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In a group of palliative patients, venous thromboembolism (VTE) is a significant cause of death and reduction in quality of life. Current guidelines and scientific research on thromboprophylaxis most often refer to the population of oncology patients, who differ in many aspects from patients receiving palliative care. Thus, doctors working with patients undergoing palliative treatment have to face many problems related to safety and effectiveness of antithrombotic therapy in this type of care. In the case of chronically ill patients, diagnostic process may be somewhat difficult because the symptoms resulting from the underlying diseases can mask VTE symptoms. The aim of this article is to review the literature on symptoms and thromboprophylaxis in this group of patients. According to the latest guidelines of the American Society of Clinical Oncology (ASCO), it is not recommended to use VTE prophylaxis in outpatient oncology patients routinely, but it should be considered in high-risk patients who received a Khorana score of at least 2 before starting a new chemotherapy cycle. In patients diagnosed with VTE, in long-term prophylaxis lasting at least 6 months, due to greater effectiveness, it is recommended to use low-molecular-weight heparins, edoxaban, rivaroxaban or apixaban instead of vitamin K antagonists, which can be used if the previously mentioned drugs are unavailable. There are some studies which show that thromboprophylaxis may be beneficial for patients in palliative care. On the other hand, another studies’ results suggest that patients won’t gain any benefit from prevention. As our article shows it is very crucial to conduct scientific research on palliative patients and create clear guidelines for prophylaxis for this group of people. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is a significant cause of death among palliatively treated patients. So far, numerous studies have been conducted on the general population. As a result, special scales were created to assess the risk of VTE or the probability of its occurrence. Among patients with terminal disease, there are much fewer publications discussing the problem of VTE. Hospice care patients constitute a special group due to their epidemiological structure and accompanying diagnoses. The most common are malignant tumors and heart failure. For this reason, they are particularly vulnerable to VTE events. This article reviews the literature on risk scales such as The Padua Risk Assessment Scale, Khoran score, Wells scale, PVFS scale and VTE-BLEED scale. W also present risk factors which contribute to the development of the VTE as well as to a more serious course of VTE. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used to treat it. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used in its treatment. We describe how the presence of a catheter and immobilization contribute to the development of VTE. We focus particularly on scales and risk factors to which a patient with a terminal disease is exposed. More research is needed in the future to better predict VTE in hospice patients. We hope that this work will increase awareness and encourage researchers to expand knowledge in this area. [ABSTRACT FROM AUTHOR]

Diseases due to microbial infection had been a great hindrance towards sustainable growth in the aquaculture sector across the globe. The present study identified an alternative stimulatory Mx gene product in catla (Labeo catla) and demonstrated its tissue-specific expression kinetics through semi-quantitative real-time polymerase chain reaction (semi-q-PCR). Mx genes were quantified in catla infected with Flavobacterium columnare and Aeromonas veronii and myxosporean parasites, Myxobolus sp. The ratio of Mx/β-actin (housekeeping gene) expression in all organs of catla has been determined continuously for 14 days. The results showed the highest expression of Mx in the spleen (p < 0.05), followed by the brain, liver, intestine, heart, kidney, and gill. Mx expression was observed to be highest on day 2 in all the organs except in the spleen, where its upregulation was noticed on day 3 with a gradual decrease in expression level over the study period. It has been evident that the ratio of Mx/β-actin ratio was significantly (p < 0.05) upregulated in all tissues irrespective of types of infections and saponin administration. Noticeably, maximum heterologous expression of Mx due to bacteria and parasites challenge was observed on the 3rd day, while in the case of saponin administration, it showed at 30 min. The present study revealed the prospects of microbial infection and saponin treatment as potent immuno-stimulatory agents. Thus, the present finding provides an insight into the inherent origin of the Mx gene in the early stages of fish that provide protection against microbial infection as a natural gatekeeper, which could advocate the safe valorization of saponins at ≤ 40 mg. L−1 as an immune booster in fish as well as a future source for fish vaccination. [ABSTRACT FROM AUTHOR]

