analysis of variance was employed to examine the differences in nursing performance between the four profiles. Results: Shared leadership (β=.30, p< .001 ) was most strongly associated with nursing performance, followed by authentic leadership (β=.16, p=.009), and education level (β=. 15, p=.006). Significant differences in nursing performance (F=22.48, p<.001) were observed across profiles, with the groups deemed "excellent" and "best" scoring higher in nursing performance and authentic leadership compared to the "fair" and "worst" groups. However, no significant difference in education level was found across the latent profiles (p=.212). Conclusion: This research examined the impact on nursing performance through variable-centered analysis and a person-centered approach. Accordingly, this study provides valuable insights for interpreting the results of linear regression analysis, highlighting the need to consider individual heterogeneity. [ABSTRACT FROM AUTHOR]

Background: There is a steady increase in the number of suicide deaths throughout the life span, particularly among youth compared with other age groups. The youth are naturally vulnerable to mental health problems, especially during their adolescent years. Our study aimed to estimate the proportion of youth with high suicidal intent and to assess the association of socio-demographic and clinical factors, including stressful life events, with suicidal intent in youth with intentional self-harm (ISH). Methods: This cross-sectional, descriptive study was done at the Department of Psychiatry, Government Medical College, Thrissur, Kerala, from December 2019 to May 2021 after getting approval from the Institutional Ethics Committee. The study sample consisted of 97 consecutive inpatients aged 15 to 24 years with ISH referred from various departments to the Psychiatry Department, who satisfied the inclusion and exclusion criteria. All the participants were enrolled after getting written informed consent/assent from the guardian and/or the patient. The suicide intent was assessed using Beck’s Suicide Intent scale. A specially designed proforma was used to assess the socio-demographic details and precipitating factors. The stressful life events were assessed using the Presumptive Stressful Life Events Scale. Results: 18.5% of youth with ISH had high suicidal intent. Past history of suicide attempts (p = 0.03) and life events (p = 0.002) were significantly associated with high suicidal intent. Conclusions: Past history of suicide attempts had a significant association with high suicide intent. Early recognition and correction of the risk factors can help to prevent further suicide attempts.

Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are highly selective, effective, and generally well-tolerated antihyperglycemic agents targeting the SGLT-2 transmembrane protein. Despite being primarily registered for diabetes treatment, due to their cardiorenal protective properties, SGLT-2 inhibitors caused a paradigm shift in the treatment of other diseases on the cardiorenal spectrum, becoming a fundamental part of heart failure and chronic kidney disease management. With their rapidly increasing use, there are also increased reports of a rare, often under-recognised and potentially deadly side effect, SGLT-2-inhibitor-induced euglycemic diabetic ketoacidosis (EDKA). The primary pathophysiological process behind its multifactorial aetiology comprises glucosuria and osmotic diuresis, which produce a significant carbohydrate deficit, leading to an increase in the glucagon–insulin ratio, thus resulting in accelerated ketogenesis. Although EDKA has a similar clinical presentation as diabetic ketoacidosis (DKA), the absence of the high glucose levels typically expected for DKA and the presence of urine ketone reabsorption contribute to a significant delay in its recognition and timely diagnosis. Given the broad use of SGLT-2 inhibitors, increased awareness, early recognition, and prompt identification of precipitating factors are essential. In this narrative review, we comprehensively explore the pathophysiological mechanisms of SGLT-2-inhibitor-induced EDKA, analyse its clinical manifestation, and identify the most common triggers for its development. We also discuss EDKA management and preventive strategies. [ABSTRACT FROM AUTHOR]

Introduction During training and deployment, service members (SMs) experience blast exposure, which may potentially negatively impact brain health in the short and long term. This article explores if blast exposure mitigation can be effectively achieved for four different weapon training scenarios that are being monitored as part of the CONQUER (COmbat and traiNing QUeryable Exposure/event Repository) program. The training scenarios considered here are a detonating cord linear (det linear) breaching charge, a water breaching charge, a shoulder-fired weapon, and a 120-mm mortar. Materials and Methods This article focuses on the efficacy of modification of position and standoff distance on SMs' exposure to blast overpressure. Blast overpressure exposures were measured using BlackBox Biometrics (B3) Blast Gauge System (BGS) sensors worn by SMs during normal training. The BGS involves the use of three gauges/sensors, which are worn on the head, chest, and nondominant shoulder to record surface pressures at multiple locations on the SM. For the breaching charges, we compared the level of exposure when the SMs were directly in front of the blast with a breaching blanket to a modified standoff position around a corner from the charge without a breaching blanket. For the shoulder-fired weapon training, the modified approach simply increased the standoff distance of the SM. Finally, for mortars, blast overpressure exposures were compared for different levels of their ducking height (body position) below the mortar tube at the time of firing. Results Modification of the position of SMs during training with the det linear breaching charge had the highest measured blast exposure percent reduction, at 79%. Both the water breaching charge and shoulder-fired weapon showed lowered peak overpressures on all gauges. The measured percent reduction for the 120-mm mortar was 35%. When the blast gauges did not trigger at the modified standoff distance, the percent reduction was calculated with the assumption that the new overpressures were below ∼3.4 kPa (0.5 psi) (the lowest trigger threshold for the gauges). A figure summarizes the percent reduction for each subject in the training scenarios. Conclusions Results show that the modification of the SMs' position effectively mitigated blast exposures for all considered weapon scenarios. There was at least a 50% overpressure reduction from the initial to modified standoff distances and a 35% reduction from the change in SM body posture. Based on these observations, new locations and body positioning of SMs during training have been suggested for blast mitigation. [ABSTRACT FROM AUTHOR]

Aim: Diabetic ketoacidosis (DKA) is a dreadful complication of diabetes mellitus characterized by a biochemical triad of hyperglycemia, ketosis, and metabolic acidosis. The clinic-epidemiologic pattern and outcomes of DKA in the Indian subcontinent are largely unexplored, yet understanding them is crucial for optimizing management strategies. Methods: A total of 138 patients admitted with a DKA diagnosis were reviewed retrospectively over two years. Patient demographics, clinical history, laboratory findings, precipitating factors, and intensive care management were extracted from case files. Clinical outcomes were classified as either discharge or death. Data analysis was performed using SPSSv29. Results: The mean age of the patients was 41.54 (16) years; 77 (55.79 %) were female, 56.52 % had type 1, 23.19 % had type 2, and 20.29 % had pancreatic diabetes. Non-compliance with infection (21.02 %), and pancreatitis (21.01 %) were common DKA triggers. Severity was assessed by pH, anion gap, and bicarbonate levels. The overall mortality rate was 11.59 %. Factors significantly associated with mortality included age >60 years, >3 previous DKA episodes, hypokalaemia, elevated serum creatinine, and altered sensorium. Conclusion: These findings emphasize the importance of demographics and risk factors in assessing DKA mortality risk, aiding early identification and targeted interventions for high-risk patients.

