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Sample records for intractable disease state

  1. [Palliative Care for Neurological Intractable Diseases and Home Medical Support].

    PubMed

    Yokoyama, Kazumasa; Ogino, Mieko; Ishigaki, Yasunori; Hattori, Nobutaka

    2015-08-01

    Many medical doctors regard the end stage and palliative care of neurological intractable diseases as the point at which aggressive treatment should be interrupted and death is imminent. However, the definition of health by the World Health Organization as the physical, psychological, and social goal to achieve a fully favorable health condition should be revisited. In the real clinical setting, the health condition, as the ability to adapt and self-manage in the face of social, physical, and emotional challenges with the aim to overcome stress (resilience), is dynamic and involves a healthy condition and satisfaction with one's own living. The most important step in palliative therapy that is shared by neurologists is the maintenance of the health status with the help of multi-disciplinary team with the view to improving the quality of life. PMID:26241362

  2. Revision of measures to combat intractable diseases in Japan: Three pillars will play an even greater role in the future.

    PubMed

    Song, Peipei; Kokudo, Norihiro

    2013-02-01

    Over the past 40 years, measures to combat intractable diseases in Japan have progressed substantially since the implementation of the "Outline of Measures to Combat Intractable Diseases" in 1972. However, many challenges remain. In order to further promote measures to combat intractable diseases, a "Revision of Measures to Combat Intractable Diseases" was approved by the Japanese Ministry of Health, Labor, and Welfare (MHLW) on January 25, 2013. The revision rests on the three pillars of development of effective strategies to treat intractable diseases and improved care for those affected, creation of fair and consistent mechanisms to reimburse medical expenses, and implementing measures to enhance public understanding and encourage the social participation of those affected. These pillars will play an even greater role in future measures to combat intractable diseases. PMID:25343099

  3. [Analysis on literature of acupuncture and moxibustion treatment of intractable eye diseases].

    PubMed

    Xu, Hong; Liu, Jian; Xu, Si-Wei; Zong, Lei; Zhang, Ren

    2008-08-01

    Acupuncture and moxibustion treatment has good therapeutic effects on the intractable eye diseases including pigmentary degeneration of retina, macular degeneration, glaucoma and optic atrophy, etc. This paper reviews acupuncture and moxibustion treatment of these diseases from selection of acupoints, treatment methods, effectiveness and mechanism studies, and raises the problems in existence and the prospect.

  4. Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease

    SciTech Connect

    Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul; Chang, Yoon Sik

    1999-09-15

    A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.

  5. [Effects of octreotide acetate on intractable chylothorax after surgery for congenital heart diseases].

    PubMed

    Kaneko, M; Hiramatsu, T; Nishimura, Y; Iwahashi, M; Komori, S; Shibata, M; Yuzaki, M; Okamura, Y; Suzuki, H; Takeuchi, T; Shibuta, S

    2006-07-01

    We experienced 2 infants in whom octreotide acetate was effective on intractable chylothorax after surgery for congenital heart diseases. They were 8- and 5-month-old. They were diagnosed as having corrected transposition of the great arteries (TGA) and tetralogy of Fallot respectively, and underwent bidirectional Glenn anastomosis and right modified Blalock Taussig shunt. Chylothorax was revealed on the 11th and the 1st postoperative day, and was not improved by any conventional therapy in either case. Then octreotide acetate was infused continuously with 0.1-0.6 micorg/kg/hour for 24 and 7 days. Chylothorax disappeared completely without any complications such as disturbance of blood sugar level or growth retardation. Octreotide acetate was effective and safe even in infants in intractable chylothorax after surgery for congenital heart diseases, as long as used for short period.

  6. Intractable colitis associated with chronic granulomatous disease in a young girl.

    PubMed

    Yaman, Aytaç; Kuloğlu, Zarife; Doğu, Figen; İkincioğulları, Aydan; Ensari, Arzu; Çiftçi, Ergin; Kansu, Aydan

    2015-01-01

    Chronic granulomatous disease (CGD) is an autosomal recessive or X-linked disorder caused by NADPH oxidase deficiency leading to an impaired ability of reactive superoxide anion and metabolite formation and recurring severe bacterial and fungal infections, with a high mortality rate. Diarrhea, colitis, ileus, perirectal abscess formation and anal fissures are reported gastrointestinal findings in these patients. We report a case of intractable colitis associated with CGD in a young girl.

  7. Orthotropic liver transplantation for intractable neurological manifestations of Wilson's disease.

    PubMed

    Sutariya, Vaibhav K; Tank, Anad H; Modi, Pranjal R

    2015-01-01

    Wilson's disease (WD) is an inherited autosomal recessive disorder characterized by copper accumulation and toxicity, affecting mainly the liver and brain. Orthotopic liver transplantation (OLT) is the definitive therapy for patients with WD. Acute fulminant hepatic failure and decompensated cirrhosis are well-established indications for OLT. Patients with severe neurologic impairment can also be benefited by OLT. Here, we present a patient who underwent OLT for isolated neurological WD.

  8. [My way to "Keep Pioneering": integrated neuroscience and immunology research produces a paradigm shift for intractable neurological disease].

    PubMed

    Kira, Jun-ichi

    2014-01-01

    The motto of Prof. Yoshigoro Kuroiwa, who established the first independent neurology department in Japan at Kyushu University, is "Keep Pioneering". His students have followed this motto in all fields. I hereby present my efforts to keep pioneering in the following fields: (1) multiple sclerosis (MS); (2) central nervous system (CNS) involvement associated with peripheral atopic inflammation; and (3) care network for patients with intractable neurological disease. In MS, I propose that Th1/Th17 cell-mediated connexin astrocytopathy may play a critical role in producing huge demyelinating lesions in MS, neuromyelitis optica (NMO), and Baló's concentric sclerosis. I discovered a peculiar myelitis that occurred in patients with atopic disorders, and designated it atopic myelitis. In this condition, allodynia and neuropathic pain are cardinal features, regardless of the presence or absence of spinal cord MRI lesions. We found that peripheral atopic inflammation in mice produces allodynia as well as activation of microglia and astroglia in the spinal cord. It is important to involve a variety of medical specialists and care coordinators for collaborative work on medical and social care issues for people with intractable disease. The motto of "Keep Pioneering" in neurology covers not only advanced research for the creation of new therapies for intractable neurological disease, but also caring for actual people with intractable disease, which I believe is the corporate social responsibility of our neurological society. I think that "Keep Pioneering" is a challenging process that never ends throughout one's life. PMID:25672676

  9. Gene-manipulated Adipocytes for the Treatment of Various Intractable Diseases.

    PubMed

    Kuroda, Masayuki; Bujo, Hideaki; Aso, Masayuki; Saito, Yasushi; Yokote, Koutaro

    2016-01-01

    Although protein replacement is an effective treatment for serum protein deficiencies such as diabetes and hemophilia, recombinant protein products are not available for all rare inherited diseases due to the instability of the recombinant proteins and/or to cost. Gene therapy is the most attractive option for treating patients with such rare diseases. To develop an effective ex vivo gene therapy-based protein replacement treatment requires recipient cells that differ from those used in standard gene therapy, which is performed to correct the function of the recipient cells. Adipose tissue is an expected source of proliferative cells for cell-based therapies, including regenerative medicine and gene transfer applications. Based on recent advances in cell biology and extensive clinical experience in transplantation therapy for adipose tissue, we focused on the mature adipocyte fraction, which is the floating fraction after collagenase digestion and centrifugation of adipose tissue. Proliferative adipocytes were propagated from the floating fraction by the ceiling culture technique. These cells are designated as ceiling culture-derived proliferative adipocytes (ccdPAs). We first focused on lecithin:cholesterol acyltransferase (LCAT) deficiency, an inherited metabolic disorder caused by lcat gene mutation, and ccdPAs as a therapeutic gene vehicle for LCAT replacement therapy. In our recent in vitro and animal model studies, we developed an adipose cell manipulation procedure using advanced gene transduction methods and transplantation scaffolds. We herein introduce the progress made in novel adipose tissue-based therapeutic strategies for the treatment of protein deficiencies and describe their future applications for other intractable diseases. PMID:27150923

  10. [Prognosis of patient with intractable diseases in Wakayama Prefecture--a follow-up study based on medical care certificates].

    PubMed

    Kasamatsu, T; Yoshimura, N; Ueda, A; Morioka, S; Sugita, K; Hashimoto, T

    1994-04-01

    To clarify the prognosis of patients with intractable diseases, a baseline survey of patients who received financial aid for intractable disease treatment between April 1984 and March 1985 was performed in Wakayama Prefecture, followed by a follow-up survey over a period of 8 years. Based on public welfare-subsidized system in Wakayama Prefecture, all patients with intractable diseases were checked up annually their certificates of financial aid for treatment. The results obtained were as follows: Parkinson's disease had the highest rate of discontinuation of medical care at 65%, followed by idiopathic thrombocytopenic purpura (ITP) at 64%, aplastic anemia at 55%, ulcerative colitis (UC) at 54%, and Behcet's disease at 50%. Systemic lupus erythematosus (SLE) had the lowest rate of discontinuation of medical care at 32%. Discontinuation was due to death in approximately 50% of the patients with SLE, scleroderma, dermatomyositis and polymyositis, and aplastic anemia. Of these, the causes of death in more than 50% were directly related to the primary diseases. However, in patients with SLE and aplastic anemia, 25% discontinued care because of cure or alleviation. Some patients remained in remission even though the prognosis for these diseases is not generally considered to be favorable. Transfer of jurisdiction to the Disabled Persons Welfare Act was seen in 28% of patients with Parkinson's disease, 24% with Behcet's disease, and 23% with ossification of posterior longitudinal ligament, diseases which are believed to cause restriction in daily activities of patients in some cases. On the other hand, cure or alleviation was the reason for discontinuation in 60-70% of patients with Buerger's disease, UC and ITP.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8025309

  11. Perceptions regarding a range of work-related issues and corresponding support needs of individuals with an intractable disease

    PubMed Central

    Imahashi, Kumiko; Fukatsu, Reiko; Nakajima, Yasoichi; Nakamura, Megumi; Ito, Tateo; Horigome, Mariko; Haruna, Yuichiro; Noda, Tatsuya; Itoyama, Yasuto

    2016-01-01

    Summary A number of persons with an intractable disease (ID) experience work-related problems that could lead to job loss. The aim of this study was to ascertain perceptions regarding a range of work-related issues and corresponding support needs of individuals with an ID. Potential participants were people ages 15 to 64 with one of the 130 intractable chronic diseases designated in the Act to Comprehensively Support the Daily and Social Activities of Persons with Disabilities (Comprehensive Support for the Disabled Act). Participants completed a self-administered questionnaire. With the assistance of patients' organizations, 3,000 questionnaires were mailed to potential participants. Questions included demographic characteristics, family concerns, employment/supported employment, work accommodations, and other aspects of life. Responses were received from 889 (29.6%) participants, and respondents had 57 IDs. Forty-six-point-seven percent of respondents reported being unemployed due to fatigue and/or long-term treatment. Nearly half of the unemployed respondents reported that they had been unable to work despite their willingness to do so. Common requests for accommodation included flexible work hours, working at home, and job/workplace modifications. Only 30% of respondents knew about job training programs and supported work available for persons with disabilities. The results of the study are relevant for employees, employers, and occupational health/human resource professionals. The issue of reasonable accommodations for persons with an ID needs to be addressed in future research in order to promote continued work by those persons.

  12. Perceptions regarding a range of work-related issues and corresponding support needs of individuals with an intractable disease.