In a group of palliative patients, venous thromboembolism (VTE) is a significant cause of death and reduction in quality of life. Current guidelines and scientific research on thromboprophylaxis most often refer to the population of oncology patients, who differ in many aspects from patients receiving palliative care. Thus, doctors working with patients undergoing palliative treatment have to face many problems related to safety and effectiveness of antithrombotic therapy in this type of care. In the case of chronically ill patients, diagnostic process may be somewhat difficult because the symptoms resulting from the underlying diseases can mask VTE symptoms. The aim of this article is to review the literature on symptoms and thromboprophylaxis in this group of patients. According to the latest guidelines of the American Society of Clinical Oncology (ASCO), it is not recommended to use VTE prophylaxis in outpatient oncology patients routinely, but it should be considered in high-risk patients who received a Khorana score of at least 2 before starting a new chemotherapy cycle. In patients diagnosed with VTE, in long-term prophylaxis lasting at least 6 months, due to greater effectiveness, it is recommended to use low-molecular-weight heparins, edoxaban, rivaroxaban or apixaban instead of vitamin K antagonists, which can be used if the previously mentioned drugs are unavailable. There are some studies which show that thromboprophylaxis may be beneficial for patients in palliative care. On the other hand, another studies’ results suggest that patients won’t gain any benefit from prevention. As our article shows it is very crucial to conduct scientific research on palliative patients and create clear guidelines for prophylaxis for this group of people.

Venous thromboembolism (VTE) is a significant cause of death among palliatively treated patients. So far, numerous studies have been conducted on the general population. As a result, special scales were created to assess the risk of VTE or the probability of its occurrence. Among patients with terminal disease, there are much fewer publications discussing the problem of VTE. Hospice care patients constitute a special group due to their epidemiological structure and accompanying diagnoses. The most common are malignant tumors and heart failure. For this reason, they are particularly vulnerable to VTE events. This article reviews the literature on risk scales such as The Padua Risk Assessment Scale, Khoran score, Wells scale, PVFS scale and VTE-BLEED scale. W also present risk factors which contribute to the development of the VTE as well as to a more serious course of VTE. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used to treat it. We discuss the epidemiological structure of patients, the impact of cancer as well as the chemotherapy used in its treatment. We describe how the presence of a catheter and immobilization contribute to the development of VTE. We focus particularly on scales and risk factors to which a patient with a terminal disease is exposed. More research is needed in the future to better predict VTE in hospice patients. We hope that this work will increase awareness and encourage researchers to expand knowledge in this area.

Introduction: Breast cancer is the most frequently diagnosed cancer in the world and second most common malignancy among Nepalese women with high prevalence. Countries with lower level of resources like Nepal, prevention of breast cancer is more important. The objective of the study was to find out the level of awareness on breast cancer among female at Bharatpur Metropolitan, Nepal. Methods: An analytical cross- sectional study was conducted among 263 female of Bharatpur Metropolitan city, Nepal. Non probability purposive sampling technique was used for data collection. Data was entered and analyzed by using SPSS-20, p-value

While the use of Pediatric Track and Trigger Tools as a standard to discriminate high level of urgency in pediatric care has received considerable attention, less focus has been given to other important factors such as nurses' clinical observations and judgement. The purpose of this study was to explore nurses' observational practice and focus on which non-measurable signs and symptoms nurses find important when identifying inpatient pediatric patients at risk of clinical deterioration. This was an inductive qualitative study based on an interpretive description methodology. Data were obtained through participant observation of experienced nurses working in a Danish pediatric unit and focus group interviews with pediatric nurses. Field notes were taken, and focus group interviews were audio taped and transcribed. A thematic text condensation method was used to analyse data. Findings revealed the following four main themes of non-measurable signs and symptoms that nurses find important when identifying children at risk of clinical deterioration: Colour and skin tone; sounds; movement patterns; behavioural signs. This study suggest that pediatric patients show signs and symptoms that go beyond the objective measurements integrated in Pediatric Track and Trigger Tools and they should not be ignored as they are highly valuable to nurses who are responsible for observing inpatient pediatric patients at risk of clinical deterioration. More empirical research on nurses' observational practice is recommended, especially research to identify the signs and symptoms - both measurable and non-measurable – that are significant to nurses at the bedside. • Children often present subtle signs and symptoms of clinical deterioration. • Identifying pediatric patients at risk of deterioration requires more than relying on a score. • Non-measurable signs and symptoms are important to nurses when observing inpatient pediatric patients at the bedside. [ABSTRACT FROM AUTHOR]