Background: Hepatic Encephalopathy (HE) is a challenging and prevalent complication that arises in the context of liver cirrhosis characterized by cognitive dysfunction resulting from liver insufficiency and/or the development of portosystemic shunts. Aim and Objectives: To investigate the clinical characteristics, precipitating factors, and clinical outcomes of HE with liver disease in patients admitted to a tertiary care center. Material and Methods: A retrospective observational study at a hospital reviewed records of 100 HE patients admitted from Jan-Dec 2022. Data on demographics, clinical features, lab results, stay duration, and outcomes were collected from past records. Statistical analysis explored links between outcomes, symptoms, lab results, causes, Model for End-Stage Liver Disease (MELD) scores, and hospital duration (p < 0.05 considered significant). Patients were tracked until discharge or death. Results: Most HE cases were males (75.8%) and aged 21-87. Key symptoms were abdominal distension (62.6%) and jaundice (60.4%). Jaundice impacted outcomes (p = 0.045); infections triggered 39.6% of cases, impacting outcomes (p = 0.039). High direct bilirubin levels affected prognosis (p = 0.000). Alcohol-related liver disease was the main cause (41.8%). Higher MELD scores were linked to worse outcomes; etiology and hospitalization duration (p = 0.138) had no significant effect on outcomes. Conclusion: This study provides valuable insights into HE in liver disease patients, facilitating early detection and effective management to reduce mortality and morbidity rates.

We report a case of massive chest wall bleeding after lung wedge resection caused by a protruding staple. On the third postoperative day, the patient experienced sudden left posterior back pain without any apparent trigger, accompanied by signs of shock. Computed tomography imaging revealed a significant accumulation of blood in the pleural cavity on the side of the surgery. A reoperation was performed, during which we identified active arterial bleeding from a small vessel at the second intercostal space on the posterior chest wall. Hemostasis was achieved using electrocautery. Further examination revealed a protruding staple at the left upper lobe resection margin, which we speculated was likely causing abrasion against the chest wall and leading to the bleeding. This case reveals the potential risk posed by protruding staples. Appropriate precautions should be taken to prevent this rare but dangerous occurrence. [ABSTRACT FROM AUTHOR]

Despite effective antiretroviral therapies, 20–30% of persons with treated HIV infection develop a neurodegenerative syndrome termed HIV-associated neurocognitive disorder (HAND). HAND is driven by HIV expression coupled with inflammation in the brain but the mechanisms underlying neuronal damage and death are uncertain. The inflammasome-pyroptosis axis coordinates an inflammatory type of regulated lytic cell death that is underpinned by the caspase-activated pore-forming gasdermin proteins. The mechanisms driving neuronal pyroptosis were investigated herein in models of HAND, using multi-platform molecular and morphological approaches that included brain tissues from persons with HAND and simian immunodeficiency virus (SIV)-infected non-human primates as well as cultured human neurons. Neurons in the frontal cortices from persons with HAND showed increased cleaved gasdermin E (GSDME), which was associated with β-III tubulin degradation and increased HIV levels. Exposure of cultured human neurons to the HIV-encoded viral protein R (Vpr) elicited time-dependent cleavage of GSDME and Ninjurin-1 (NINJ1) induction with associated cell lysis that was inhibited by siRNA suppression of both proteins. Upstream of GSDME cleavage, Vpr exposure resulted in activation of caspases-1 and 3. Pretreatment of Vpr-exposed neurons with the caspase-1 inhibitor, VX-765, reduced cleavage of both caspase-3 and GSDME, resulting in diminished cell death. To validate these findings, we examined frontal cortical tissues from SIV-infected macaques, disclosing increased expression of GSDME and NINJ1 in cortical neurons, which was co-localized with caspase-3 detection in animals with neurological disease. Thus, HIV infection of the brain triggers the convergent activation of caspases-1 and -3, which results in GSDME-mediated neuronal pyroptosis in persons with HAND. These findings demonstrate a novel mechanism by which a viral infection causes pyroptotic death in neurons while also offering new diagnostic and therapeutic strategies for HAND and other neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Abstract Background Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families, and the community. Objectives The aim of this study was to find a correlation between precipitating factors of acute asthma attacks of patients attending to emergency departments and different factors such as socioeconomic status. Methods The study included patients 2–12 years old of both sexes who were already diagnosed with bronchial asthma coming to ER with acute asthmatic attacks. Data were collected by a questionnaire which includes personal data (name, age, and sex), anthropometric data, score for assessment of socioeconomic status (SES), symptoms of asthmatic attack, risk factors, mode and type of treatment, compliance to treatment, or evaluation of asthma severity and outcome of patients attending to ER. Results This study included 170 patients. Males represented 63.5% of the patients. The mean age of the patients was 5.4 ± 2.7 years. Our patients were distributed into the following: 65.9% were low SES, 22.9% were very low SES, and 11.2% were moderate SES. As regards presenting symptoms of the study group, all the patients (100%) presented to ER with cough, while 88.2% of them presented with wheezes, 85.8% presented with dyspnea, 21.2% of them presented with tightness, and only 0.01% presented with cyanosis. As regards precipitating factors of asthma, the most common precipitating factors among our patients causing attending to ER were irritant inhalers (72.4%), passive smoking (60.6%), exercise (70.5%), certain foods (45.3%), upper respiratory tract infection (12.9%), and non-compliance to asthma treatment (85.2%). The most common causes of non-compliance to treatment were family negligence and illiteracy (34.1%) and poor socioeconomic conditions (17.1%). The majority of patients (96.5%) who could be stabilized with medications were discharged, whereas a merged proportion of critically ill patients (3.5%) required ICU admission. However, no deaths were reported. Conclusion The most common precipitating factors of our patients that led to more attending to ER in the previous 6 months were exercise, irritant inhalers, and non-compliance to asthma treatment.