    PubMed

    Imahashi, Kumiko; Fukatsu, Reiko; Nakajima, Yasoichi; Nakamura, Megumi; Ito, Tateo; Horigome, Mariko; Haruna, Yuichiro; Noda, Tatsuya; Itoyama, Yasuto

    2016-08-01

    A number of persons with an intractable disease (ID) experience work-related problems that could lead to job loss. The aim of this study was to ascertain perceptions regarding a range of work-related issues and corresponding support needs of individuals with an ID. Potential participants were people ages 15 to 64 with one of the 130 intractable chronic diseases designated in the Act to Comprehensively Support the Daily and Social Activities of Persons with Disabilities (Comprehensive Support for the Disabled Act). Participants completed a self-administered questionnaire. With the assistance of patients' organizations, 3,000 questionnaires were mailed to potential participants. Questions included demographic characteristics, family concerns, employment/supported employment, work accommodations, and other aspects of life. Responses were received from 889 (29.6%) participants, and respondents had 57 IDs. Forty-six-point-seven percent of respondents reported being unemployed due to fatigue and/or long-term treatment. Nearly half of the unemployed respondents reported that they had been unable to work despite their willingness to do so. Common requests for accommodation included flexible work hours, working at home, and job/workplace modifications. Only 30% of respondents knew about job training programs and supported work available for persons with disabilities. The results of the study are relevant for employees, employers, and occupational health/human resource professionals. The issue of reasonable accommodations for persons with an ID needs to be addressed in future research in order to promote continued work by those persons. PMID:27672543

  13. Microvascular decompression for intractable singultus.

    PubMed

    Saito, Atsushi; Hatayama, Toru; Kon, Hiroyuki; Nakamura, Taigen; Sasaki, Tatsuya

    2016-10-01

    Intractable singultus due to cerebrovascular disease is very rare. We report a case of intractable singultus that improved after microvascular decompression and present a literature review. The patient was a 58-year-old man with a 30-year history of persistent singultus. Its frequency and duration gradually increased and it was resistant to multiple medical treatments. Microvascular decompression to relieve pressure on the anterolateral surface of the lower medulla oblongata from the vertebral artery resulted in the resolution of singultus. Patients with intractable idiopathic singultus who fail to respond to medical therapy need to be considered for the evaluation of cerebrovascular diseases and microvascular decompression. PMID:27335312

  14. Perceptions regarding a range of work-related issues and corresponding support needs of individuals with an intractable disease

    PubMed Central

    Imahashi, Kumiko; Fukatsu, Reiko; Nakajima, Yasoichi; Nakamura, Megumi; Ito, Tateo; Horigome, Mariko; Haruna, Yuichiro; Noda, Tatsuya; Itoyama, Yasuto

    2016-01-01

    Summary A number of persons with an intractable disease (ID) experience work-related problems that could lead to job loss. The aim of this study was to ascertain perceptions regarding a range of work-related issues and corresponding support needs of individuals with an ID. Potential participants were people ages 15 to 64 with one of the 130 intractable chronic diseases designated in the Act to Comprehensively Support the Daily and Social Activities of Persons with Disabilities (Comprehensive Support for the Disabled Act). Participants completed a self-administered questionnaire. With the assistance of patients' organizations, 3,000 questionnaires were mailed to potential participants. Questions included demographic characteristics, family concerns, employment/supported employment, work accommodations, and other aspects of life. Responses were received from 889 (29.6%) participants, and respondents had 57 IDs. Forty-six-point-seven percent of respondents reported being unemployed due to fatigue and/or long-term treatment. Nearly half of the unemployed respondents reported that they had been unable to work despite their willingness to do so. Common requests for accommodation included flexible work hours, working at home, and job/workplace modifications. Only 30% of respondents knew about job training programs and supported work available for persons with disabilities. The results of the study are relevant for employees, employers, and occupational health/human resource professionals. The issue of reasonable accommodations for persons with an ID needs to be addressed in future research in order to promote continued work by those persons. PMID:27672543

  15. [The most probable clinical diagnosis to the applicants for the intractable disease registration of Parkinson's disease, spinocerebellar degeneration and amyotrophic lateral sclerosis].

    PubMed

    Narita, Yugo; Taniguchi, Akira; Kuzuhara, Shigeki

    2006-03-01

    Amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD) and spinocerebellar degeneration (SCD) are included in the 45 intractable diseases" acknowledged by the Ministry of Health, Labour and Welfare of Japan. The registration of applicants is based on the attending doctors' diagnosis, and medical costs of registered patients are covered by the government. However, the accuracy of the diagnoses has not been investigated previously. The aim of the present study is to investigate the accuracy of the diagnoses of patients registered as PD, SCD and ALS in Mie prefecture of Japan. The study design was cross-sectional and the survey was carried out using an anonymous questionnaire. We asked the attending doctors the most probable clinical diagnosis in each applicant for PD, SCD or ALS at the annual renewal of application form of the specified diseases by the Ministry. The questionnaires were sent to the 57 neurologists in 20 general hospitals and 2 neurology clinics in Mie prefecture, Japan. The survey was carried out from July to September, 2003. For each disorder (PD, ALS, SCD), the accuracy rates were calculated as the ratio of the number of patients with the most probable diagnosis of the consistent disease to the number of all patients registered each disease. Questionnaires on 678 patients replied from 31 neurologists, 27 of whom were the neurology specialists approved by the Japanese Society of Neurology, were retrieved and analyzed. They covered 41.1% of the total registered PD cases, 45.4% of total SCD cases, and 54.0% of total ALS cases in Mie prefecture. The final clinical diagnosis were made by such specialists in 641 cases (94.5%). The accuracy rate of PD was 97.3% for all degenerative parkinsonisms and 90.2% for idiopathic PD, 96.0% for SCD, and 77.8% for typical ALS and 81.5% for ALS and Kennedy-Alter-Sung syndrome. Although the most probable diagnoses were performed by the attending physicians without verification by other raters, the accuracy rates

  16. Mindfulness: overcoming intractable conflict.

    PubMed

    Horton-Deutsch, Sara L; Horton, Janell M

    2003-08-01

    Intractable conflict involves reoccurring patterns of ineffective communication in which issues are not resolved and build over time. These situations can lead to bad feelings, damaged relationships, depression, aggression, anxiety and substance abuse. Grounded theory methods were used to study the processes involved in intractable conflicts and to identify ways of responding that promote growth and/or resolution. Results indicate that developing mindfulness over mindlessness is the basic social process that threads through three phases of working through intractable conflict. Phases include: growing awareness, self-realization, and regaining equilibrium. Mental health professionals can use this knowledge to support mindful practices as a means to protect against destructive conflict and mental health woes. PMID:14508774

  17. Mindfulness: overcoming intractable conflict.

    PubMed

    Horton-Deutsch, Sara L; Horton, Janell M

    2003-08-01

    Intractable conflict involves reoccurring patterns of ineffective communication in which issues are not resolved and build over time. These situations can lead to bad feelings, damaged relationships, depression, aggression, anxiety and substance abuse. Grounded theory methods were used to study the processes involved in intractable conflicts and to identify ways of responding that promote growth and/or resolution. Results indicate that developing mindfulness over mindlessness is the basic social process that threads through three phases of working through intractable conflict. Phases include: growing awareness, self-realization, and regaining equilibrium. Mental health professionals can use this knowledge to support mindful practices as a means to protect against destructive conflict and mental health woes.

  18. Intractable trigeminal neuralgia.

    PubMed Central

    Watts, P G

    1987-01-01

    In 49 cases of trigeminal neuralgia seen at the Abingdon Pain Relief Unit, Oxfordshire, the average time between initial onset of pain and first referral to the unit was 9.8 years. The pattern of presentation and distribution was no different from previously published studies, indicating that the more intractable cases cannot be predicted at first presentation. PMID:3681871

  19. Intractable ulcerating enterocolitis of infancy.

    PubMed Central

    Sanderson, I R; Risdon, R A; Walker-Smith, J A

    1991-01-01

    Five children (three boys, two girls) presenting in the first year of life with intractable diarrhoea had a number of features in common. All had ulcerating stomatitis, four had partial villous atrophy on small intestinal biopsy, all had colitis characterised by large ulcers with overhanging edges, and four had severe perianal disease; no stool pathogens were detected. Treatment with steroids, sulphasalazine, and azathioprine was unsuccessful. All five required subtotal colectomy. Four were children of consanguinous marriages, two were siblings of Pakistani origin, two were cousins of Arab origin, and the fifth was Portuguese. Although the diagnoses of Behçet's disease and Crohn's disease were considered, it appears that these children represent a distinct inherited condition affecting the whole gastrointestinal tract, particularly the colon. Images Figure 1 Figure 2 Figure 5 Figure 6 Figure 7 PMID:2025003

  20. Progressive lymphadenopathy and intractable pain in an immunocompetent African-American adult with cat-scratch disease.

    PubMed

    Bonza, Sarah; McDougle, Leon; McConaghy, John R

    2008-10-01

    Persistent, painful cervical lymphadenopathy associated with malaise that does not respond to oral antibiotics may be cat-scratch disease. This condition is challenging to treat and may require surgical intervention. We present a case report of an immunocompetent 47-year-old African-American woman who was diagnosed with cat-scratch disease and hospitalized after multiple outpatient evaluations for progressive, painful lymphadenopathy. This case report outlines the patient's treatment in the author's urban outpatient clinic followed by an inpatient hospital stay with surgical intervention. Although the reported incidence of cat-scratch disease is higher in whites, primary care physicians should include cat-scratch disease in their differential diagnosis for African-American patients with regional lymphadenopathy, which is a hallmark of the disease. In addition, primary care physicians should be familiar with the atypical presentations of cat-scratch disease and the broad differential diagnosis for regional lymphadenopathy, including sarcoidosis, which is more common in African Americans.

  1. Definition of intractable epilepsy.

    PubMed

    Sinha, Shobhit; Siddiqui, Khurram A

    2011-01-01

    Defining intractable epilepsy is essential not only to identify up to 40% of patients refractory to pharmacological management, but also to facilitate selection and comparison of such patients for research purposes. The ideal definition still eludes us. Multiple factors including number of antiepileptic drug (AED) failures, seizure frequency and duration of unresponsiveness, etiology, and epilepsy syndromes are considered in formulating the definition of pharmaco-resistant epilepsy. Most definitions used in the literature agree on the number of AED failures, which seem to be 2 or 3, however, the seizure frequency and time factor are varied. The International League Against Epilepsy proposed a definition of drug-resistant epilepsy as a failure of adequate trials of 2 tolerated and appropriately chosen and used AED schedules. This for now, could provide an operational definition for clinical and research settings. However, with emergence of new data and novel treatments the criteria for intractability may change.

  2. Chronic intractable diarrhea caused by gastrointestinal mastocytosis

    PubMed Central

    Seo, Hyungil; Byeon, Jeong-Sik; Woo, Chang Gok; Hong, Seung-Mo; Chang, Kiju; So, Hoonsub; Kwak, Minseob; Kim, Wan Soo; Lee, Jeong-Mi; Yang, Dong-Hoon; Kim, Kyung-Jo; Ye, Byong Duk; Myung, Seung-Jae; Yang, Suk-Kyun

    2016-01-01

    As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines. PMID:27433151

  3. Chronic intractable diarrhea caused by gastrointestinal mastocytosis.

    PubMed

    Seo, Hyungil; Park, Sang Hyoung; Byeon, Jeong-Sik; Woo, Chang Gok; Hong, Seung-Mo; Chang, Kiju; So, Hoonsub; Kwak, Minseob; Kim, Wan Soo; Lee, Jeong-Mi; Yang, Dong-Hoon; Kim, Kyung-Jo; Ye, Byong Duk; Myung, Seung-Jae; Yang, Suk-Kyun

    2016-07-01

    As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines. PMID:27433151

  4. PSYCHIATRIC ASPECTS OF CHRONIC INTRACTABLE PAIN

    PubMed Central

    Varma, Vijoy K.; Chaturvedi, Santosh K.; Malhotra, Anil; Chari, Promilla

    1983-01-01

    SUMMARY Two hundred patients with chronic intractable pain have been evaluated in order to study the clinical characteristics of pain and associated psychiatric illnesses. The commonest site of pain was reported to be head and face, usually dull in nature. Almost 75% of patients reported continuous pain. A great majority (40%–80%) had some psycho-social problem or other problem resultant from the chronic pain. 72% patients had identifiable psychiatric illness, commonest being neurotic depression and anxiety states. The common symptoms reported on the Present State Examination (PSE) were worrying (77%), depression (40%), hypochondrical pre-occupation (35%), autonomic anxiety (42%) and irritability (40%). There is no specific clinical characteristic associated with any particular psychiatric diagnosis. The relevance of psychiatric symptoms and illness associated with chronic pain has been discussed. PMID:21847282

  5. Cryoanalgesia for intractable perineal pain.

    PubMed Central

    Evans, P J; Lloyd, J W; Jack, T M

    1981-01-01

    Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through the sacral hiatus into the sacral canal to produce anaesthesia of the lower sacral nerve roots. Forty patients received a total of 70 treatments: 31 patients (78%) were helped by the procedure and the median duration of improvement was 30 days. The treatment was more successful in relieving symptoms in patients suffering from pelvic cancer and coccydynia. The best results were obtained in those patients who received numerous freeze applications or prolonged freezing. Images Figure 1. PMID:7299782

  6. Cryoanalgesia for intractable perineal pain.

    PubMed

    Evans, P J; Lloyd, J W; Jack, T M

    1981-11-01

    Cryoanalgesia, the local application of extreme cold to nerves to produce analgesia, has been used to treat patients with intractable perineal pain. The cryoprobe was inserted percutaneously through the sacral hiatus into the sacral canal to produce anaesthesia of the lower sacral nerve roots. Forty patients received a total of 70 treatments: 31 patients (78%) were helped by the procedure and the median duration of improvement was 30 days. The treatment was more successful in relieving symptoms in patients suffering from pelvic cancer and coccydynia. The best results were obtained in those patients who received numerous freeze applications or prolonged freezing. PMID:7299782

  7. A Man With Intractable Convulsion

    PubMed Central

    Xia, Yun; Cutrona, Anthony; Barreiro, Timothy J.