Diabetic ketoacidosis(DKA) is a serious life threatening condition and it occurs when insulin production in our body is less.Diabetic ketoacidosis is a complication of diabeties mellitus and it mostly occur in hospitalize patients . Diabetic ketoacidisis condition mostly found in both type of diabeties such as Type 1 and Type 2 diabeties patients. In between 20-30% of cases of diabetic ketacidosis condition occure in newly diagnosed patient with diabeties . Almost till 20 years the mortality rate of diabetic ketoacidosis is 100 percent and till now there is no reduction in prevalence of diabetic ketoacidosis in younger patients due to that children are continuous suffering with death . The mortality rate in Diabetic ketoacidosis is very important because it is a very serious life threatening condition so the prevalence of diabeties is very crucial. The younger are the foundation of future health care delivery system so the evaluation of their knowledge and continue development and upgrading regarding awareness and unstanding the sign and symptoms of diabetic ketoacidosis it helps to reduce the mortality rate of Diabetic ketoacidosis. It’s an emergency condition, so the health care professional becomes a vital part of managing diabetesrelated hyperglycemic emergencies, rising health care costs and changing health care systems preventing signs and symptoms of diabetic ketoacidosis remains an essential requirement. Effective management and prevention on diabetic ketoacidosis can reduced longer stay time in hospitalize patient. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the commonest mode of presentation at our sarcoma unit and the duration from onset of symptoms till presentation. Study Design: Retrospectively study. Setting: Sarcoma Unit of Hayatabad Medical Complex, Peshawar. Period: June 2016 to December 2019. Material & Methods: Two hundred and eighty two patients were included in this study of which 172 patients were male and 110 were female. Sample size was calculated through non-probability consecutive sampling technique. Results: Average age of patients presenting to us was 30.2years (±18.5) ranging from 3years to 83years. Highest numbers of patients fell into the age group category of 11-20years i.e. 94 (33.33%). The average duration of symptoms among our patients was 19.6 months (±26.09) ranging from 0.1months (3 days) to 168 months (14years). Highest number of patients fell into the 7months-12months category i.e. 86 patients (30.5%). The commonest mode of presentation among our patients was painful lump i.e. 128(45.3%) while patients presenting with painless lump were 57(20.2%) and those presenting with only pain were 28(9.9%). Conclusion: The study concluded that there is a need of greater awareness among general population and health care professionals regarding red flag signs and symptoms in order to avoid the delays in diagnosis which may lead to poor prognosis. [ABSTRACT FROM AUTHOR]

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Introduction Bacterial meningitis (BM) is a neurologic emergency mainly affecting children under the age of two. Clinical symptoms are rarely evident in children, thus making a diagnosis is a challenge. Antibiotic therapy should be started timely to ensure the avoidance of significant morbidity and mortality. This study aims to assess the outcomes, mortality, and symptomatology of children presenting with BM in allied hospitals of Rawalpindi Medical University, Pakistan. Methods It is a cross-sectional study employing a sample size of 201, conducted at the Allied Hospitals of Rawalpindi Medical University, Pakistan from a period of January 2023 to August 2023. Non-probability convenience sampling was used. Children aged between newborns and 14 years of age with a confirmed diagnosis of bacterial meningitis were included in this study. The study population was divided into five different age groups. Three different outcomes were studied including complete recovery, development of complications, and death. Data was entered into and analyzed by Statistical Package for the Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY, USA). Descriptive statistics were applied to the demographic data. The chi-square analytical test was applied to study the association between the categorical variables. Results One hundred nineteen (59.2%) of the study's population were males. One hundred twenty-six (62.7%) of the patients were born through a spontaneous vaginal delivery (SVD). The majority (54%) of the study population were infants. Twenty-three percent were newborns, 13% were toddlers, 6% were preschool children, and 4% were school-age children. The majority (85%) of the study participants belonged to lower socioeconomic backgrounds. Ninety percent of the cases had symptoms of fever, seizures, and poor feeding. Neck stiffness was significantly associated with death as an outcome (p-value=0.01). The overall mortality amongst the study population was 20%. Forty-nine percent of the study population recovered completely, whereas 31% had complications following the diagnosis. Neonates had a higher mortality rate than infants (45% vs 9% respectively). Conclusion The most common presenting symptoms were fever, vomiting, seizures, and neck stiffness. Poor feeding was also seen in most cases. The rate of complications and death is observed to be relatively higher following the diagnosis of bacterial meningitis as compared to rates in the surrounding and developed countries. Out of all signs and symptoms, the presence of neck stiffness was significantly associated with death as an outcome among children with bacterial meningitis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zarak Khan et al.)