OBJECTIVE: Major negative life events, such as trauma exposure, can play a key role in igniting or exacerbating psychopathology. However, few disorders are diagnosed with respect to precipitating events, and the role of these events in the unfolding of new psychopathology is not well understood. The authors conducted a multisite transdiagnostic longitudinal study of trauma exposure and related mental health outcomes to identify neurobiological predictors of risk, resilience, and different symptom presentations. METHODS: A total of 146 participants (discovery cohort: N=69; internal replication cohort: N=77) were recruited from emergency departments within 72 hours of a trauma and followed for the next 6 months with a survey, MRI, and physiological assessments. RESULTS: Task-based functional MRI 2 weeks after a motor vehicle collision identified four clusters of individuals based on profiles of neural activity reflecting threat reactivity, reward reactivity, and inhibitory engagement. Three clusters were replicated in an independent sample with a variety of trauma types. The clusters showed different longitudinal patterns of posttrauma symptoms. CONCLUSIONS: These findings provide a novel characterization of heterogeneous stress responses shortly after trauma exposure, identifying potential neuroimaging-based biotypes of trauma resilience and psychopathology.

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE 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.)

Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) are fatal neurodegenerative diseases that represent ends of the spectrum of a single disease. The most common genetic cause of FTD and ALS is a hexanucleotide repeat expansion in the C9orf72 gene. Although epidemiological data suggest that traumatic brain injury (TBI) represents a risk factor for FTD and ALS, its role in exacerbating disease onset and course remains unclear. To explore the interplay between traumatic brain injury and genetic risk in the induction of FTD/ALS pathology we combined a mild repetitive traumatic brain injury paradigm with an established bacterial artificial chromosome transgenic C9orf72 (C9BAC) mouse model without an overt motor phenotype or neurodegeneration. We assessed 8–10 week-old littermate C9BACtg/tg (n = 21), C9BACtg/− (n = 20) and non-transgenic (n = 21) mice of both sexes for the presence of behavioural deficits and cerebral histopathology at 12 months after repetitive TBI. Repetitive TBI did not affect body weight gain, general neurological deficit severity, nor survival over the 12-month observation period and there was no difference in rotarod performance, object recognition, social interaction and acoustic characteristics of ultrasonic vocalizations of C9BAC mice subjected to repetitive TBI versus sham injury. However, we found that repetitive TBI increased the time to the return of the righting reflex, reduced grip force, altered sociability behaviours and attenuated ultrasonic call emissions during social interactions in C9BAC mice. Strikingly, we found that repetitive TBI caused widespread microglial activation and reduced neuronal density that was associated with loss of histological markers of axonal and synaptic integrity as well as profound neuronal transactive response DNA binding protein 43 kDa mislocalization in the cerebral cortex of C9BAC mice at 12 months; this was not observed in non-transgenic repetitive TBI and C9BAC sham mice. Our data indicate that repetitive TBI can be an environmental risk factor that is sufficient to trigger FTD/ALS-associated neuropathology and behavioural deficits, but not paralysis, in mice carrying a C9orf72 hexanucleotide repeat expansion. [ABSTRACT FROM AUTHOR]

Background: Diabetic ketoacidosis (DKA) is one of the most common medical emergencies in the world. The patient can present with manifestations like ketosis, ketoacidosis, ketoacidosis precoma and coma, but often these manifestations are submerged in the clinical presentation of precipitating illnesses. Objective: To assess the clinical profile and biochemical characteristics in diabetic ketoacidotic patients and to assess the precipitating factors triggering diabetic ketoacidosis. Methods: This cross sectional study conducted in Mandya Institute of Medical Sciences, Mandya was done from January 2019 to December 2019 involving 50 patients who presented with Diabetes Ketoacidosis. Method of data collection was done by history taking, clinical examination, laboratory and radiological investigations. SPSS V22 was used for statistical analysis. P <0.05 was considered as statistically significant. Results: Out of 50 patients admitted for diabetic ketoacidosis; 30 were type 2 diabetes (60%) and 20 (40%) were type 1 diabetes mellitus. Average age at the time of presentation was 45 + 18.45 years. The most common clinical features at the time of presentation were vomiting (72%), abdominal pain (42%), acidotic breathing (84%) and dehydration (88%). The commonest precipitating factor was infection (50%) followed by irregular treatment (26%) and other factors (26%). The mean values for RBS, HCO3 and pH was 432.9 + 88, 13 + 3.57 and 7.18 + 0.96 respectively. Mortality rate was 8% and factors found to be predict the high mortality were high RBS, low pH, low HCO3, altered sensorium at the time of presentation and comorbid conditions. Conclusion: Most common precipitating factors are infection and irregular treatment. Most common clinical features at the time of presentation are vomiting, abdominal pain, dehydration, acidotic breathing. There is no significant difference in the clinical and biochemical profile of patients with type 1 and type 2 diabetes. Mortality rate in diabetic ketoacidosis is 8% and the predictors of poor prognosis are; high RBS, low pH, low HCO3, altered sensorium at the time of presentation and comorbid conditions. [ABSTRACT FROM AUTHOR]