    2015-01-01

    Abstract Tetanus is a rare disease in the United States. Fewer than 40 cases are reported annually because of the high incidence of vaccination. Recognition of the clinical presentations is important because laboratory recovery of pathogen is only 30%, and toxin detection is rare because of consumption at motor neurons. We report a case of tetanus in an elderly man who had a reaction to tetanus vaccination as a child and was nonvaccinated through adult life. PMID:27330266

  8. Revised criteria for classification of the etiologies of acute liver failure and late-onset hepatic failure in Japan: A report by the Intractable Hepato-biliary Diseases Study Group of Japan in 2015.

    PubMed

    Mochida, Satoshi; Nakayama, Nobuaki; Ido, Akio; Takikawa, Yasuhiro; Yokosuka, Osamu; Sakaida, Isao; Moriwaki, Hisataka; Genda, Takuya; Takikawa, Hajime

    2016-03-01

    In 2011, the Intractable Liver Diseases Study Group of Japan, established novel diagnostic criteria for "acute liver failure ", and published the classification criteria for the etiologies of acute liver failure and late-onset hepatic failure (LOHF) in 2013. According to this classification, HBV carriers showing acute hepatitis exacerbation were divided into 3 subgroups; asymptomatic or inactive HBV carriers without drug exposure, asymptomatic or inactive HBV carriers developing HBV reactivation during and after immunosuppressive therapies and/or antineoplastic chemotherapies and those with previously resolved HBV infection showing iatrogenic HBV reactivation. In an annual nationwide survey in 2013, however, a patient with previously resolved HBV infection was enrolled, in whom LOHF developed as a result of HBV reactivation despite in the absence of immunosuppressive therapies and/or antineoplastic chemotherapies. Thus, the study group revised the classification criteria in 2015; HBV carriers developing acute hepatitis exacerbation were classified into asymptomatic or inactive HBV carriers and patients with previously resolved HBV infection, and both groups were further sub-classified into those receiving immunosuppressive therapies and/or antineoplastic chemotherapies and those without such drugs exposure.

  9. Mining disease state converters for medical intervention of diseases.

    PubMed

    Dong, Guozhu; Duan, Lei; Tang, Changjie

    2010-02-01

    In applications such as gene therapy and drug design, a key goal is to convert the disease state of diseased objects from an undesirable state into a desirable one. Such conversions may be achieved by changing the values of some attributes of the objects. For example, in gene therapy one may convert cancerous cells to normal ones by changing some genes' expression level from low to high or from high to low. In this paper, we define the disease state conversion problem as the discovery of disease state converters; a disease state converter is a small set of attribute value changes that may change an object's disease state from undesirable into desirable. We consider two variants of this problem: personalized disease state converter mining mines disease state converters for a given individual patient with a given disease, and universal disease state converter mining mines disease state converters for all samples with a given disease. We propose a DSCMiner algorithm to discover small and highly effective disease state converters. Since real-life medical experiments on living diseased instances are expensive and time consuming, we use classifiers trained from the datasets of given diseases to evaluate the quality of discovered converter sets. The effectiveness of a disease state converter is measured by the percentage of objects that are successfully converted from undesirable state into desirable state as deemed by state-of-the-art classifiers. We use experiments to evaluate the effectiveness of our algorithm and to show its effectiveness. We also discuss possible research directions for extensions and improvements. We note that the disease state conversion problem also has applications in customer retention, criminal rehabilitation, and company turn-around, where the goal is to convert class membership of objects whose class is an undesirable class.

  10. Subanaesthetic dose of ketamine in intractable asthma.

    PubMed

    Garg, Dinesh; Kaistha, Sanjay; Sood, Dinesh

    2011-06-01

    A 75-year-old male diagnosed to be a case of intractable asthma resistant to all conventional therapies requiring ventilatory support, was successfully weaned off the ventilator after treatment with subanaesthetic dose of intravenous ketamine. PMID:22315777

  11. [Management of intractable migraine in adults].

    PubMed

    Pradalier, André; Baudesson, Gilles; Delage, Alain

    2003-01-01

    The management of intractable migraine is not yet standardised. The first point in the emergency department is to eliminate severe cephalalgic non-migrainous disease, then to confirm the diagnosis of migraine. The second point is to determine trigger factors responsible for the refractory migraine--principally inadequate therapy, such as too low a dosage, inadequate treatment compared with intensity, and delayed treatment. Examples of inadequate classical treatments are presented for the following four main oral therapies: a nonsteroidal anti-inflammatory drug (NSAID), analgesics, ergot derivatives, and triptans. When these drugs are ineffective, the following are used via injections: propacetamol, aspirin (lysine acetylsalicylate), injectable NSAIDs, and nefopam. These products differ from country-to-country. For example, morphinomimetics, phenothiazines and corticosteroids are widely prescribed in the US, while metamizole (dipyrone) is preferred in developing countries. The authors describe the different models of administration and the adverse effects of the substances. Finally, they describe the treatment of status migrainosus. Globally, triptans are underused in emergency departments. This review confirms the need for controlled trials of treatments for migraine in emergency departments in order to develop an international therapeutic consensus. PMID:14679670

  12. Intractable sneezing due to IgE-mediated triethanolamine sensitivity.

    PubMed

    Herman, J J

    1983-03-01

    Sneezing has been commonly recognized as part of the nasal allergic reaction in response to pollen and inhalant allergens; isolated intractable sneezing is an unusual presentation in allergic patients. An 8-yr-old white girl developed intractable sneezing in the fall while walking past an area where fresh roofing tar was being prepared. Her personal and family histories were negative for allergic disease or symptoms. Positive physical findings were boggy nasal mucosa; pollen and inhalant skin tests were negative. Response to topical cromolyn and beclomethasone administered intranasally was only partial; antihistamines were little help. Upon careful review of history, exposure to clothes washed in Miracle White Laundry Soil and Stain Remover correlated to symptoms; removal from clothing by extensive washing relieved the sneezing, which recurred upon exposure. Prick test was positive to triethanolamine at 10(7)M to 10(-4)M and not to other ingredients of this product. Investigation demonstrated dose-dependent leukocyte histamine release (25% to 27% specific release) to triethanolamine (10(-4)M to 10(-7)M); this release (50% at 10(-5)M) was inhibited by preincubation with cromolyn sodium (5 X 10(-6)M). Passive cutaneous anaphylaxis was demonstrated to triethanolamine (10(-7)M to 10(-4)M); specific IgE to triethanolamine was demonstrated by polystyrene tube radioimmunoassay. Controls had no histamine release or specific IgE. Thus exposure to triethanolamine caused IgE-mediated intractable sneezing.

  13. Sequencing Intractable DNA to Close Microbial Genomes

    SciTech Connect

    Hurt, Jr., Richard Ashley; Brown, Steven D; Podar, Mircea; Palumbo, Anthony Vito; Elias, Dwayne A

    2012-01-01

    Advancement in high throughput DNA sequencing technologies has supported a rapid proliferation of microbial genome sequencing projects, providing the genetic blueprint for for in-depth studies. Oftentimes, difficult to sequence regions in microbial genomes are ruled intractable resulting in a growing number of genomes with sequence gaps deposited in databases. A procedure was developed to sequence such difficult regions in the non-contiguous finished Desulfovibrio desulfuricans ND132 genome (6 intractable gaps) and the Desulfovibrio africanus genome (1 intractable gap). The polynucleotides surrounding each gap formed GC rich secondary structures making the regions refractory to amplification and sequencing. Strand-displacing DNA polymerases used in concert with a novel ramped PCR extension cycle supported amplification and closure of all gap regions in both genomes. These developed procedures support accurate gene annotation, and provide a step-wise method that reduces the effort required for genome finishing.

  14. Intractable diarrhoea of infancy and latent otomastoiditis.

    PubMed Central

    Salazar de Sousa, J; da Silva, A; da Costa Ribeiro, V

    1980-01-01

    In 16 infants with intractable diarrhoea, latent otomastoiditis was found in 9 (3 at necropsy and 6 at myringotomy-antrotomy). In 5 of the 6 operated group, surgery was followed by a striking cessation of the diarrhoea and with weight gain. It is concluded that (1) latent otomastoiditis may be a perpetuating factor in intractable diarrhoea; (2) myringotomy-antrotomy should be considered if other forms of treatment have failed, and especially if there is leucocytosis; (3) mastoiditis with diffuse osteitis seems to be associated with a poor prognosis. PMID:7458392

  15. Efficacy of the Atkins diet as therapy for intractable epilepsy.

    PubMed

    Kossoff, Eric H; Krauss, Gregory L; McGrogan, Jane R; Freeman, John M

    2003-12-23

    The ketogenic diet is effective for treating seizures in children with epilepsy. The Atkins diet can also induce a ketotic state, but has fewer protein and caloric restrictions, and has been used safely by millions of people worldwide for weight reduction. Six patients, aged 7 to 52 years, were started on the Atkins diet for the treatment of intractable focal and multifocal epilepsy. Five patients maintained moderate to large ketosis for periods of 6 weeks to 24 months; three patients had seizure reduction and were able to reduce antiepileptic medications. This provides preliminary evidence that the Atkins diet may have a role as therapy for patients with medically resistant epilepsy.

  16. Intractable Pruritus After Traumatic Spinal Cord Injury

    PubMed Central

    Crane, Deborah A; Jaffee, Kenneth M; Kundu, Anjana

    2009-01-01

    Background: This report describes a young woman with incomplete traumatic cervical spinal cord injury and intractable pruritus involving her dorsal forearm. Method: Case report. Findings: Anatomic distribution of the pruritus corresponded to the dermatomal distribution of her level of spinal cord injury and vertebral fusion. Symptoms were attributed to the spinal cord injury and possible cervical root injury. Pruritus was refractory to all treatments, including topical lidocaine, gabapentin, transcutaneous electrical nerve stimulation, intravenous Bier block, stellate ganglion block, and acupuncture. Conclusions: Further understanding of neuropathic pruritus is needed. Diagnostic workup of intractable pruritus should include advanced imaging to detect ongoing nerve root compression. If diagnostic studies suggest radiculopathy, epidural steroid injection should be considered. Because the autonomic nervous system may be involved in complex chronic pain or pruritic syndromes, sympatholysis via such techniques as stellate ganglion block might be effective. PMID:19777867

  17. Intractable vomiting from glioblastoma metastatic to the fourth ventricle: three case studies.

    PubMed Central

    Cohen, Zvi R.; Hassenbusch, Samuel J.; Maor, Moshe H.; Pfeffer, Raphael M.; Ram, Zvi

    2002-01-01

    Dissemination of malignant glioma to the fourth ventricle with metastatic deposits and intractable vomiting is rare. Leptomeningeal extension of malignant glioma is an uncommon condition that has been reported in patients with end-stage disease and is usually unresponsive to any treatment modality. We describe 3 patients with progressing recurrent glioblastoma multiforme in whom leptomeningeal invasion manifested itself as intractable vomiting due to tumor metastases in the floor of the fourth ventricle. All patients received additional radiation therapy focused to the posterior fossa, with complete resolution of vomiting occurring within 10 days after irradiation. The remission of symptoms in these patients persisted until their death 3-4 months after the repeat radiation therapy. These reports indicate that additional focused radiation should be considered because of its significant therapeutic effect in alleviating intractable nausea and vomiting in patients with glioma metastasized to the posterior fossa. PMID:11916505

  18. What Predicts Enduring Intractability in Children Who Appear Medically Intractable In The First Two Years After Diagnosis?