The main purpose of this article is to present a review on oral submucous fibrosis patients, those who are suffering from hypochondriasis disorder and identifying its interrelationship with their family how they are also suffering due to this problem. The article also focuses on the sign and symptoms of this disorder. Also, it highlights the treatment planning of this disorder. [ABSTRACT FROM AUTHOR]

Bone metabolism and development of teeth are under the influence of systemic factors. Systemic disorders affect development and organization of these tissues. Earliest findings of many systemic diseases arise in the mouth and dentists being aware of these findings facilitates differentiation of the cause of pathologies and early diagnosis of diseases. In this rewiev, general characteristics of systemic diseases and their intraoral findings are classified under the headings of metabolic, endocrine, rheumatic disorders and blood diseases, and discussed with their occurance mechanisms. [ABSTRACT FROM AUTHOR]

Background: There is an increasing trend of stroke occurrence among Malaysian populations recently. Thus, there is a need for further early management and secondary prevention of stroke. Objectives: To provide an overview on knowledge, attitude and practice (KAP) had been carried out among stroke patients and general population. Data sources: Published survey studies on KAP had been carried out among stroke patients general population in Malaysia and globally. Review methods: Searches were conducted in two data-bases (ProQuest, EBSCOhost). Reviews were included, if these were based on a survey study that measures KAP between 2005 and 2015. The authors had focused the survey study design, population and sampling method highlighting the tools and interview strategy used in order to obtain the information on KAP. The scope of interest were perceptions towards stroke, knowledge on risk factors, signs and symptoms of stroke and its association with socio-demography background of the participants. Results: A total of 22 articles were reviewed and included, but none of them was derived from Malaysia studies. However, only 14 were reviewed systematically on the basis of its completeness for quantitative synthesis. In this article, we had reviewed the existing literatures on the scope mentioned earlier and compared it with those of developed countries. Findings highlighted the level of stroke knowledge on risk factors as well as signs and symptoms rangeing from moderate to poor. This knowledge level was found to be associated with age, gender, education level and income status. Conclusion: Study on KAP is crucial in order to increase the awareness about stroke disease on the risk factors management, administration of appropriate treatment as well as further secondary prevention. This findings may be adopted in Malaysia to improve awareness and knowledge specifically for the stroke patients and their family members and among the public generally. [ABSTRACT FROM AUTHOR]

Fabio Coppedè Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy Abstract: Hutchinson–Gilford Progeria Syndrome and Werner syndrome, also known as childhood- and adulthood-progeria, respectively, represent two of the best characterized human progeroid diseases with clinical features mimicking physiological aging at an early age. The discovery of their genetic basis has led to the identification of several gene mutations leading to a spectrum of progeroid phenotypes ranging from moderate and mild–severe to very aggressive forms. In parallel, the creation of disease registers and databases provided available data for the design of relatively large-scale epidemiological studies, thereby allowing a better understanding of the nature and frequency of the premature aging-associated signs and symptoms. The aim of this article is to review the most recent findings concerning the epidemiology of premature aging disorders, their genetic basis, and the most recent reports on the frequency of associated diseases. Keywords: Hutchinson–Gilford Progeria Syndrome, Werner syndrome, premature aging disorders, epidemiology, cardiovascular diseases, cancer, atherosclerosis, genetics, sign and symptoms