Background: Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families, and the community. Objectives: The aim of this study was to find a correlation between precipitating factors of acute asthma attacks of patients attending to emergency departments and different factors such as socioeconomic status. Methods: The study included patients 2–12 years old of both sexes who were already diagnosed with bronchial asthma coming to ER with acute asthmatic attacks. Data were collected by a questionnaire which includes personal data (name, age, and sex), anthropometric data, score for assessment of socioeconomic status (SES), symptoms of asthmatic attack, risk factors, mode and type of treatment, compliance to treatment, or evaluation of asthma severity and outcome of patients attending to ER. Results: This study included 170 patients. Males represented 63.5% of the patients. The mean age of the patients was 5.4 ± 2.7 years. Our patients were distributed into the following: 65.9% were low SES, 22.9% were very low SES, and 11.2% were moderate SES. As regards presenting symptoms of the study group, all the patients (100%) presented to ER with cough, while 88.2% of them presented with wheezes, 85.8% presented with dyspnea, 21.2% of them presented with tightness, and only 0.01% presented with cyanosis. As regards precipitating factors of asthma, the most common precipitating factors among our patients causing attending to ER were irritant inhalers (72.4%), passive smoking (60.6%), exercise (70.5%), certain foods (45.3%), upper respiratory tract infection (12.9%), and non-compliance to asthma treatment (85.2%). The most common causes of non-compliance to treatment were family negligence and illiteracy (34.1%) and poor socioeconomic conditions (17.1%). The majority of patients (96.5%) who could be stabilized with medications were discharged, whereas a merged proportion of critically ill patients (3.5%) required ICU admission. However, no deaths were reported. Conclusion: The most common precipitating factors of our patients that led to more attending to ER in the previous 6 months were exercise, irritant inhalers, and non-compliance to asthma treatment. [ABSTRACT FROM AUTHOR]

BackgroundPatients may be inadvertently harmed while undergoing dental treatments. To improve care, we must first determine the types and frequency of harms that patients experience, but identifying cases of harm is not always straightforward for dental practices. Mining data from electronic health records is a promising means of efficiently detecting possible adverse events (AEs).MethodsWe developed 7 electronic triggers (electronic health record based) to flag patient charts that contain distinct events common to AEs. These electronic charts were then manually reviewed to identify AEs.ResultsOf the 1,885 charts reviewed, 16.2% contained an AE. The positive predictive value of the triggers ranged from a high of 0.23 for the 2 best-performing triggers (failed implants and postsurgical complications) to 0.09 for the lowest-performing triggers. The most common types of AEs found were pain (27.5%), hard tissue (14.8%), soft tissue (14.8%), and nerve injuries (13.3%). Most AEs were classified as temporary harm (89.2%). Permanent harm was present in 9.6% of the AEs, and 1.2% required transfer to an emergency room.ConclusionBy developing these triggers and a process to identify harm, we can now start measuring AEs, which is the first step to mitigating harm in the future.Knowledge transfer statementA retrospective review of patients' health records is a useful approach for systematically identifying and measuring harm. Rather than random chart reviews, electronic health record-based dental trigger tools are an effective approach for practices to identify patient harm. Measurement is one of the first steps in improving the safety and quality of care delivered.

Abstract Background Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. Results We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P

Objective: To observe baseline characteristics, ACLF (Acute on Chronic Liver Failure) grading and mortality in ACLF patients using EASL CLIF CRITERIA. Study Design: Prospective, Observational study. Setting: Medical unit III, ward 7, Jinnah Postgraduate Medical Centre, Karachi. Period: January 2022 to June 2022. Material & Methods: We prospectively analysed data of hospitalised liver cirrhosis patients at a tertiary care hospital in Karachi, Pakistan. The data was analysed in SPSS version 25. Results: There were a total of 43 ACLF patients, with the median age of IQR of 56(47-62) years, out of which 20 (46.5%) patients were male and 23 (53.5%) were females. The most common etiology of liver cirrhosis was hepatitis C 26(60.5%) followed by other etiologies nine (20.9%) and hepatitis B eight (18.6%). The most common precipitating factor was infection 19(44.2%) and the most frequent organ failure (OF) was renal failure (60.5%), followed by cerebral failure (46.5%) and other OFs. There were 24 patients in ACLF grade one, 13 in grade two and six in grade three ACLF. All six patients of ACLF grade three belonged to CTP C (Child-Turcotte-Pugh score) (100%) with 100% mortality. ACLF grade two had nine (69.2%) and ACLF grade one had eight (33.33%) CTP C patients. The in hospital mortality of ACLF was 23%. The median MELD Na of these patients was 28 (23-31), CLIF Consortium Organ Failure score was 9(8-10) and CLIF C ACLF Score was 45 (38-55). Conclusion: Highest mortality was observed in Child Pugh C and ACLF grade three in our patients. Such patients must be closely monitored and referred early for medical management and liver transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Localized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers. Methods: We hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology. Results: During follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors. Conclusion: LBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases. [ABSTRACT FROM AUTHOR]

Mesa redonda apresentada no Simpósio Internacional sobre Doença de Hodgkin, realizado no Instituto Nacional de Câncer no Rio de Janeiro — 16 a 20 de Janeiro de 1967. Transcrição da gravação não revista pelos autores.

Occupational asthma triggered by inhaling fish-derived aerosols is estimated to affect 2–8% of exposed individuals. This primarily affects workers in the fish processing industry. Fishmongers, rarely experience this issue, as recent research found no significant difference in asthma rates compared to a control group. We report the case of a fishmonger who presented with a 1-year history of rhinoconjunctivitis and asthma. The patient attributed these symptoms to his occupational exposure within the fish market environment, which worsened in the cold storage warehouse. Symptoms improved during holidays. Diagnosis involved skin-prick tests, sIgE (ImmunoCAP-specific IgE) measurements, and bronchial challenge tests, confirming occupational asthma from fish bioaerosol exposure. Parvalbumins, common fish proteins, share structural similarities, leading to cross-reactivity in fish allergy sufferers. In this case, sensitivity to rGad c1 (cod parvalbumin) was identified as the primary trigger for the patient's asthma, and responsible for sensitizations observed across various tested fish species. [ABSTRACT FROM AUTHOR]