    PubMed Central

    Wirrell, Elaine C.; Wong-Kisiel, Lily C.-L.; Mandrekar, Jay; Nickels, Katherine C.

    2013-01-01

    SUMMARY Purpose In a population-based retrospective cohort of children with newly-diagnosed epilepsy, to determine (1) what proportion meet criteria for early medical intractability, and (2) predictors of enduring intractability. Methods Children with newly-diagnosed epilepsy between 1980–2009 while resident in Olmsted County, MN, and followed >36 months were stratified into groups, based on both early medical intractability (“apparent” medical intractability in the first 2 years) and enduring intractability (persisting intractability at final follow-up or having undergone surgery for intractable epilepsy), and variables predicting these outcomes were evaluated. Key Findings Three hundred and eighty one children were included, representing 81% of our cohort with newly diagnosed epilepsy. Seventy five (19.7%) had early medical intractability, and predictors of this outcome on multivariable analysis were neuroimaging abnormality (p=0.0004), abnormal neurological examination at diagnosis (p=0.015) and mode of onset [association was significant for focal vs generalized onset (p<0.0001) but not unknown vs generalized onset (p=0.065)]. After a median follow-up of 11.7 years, 49% remained intractable, 8% had rare seizures (≤q6 months), and the remainder were seizure-free. The only factor predicting for enduring intractability on multivariable analysis was neuroimaging abnormality (p=0.0006). Significance While a significant minority of children with early medical intractability ultimately achieved seizure control without surgery, those with an abnormal imaging study did poorly. For this subgroup, early surgical intervention is strongly advised to limit co-morbidities of ongoing, intractable seizures. Conversely, a cautious approach is suggested for those with normal imaging, as most will remit with time. PMID:23551186

  19. Rethinking Intractable Conflict: The Perspective of Dynamical Systems

    ERIC Educational Resources Information Center

    Vallacher, Robin R.; Coleman, Peter T.; Nowak, Andrzej; Bui-Wrzosinska, Lan

    2010-01-01

    Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified…

  20. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    SciTech Connect

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina

    1999-11-15

    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up.

  1. Prominent emerging diseases within the United States

    USGS Publications Warehouse

    Cipriano, R.C.; Bowser, A.; Dove, A.; Goodwin, A.; Puzach, C.; Cipriano, R.C.; Bruckner, A.W.; Shchelkunov, I.S.

    2011-01-01

    This manuscript reviews disease syndromes that have become significant aquatic animal health issues within the United States since 2003. The emergence of Viral Hemorrhagic Septicemia (VHS) disease among wild fish in the Great Lakes is probably the most problematic and political issue. The emergence of this pathogen resulted in the issuance of a 2006 VHSV Federal order that placed restrictions on the movement of certain species of fish in the eight states that border the Great Lakes (New York, Pennsylvania, Ohio, Indiana, Illinois, Michigan, and Wisconsin and Minnesota) as well as the movement of live fish into the United States from the Ontario and Quebec Provinces, Canada. Spring Viremia of Carp (SVC) was identified for the first times in the United States during 2002. It was diagnosed as the source of mortality among koi at a private facility in North Carolina as well as from feral carp in Cedar Lake (WI). In 2004, Koi Herpesvirus (KHV) killed 8,000 adult common carp (Cyprinus carpio) in the Chadakoin River (NY); it reoccurred the next year within Chautauqua Lake (NY), killing an estimated 25,000 carp (20–30 lbs. apiece). During the summers of 2007 and 2008, KHV epizootics also occurred among carp in Ontario (Canada). Finally, outbreaks of epizootic shell disease in American lobster (Homarus americanus) have generated concern along the southern New England coast and eastern Long Island Sound. The prevalence and severity of shell disease have increased within inshore areas of southern New England and resulted in significant decreases in lobster catches and marketability.

  2. Atherosclerotic renovascular disease in the United States.

    PubMed

    Kalra, Philip A; Guo, Haifeng; Gilbertson, David T; Liu, Jiannong; Chen, Shu-Cheng; Ishani, Areef; Collins, Allan J; Foley, Robert N

    2010-01-01

    Atherosclerotic renovascular disease (ARVD) is an increasingly recognized clinical condition that is diagnosed predominantly in older patients. Here we used annual United States Medicare 5% Denominator Files and studied 16,036,904 patients, 66 years of age and older, to quantify trends in diagnostic rates, associations, treatment, and outcomes of ARVD over a 13-year period. Overall, there was an ARVD rate of 3.09 per 1000 patient-years, which rose progressively with an adjusted hazard ratio of 3.35, comparing data from 1992 to 2004. Within 6 months of disease diagnosis, 13.4% of patients had undergone revascularization. A biphasic pattern of revascularization was found where the adjusted hazard ratios significantly increased in a progressive manner until 1999, following which there was a decline through 2004, which was not significant. The method of revascularization changed markedly over time with endovascular intervention steadily replacing direct surgical revascularization. As a time-dependent variable, ARVD was associated with excess mortality in each calendar year, albeit with declining hazard ratio estimates in more recent years. Among patients with this disease, revascularization was associated with mortality adjusted hazard ratios <1 in each year. Our study shows the diagnosis of ARVD has substantially risen in the United States but the survival implications were not fully explained by other comorbid vascular diseases.

  3. Sustained improvement of intractable rheumatoid arthritis after total lymphoid irradiation

    SciTech Connect

    Field, E.H.; Strober, S.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.L.; Tanay, A.S.; Calin, H.J.; Terrell, C.P.; Kaplan, H.S.

    1983-08-01

    Total lymphoid irradiation (TLI) was administered to 11 patients who had intractable rheumatoid arthritis that was unresponsive to conventional medical therapy, including aspirin, multiple nonsteroidal antiinflammatory drugs, gold salts, and D-penicillamine. Total lymphoid irradiation was given as an alternative to cytotoxic drugs such as azathioprine and cyclophosphamide. After radiotherapy, 9 of the 11 patients showed a marked improvement in clinical disease activity as measured by morning stiffness, joint tenderness, joint swelling, and overall functional abilities. The mean improvement of disease activity in all patients ranged from 40-70 percent and has persisted throughout a 13-28 month followup period. This improvement permitted the mean daily steroid dose to be reduced by 54%. Complications included severe fatigue and other constitutional symptoms during radiotherapy, development of Felty's syndrome in 1 patient, and an exacerbation of rheumatoid lung disease in another. After therapy, all patients exhibited a profound T lymphocytopenia, and a reversal in their T suppressor/cytotoxic cell to helper cell ratio. The proliferative responses of peripheral blood mononuclear cells to phytohemagglutinin, concanavalin A, and allogeneic leukocytes (mixed leukocyte reaction) were markedly reduced, as was in vitro immunoglobulin synthesis after stimulation with pokeweed mitogen. Alterations in T cell numbers and function persisted during the entire followup period, except that the mixed leukocyte reaction showed a tendency to return to normal values.

  4. Intractable Electrical Storm After Coronary Artery Bypass Grafting Originating in Abnormal Purkinje Fibers.

    PubMed

    Tokunaga, Chiho; Tsukada, Toru; Sakamoto, Hiroaki; Naruse, Yoshihisa; Yoshida, Kentaro; Sekiguchi, Yukio; Imai, Akito; Aonuma, Kazutaka; Hiramatsu, Yuji

    2016-01-01

    Electrical storm is a rare but critical complication following revascularization in patients with ischemic heart disease. We report the case of a 67-year-old man who developed drug refractory intractable electrical storm after emergent coronary artery bypass grafting for ischemic cardiomyopathy. The electrical storm was successfully eliminated by percutaneous endocardial radiofrequency catheter ablation targeting the abnormal Purkinje-related triggering ventricular premature contractions in a low-voltage zone.

  5. Cell mechanics and human disease states

    NASA Astrophysics Data System (ADS)

    Suresh, Subra

    2006-03-01

    This presentation will provide summary of our very recent studies exploring the effects of biochemical factors, influenced by foreign organisms or in vivo processes, on intracellular structural reorganization, single-cell mechanical response and motility of a population of cells in the context of two human diseases: malaria induced by Plasmodium falciparum merozoites that invade red blood cells, and gastrointestinal cancer metastasis involving epithelial cells. In both cases, particular attention will be devoted to systematic changes induced in specific molecular species in response to controlled alterations in disease state. The role of critical proteins in influencing the mechanical response of human red bloods during the intra-erythrocytic development of P. falciparum merozoites has also been assessed quantitatively using specific protein knock-out experiments by recourse to gene inactivation methods. Single-cell mechanical response characterization entails such tools as optical tweezers and mechanical plate stretchers whereas cell motility assays and cell-population biorheology characterization involves microfluidic channels. The experimental studies are accompanied by three-dimensional computational simulations at the continuum and mesoscopic scales of cell deformation. An outcome of such combined experimental and computational biophysical studies is the realization of how chemical factors influence single-cell mechanical response, cytoadherence, the biorheology of a large population of cells through microchannels representative of in vivo conditions, and the onset and progression of disease states.

  6. Intractable yawning associated with mature teratoma of the supramedial cerebellum.

    PubMed

    Saura, Hiroaki; Beppu, Takaaki; Matsuura, Hideki; Asahi, Shigeki; Uesugi, Noriyuki; Sasaki, Makoto; Ogasawara, Kuniaki

    2014-08-01

    Yawning occurs in various conditions such as hypoxia, epilepsy, and sleep disorders including sleep apnea. Intractable yawning associated with a brain tumor has been rarely reported. A 19-year-old woman presented with intractable yawning. Magnetic resonance imaging showed a tumor in the supramedial cerebellum that compressed the dorsal side of the midbrain and upper pons. After subtotal removal of the tumor, the yawning completely disappeared. Postoperative MRI showed resolution of compression of the brainstem. The tumor was histologically diagnosed as a mature teratoma. The present case suggested that the intractable yawning resulted from the tumor compressing the dorsal side of the junction between the midbrain and pons.

  7. Mechanisms of Cachexia in Chronic Disease States.

    PubMed

    Yoshida, Tadashi; Delafontaine, Patrice

    2015-10-01

    Sarcopenia and cachexia are muscle wasting syndromes associated with aging and with many chronic diseases, such as congestive heart failure (CHF), diabetes, cancer, chronic obstructive pulmonary disease and chronic kidney disease (CKD). While mechanisms are complex, these conditions are often accompanied by elevated angiotensin II (Ang II). Patients with advanced CHF or CKD often have increased Ang II levels and cachexia, and angiotensin-converting enzyme inhibitor treatment improves weight loss. It was found that Ang II infusion in rodents leads to skeletal muscle wasting. Ang II increases cytokines and circulating hormones, such as tumor necrosis factor-α, interleukin-6, serum amyloid-A and glucocorticoids, which regulate muscle protein synthesis and degradation. Ang II-induced muscle wasting is caused by alterations in insulin-like growth factor-1 signaling, enhanced muscle protein breakdown via the ubiquitin-proteasome system and decreased appetite resulting from the downregulation of hypothalamic orexigenic neuropeptides, such as Npy and orexin. Ang II also inhibits 5' adenosine monophosphate-activated protein kinase activity and disrupts normal energy balance via the activation of 5' adenosine monophosphate-activated protein kinase phosphatase PP2Cα. Furthermore, Ang II inhibits skeletal muscle stem (satellite) cell proliferation, leading to lowered muscle regenerative capacity. Distinct satellite cell angiotensin receptor subtypes have different effects on different stages of differentiation and are critical for the regulation of muscle regeneration. These data suggest that the renin-angiotensin system plays a critical role in mechanisms underlying cachexia in chronic disease states, and it is a promising target for the treatment of muscle atrophy in patients with diseases such as CHF and CKD.