Background/Aim. Besides viral serotype, HLA haplotype and cytokine genes polymorphism are associated with clinical presentation of hemorrhagic fever with renal syndrome. Since these analyses are unavailable in routine clinical practice, the aim of this study was to assess clinical, laboratory and radiographic findings associated with clinical presentation of disease severity. Methods. A total of 30 patients (27 men and 3 women), average age 40 ± 14.9 years, treated for hemorrhagic fever with renal syndrome from January 1, 1999 to December 31, 2009 in Clinical Center of Serbia, were included in the study. Nine patients (30%) had mild, 14 (46.7%) moderate and 7 (23.3%) severe form of the disease; 24 (80%) recovered, 6 (20%) died in the acute phase of the illness, and 19 patients (63.3%) required hemodialysis. Results. The average titer of antiviral antibodies in patients infected with Belgrade serotype virus were significantly higher in those with severe clinical presentation. Hypotension, anuria, macrohaematuria, pulmonary infiltration, pleural effusion, hepatomegalia and positive meningeal signs were more frequent in the patients with severe form of the disease. Statistically significant differences between groups with mild, moderate and severe clinical picture were found in serum total protein, albumin, calcium, glutamate pyruvate and glutamate oxaloacetate transaminase on admittance; serum creatinine and phosphorus concentration on day 14 and day 21; serum sodium and calciums on day 14; hemoglobine concentration on day 21. A statistically significant correlation was found between clinical presentation of the disease severity and platelet count, white blood cell count, hemoglobine concentration, serum calcium and serum transaminases on admittance. Multivariate analysis identified variables` combinations associated with clinical presentation of the disease. Conclusion. Our study confirmed that we can distinguish patients who will manifest different severities of the disease on the basis of careful consideration of laboratory and clinical findings on admission.

Dengue is a major public health concern and an economic burden in the Philippines. Despite the country’s improved dengue surveillance, it still suffers from various setbacks and needs to be complemented with alternative approaches. Previous studies have demonstrated the potential of Internet-based surveillance such as Google Dengue Trends (GDT) in supplementing current epidemiological methods for predicting future dengue outbreaks and patterns. With this, our study has two objectives: (1) assess the temporal relationship of weekly GDT and dengue incidence in Metropolitan Manila from 2009⁻2014; and (2) examine the health-seeking behavior based on dengue-related search queries of the population. The study collated the population statistics and reported dengue cases in Metropolitan Manila from respective government agencies to calculate the dengue incidence (DI) on a weekly basis for the entire region and annually per city. Data processing of GDT and dengue incidence was performed by conducting an ‘adjustment’ and scaling procedures, respectively, and further analyzed for correlation and cross-correlation analyses using Pearson’s correlation. The relative search volume of the term ‘dengue’ and top dengue-related search queries in Metropolitan Manila were obtained and organized from the Google Trends platform. Afterwards, a thematic analysis was employed, and word clouds were generated to examine the health behavior of the population. Results showed that weekly temporal GDT pattern are closely similar to the weekly DI pattern in Metropolitan Manila. Further analysis showed that GDT has a moderate and positive association with DI when adjusted or scaled, respectively. Cross-correlation analysis revealed a delayed effect where GDT leads DI by 1⁻2 weeks. Thematic analysis of dengue-related search queries indicated 5 categories namely; (a) dengue, (b) sign and symptoms of dengue, (c) treatment and prevention, (d) mosquito, and (e) other diseases. The majority of the search queries were classified in ‘signs and symptoms’ which indicate the health-seeking behavior of the population towards the disease. Therefore, GDT can be utilized to complement traditional disease surveillance methods combined with other factors that could potentially identify dengue hotspots and help in public health decisions.

