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Michel Klein, Pele Chong
Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials...
2015: Human Vaccines & Immunotherapeutics
Patric Blomstedt, Rasmus Stenmark Persson, Gun-Marie Hariz, Jan Linder, Anna Fredricks, Björn Häggström, Johanna Philipsson, Lars Forsgren, Marwan Hariz
BACKGROUND: Several open-label studies have shown good effect of deep brain stimulation (DBS) in the caudal zona incerta (cZi) on tremor, including parkinsonian tremor, and in some cases also a benefit on akinesia and axial symptoms. The aim of this study was to evaluate objectively the effect of cZi DBS in patients with Parkinson's disease (PD). METHOD: 25 patients with PD were randomised to either cZi DBS or best medical treatment. The primary outcomes were differences between the groups in the motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS-III) rated single-blindly at 6 months and differences in the Parkinson's Disease Questionnaire 39 items (PDQ-39)...
January 31, 2018: Journal of Neurology, Neurosurgery, and Psychiatry
Helena U Westergren, Erik Michaëlsson, Juuso I Blomster, Tasso Miliotis, Sara Svedlund, Li-Ming Gan
BACKGROUND: Microvascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR) in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner. METHODS: A total of 202 (128 women) non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling...
2017: PloS One
Andrei D Mărgulescu
No abstract text is available yet for this article.
March 21, 2017: Circulation
Michael Ganetsky, Gregory Lopez, Tara Coreanu, Victor Novack, Steven Horng, Nathan I Shapiro, Kenneth A Bauer
OBJECTIVES: Anticoagulant and antiplatelet medications are known to increase the risk and severity of traumatic intracranial hemorrhage (tICH), even with minor head trauma. Most studies on bleeding propensity with head trauma are retrospective, are based on trauma registries, or include heterogeneous mechanisms of injury. The goal of this study was to determine the rate of tICH from only a common low-acuity mechanism of injury, that of a ground-level fall, in patients taking one or more of the following antiplatelet or anticoagulant medications: aspirin, warfarin, prasugrel, ticagrelor, dabigatran, rivaroxaban, apixaban, or enoxaparin...
October 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N Lobo, Robert Martindale, Dan L Waitzberg, Stephan C Bischoff, Pierre Singer
Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e...
June 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Isabelle Scheers, Joseph J Palermo, Steven Freedman, Michael Wilschanski, Uzma Shah, Maisam Abu-El-Haija, Bradley Barth, Douglas S Fishman, Cheryl Gariepy, Matthew J Giefer, Melvin B Heyman, Ryan W Himes, Sohail Z Husain, Tom K Lin, Quin Liu, Mark Lowe, Maria Mascarenhas, Veronique Morinville, Chee Y Ooi, Emily R Perito, David A Piccoli, John F Pohl, Sarah J Schwarzenberg, David Troendle, Steven Werlin, Bridget Zimmerman, Aliye Uc, Tanja Gonska
OBJECTIVES: Autoimmune pancreatitis (AIP) is an increasingly recognized disease entity, but data in children are limited. AIP presentation and outcome in children might differ from the adult experience. We aim to determine the characteristic features of AIP in children. METHODS: Data about clinical symptoms, imaging, histology, and treatment were collected using two sources: (i) a systematic literature search and (ii) the INSPPIRE database, the largest international multicenter study of pancreatitis in children and the Cliniques Universitaires St-Luc (CUSL) registry...
October 2017: American Journal of Gastroenterology
Yusuke Tsugawa, Anupam B Jena, Jose F Figueroa, E John Orav, Daniel M Blumenthal, Ashish K Jha
Importance: Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown. Objective: To determine whether mortality and readmission rates differ between patients treated by male or female physicians. Design, Setting, and Participants: We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014...
February 1, 2017: JAMA Internal Medicine
Stephen D Hoag, Karen Chung
The patient was nauseous, and had been experiencing headaches, generalized weakness, and fatigue. Her physical exam revealed a maculopapular rash on her trunk and upper extremities. She had tenderness and pain, as well as decreased range of motion in her ankles, knees, and wrists. The patient had no erythema, swelling, petechiae, or bruising. She had a past medical history of Graves' disease and had received all of her childhood immunizations.
April 2017: Journal of Family Practice
Benjamin F Donohue, Marc G Lubitz, Timothy E Kremchek
Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings...
August 2017: American Journal of Sports Medicine
Qiang Meng, Lingchun Liu
A 23-year-old woman presented with a 1-month history of headache, vomiting, recurrent episodes of syncope, weight gain, and leg pain. A physical examination revealed several subcutaneous nodules on the patient’s face and trunk. Exophthalmos, fundal hemorrhage, neck rigidity, and a hypertrophic..