  8. Update on the use of rituximab for intractable rheumatoid arthritis

    PubMed Central

    Looney, R John

    2009-01-01

    It has been 3 years since rituximab, a mouse x human chimeric anti-CD20 monoclonal antibody that selectively depleted B cells, was approved by the FDA for the treatment of moderate to severe rheumatoid arthritis (RA) with an inadequate response to anti-TNF therapies. Since approval rituximab has become a part of standard treatment, and additional data have become available on long-term efficacy and safety both from clinical trials and from post-marketing surveillance. In open long-term follow-up from clinical trials, patients treated with multiple courses of rituximab continued to respond in terms of signs and symptoms, and damage assessed radiographically was significantly inhibited. Moreover, the rate of serious infectious events was not increased as the number of courses increased. However, because of case reports of progressive multifocal leukoencephalopathy in patients treated with rituximab for non-malignant conditions, a black box warning has been added. Studies on the immunologic correlates of response to rituximab treatment including B cell subsets in peripheral blood and synovial biopsies are providing clues into how rituximab works for autoimmune disease. However, at this time we are not able to explain why some patients do not respond and cannot predict who will respond. Future challenges for the further development of rituximab for intractable RA will be discussed.

  9. Arginine transport in catabolic disease states.

    PubMed

    Pan, Ming; Choudry, Haroon A; Epler, Mark J; Meng, Qinghe; Karinch, Anne; Lin, Chengmao; Souba, Wiley

    2004-10-01

    Arginine appears to be a semiessential amino acid in humans during critical illness. Catabolic disease states such as sepsis, injury, and cancer cause an increase in arginine utilization, which exceeds body production, leading to arginine depletion. This is aggravated by the reduced nutrient intake that is associated with critical illness. Arginine depletion may have negative consequences on tissue function under these circumstances. Nutritional regimens containing arginine have been shown to improve nitrogen balance and lymphocyte function, and stimulate arginine transport in the liver. We have studied the effects of stress mediators on arginine transport in vascular endothelium, liver, and gut epithelium. In vascular endothelium, endotoxin stimulates arginine uptake, an effect that is mediated by the cytokine tumor necrosis factor-alpha (TNF-alpha) and by the cyclo-oxygenase pathway. This TNF-alpha stimulation involves the activation of intracellular protein kinase C (PKC). A significant increase in hepatic arginine transport activity also occurs following burn injury and in rats with progressive malignant disease. Surgical removal of the growing tumor results in a normalization of the accelerated hepatic arginine transport within days. Chronic metabolic acidosis and sepsis individually augment intestinal arginine transport in rats and Caco-2 cell culture. PKC and mitogen-activated protein kinases are involved in mediating the sepsis/acidosis stimulation of arginine transport. Understanding the regulation of plasma membrane arginine transport will enhance our knowledge of nutrition and metabolism in seriously ill patients and may lead to the design of improved nutritional support formulas. PMID:15465794

  10. Intractable itch relieved by 4-phenylbutyrate therapy in patients with progressive familial intrahepatic cholestasis type 1

    PubMed Central

    2014-01-01

    Background Progressive familial intrahepatic cholestasis type 1 (PFIC1), an inherited liver disease caused by mutations in ATP8B1, progresses to severe cholestasis with a sustained intractable itch. Currently, no effective therapy has been established for PFIC1. Decreased function of the bile salt export pump (BSEP) in hepatocytes is suggested to be responsible for the severe cholestasis observed in PFIC1. We found a previously unidentified pharmacological effect of 4-phenylbutyrate (4PB) that increases the expression and function of BSEP. Here, we tested 4PB therapy in three patients with PFIC1. Methods The therapeutic potency of 4PB in these patients was tested by oral administration of this drug with gradually increasing dosage (200, 350, and 500 mg/kg/day) for 6 months. Biochemical, histological, and clinical data were collected. Results 4PB therapy had no beneficial effect on the patients’ liver functions, as assessed by biochemical and histological analyses, despite an increase in hepatic BSEP expression. However, therapy with 4PB at a dosage of 350 or 500 mg/kg/day significantly relieved the intractable itch. Serum levels of potential pruritogens in cholestasis were much higher than the reference ranges during the 4PB therapy. Conclusions 4PB therapy may be a new medication for patients with intractable cholestatic pruritus and may improve quality of life for patients and their families. PMID:25022842

  11. The intractable cigarette ‘filter problem’

    PubMed Central

    2011-01-01

    production. The synthetic plastic cellulose acetate became the fundamental cigarette filter material. By the mid-1960s, the meaning of the phrase ‘filter problem’ changed, such that the effort to develop effective filters became a campaign to market cigarette designs that would sustain the myth of cigarette filter efficacy. Conclusions This study indicates that cigarette designers at Philip Morris, British-American Tobacco, Lorillard and other companies believed for a time that they might be able to reduce some of the most dangerous substances in mainstream smoke through advanced engineering of filter tips. In their attempts to accomplish this, they developed the now ubiquitous cellulose acetate cigarette filter. By the mid-1960s cigarette designers realised that the intractability of the ‘filter problem’ derived from a simple fact: that which is harmful in mainstream smoke and that which provides the smoker with ‘satisfaction’ are essentially one and the same. Only in the wake of this realisation did the agenda of cigarette designers appear to transition away from mitigating the health hazards of smoking and towards the perpetuation of the notion that cigarette filters are effective in reducing these hazards. Filters became a marketing tool, designed to keep and recruit smokers as consumers of these hazardous products. PMID:21504917

  12. Donepezil-related intractable hiccups: a case report.

    PubMed

    McGrane, Ian R; Shuman, Michael D; McDonald, Robert W

    2015-03-01

    This case report describes a man with intractable hiccups probably caused by donepezil. The patient's symptoms were not responsive to commonly used medications for hiccups, but they were improved and completely relieved upon donepezil dose deescalation and discontinuation. We report two occasions in which the discontinuation of donepezil resulted in hiccup resolution and three occasions in which initiation of donepezil was associated with the onset of hiccups. This report contributes to the growing body of literature that describes an association between centrally acting medications and intractable hiccups.

  13. Early Career Teacher Attrition: New Thoughts on an Intractable Problem

    ERIC Educational Resources Information Center

    Gallant, Andrea; Riley, Philip

    2014-01-01

    Early career exit from teaching has reached epidemic proportions and appears intractable. Previous attempts to find solutions are yet to make much of an inroad. The aim of the research was to discover what nine beginning teachers required to remain in the classroom, by adopting a phenomenological approach. The authors identified participants'…

  14. Hydrophilic treatment of porous PTFE for intractable glaucoma implant devices

    NASA Astrophysics Data System (ADS)

    Murahara, Masataka M.; Sato, Yuji; Fernandez, Viviana; Fantes, Francisco; Nose, Izuru; Lee, William E.; Milne, Peter J.; Parel, Jean-Marie A.

    2001-06-01

    Intractable glaucoma results from hindrances in the eyeball aqueous humor pathways that increase the intraocular pressure above normal physiological levels (over 20 mmHg). In this study porous PTFE membranes were made hydrophilic with a photochemical method that use ethyl alcohol and water for the chemical solution.

  15. Rethinking intractable conflict: the perspective of dynamical systems.

    PubMed

    Vallacher, Robin R; Coleman, Peter T; Nowak, Andrzej; Bui-Wrzosinska, Lan

    2010-01-01

    Intractable conflicts are demoralizing. Beyond destabilizing the families, communities, or international regions in which they occur, they tend to perpetuate the very conditions of misery and hate that contributed to them in the first place. Although the common factors and processes associated with intractable conflicts have been identified through research, they represent an embarrassment of riches for theory construction. Thus, the current task in this area is integrating these diverse factors into an account that provides a coherent perspective yet allows for prediction and a basis for conflict resolution in specific conflict settings. We suggest that the perspective of dynamical systems provides such an account. This article outlines the key concepts and hypotheses associated with this approach. It is organized around a set of basic questions concerning intractable conflict for which the dynamical perspective offers fresh insight and testable propositions. The questions and answers are intended to provide readers with basic concepts and principles of complexity and dynamical systems that are useful for rethinking the nature of intractable conflict and the means by which such conflict can be transformed.

  16. Item Characteristic Curve Solutions to Three Intractable Testing Problems

    ERIC Educational Resources Information Center

    Marco, Gary L.

    1977-01-01

    This paper summarizes three studies that illustrate how application of the three-parameter logistic test model helped solve three relatively intractable testing problems. The three problems are: designing a multi-purpose test, evaluating an multi-level test, and equating a test on the basis of pretest statistics. (Author/JKS)

  17. Geographic Distribution and Expansion of Human Lyme Disease, United States.

    PubMed

    Kugeler, Kiersten J; Farley, Grace M; Forrester, Joseph D; Mead, Paul S

    2015-08-01

    Lyme disease occurs in specific geographic regions of the United States. We present a method for defining high-risk counties based on observed versus expected number of reported human Lyme disease cases. Applying this method to successive periods shows substantial geographic expansion of counties at high risk for Lyme disease.

  18. Intractable Central Hyperthermia in the Setting of Brainstem Hemorrhage

    PubMed Central

    Figueroa, Stephen

    2016-01-01

    Hyperthermia from a central cause is associated with increased morbidity and mortality. Dysfunction of brainstem thermoregulatory pathways may explain the intractable rise in temperature. Antipyretics, dantrolene, bromocriptine, and surface and intravascular cooling devices have been attempted for temperature control. We report the case of a 54-year-old woman with history of hypertension who presented with pontine hemorrhage with extension into the midbrain and medulla. On days 8–9 of her hospital admission, she developed intractable fever and expired the same day despite aggressive treatment of hypothermia, including antipyretics, ice lavage, cold fluid boluses, surface cooling, dantrolene, and bromocriptine. Hyperthermia from brainstem hemorrhage can be difficult to manage with current treatment options. Early recognition of those patients who may develop hyperthermia could lead to early intervention and possibly better outcomes. More evidence from prospective randomized controlled trials will elucidate the risk–benefit profile of achieving normothermia with aggressive fever control in these patients. PMID:26982342

  19. Lyme Disease Coinfections in the United States.

    PubMed

    Caulfield, Adam J; Pritt, Bobbi S

    2015-12-01

    Lyme disease in North America is caused by infection with the spirochetal bacterium Borrelia burgdorferi and transmitted by Ixodes scapularis and Ixodes pacificus ticks. These ticks also have the potential to transmit a rapidly expanding list of other pathogenic bacteria, viruses, and parasites, including Anaplasma phagocytophilum, Babesia microti, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris-like organism. Coinfections with B burgdorferi and these other agents are often difficult to diagnose and may go untreated, and thus contribute significantly to patient morbidity and mortality from tick-borne infections. PMID:26593260

  20. Lyme Disease Coinfections in the United States.

    PubMed

    Caulfield, Adam J; Pritt, Bobbi S

    2015-12-01

    Lyme disease in North America is caused by infection with the spirochetal bacterium Borrelia burgdorferi and transmitted by Ixodes scapularis and Ixodes pacificus ticks. These ticks also have the potential to transmit a rapidly expanding list of other pathogenic bacteria, viruses, and parasites, including Anaplasma phagocytophilum, Babesia microti, deer tick (Powassan) virus, Borrelia miyamotoi, and the Ehrlichia muris-like organism. Coinfections with B burgdorferi and these other agents are often difficult to diagnose and may go untreated, and thus contribute significantly to patient morbidity and mortality from tick-borne infections.

  1. [Advances on pharmacokinetics of traditional Chinese medicine under disease states].

    PubMed

    Gong, Zi-peng; Chen, Ying; Zhang, Rui-jie; Yang, Qing; Zhu, Xiao-xin

    2015-01-01

    In recent years, more and more research shows that the pharmacokinetic parameter of traditional Chinese medicine can be affected by the disease states. It's possible that drug metabolic enzymes, transporters, cell membrane permeability and the change of microbes group could be interfered with physiological and pathological changes, which enables the pharmacokinetics of traditional Chinese medicine in the body to be altered, including the process of absorption, distribution, metabolism and excretion, and then the pharmacokinetic parameters of traditional chinese medicine are altered. It's found that investigating the pharmacokinetic of traditional Chinese medicine in the pathological state is more useful than that of in normal state because the great part of traditional Chinese medicine is mainly used to treat disease. This article reflects the latest research on the pharmacokinetic of traditional Chinese medicine in the disease state such as diabete, cerebral ischemia, liver injury, inflammatory disease, nervous system disorders and fever in order to provide certain reference for clinicians designing reasonable administration dose.

  2. Lymphoproliferative disease virus in wild turkeys in southeast United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Previously, retroviral neoplasms reported in wild upland game birds in the United States of America have typically been associated with reticuloendotheliosis virus (REV) infection. The information presented herein described the first reports of lymphoproliferative disease virus (LPDV) infection in ...