IntroductionLocalized bullous pemphigoid (LBP) is an infrequent bullous pemphigoid (BP) variant restricted to a body region. According to the most compelling evidence, LBP occurs in patients with pre-existent serum antibodies against the basement membrane zone, which occasionally acquire the capacity to induce disease after the influence of different local factors acting as triggers.MethodsWe hereby present a multicenter cohort of 7 patients with LBP developed after local triggers: radiotherapy, thermal burns, surgery, rosacea, edema and a paretic leg. In addition, we conducted a review of the literature, and we propose a set of diagnostic criteria for LBP, also based on our case series and the 2022 BP guidelines from the European Academy of Dermatology and Venereology.ResultsDuring follow-up, three of the patients from our series evolved to a generalized BP, with only one requiring hospitalization. Our literature search retrieved 47 articles including a total of 108 patients with LBP, with a 63% with a potential local precipitating factor previous to their diagnosis. LBP mostly affected older females, and a subsequent generalized progression occurred in 16.7% of the cases. The most frequently involved areas were the lower limbs. Radiation therapy and surgery were responsible for the inducement of nearly 2 in 3 cases of LBP. We observed a significantly higher risk of generalization in cases where the trigger led to the developing of LBP earlier (p=0.016). Our statistical analysis did not detect any other prognosis factor for generalization when assessing direct immunofluorescence, histological and serological results, or other patient related factors.ConclusionLBP should be suspected in patients with recurrent localized bullous eruptions. The presence of a trauma history in the same anatomic area is reported in most cases.

Background: Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. Results: We included 1515 patients (mean age 60 ± 12 years, 69% males). The mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. Conclusions: Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality. [ABSTRACT FROM AUTHOR]

Aim: To investigate New South Wales adults' perceived adequacy of their fruit and vegetable consumption and to identify the barriers to consumption. Method: An online cross‐sectional survey of a sample of adults in New South Wales (n = 1603) in February 2019 measured self‐reported fruit and vegetable intakes, perception of consumption adequacy and barriers to consumption. Proportions of participants whose reported consumption met the daily recommended serves of fruit and vegetables per day were calculated. Chi‐square and Fisher's exact tests were used to explore differences between demographic characteristics and meeting fruit and vegetable recommendations. For those not meeting recommendations, Chi‐square and Fisher's exact tests were used to explore perceived adequacy of intake as a potential barrier to consumption. Results: The sample included 52.7% women, 40.0% aged under 40 years and 28.6% over 59 years, 68.2% lived in a major city, and 32.6% were university educated. Overall, 64.8% of participants reported consuming adequate fruit and 12.4% reported consuming adequate vegetables. Of those consuming less than the guidelines, 21.3% perceived that they were eating enough fruit and 53.7% perceived they were eating enough vegetables. The most common barriers to eating more fruit were preference for other foods (29.6%), fruit spoiling too quickly (28.3%), and habit (27.0%). The most common barriers to eating more vegetables were the perception that they eat enough (26.8%), preference for other foods (21.9%), and habit (19.7%). Conclusions: Greater efforts are needed to support the public to eat adequate fruit and vegetables, consistent with dietary guidelines. Public education campaigns specifically targeting increasing vegetable consumption are required to address knowledge gaps, given a large proportion of our study population consumed inadequate levels of vegetables yet perceived their intake to be adequate. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic encephalopathy (HE) is a decline in brain function as a result of severe liver disease and its inadequacy to remove toxins from the body. It is characterized by personality changes, intellectual impairment, and loss of consciousness. This study was conducted to determine the precipitating factors and endoscopic features of hepatic encephalopathy in patients with liver cirrhosis and evaluate the associated clinical features admitted in a tertiary hospital in Central India. Materials and Methods: This hospital-based descriptive cross-sectional study was conducted from November 2016 to October 2018 on 102 patients with hepatic encephalopathy type C, aged above 18. All patients were carefully examined, relevant investigations performed, and data collected through pre-designed proforma. They were sent for statistical analysis where categorical outcomes were compared between study groups using the Chi-square test /Fisher's Exact test. Results: The prevalence of HE was 19.6% in our study. In this study, we observed that constipation (26.5%), electrolyte imbalance (21.6%), renal failure (18.6%), and upper GI bleeding (18.6%) be among the leading precipitants for HE. Besides liver failure, the associated abnormalities in various factors like coagulation abnormalities, renal derangement, and changes in serum sodium levels can lead to the progression of HE to higher grades. Conclusion: It is essential to identify the different factors like constipation, electrolyte imbalance, renal failure, and upper GI bleeding early in the course of cirrhosis to help prevent the development of HE.

Recent advances on the environmental determinants of Kawasaki Disease have pointed to the important role of the atmospheric transport of a still unknown agent potentially triggering the disease. The hypothesis arose from an innovative methodology combining expertise in climate dynamics, the analysis of ocean and atmosphere data, the use of dispersion models and the search for biological agents in air samples. The approach offered a new perspective to reveal the identity of the potential trigger, but at the same time, it increased the level of complexity, which could potentially lead to the misinterpretation of the mechanisms. Some years after it was originally formulated, we here provide a brief clarification on the approach and limits of the methodology in order to prevent an eventual misuse of our research ideas and theory, so that further research can better focus on the knowledge gaps that still remain open.

Allergic diseases are developed through complex interaction between exposure to environmental substances and genetic susceptibility. The prevalence of allergic diseases has increased during last decade globally. The present cross sectional study was designed to evaluate the skin prick test reactivity in children with allergic diseases. A total of 400 children between age group 1-12 years were recruited. The Skin prick tests (SPT) using 14 standardized allergen extracts were conducted in the volar surface of forearm. Majority children had asthma (52.5%), followed by atopic dermatitis (22.75%) and allergic rhinitis (15.75%). Food habits triggering allergic conditions in 76% children, environmental factors in 4.75% children, pets in 8.25% and indoor conditions in 11% children. Skin prick test was positive to egg (13.5%), milk (22%), wheat (9.75%), apple (4.5%), cereals (6.5%), cat (18%), dog (6%), blatella (9.5%), aspergillus fumigatus (9.5%), fungi (12.75%), Dermatophytes farina (24.75%), Dermatophytes pteromyssinus (23.75%), Blomia tropicalis (9.5%) and Bermuda grass (13.75%). Determination of allergen sensitization patterns in children with atopic disease is crucial for selecting proper preventive and therapeutic strategies which helps to improve quality of life of in children. [ABSTRACT FROM AUTHOR]