"n Objective: "n "nThe aim of this report was to study the gender role on autismsymptoms distribution and severity in a clinical sample from Iran. Then, the results were compared with the published study from the same community population sample, Iran. "nMethod: The subjects of this retrospective study were a convenient clinical sample of the referrals of children with pervasive developmental disorders. The diagnosis was made according to DSM-IV diagnostic criteria. "nResults: "nMost of the subjects were boys. Boys were referred for evaluation more frequently than girls. The sample included 61 children and adolescents aged 2.1 to 15 years; of whom, 49 had autism. The mean age of children with autism was 7.2(SD=3.2) years. The mean of age, the diagnosis and severity of the symptoms were not related to gender . "n "n "nConclusion: Usually, those with severe cases of autism refer to clinics for treatment. Therefore, the clinical sample of children with autism is just the tip of the iceberg and they may not be the actual representative of community sample of children with autism. Preventive programs should be more focused on the screening and referring of inflected girls for service utilization .

Objectives: Culture may place a differential emphasis on particular emotions. The aim of this study is to find the most frequent symptoms in patients with major depressive disorder in Tehran. Method: 509 patients were recruited from 5 treatment settings. The sample was used from the project of assessing psychometric properties of CIDI in the Iranian population. The patients were evaluated by conducting clinical interviews and using DSM-IV criteria (American Psychiatric Association, 1994) for major depressive disorder. Results: Depressed mood (98.7%), sleep change (92.1%) and, fatigue / energy loss (89.4%) were the three highest-ranking symptoms. As cognitive factors, guiltiness and worthlessness were among the lowest ranking symptoms. There were no significant differences between men and women in frequency of symptoms with the exception of suicidal thoughts. Men had significantly higher suicidal thoughts than women. (P: 0. 01) Conclusion: Data were presented on the depressive symptomatology in population of Tehran. Key findings included a high rate of somatic symptoms in patients who suffered from MDD in this population.

Abstract This case, which evolves over three sessions, describes the course of a pregnant woman from the Dominican Republic who presents to the emergency department complaining of abdominal pain. Developed by faculty from multiple clinical departments, this case allows learners to integrate and apply collected data to problem-solve. It also helps students develop the skills necessary for the interpretation and utilization of relevant historical, physical examination, and laboratory information in a patient who is acutely ill. Topics addressed in the exercise include symptom presentation/evolution, generation of differential diagnosis, diagnostic testing, and patient management. The exercise reiterates the clinical relevance of basic science topics, including embryology, anatomy, pharmacology, physiology, and pathophysiology. It also allows students to address culture, intimate partner violence, health beliefs, population medicine, and evidenced-based practice. The problem-based format fosters self-directed learning, reflection, and collaborative practice. Student evaluations have consistently indicated that the exercise has helped them to think about a clinical case in a multidisciplinary fashion, across specialty lines, and from a cultural perspective. Since first implementing this case in 2003, we have recognized the benefit of having fourth-year students cofacilitate the exercise. We have also involved the medical library staff in the implementation of this exercise to provide students with an additional resource to help them with more challenging literature searches. This problem-based learning exercise allows third-year medical students to consolidate educational experiences from across their clerkships and encourages multidisciplinary thinking in their clinical interactions. The strength of the case is that students are required to think outside the context of a specific clerkship and integrate symptoms across organ systems.

Abstract: The objective is to clarify the early clinical characteristics in childhood moyamoya disease (MD). Epidemiologic characteristics, symptoms and diagnostic rates were assessed in 64 children (0–18years) with definite MD according to developmental stage: infancy (5; 0–1years); toddlerhood/preschool age (22; 2–5years); school age (29; 6–10years); and adolescence (8; 11–18years). The median ages at onset was 6.25years and the female to male ratio was 1.9 (⩾2.5 in toddlerhood/preschool age and in adolescence, P =0.71). Previous headache was observed in 23% (14/64): frequently in school age (38%, P =0.02) and within 6months before main symptoms (6/11). As an initial symptom, weakness was observed in 78% (50/64) mainly as transient ischemic attack (TIA, 61%) in limbs (90%) and unilaterally (82%). TIA was less frequent in infancy (40%, P =0.04). Seizure was observed in 27% (17/64): frequently in infancy (100%, P <0.01), as the focal type (71%), and in the right extremity (3:1). Isolated seizures without other symptoms was frequent in children ⩽5years (P <0.01). Severe headache associated with MD was observed in 14% (9/64). Provoking events were positive in 42% (27/64): in school age, frequently during eating (28%); and in toddlerhood/preschool age, during crying (27%). The diagnostic rates at 3 and 12months from symptom-onset were 39% (80% during infancy vs. 28% in school age, P =0.14) and 67%, respectively. Symptomatic progression at diagnosis was observed in 38% (24/64). Initial clinical characteristics in childhood definite MD differed according to developmental stage and from at diagnosis. [Copyright &y& Elsevier]