  3. Hepatic Angiosarcoma: An Unusual Case of Intractable Gastrointestinal Bleeding

    PubMed Central

    Enweluzo, Chijioke; Chaudry, Dipendra; Philip, John Kennedy Sir; Aziz, Fahad

    2013-01-01

    Hepatic Angiosarcoma is an extremely rare malignant neoplasm of the vascular or lymphatic endothelium accounting for about 2% of all sarcomas. It is considered idiopathic in up to 70% of cases. We describe the case of a 32-year female transferred to our center for evaluation of intractable gastrointestinal bleeding. Definitive diagnosis remained elusive despite multiple endoscopic assessments with repeated cauterization of arteriovenous malformations (AVMs). Autopsy results confirmed metastatic hepatic Angiosarcoma.

  4. Neglected diseases amid wealth in the United States and Europe.

    PubMed

    Hotez, Peter

    2009-01-01

    Neglected tropical diseases are not exclusive to low-income countries. In the United States, such infections account for a sizable but largely hidden disease burden among minority populations living in poverty and among people of African descent in particular. Similar infections also occur in Europe. As efforts to control neglected tropical diseases expand throughout Africa, parallel efforts should also target poor and forgotten people in wealthy nations.

  5. State-space size considerations for disease-progression models.

    PubMed

    Regnier, Eva D; Shechter, Steven M

    2013-09-30

    Markov models of disease progression are widely used to model transitions in patients' health state over time. Usually, patients' health status may be classified according to a set of ordered health states. Modelers lump together similar health states into a finite and usually small, number of health states that form the basis of a Markov chain disease-progression model. This increases the number of observations used to estimate each parameter in the transition probability matrix. However, lumping together observably distinct health states also obscures distinctions among them and may reduce the predictive power of the model. Moreover, as we demonstrate, precision in estimating the model parameters does not necessarily improve as the number of states in the model declines. This paper explores the tradeoff between lumping error introduced by grouping distinct health states and sampling error that arises when there are insufficient patient data to precisely estimate the transition probability matrix. PMID:23609629

  6. State-space size considerations for disease-progression models.

    PubMed

    Regnier, Eva D; Shechter, Steven M

    2013-09-30

    Markov models of disease progression are widely used to model transitions in patients' health state over time. Usually, patients' health status may be classified according to a set of ordered health states. Modelers lump together similar health states into a finite and usually small, number of health states that form the basis of a Markov chain disease-progression model. This increases the number of observations used to estimate each parameter in the transition probability matrix. However, lumping together observably distinct health states also obscures distinctions among them and may reduce the predictive power of the model. Moreover, as we demonstrate, precision in estimating the model parameters does not necessarily improve as the number of states in the model declines. This paper explores the tradeoff between lumping error introduced by grouping distinct health states and sampling error that arises when there are insufficient patient data to precisely estimate the transition probability matrix.

  7. [Pre-Thrombotic (Hypercoagulable) State/Hypercoagulable Disease].

    PubMed

    Wada, Hideo

    2015-12-01

    A pre-thrombotic (hypercoagulable) state is observed in patients with thrombophilia, malignant diseases, pregnancy, auricular fibrillation, connective tissue diseases, prosthetic replacement arthroplasty, infection, or old age, and these states are also caused by dehydration, remaining in the same position for a long time, or estrogen drugs. Such patients have a high risk of developing thrombosis. The pre-thrombotic state is diagnosed or excluded by fibrin-related markers (FRMs), such as soluble fibrin (SF), fibrinogen and fibrin degradation products (FDP), and D-dimer. The cut-off values of FRMs are higher in patients with pregnancy or malignant diseases than in other patients. Patients with more than two of the eight underlying states and three causative factors for pre-thrombotic conditions or those with one of those conditions and high levels of FRMs are diagnosed as being in a prethrombotic state. These patients should receive treatment with anticoagulant therapy. PMID:27089657

  8. Drug-usage evaluation by disease state: developing protocols.

    PubMed

    Enlow, M L

    1996-07-01

    The Joint Commission definition of drug-usage evaluation (DUE) also applies to DUE by disease state. The criteria for disease process selection, key processes being evaluated, methods to develop initial DUE protocols, and DUE validation and approval processes are reviewed. The treatment of community-acquired pneumonia is a disease state DUE performed at Saint Joseph Health Center in Kansas City, Missouri. The preliminary protocol was developed by a collaborative network of clinical pharmacists in the metropolitan area. Outcome measures were included in the evaluation. The results were used as baseline data in the development of a pneumonia clinical pathway.

  9. Trypanosoma cruzi and Chagas' Disease in the United States

    PubMed Central

    Bern, Caryn; Kjos, Sonia; Yabsley, Michael J.; Montgomery, Susan P.

    2011-01-01

    Summary: Chagas' disease is caused by the protozoan parasite Trypanosoma cruzi and causes potentially life-threatening disease of the heart and gastrointestinal tract. The southern half of the United States contains enzootic cycles of T. cruzi, involving 11 recognized triatomine vector species. The greatest vector diversity and density occur in the western United States, where woodrats are the most common reservoir; other rodents, raccoons, skunks, and coyotes are also infected with T. cruzi. In the eastern United States, the prevalence of T. cruzi is highest in raccoons, opossums, armadillos, and skunks. A total of 7 autochthonous vector-borne human infections have been reported in Texas, California, Tennessee, and Louisiana; many others are thought to go unrecognized. Nevertheless, most T. cruzi-infected individuals in the United States are immigrants from areas of endemicity in Latin America. Seven transfusion-associated and 6 organ donor-derived T. cruzi infections have been documented in the United States and Canada. As improved control of vector- and blood-borne T. cruzi transmission decreases the burden in countries where the disease is historically endemic and imported Chagas' disease is increasingly recognized outside Latin America, the United States can play an important role in addressing the altered epidemiology of Chagas' disease in the 21st century. PMID:21976603

  10. Costs of Chronic Diseases at the State Level: The Chronic Disease Cost Calculator

    PubMed Central

    Murphy, Louise B.; Khavjou, Olga A.; Li, Rui; Maylahn, Christopher M.; Tangka, Florence K.; Nurmagambetov, Tursynbek A.; Ekwueme, Donatus U.; Nwaise, Isaac; Chapman, Daniel P.; Orenstein, Diane

    2015-01-01

    Introduction Many studies have estimated national chronic disease costs, but state-level estimates are limited. The Centers for Disease Control and Prevention developed the Chronic Disease Cost Calculator (CDCC), which estimates state-level costs for arthritis, asthma, cancer, congestive heart failure, coronary heart disease, hypertension, stroke, other heart diseases, depression, and diabetes. Methods Using publicly available and restricted secondary data from multiple national data sets from 2004 through 2008, disease-attributable annual per-person medical and absenteeism costs were estimated. Total state medical and absenteeism costs were derived by multiplying per person costs from regressions by the number of people in the state treated for each disease. Medical costs were estimated for all payers and separately for Medicaid, Medicare, and private insurers. Projected medical costs for all payers (2010 through 2020) were calculated using medical costs and projected state population counts. Results Median state-specific medical costs ranged from $410 million (asthma) to $1.8 billion (diabetes); median absenteeism costs ranged from $5 million (congestive heart failure) to $217 million (arthritis). Conclusion CDCC provides methodologically rigorous chronic disease cost estimates. These estimates highlight possible areas of cost savings achievable through targeted prevention efforts or research into new interventions and treatments. PMID:26334712

  11. Managing Cushing's disease: the state of the art.

    PubMed

    Colao, Annamaria; Boscaro, Marco; Ferone, Diego; Casanueva, Felipe F

    2014-09-01

    Cushing's disease is a rare chronic disease caused by a pituitary adenoma, which leads to excess secretion of adrenocorticotropic hormone (ACTH). The over-production of ACTH leads to hyperstimulation of the adrenal glands and a chronic excess of cortisol, resulting in the signs and symptoms of a severe clinical state (Cushing's syndrome) that leads to significant morbidity, negative impacts on the patient's quality of life, and, if untreated, increased mortality. The management of patients with Cushing's disease is complicated by the heterogeneity of the condition, with signs and symptoms that overlap with those of other diseases, and high subclinical incidence rates. Controversies surrounding the tests used for screening and identifying patients with Cushing's disease add to the challenge of patient management. Surgical intervention to remove the adenoma is the first-line treatment for patients with Cushing's disease, but medical therapies are useful in patients who relapse or are unsuitable for surgery. The recent introduction of pasireotide, the first pituitary-directed medical therapy, expands the number of treatment options available for patients with Cushing's disease. This state-of-the-art review aims to provide an overview of the most recent scientific research and clinical information regarding Cushing's disease. Continuing research into improving the diagnosis and treatment of Cushing's disease will help to optimize patient management.

  12. Intractable bone marrow edema syndrome of the hip.

    PubMed

    Gao, Fuqiang; Sun, Wei; Li, Zirong; Guo, Wanshou; Kush, Nepali; Ozaki, Koji

    2015-04-01

    There is a need for an effective and noninvasive treatment for intractable bone marrow edema syndrome of the hip. Forty-six patients with intractable bone marrow edema syndrome of the hip were retrospectively studied to compare the short-term clinical effects of treatment with high-energy extracorporeal shock wave therapy vs femoral head core decompression. The postoperative visual analog scale score decreased significantly more in the extracorporeal shock wave therapy group compared with the femoral head core decompression group (P<.05). For unilateral lesions, postoperative Harris Hip Scores for all hips in the extracorporeal shock wave therapy group were more significantly improved than Harris Hip Scores for all hips in the femoral head core decompression group (P<.05). Patients who underwent extracorporeal shock wave therapy also resumed daily activities significantly earlier. Average overall operative time was similar in both groups. Symptoms disappeared significantly sooner in the extracorporeal shock wave therapy group in patients with both unilateral (P<.01) and bilateral lesions (P<.05). Hospital costs were significantly lower with extracorporeal shock wave therapy compared with femoral head core decompression. The intraoperative fluoroscopy radiation dose was lower in extracorporeal shock wave therapy than in femoral head core decompression for both unilateral (P<.05) and bilateral lesions (P<.01). On magnetic resonance imaging (MRI), bone marrow edema improved in all patients during the follow-up period. After extracorporeal shock wave therapy, all patients remained pain-free and had normal findings on posttreatment radiographs and MRI scans. Extracorporeal shock wave therapy appears to be a valid, reliable, and noninvasive tool for rapidly resolving intractable bone marrow edema syndrome of the hip, and it has a low complication rate and relatively low cost compared with other conservative and surgical treatment approaches.

  13. Intractable pain due to rectus abdominis intramuscular haemangioma.

    PubMed

    Scozzari, G; Reddavid, R; Conti, L; Trombetta, F; Toppino, M; Sandrucci, S

    2014-08-01

    Haemangiomas are tumours of vascular origin accounting for approximately 7 % of all benign tumours. Three types of haemangioma have been described according to the vessel type involved: capillary, cavernous and mixed. Intramuscular haemangiomas (IMHs) are infrequent, accounting for less than 1 % of all haemangiomas and are mostly located in the extremities and the trunk. Intramuscular haemangiomas of the rectus abdominis muscle are extremely rare, with only one previous case reported in the literature to the best of our knowledge. In this report, we present the case of a patient with intractable pain related to IMHs of the rectus abdominis and we analyse diagnostic assessment and surgical management of the condition.

  14. Sex differences in episodic memory among children with intractable epilepsy.

    PubMed

    Smith, Mary Lou; Elliott, Irene; Naguiat, Abigail

    2009-01-01

    This study investigated whether children with epilepsy exhibit sex differences in episodic memory. Fifty-one children and adolescents (26 boys and 25 girls) with intractable epilepsy were administered two verbal-auditory tasks (learning and recall of a word list and story recall) and two visual tasks (design recall and face recognition). Girls exhibited an advantage on the delayed recall of stories and on the learning phase of the word list task. No significant differences were observed on the delayed recall of words or the visual tasks. These results identify a particular risk for cognitive impairment in boys that could have an important impact on their academic performance.