Recent research has characterized the behavioral defense against disease. In particular the detection of sickness cues, the adaptive reactions (e.g. avoidance) to these cues and the mediating role of disgust have been the focus. A presumably important but less investigated part of a behavioral defense is the immune system response of the observer of sickness cues. Odors are intimately connected to disease and disgust, and research has shown how olfaction conveys sickness cues in both animals and humans. This study aims to test whether odorous sickness cues (i.e. disgusting odors) can trigger a preparatory immune response in humans. We show that subjective and objective disgust measures, as well as TNFα levels in saliva increased immediately after exposure to disgusting odors in a sample of 36 individuals. Altogether, these results suggest a collaboration between behavioral mechanisms of pathogen avoidance in olfaction, mediated by the emotion of disgust, and mechanisms of pathogen elimination facilitated by inflammatory mediators. Disgusting stimuli are associated with an increased risk of infection. We here test whether disgusting odors, can trigger an immune response in the oral cavity. The results indicate an increase level of TNFα in the saliva. This supports that disease cues can trigger a preparatory response in the oral cavity. [ABSTRACT FROM AUTHOR]

Copyright of Acta Medica Croatica is the property of Croatian Academy of Medical Sciences 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.)

Purpose: This study aimed to identify the factors associated with chemotherapy-induced neutropenia (CIN) in diffuse large B-cell lymphoma (DLBCL) patients undergoing combination chemotherapy. Methods: A total of 111 patients with DLBCL participated in this study at C University Hospital. The CIN group consisted of patients with an absolute neutrophil count (ANC) lower than 1,000 cells/µL. Clinical factors, the level of depression, and the level of healthy lifestyle were measured on the chemotherapy administration day, and the ANC was measured on the next follow-up day. Results: Binary logistic regression analysis showed that the factors associated with CIN in DLBCL were the presence of B symptoms at diagnosis (β=4.69) and low-risk CIN regimen (β=0.10) among clinical factors, and the level of healthy lifestyle (β=0.17). Conclusion: Oncology nurses have to focus on the patients vulnerable to CIN having B symptoms at diagnosis, receiving a low-risk CIN regimen, and showing non-adherence to healthy lifestyle practice. Administration of granulocyte colony-stimulating factor can be considered for the patients receiving low-risk CIN regimen to reduce CIN. Education programs including healthy lifestyle practice to improve the immune system should be applied to the DLBCL patients. [ABSTRACT FROM AUTHOR]

Globally, family systems are being diversified as most children are no longer living with their biological parents due to divorce, remarriage, separation and unmarried personhood leading to a rise in stepfamilies. Despite the rise of stepfamilies in the sub-Saharan African countries, they have been largely under-studied, especially among the adolescent population. This study explored the nature of experiences and their determining factors as well as impact on adolescent stepchildren in the Ghanaian context. A purposive sample of 22 adolescents who were living or had lived in a stepfamily household in the Koforidua Metropolis of Ghana were interviewed; and their responses analyzed thematically. Findings show that stepchildren had both pleasant and unpleasant experiences which had psychological, social and academic implications to their wellbeing. Precipitating factors bothered on stepchildren's conduct, lack of blood ties between stepchildren and stepfamilies and lack of prospective benefits to stepparents. These findings underscore the need for psychological interventions for adolescents within the stepfamily context to help address the unpleasant experiences that may negatively impact on their social and psychological wellbeing. [ABSTRACT FROM AUTHOR]

Background and objective: People with functional motor disorder (FMD) report triggers—sensory or motor-induced stimuli that exacerbate or initiate paroxysmal occurrences of their movement disorder. These are a distinct phenomenon from precipitating factors occurring at the initial onset of the disorder. We aimed to assess triggers in FMD and understand their relevance to paroxysmal variability often seen in FMD. Methods: We enrolled consecutive outpatients with a definite diagnosis of FMD. Each patient underwent a detailed clinical evaluation also including the presence of trigger factors and video-recordings both during neurological examination and physiotherapy treatment. Patients were classified as having "triggers" (T-FMD) or "not having triggers" (NoT-FMD) as well as "paroxysmal" compared to "persistent with paroxysmal variability". Results: The study sample was 100 patients (82% female) with FMD; the mean age at onset was 41 years. Triggers were observed in 88% of patients and in 65 of these the FMD was pure paroxysmal. The most common triggers were movement or physical exercise, followed by emotional, visual, touch, and auditory stimuli; 39 (44%) were isolated and 49 (56%) were combined triggers. Among the T-FMD patients, FMD were paroxysmal in 74% (n = 65) and persistent with paroxysmal variability in 26% (n = 23). The T-FMD patients were younger (p = 0.016) and had a gait disorder (p = 0.035) more frequently than the NoT-FMD patients. Discussion: Triggers are frequent in FMD and may have diverse overlapping clinical presentations. In this sample, FMD was most often paroxysmal, suggesting the value of noting triggers as clinical clues in the diagnosis and rehabilitation of FMD. [ABSTRACT FROM AUTHOR]

Background: Breakthrough seizures occur in 37% of epilepsy patients even though remission has been attained. Counseling on precipitating factors form an integral part of treatment along with anti-epileptic drugs (AEDs). Identification of precipitating factors may help in reducing unnecessary hospitalization and complications of breakthrough seizures. Materials and Methods: This retrospective study was conducted in a tertiary healthcare center in Puducherry. All children with epilepsy admitted with breakthrough seizures from January 2017 to December 2019 were included in the study. Those with neonatal seizures, diagnosis of either Neurocysticercosis or tuberculoma, cases without seizure free period of 6 months and case records without adequate details were excluded. Data regarding precipitating factors were collected from case records and analyzed using SPSS version 24.0 software. Results: Of the 80 children included in the study, mean age was 4.98 (±3.52) years and 56.3% were less than 5 years of age. In total, 90% (n = 72) of the participants had generalized epilepsy, of which 67 had generalized seizures, four had absence seizures and one had atonic seizures. Majority (85%) reported at least one possible precipitating factor for breakthrough seizures and common ones were fever (27.5%) and non-compliance to medication (26.25%). Most common reason for non-compliance was forgetting to take medication (38%). Also illiterate mothers and multiple AEDs had a significant association with non-compliance (P < 0.05). Conclusion: The results of our study stress the need on adequate counseling about possible precipitants and prescription on minimum AEDs whenever possible. Parents need to ensure strict adherence to AEDs and avoidance of trigger factors. [ABSTRACT FROM AUTHOR]