Background: Cincinnati Children's Hospital Medical Center (CCHMC) has built the initial Natural Language Processing (NLP) component to extract medications with their corresponding medical conditions (Indications, Contraindications, Overdosage, and Adverse Reactions) as triples of medication-related information ([(1) drug name]-[(2) medical condition]-[(3) LOINC section header]) for an intelligent database system, in order to improve patient safety and the quality of health care. The Food and Drug Administration's (FDA) drug labels are used to demonstrate the feasibility of building the triples as an intelligent database system task. Methods: This paper discusses a hybrid NLP system, called AutoMCExtractor, to collect medical conditions (including disease/disorder and sign/symptom) from drug labels published by the FDA. Altogether, 6,611 medical conditions in a manually-annotated gold standard were used for the system evaluation. The pre-processing step extracted the plain text from XML file and detected eight related LOINC sections (e.g. Adverse Reactions, Warnings and Precautions) for medical condition extraction. Conditional Random Fields (CRF) classifiers, trained on token, linguistic, and semantic features, were then used for medical condition extraction. Lastly, dictionary-based postprocessing corrected boundary-detection errors of the CRF step. We evaluated the AutoMCExtractor on manuallyannotated FDA drug labels and report the results on both token and span levels. Results: Precision, recall, and F-measure were 0.90, 0.81, and 0.85, respectively, for the span level exact match; for the token-level evaluation, precision, recall, and F-measure were 0.92, 0.73, and 0.82, respectively. Conclusions: The results demonstrate that (1) medical conditions can be extracted from FDA drug labels with high performance; and (2) it is feasible to develop a framework for an intelligent database system. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Limited information is available regarding the characteristics of histiocytic necrotizing lymphadenitis (HNL) in children. This study compares the clinical and laboratory features as well as the immunohistochemical findings of HNL in children with those of adults. Study design: Retrospective analysis. Methods: Thirty patients who underwent a biopsy of a cervical lymph node and were histologically proven to have HNL were enrolled in this study. There were 13 children and 17 adults. CD68, CD163 and myeloperoxidase expression were analyzed by immunohistochemical staining. Results: Children had more bilateral lymphadenopathy (P =0.045) and a higher expression of CD68 (P =0.043) than did the adult patients. However, there was no significant difference between the groups in the following variables: patient gender, presence of fever, size and necrosis of enlarged lymph node, multiplicity of lymphadenopathy, WBC count, ESR, CRP, recurrence, and expression of myeloperoxidase and CD163. Conclusions: The clinical and immunohistological characteristics of HNL in pediatric patients are similar to those of adults. Bilateral involvement of lymph nodes and a high expression of CD68 were the only features significantly associated with children with HNL. [Copyright &y& Elsevier]