  15. Roux-en-Y gastric bypass for intractable biliary reflux in an individual with incomplete tetraplegia

    PubMed Central

    Caruso, Deborah; Tower, Donald; Goetz, Lance

    2015-01-01

    Context Gastroesophageal reflux disease (GERD) is a common complication in the spinal cord injury (SCI) population. Surgical treatment of GERD has a unique risk/benefit profile in this population. Findings This 68-year-old male with chronic incomplete tetraplegia, dyslipidemia, and well-controlled diabetes mellitus underwent Roux-en-Y gastric bypass surgery (RYGBP) for intractable biliary reflux. Postoperatively, the patient had resolution of his symptoms but he also presented with significant weight loss and dumping syndrome. While he did have improvement in his dyslipidemia there was no change in his functional status. Conclusions RYGBP is an option for refractory GERD treatment in the SCI population but preoperative risk assessment and close monitoring postoperatively is essential. PMID:25243335

  16. Motive attribution asymmetry for love vs. hate drives intractable conflict.

    PubMed

    Waytz, Adam; Young, Liane L; Ginges, Jeremy

    2014-11-01

    Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the "motive attribution asymmetry," driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group's aggression to ingroup love more than outgroup hate and to attribute their outgroup's aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party's involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party's involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group's involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries' actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale.

  17. Plerixafor may treat intractable post-herpetic neuralgia.

    PubMed

    Xie, Fang; Li, Xueyang; Bao, Mengmeng; Guo, Ruijuan; Zhang, Chen; Wu, Anshi; Yue, Yun; Guan, Yun; Wang, Yun

    2015-10-01

    Varicella-zoster virus (VZV) causes varicella (chicken pox) and establishes latency in ganglia. A reactivation of latent VZV leads to herpes zoster (shingles). Herpes zoster often causes herpetic pain that can last for months or years after the rash has healed. Prolonged herpetic pain is defined as post-herpetic neuralgia (PHN). There is an unmet need to explore novel therapeutic approaches for intractable PHN. Postmortem studies have shown that VZV induces neuro-inflammation and damage to the ganglia and spinal cord. These pathological changes may be critical factors resulting in PHN. Accumulated evidence suggests that stem cells may alleviate neuropathic pain in animal models through immunomodulatory actions and neuronal repair. Unfortunately, exogenous stem cell transplantation has limited clinical use due to safety concerns, immune rejection, and complications. Pharmacological mobilization of endogenous bone marrow stem cells may overcome these obstacles. Plerixafor is a SDF-1/CXCR4 axis blocker which can stimulate the release of stem cells from the bone marrow into blood circulation. We propose a hypothesis that endogenous stem cells mobilized by plerixafor may relieve the symptoms of PHN. If so, it may represent a novel approach for the treatment of intractable PHN.

  18. Motive attribution asymmetry for love vs. hate drives intractable conflict

    PubMed Central

    Waytz, Adam; Young, Liane L.; Ginges, Jeremy

    2014-01-01

    Five studies across cultures involving 661 American Democrats and Republicans, 995 Israelis, and 1,266 Palestinians provide previously unidentified evidence of a fundamental bias, what we term the “motive attribution asymmetry,” driving seemingly intractable human conflict. These studies show that in political and ethnoreligious intergroup conflict, adversaries tend to attribute their own group’s aggression to ingroup love more than outgroup hate and to attribute their outgroup’s aggression to outgroup hate more than ingroup love. Study 1 demonstrates that American Democrats and Republicans attribute their own party’s involvement in conflict to ingroup love more than outgroup hate but attribute the opposing party’s involvement to outgroup hate more than ingroup love. Studies 2 and 3 demonstrate this biased attributional pattern for Israelis and Palestinians evaluating their own group and the opposing group’s involvement in the current regional conflict. Study 4 demonstrates in an Israeli population that this bias increases beliefs and intentions associated with conflict intractability toward Palestinians. Finally, study 5 demonstrates, in the context of American political conflict, that offering Democrats and Republicans financial incentives for accuracy in evaluating the opposing party can mitigate this bias and its consequences. Although people find it difficult to explain their adversaries’ actions in terms of love and affiliation, we suggest that recognizing this attributional bias and how to reduce it can contribute to reducing human conflict on a global scale. PMID:25331879

  19. Vector Blood Meals and Chagas Disease Transmission Potential, United States

    PubMed Central

    Dorn, Patricia L.; Hobson, Julia; de la Rua, Nicholas M.; Lucero, David E.; Klotz, John H.; Schmidt, Justin O.; Klotz, Stephen A.

    2012-01-01

    A high proportion of triatomine insects, vectors for Trypanosoma cruzi trypanosomes, collected in Arizona and California and examined using a novel assay had fed on humans. Other triatomine insects were positive for T. cruzi parasite infection, which indicates that the potential exists for vector transmission of Chagas disease in the United States. PMID:22469536

  20. Periodontal Disease and Oral Hygiene Among Children. United States.

    ERIC Educational Resources Information Center

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    Statistical data presented on periodontal disease and oral hygiene among noninstitutionalized children, aged 6-11, in the United States are based on a probability sample of approximately 7,400 children involved in a national health survey during 1963-65. The report contains estimates of the Periodontal Index (PI) and the Simplified Oral Hygiene…

  1. End State Renal Disease among Native Americans, 1983-86.

    ERIC Educational Resources Information Center

    Newman, Jeffrey M.; And Others

    1990-01-01

    Determines the incidence of end-stage renal disease (ESRD) among Native Americans and Whites in the United States from 1983-86. Findings indicate 1,075 Native American cases represented an annual incidence 2.8 times the rate for Whites. Fifty-six percent of Native American cases and 27 percent of White cases were attributed to diabetes. (JS)

  2. Resting state brain networks and their implications in neurodegenerative disease

    NASA Astrophysics Data System (ADS)

    Sohn, William S.; Yoo, Kwangsun; Kim, Jinho; Jeong, Yong

    2012-10-01

    Neurons are the basic units of the brain, and form network by connecting via synapses. So far, there have been limited ways to measure the brain networks. Recently, various imaging modalities are widely used for this purpose. In this paper, brain network mapping using resting state fMRI will be introduced with several applications including neurodegenerative disease such as Alzheimer's disease, frontotemporal lobar degeneration and Parkinson's disease. The resting functional connectivity using intrinsic functional connectivity in mouse is useful since we can take advantage of perturbation or stimulation of certain nodes of the network. The study of brain connectivity will open a new era in understanding of brain and diseases thus will be an essential foundation for future research.

  3. West Nile virus disease and other arboviral diseases--United States, 2010.

    PubMed

    2011-08-01

    Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. Since West Nile virus (WNV) was first detected in the Western Hemisphere in 1999, it has become the leading cause of neuroinvasive arboviral disease in the United States. However, several other arboviruses continue to cause sporadic cases and seasonal outbreaks of neuroinvasive disease (i.e., meningitis, encephalitis, or acute flaccid paralysis). This report summarizes surveillance data reported to CDC in 2010 for WNV and other nationally notifiable arboviruses (excluding dengue, which is reported separately). In 2010, 40 states and the District of Columbia (DC) reported 1,021 cases of WNV disease. Of these, 629 (62%) were classified as WNV neuroinvasive disease, for a national incidence of 0.20 per 100,000 population. States with the highest incidence were Arizona (1.60), New Mexico (1.03), Nebraska (0.55), and Colorado (0.51). After WNV, the next most commonly reported cause of neuroinvasive arboviral disease was California serogroup viruses (CALV), with 68 cases, followed by eastern equine encephalitis virus (EEEV), 10 cases, St. Louis encephalitis virus (SLEV), eight cases, and Powassan virus (POWV), eight cases. WNV and other arboviruses continue to cause focal outbreaks and severe illness in substantial numbers of persons in the United States. Maintaining surveillance remains important to guide arboviral disease prevention activities.

  4. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water, United States 2009-2010

    EPA Science Inventory

    Despite advancements in water management and sanitation, waterborne disease outbreaks continue to occur in the United States. CDC collects data on waterborne disease outbreaks submitted from all states and territories* through the Waterborne Disease and Outbreak Surveillance Syst...

  5. Progress Toward Eliminating Hepatitis A Disease in the United States.

    PubMed

    Murphy, Trudy V; Denniston, Maxine M; Hill, Holly A; McDonald, Marian; Klevens, Monina R; Elam-Evans, Laurie D; Nelson, Noele P; Iskander, John; Ward, John D

    2016-02-12

    Hepatitis A virus (HAV) disease disproportionately affects adolescents and young adults, American Indian/Alaska Native and Hispanic racial/ethnic groups, and disadvantaged populations. During 1996-2006, the Advisory Committee on Immunization Practices (ACIP) made incremental changes in hepatitis A (HepA) vaccination recommendations to increase coverage for children and persons at high risk for HAV infection. This report examines the temporal association of ACIP-recommended HepA vaccination and disparities (on the absolute scale) in cases of HAV disease and on seroprevalence of HAV-related protection (measured as antibody to HAV [anti-HAV]). ACIP-recommended childhood HepA vaccination in the United States has eliminated most absolute disparities in HAV disease by age, race/ethnicity, and geographic area with relatively modest ≥1-dose and ≥2-dose vaccine coverage. However, the increasing proportion of cases of HAV disease among adults with identified and unidentified sources of exposure underscores the importance of considering new strategies for preventing HAV infection among U.S. adults. For continued progress to be made toward elimination of HAV disease in the United States, additional strategies are needed to prevent HAV infection among an emerging population of susceptible adults. Notably, HAV infection remains endemic in much of the world, contributing to U.S. cases through international travel and the global food economy. PMID:26916458

  6. Progress Toward Eliminating Hepatitis A Disease in the United States.

    PubMed

    Murphy, Trudy V; Denniston, Maxine M; Hill, Holly A; McDonald, Marian; Klevens, Monina R; Elam-Evans, Laurie D; Nelson, Noele P; Iskander, John; Ward, John D

    2016-02-12

    Hepatitis A virus (HAV) disease disproportionately affects adolescents and young adults, American Indian/Alaska Native and Hispanic racial/ethnic groups, and disadvantaged populations. During 1996-2006, the Advisory Committee on Immunization Practices (ACIP) made incremental changes in hepatitis A (HepA) vaccination recommendations to increase coverage for children and persons at high risk for HAV infection. This report examines the temporal association of ACIP-recommended HepA vaccination and disparities (on the absolute scale) in cases of HAV disease and on seroprevalence of HAV-related protection (measured as antibody to HAV [anti-HAV]). ACIP-recommended childhood HepA vaccination in the United States has eliminated most absolute disparities in HAV disease by age, race/ethnicity, and geographic area with relatively modest ≥1-dose and ≥2-dose vaccine coverage. However, the increasing proportion of cases of HAV disease among adults with identified and unidentified sources of exposure underscores the importance of considering new strategies for preventing HAV infection among U.S. adults. For continued progress to be made toward elimination of HAV disease in the United States, additional strategies are needed to prevent HAV infection among an emerging population of susceptible adults. Notably, HAV infection remains endemic in much of the world, contributing to U.S. cases through international travel and the global food economy.

  7. West nile virus and other arboviral diseases - United States, 2013.

    PubMed

    Lindsey, Nicole P; Lehman, Jennifer A; Staples, J Erin; Fischer, Marc

    2014-06-20

    Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States. However, several other arboviruses also cause sporadic cases and seasonal outbreaks of neuroinvasive disease (i.e., meningitis, encephalitis, and acute flaccid paralysis). This report summarizes surveillance data reported to CDC in 2013 for WNV and other nationally notifiable arboviruses, excluding dengue. Forty-seven states and the District of Columbia reported 2,469 cases of WNV disease. Of these, 1,267 (51%) were classified as WNV neuroinvasive disease, for a national incidence of 0.40 per 100,000 population. After WNV, the next most commonly reported cause of arboviral disease was La Crosse virus (LACV) (85 cases), followed by Jamestown Canyon virus (JCV), Powassan virus (POWV), and eastern equine encephalitis virus (EEEV) (eight). WNV and other arboviruses continue to cause serious illness in substantial numbers of persons annually. Maintaining surveillance remains important to help direct and promote prevention activities.