Purpose: Review the literature concerning adrenal insufficiency (AI) and adrenal crisis (AC) in adolescents and young adults. Methods: Searches of PubMed identifying relevant reports up to March 2022. Results: AI is rare disorder that requires lifelong glucocorticoid replacement therapy and is associated with substantial morbidity and occasional mortality among adolescents and young adults. Aetiologies in this age group are more commonly congenital, with acquired causes, resulting from tumours in the hypothalamic-pituitary area and autoimmune adrenalitis among others, increasing with age. All patients with AI are at risk of AC, which have an estimated incidence of 6 to 8 ACs/100 patient years. Prevention of ACs includes use of educational interventions to achieve competency in dose escalation and parenteral glucocorticoid administration during times of physiological stress, such as an intercurrent infection. While the incidence of AI/AC in young children and adults has been documented, there are few studies focussed on the AC occurrence in adolescents and young adults with AI. This is despite the range of developmental, psychosocial, and structural changes that can interfere with chronic disease management during this important period of growth and development. Conclusion: In this review, we examine the current state of knowledge of AC epidemiology in emerging adults; examine the causes of ACs in this age group; and suggest areas for further investigation that are aimed at reducing the incidence and health impact of ACs in these patients. [ABSTRACT FROM AUTHOR]

Background: In several countries, suicide is one of the leading causes of mortality and morbidity among adolescents, making it a major public health problem. Suicide can be prevented with accurate and prompt evaluation of mental illness and successful care, as well as informed media reporting of suicide and environmental monitoring of risk factors. Objective:This study was designed to assess the predictive value of the Poisoning Severity Score ((PSS) IPCS/EAPCCT)) in the outcome of suicide by pesticides in adolescents and provide data on risk/precipitating factors. Methods:Observational prospective surveys were conducted on 100 adolescent patients presented with acute suicidal pesticides poisoning within a six-month period and met the inclusion criteria. Results: Most of the patients (96.0%) reported adverse life events and recent stressors, 77.0% of the patients were diagnosed with anxiety, 52.0% were diagnosed with depression, and 29.0% were diagnosed with personality disorders. Significant higher total PSS was found in patients who died (2.22 ± 0.24) compared to those admitted to ICU (1.47 ± 0.23); p=0.001 and the total PSS for the patients admitted to ICU(1.47 ± 0.23) was significantly higher than those admitted to Alexandria Poison Center (0.64 ± 0.26) p 2 and P-value was highly significant (p

ABSTRACT Objective: To evaluate the precipitating factors of diabetic ketoacidosis (DKA) in patients with type 1 diabetes hospitalized through the emergency department of a tertiary hospital. Materials and methods: Individuals with type 1 diabetes hospitalized for DKA from January 2005 to March 2010 (first period [P1], n = 75) and from April 2010 to January 2017 (second period [P2], n = 97) were identified through a query of electronic medical records. Data were collected by reviewing medical records. Only the first hospitalization of each participant in each period was included. Results: In P2, 44 patients (45.4%) were women, mean age was 26.2 ± 14.5 years, and 74 patients (76.3%) had a previous diagnosis of type 1 diabetes. Only 1 patient had glycated haemoglobin (HbA1c) below 64 mmol/mol (8.0%). Most patients (62.2%) had had a previous episode of DKA. In P1, non-adherence was the main cause of DKA (38.7%), followed by infection (24.0%). In P2, these rates were 34.0% and 24.7%, respectively; no statistical difference was observed between the two study periods (p = 0.790). Conclusion: Over time, non-adherence remained the main precipitating factor of DKA, followed by infection, and no significant difference was observed between the two study periods. Elevated HbA1c, outside the therapeutic range, indicates suboptimal diabetes care and may explain, at least in part, poor adherence as a precipitating factor of decompensation. Health strategies, such as improved self-management of type 1 diabetes, may contribute to a future reduction in DKA episodes.

Aim: To investigate the precipitating factors that contribute to hospitalization and mortality in postacute heart failure (AHF) hospitalization in the Middle-East region. Methods: We evaluated patient data from the Gulf AHF registry (Gulf CARE), a prospective multicenter study conducted on hospitalized AHF patients in 47 hospitals across seven Middle Eastern Gulf countries in 2012. We performed analysis by adjusting confounders to identify important precipitating factors contributing to rehospitalization and 90- to 120-day follow-up mortality. Results: The mean age of the cohort (n = 5005) was 59.3 ± 14.9 years. Acute coronary syndrome (ACS) (27.2%), nonadherence to diet (19.2%), and infection (14.6%) were the most common precipitating factors identified. After adjusting for confounders, patients with AHF precipitated by infection (hazard ratio [HR], 1.40; 95% confidence interval [CI] 1.10–1.78) and ACS (HR-1.23; 95% CI: 0.99-1.52) at admission showed a higher 90-day mortality. Similarly, AHF precipitated by infection (HR-1.13; 95% CI: 0.93–1.37), and nonadherence to diet and medication (HR-1.12; 95% CI: 0.94–1.34) during hospitalization showed a persistently higher risk of 12-month mortality compared with AHF patients without identified precipitants. Conclusion: Precipitating factors such as ACS, nonadherence to diet, and medication were frequently identified as factors that influenced frequent hospitalization and mortality. Hence, early detection, management, and monitoring of these prognostic factors in-hospital and postdischarge should be prioritized in optimizing the management of HF in the Gulf region.