December 29, 2016: New England Journal of Medicine
Jorge L Polo, Juan C Porres
A 90-year-old man presented with a 1-month history of progressive edema in both legs and several episodes of malaise and dizziness that were associated with hypoglycemia. On examination, a nontender epigastric mass was palpated. A plain radiograph of the chest showed a round, irregular opacity..
January 5, 2017: New England Journal of Medicine
Mistyann-Blue Miller, Demetrio R Flores
A 68-year-old woman presented with exertional dyspnea and chest pain, symptoms that suggested unstable angina. She had undergone coronary-artery bypass grafting 5 years earlier. Vascular examination revealed palpable radial pulses on both sides of the body. The results of Allen’s test, conducted..
January 12, 2017: New England Journal of Medicine
Christoph Schlapbach, Parham Sendi
A 37-year-old woman who was receiving adalimumab for ankylosing spondylitis presented with a 6-week history of swelling and ulcerations with a hemorrhagic crust over her nose (Panels A and B). Serratia liquefaciens grew in biopsy samples obtained from the ulcers. A 3-week course of ciprofloxacin..
January 19, 2017: New England Journal of Medicine
Cyriac A Philips, Amrish Sahney
A 48-year-old man presented with a 2-month history of abdominal discomfort and lethargy. Physical examination revealed pallor, and results from laboratory studies showed mild anemia (hemoglobin level, 9.2 g per deciliter [normal, 12 to 15 g per deciliter]). Colonoscopy revealed a proglottid from a..
January 26, 2017: New England Journal of Medicine
Jennifer K Plichta, Kevin Hughes
A 72-year-old woman presented with skin changes on her left breast; 5 years earlier, she had undergone lumpectomy and radiation therapy for breast cancer. Physical examination revealed an area of skin 10 cm in diameter, medial to the areola, that had an ecchymotic appearance (Panel A). The area..
January 26, 2017: New England Journal of Medicine
Krystyna Romańska-Gocka, Magdalena Woźniak, Elżbieta Kaczmarek-Skamira, Barbara Zegarska
Acne in adults is a chronic, increasingly common disease, especially among women. It differs in pathogenesis and clinical presentation from adolescent acne. Acne in adults is associated with Western diet, defined as high consumption of milk, high glycemic load and high calorie intake. Metabolic signals of this diet result in a significant increase in insulin/insulin growth factor 1 serum level and consequently in the molecular interplay of mammalian target of rapamycin complex 1 kinase (mTORC1)/forkhead box protein 1 (FoxO1) mediated nutrient signaling, leading to increased proliferation of keratinocytes, increased lipogenesis and sebum production and finally to aggravation of acne...
December 2016: Postȩpy Dermatologii i Alergologii
Shyh-Shyong Sim, Jen-Tang Sun
A 46-year-old woman was brought to the emergency department because of agitation. On arrival, she had a fever (temperature, 38.6°C) and tachycardia (heart rate, 169 beats per minute). The patient was agitated and had ocular flutter (Video 1) as well as rigidity in the legs and myoclonus in the arms..
November 3, 2016: New England Journal of Medicine
Viren S Vasudeva, Alexander E Ropper, Samuel Rodriguez, Kyle C Wu, John H Chi
En bloc resection of tumors involving the spinal column is technically challenging and is associated with high morbidity to the patient due to the proximity of critical neurological and vascular structures and the destabilizing nature of this surgery. Nevertheless, evidence has shown improved progression-free survival with en bloc resection for certain low-grade malignant and aggressive benign musculoskeletal tumors. To avoid the morbidity of en bloc spondylectomy in patients with tumors localized to the lateral and posterolateral spinal column, the authors have found that the goals of surgery can be accomplished through a contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER)...
March 2017: Journal of Neurosurgery. Spine
Pedro David Delgado-López, Cecilia Gil-Polo, Vicente Martín-Velasco, Javier Martín-Alonso, Ana María Galacho-Harriero, Elena Araus-Galdós
Idiopathic spinal cord herniation (ISCH) is a relatively rare and frequently misdiagnosed condition. It preferentially affects women and causes progressive thoracic myelopathy that presents as a Brown-Séquard syndrome or as spastic paraparesis. Although its etiology and pathogenesis are controversial, ISCH is characterized by the presence of an anterior dural defect that allows the incarceration of a segment of the cord. Typically, a C-shaped ventral displacement and kinking of the cord are visible on sagittal MRI...
March 2017: Journal of Neurosurgery. Spine
2016-11-08 10:39:29
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