The objective of this study is to estimate the prevalence of self-reported secondhand smoke (SHS) exposures and its association with respiratory symptoms in a sample of young adults residing in a state with a partial clean indoor air law. A cross-sectional telephone survey of Florida households and a single state University was conducted in 2005. Enrolled participants between 18 and 24 years of age completed a 15-20 min interview assessing past and current SHS exposure and current respiratory symptoms (n = 1858). Approximately 60% of the sample were female; nearly 70% were non-Hispanic white, 10% were non-Hispanic Black, and 11% were Hispanic. Over two-thirds reported completing at least some college; 23% reported smoking in the past month. Nearly two-thirds (64%) reported visiting a bar or nightclub which exposed them to SHS in the previous month; nearly half (46%) reported SHS exposure while riding in automobiles; 15% reported occupational SHS exposure; and nearly 9% reported living with at least one smoker. In multivariable models, personal smoking behavior, parental smoking history, and exposure to SHS in automobiles and in bars or nightclubs were significantly associated with increased reports of respiratory symptoms. Despite residing in a ''clean'' indoor air state, the majority of surveyed young adults continue to report exposure to SHS, especially in automobiles and in bars, and these exposures adversely impact respiratory health. All municipalities should pursue clean indoor air legislation which does not exempt bars and restaurants. Educational campaigns directed at reducing SHS exposure in motor vehicles also are needed. [ABSTRACT FROM AUTHOR]

Coronavirus disease (COVID-19) became a priority health problem. The objective was to evaluate the clinical characteristics, evolution and severity of COVID-19 in a third-level hospital, in the province of Buenos Aires, Argentina. We conducted a retrospective cohort of 101 patients with COVID-19 from March 3 to June 21, 2020. The patients were divided according to the presence or absence of pneumonia and the severity of the disease. The median age was 42 years and 53% were women. The most common symptoms were fever 66% and cough 57%. Dyspnea and fever were associated with the presence of pneumonia. The most prevalent comorbidities were: hypertension 22%, obesity 18%, cardiovascular disease 7% and chronic respiratory disease 7%. The presence of any comorbidity and hypertension were more common in severe cases. The most frequent laboratory findings were: lymphopenia 55%, elevated D-dimer 38%, and thrombocytopenia 20%. In severe diseases, the level of C-reactive protein and D-dimer were higher. Twenty six patients had pneumonia and 24% were healthcare workers. For diagnosis, more than one reverse transcriptase polymerase chain reaction (RT-PCR) sample was needed in 24% of cases. A moderate-high value of the Pneumonia Severity Index (PSI) was more prevalent in severe than mild pneumonia (63% vs. 17%, p 0.032). A mortality of 5% was registered (95% CI 1-11%). The clinical characteristics, severity and prognosis were similar to those described worldwide. We highlight a high proportion of healthcare workers were SARS-CoV-2 positive, the false negative rate of the RT-PCR and the usefulness of the PSI to discriminate the severity of pneumonia.

Objective: To explore the utility of pharyngeal pH monitoring which positive standard is Ryan index in diagnosis of laryngopharyngeal reflux disease. Methods: In a retrospective study, clinical data of 590 patients who had symptoms laryngopharyngeal reflux disease from February 2016 to March 2017 were analyzed. All patients were received electronic laryngoscopy, assessment of reflux symptom index(RSI) and reflux finding score(RFS), and pharyngeal pH monitoring. SPSS 19.0 software was used to analyze the date. Results: There were 94 patients whose Ryan index were positive(15.93%). Among the 94 patients, 70 were positive during upright, 12 during supine and 12 during both upright and supine. There were 40 patients(6.78%)with pH decline events related to symptoms, while those Ryan index were normal. There were 536(90.85%), 417(70.68%), 233(39.49%) and 117(19.83%) patients with pH<6.5, pH<6.0, pH<5.5 and pH<5.0 events respectively. The positive rate of RSI, RFS, RSI and RFS, RSI or RFS were 44.24%, 16.78%, 7.12%, 53.90% respectively. The RFS score in Ryan index positive group was higher than that in Ryan index negative group[(8.2±2.4) vs (4.0±2.9), u =5.424, P <0.05], while the RSI score in Ryan index positive group was not statistically different from that in Ryan index negative group[(11.3±6.2) vs (12.7±5.8), t =1.247, P =0.167]. Conclusions: Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. However, with the Ryan index as a criterion for the diagnosis of laryngopharyngeal reflux disease, partial patients may be missed. Further studies are needed to obtain more accurate and objective laryngopharyngeal pH statistical index for diagnosis of laryngopharyngeal reflux disease.