Aim: We aimed to assess the impact of precipitating factors and signs of acute heart failure on the length of hospital stay according to the ejection fraction (EF) subgroups. Methods: We conducted a retrospective study among acute heart failure patients hospitalized at the Department of Cardioan‑ giology in 2017. The most frequent precipitants and signs were included in the multivariate analysis to assess their association with the length of hospital stay. Results: We included 376 patients with a median length of hospital stay 11 days. There were 198, 58, and 120 patients with reduced, mildly reduced, and preserved EF, respectively. In reduced EF, peripheral swelling (OR 1.97, CI 1.02–3.78) and pul‑ monary congestion (OR 2.72, CI 1.38–5.34) were associated with a longer hospital stay. Non‑pulmonary infection (OR 50.57, CI 2.82–906.84) and heart failure progression (OR 15.33, CI 1.25–188.53) were associated with a longer hospital stay in mildly reduced EF, and acute pulmonary disease was associated with a longer hospital stay in patients with mildly reduced (OR 10.77, CI 1.07–108.81) and preserved (OR 3.96, CI 1.05–14.99) EF. Conclusion: Precipitating factors and signs of acute heart failure have different impacts on the length of hospital stay among patients with reduced, mildly reduced or preserved EF. [ABSTRACT FROM AUTHOR]

Objective To evaluate the precipitating factors for heart failure decompensation in primary care and associations with short-term prognosis. Design Prospective cohort study with a 30-d follow-up from an index consultation. Regression models to determine independent factors associated with hospitalisation or death. Setting Primary care in ten European countries. Patients Patients with diagnosis of heart failure attended in primary care for a heart failure decompensation (increase of dyspnoea, unexplained weight gain or peripheral oedema). Main outcome measures Potential precipitating factors for decompensation of heart failure and their association with the event of hospitalisation or mortality 30 d after a decompensation. Results Of 692 patients 54% were women, mean age 81 (standard deviation [SD] 8.9) years; mean left ventricular ejection fraction (LVEF) 55% (SD 12%). Most frequently identified heart failure precipitation factors were respiratory infections in 194 patients (28%), non-compliance of dietary recommendations in 184 (27%) and non-compliance with pharmacological treatment in 157 (23%). The two strongest precipitating factors to predict 30 d hospitalisation or death were respiratory infections (odds ratio [OR] 2.8, 95% confidence interval [CI] (2.4–3.4)) and atrial fibrillation (AF) > 110 beats/min (OR 2.2, CI 1.5–3.2). Multivariate analysis confirmed the association between the following variables and hospitalisation/death: In relation to precipitating factors: respiratory infection (OR 1.19, 95% CI 1.14–1.25) and AF with heart rate > 110 beats/min (OR 1.22, 95% CI 1.10–1.35); and regarding patient characteristics: New York Heart Association (NYHA) III or IV (OR 1.22, 95% CI 1.15–1.29); previous hospitalisation (OR 1.15, 95% CI 1.11–1.19); and LVEF < 40% (OR 1.14, 95% CI 1.09–1.19). Conclusions In primary care, respiratory infections and rapid AF are the most important precipitating factors for hospitalisation and death within 30 d following an episode of heart failure decompensation.Key points Hospitalisation due to heart failure decompensation represents the highest share of healthcare costs for this disease. So far, no primary care studies have analysed the relationship between precipitating factors and short term prognosis of heart failure decompensation episodes. We found that in 692 patients with heart failure decompensation in primary care, the respiratory infection and rapid atrial fibrillation (AF) increased the risk of short-term hospital admission or death. Patients with a hospital admission the previous year and a decompensation episode caused by respiratory infection were even more likely to be hospitalized or die within 30 d.

The Thyroid Storm (TS) is the severest form of thyrotoxicosis and is associated with a high mortality rate. TS presents with fever, tachycardia, gastrointestinal symptoms, and central nervous system dysfunction and may be overlooked if patients do not present thyrotoxic symptoms or have precipitating factors. We reported a pediatric case of TS with mild proptosis but no obvious precipitating factors in a previously healthy child. A 9-year-old, female patient with a history of attention-deficit hyperactivity disorder presented with the complaint of frequent vomiting. She was alert but lethargic with fever and tachycardia. Physical examination was unremarkable except for coolness in the extremities and a delayed capillary refill time of two seconds. Fluid resuscitation was ineffective in alleviating the tachycardia. Additional history-taking revealed a one-month history of mild proptosis but no other thyrotoxic findings or precipitating factors were found. Markedly elevated thyroxine and triiodothyronine and suppressed thyroid-stimulating hormone on thyroid function tests led to a diagnosis of TS. Methimazole, potassium iodine, bisoprolol, and hydrocortisone were administered. Her vital signs and thyroid functions gradually improved, and she was discharged 18 days after admission without any serious complications. She is currently euthyroid and clinically stable on 5 mg of methimazole at three months after admission. When tachycardia that is resistant to usual resuscitation is found, careful history-taking and physical examination targeting thyroid disorders should be performed to assess for TS.

Objective: to detect the incidence of postoperative delirium in critically ill patients admitted to a surgical intensive care unit and to evaluate the predisposing and precipitating factors associated with postoperative delirium in critically ill patients admitted to a surgical intensive care unit., Method: this is a prospective cohort study of 157 critically ill surgical patients. Fisher's exact test and Chi-square test were used for the association between factors and the occurrence of delirium, the Wilcoxon test for numerical variables, and the logistic regression model for the analysis of predisposing and precipitating factors., Results: the incidence of delirium was 28% (n=44). Age was a significant predisposing factor (p=0.001), followed by the length of surgery (p<0.001), blood transfusion (p=0.043), administration of crystalloids (p=0.008), and anti-inflammatory drugs (p=0.037), which were the precipitating factors identified. The best-adjusted models were: age, length of surgery, non-administration of anti-emetics, use of sufentanil, and blood transfusion., Conclusion: delirium is a frequent condition in critically ill adults undergoing surgery and the existence of precipitating and predisposing factors is relevant to the outcome, with the anesthetic-surgical procedure as the catalyst event.