  8. Environmental tobacco smoke and periodontal disease in the United States.

    PubMed Central

    Arbes, S J; Agústsdóttir, H; Slade, G D

    2001-01-01

    OBJECTIVES: Cigarette smoking is a leading risk factor for periodontal disease. This cross-sectional study investigated the relation between environmental tobacco smoke (ETS) and periodontal disease in the United States. METHODS: Data were obtained from the Third National Health and Nutrition Examination Survey (1988-1994). The outcome was periodontal disease, defined as 1 or more periodontal sites with attachment loss of 3 mm or greater and a pocket depth of 4 mm or greater at the same site. Exposure to ETS at home and work was self-reported. The study analyzed 6611 persons 18 years and older who had never smoked cigarettes or used other forms of tobacco. RESULTS: Exposure to ETS at home only, work only, and both was reported by 18.0%, 10.7%, and 3.8% of the study population, respectively. The adjusted odds of having periodontal disease were 1.6 (95% confidence interval = 1.1, 2.2) times greater for persons exposed to ETS than for persons not exposed. CONCLUSIONS: Among persons in the United States who had never used tobacco, those exposed to ETS were more likely to have periodontal disease than were those not exposed to ETS. PMID:11211634

  9. Peace Education in Societies Involved in Intractable Conflicts: Direct and Indirect Models

    ERIC Educational Resources Information Center

    Bar-Tal, Daniel; Rosen, Yigal

    2009-01-01

    The present article deals with the crucial question: Can peace education facilitate change in the sociopsychological infrastructure that feeds continued intractable conflict and then how the change can be carried? Intractable conflicts still rage in various parts of the globe, and they not only cause local misery and suffering but also threaten…

  10. Identity and psychological ownership in chronic illness and disease state.

    PubMed

    Karnilowicz, W

    2011-03-01

    Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient-healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity. PMID:20738388

  11. Identity and psychological ownership in chronic illness and disease state

    PubMed Central

    Karnilowicz, W

    2011-01-01

    Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient–healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity. PMID:20738388

  12. Identity and psychological ownership in chronic illness and disease state.

    PubMed

    Karnilowicz, W

    2011-03-01

    Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient-healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity.

  13. West nile virus disease and other arboviral diseases - United States, 2011.

    PubMed

    2012-07-13

    Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. Symptomatic infections most often manifest as a systemic febrile illness and, less commonly, as neuroinvasive disease (e.g., meningitis, encephalitis, or acute flaccid paralysis). West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States. However, several other arboviruses also cause seasonal outbreaks and sporadic cases. In 2011, CDC received reports of 871 cases of nationally notifiable arboviral diseases (excluding dengue); etiological agents included WNV (712 cases), La Crosse virus (LACV) (130), Powassan virus (POWV) (16), St. Louis encephalitis virus (SLEV) (six), Eastern equine encephalitis virus (EEEV) (four), and Jamestown Canyon virus (JCV) (three). Of these, 624 (72%) were classified as neuroinvasive disease, for a national incidence of 0.20 per 100,000 population. WNV and other arboviruses continue to cause focal outbreaks and severe illness in substantial numbers of persons in the United States.

  14. Total lymphoid irradiation for treatment of intractable cardiac allograft rejection

    SciTech Connect

    Hunt, S.A.; Strober, S.; Hoppe, R.T.; Stinson, E.B. )

    1991-03-01

    The ability of postoperative total lymphoid irradiation to reverse otherwise intractable cardiac allograft rejection was examined in a group of 10 patients in whom conventional rejection therapy (including pulsed steroids and monoclonal or polyclonal anti-T-cell antibody therapy) had failed to provide sustained freedom from rejection. Follow-up periods range from 73 to 1119 days since the start of total lymphoid irradiation. No patient died or sustained serious morbidity because of the irradiation. Three patients have had no further rejection (follow-up periods, 105 to 365 days). Two patients died--one in cardiogenic shock during the course of total lymphoid irradiation, the other with recurrent rejection caused by noncompliance with his medical regimen. Total lymphoid irradiation appears to be a safe and a moderately effective immunosuppressive modality for 'salvage' therapy of cardiac allograft rejection unresponsive to conventional therapy.

  15. Idiopathic myenteric ganglionitis underlying intractable vomiting in a young adult.

    PubMed

    De Giorgio, R; Barbara, G; Stanghellini, V; Cogliandro, R F; Arrigoni, A; Santini, D; Ceccarelli, C; Salvioli, B; Rossini, F P; Corinaldesi, R

    2000-06-01

    Inflammatory infiltration of intestinal myenteric plexuses (i.e. myenteric ganglionitis), along with severe intestinal motor abnormalities, may accompany paraneoplastic syndromes, neurological disorders and gastrointestinal infections, although rare cases can be idiopathic. In this report, we describe the case of a patient who presented with chronic intractable vomiting and weight loss associated with idiopathic myenteric ganglionitis mainly involving the stomach. Tissue analysis showed that the inflammatory infiltrate comprised T lymphocytes (CD4+ and CD8+), and peptide immunolabelling revealed a marked decrease of substance P/tachykinin immunoreactive staining in nerve fibres and myenteric neurones. Following systemic steroid therapy, the patient's symptoms dramatically improved, and after one year of follow-up his general condition remains satisfactory. The possible mechanisms leading to symptom generation and gastric dysmotility in the context of an idiopathic myenteric ganglionitis are discussed.

  16. Heart transplantation as salvage treatment of intractable infective endocarditis.

    PubMed

    Aymami, Marie; Revest, Matthieu; Piau, Caroline; Chabanne, Céline; Le Gall, François; Lelong, Bernard; Verhoye, Jean-Philippe; Michelet, Christian; Tattevin, Pierre; Flécher, Erwan

    2015-04-01

    This study reports six consecutive patients who underwent heart transplantation as salvage treatment for endocarditis (Duke criteria) with extensive perivalvular lesions and end-stage heart failure. The median age was 45 years (range, 24 to 64), and the aortic valve was affected in all patients. Pathogens were Staphylococcus aureus (n = 2), Streptococcus pneumoniae (n = 2), Streptococcus agalactiae (n = 1), or not documented (n = 1). All patients survived, with no relapse, after a median follow-up of 24.5 months. The 10 patients with heart transplantation for endocarditis previously reported also survived (median follow-up, 27.5 months). Heart transplantation may be considered as salvage treatment in selected patients with intractable infective endocarditis.

  17. Metabolic resting-state brain networks in health and disease.

    PubMed

    Spetsieris, Phoebe G; Ko, Ji Hyun; Tang, Chris C; Nazem, Amir; Sako, Wataru; Peng, Shichun; Ma, Yilong; Dhawan, Vijay; Eidelberg, David

    2015-02-24

    The delineation of resting state networks (RSNs) in the human brain relies on the analysis of temporal fluctuations in functional MRI signal, representing a small fraction of total neuronal activity. Here, we used metabolic PET, which maps nonfluctuating signals related to total activity, to identify and validate reproducible RSN topographies in healthy and disease populations. In healthy subjects, the dominant (first component) metabolic RSN was topographically similar to the default mode network (DMN). In contrast, in Parkinson's disease (PD), this RSN was subordinated to an independent disease-related pattern. Network functionality was assessed by quantifying metabolic RSN expression in cerebral blood flow PET scans acquired at rest and during task performance. Consistent task-related deactivation of the "DMN-like" dominant metabolic RSN was observed in healthy subjects and early PD patients; in contrast, the subordinate RSNs were activated during task performance. Network deactivation was reduced in advanced PD; this abnormality was partially corrected by dopaminergic therapy. Time-course comparisons of DMN loss in longitudinal resting metabolic scans from PD and Alzheimer's disease subjects illustrated that significant reductions appeared later for PD, in parallel with the development of cognitive dysfunction. In contrast, in Alzheimer's disease significant reductions in network expression were already present at diagnosis, progressing over time. Metabolic imaging can directly provide useful information regarding the resting organization of the brain in health and disease.

  18. Chronic obstructive pulmonary disease among adults--United States, 2011.

    PubMed

    2012-11-23

    Chronic obstructive pulmonary disease (COPD) is a group of progressive, debilitating respiratory conditions, including emphysema and chronic bronchitis, characterized by difficulty breathing, lung airflow limitations, cough, and other symptoms. COPD often is associated with a history of cigarette smoking and is the primary contributor to mortality caused by chronic lower respiratory diseases, which became the third leading cause of death in the United States in 2008. Despite this substantial disease burden, state-level data on the prevalence of COPD and associated health-care resource use in the United States have not been available for all states. To assess the state-level prevalence of COPD among adults, the impact of COPD on their quality of life, and the use of health-care resources by those with COPD, CDC analyzed data from the 2011 Behavioral Risk Factor Surveillance System (BRFSS). Among BRFSS respondents in all 50 states, the District of Columbia (DC), and Puerto Rico, 6.3% reported having been told by a physician or other health professional that they had COPD. In addition to the screening question asked of all respondents, 21 states, DC, and Puerto Rico elected to include an optional COPD module. Among persons who reported having COPD and completed the optional module, 76.0% reported that they had been given a diagnostic breathing test, 64.2% felt that shortness of breath impaired their quality of life, and 55.6% were taking at least one daily medication for their COPD. Approximately 43.2% of them reported visiting a physician for COPD-related symptoms in the previous 12 months, and 17.7% had either visited an emergency department or been admitted to a hospital for their COPD in the previous 12 months. Continued surveillance for COPD, particularly at state and local levels, is critical to 1) identify communities that likely will benefit most from awareness and outreach campaigns and 2) evaluate the effectiveness of public health efforts related to the

  19. Intermittent venovenous hemofiltration as a chronic treatment for refractory and intractable heart failure.

    PubMed

    Biasioli, S; Barbaresi, F; Barbiero, M; Petrosino, L; Cavallini, L; Zambello, A; Cavalcanti, G; Foroni, R; Bonofiglio, C

    1992-01-01

    Chronic heart failure (HF) is considered to be refractory when persisting despite an intensive drug regimen, or intractable when requiring "artificial" supports. Among them, hemofiltration (HE) has been used frequently, but only on an "acute" basis, to induce fast and safe water removal. Since 1985 the authors have treated refractory and intractable HF first by means of acute CAVH (continuous arteriovenous HE: 11 patients) and then (1988-1992) with IVVH (intermittent venovenous HE), initially done on an "acute" basis (13 patients) and then an a chronic basis (CIVVH): 8 subjects (6M, 2F; mean age, 60.8 years), 3 with RCHF and 5 with ICHF. This report deals with our experience in CIVVH. All patients were in severe failure. During a follow-up period of 63 months (range, 1-17/patient), 82 IVVH treatments (10.2/patient) were carried out, using this schedule: permanent Tesio catheter in superior vena cava, 0.6 m2 filter, double blood pump (blood flow = 80-250 ml/min); transmembrane pressure = 50-150 mmHg; mean ultrafiltration = 19 ml/min; replacement fluid = 8.6 ml/min; and session time = 340 +/- 88 min, according to individual dry weight (bioimpedance system). Six patients died (1-13 months after IVVH began); four of six had ICHF and two of six had RCHF; five of eight patients showed a significant amelioration of functional state, changing from fourth to third, to second and first degree failure, but this was after heart transplantation. In all cases a marked reduction in the drug regimen and in hospitalization was the rule. PMID:1457943

  20. Diagnostic reframing of intractable environmental problems: case of a contested multiparty public land-use conflict.

    PubMed

    Asah, Stanley T; Bengston, David N; Wendt, Keith; Nelson, Kristen C

    2012-10-15

    Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional reframing are the two major approaches to conflict transformation. These approaches have some drawbacks. Cognitive reframing does not guarantee commensurate consideration of all disputants' views about the problem. Interactional reframing is prone to inter-disputant influences that interfere with presenting the problems as accurately as they exist in disputants' minds. Inadequate consideration of other disputants' views and inter-disputant influences often lead to inaccurate problem identification and definition. This in turn leads to solving the wrong problem, enabling intractability to persist. Proper problem identification and definition requires commensurate consideration of all sides of the conflict while minimizing inter-disputant influences. From a problem diagnosis perspective, we show how Q methodology is used to reframe environmental problems, rendering them more tractable to analysis while minimizing the influence of who disputants are talking with, and without ignoring the perspectives of other disputants. Using a case of contentious All-Terrain Vehicle (ATV) use in a state-administered public land, conflicting parties reframed the problem by prioritizing issues, outlining areas and levels of consensus and disagreement, and revealing inherent unrecognized and/or unspoken agendas. The reframing process surprisingly revealed several areas of common ground in disputants' diagnosis of the problem, including lack of emphasis on environmental protection and uncoordinated management factions. Emergent frames were misaligned on some issues, such as the behaviors of ATV riders and the role of management

  1. Diagnostic reframing of intractable environmental problems: case of a contested multiparty public land-use conflict.

    PubMed

    Asah, Stanley T; Bengston, David N; Wendt, Keith; Nelson, Kristen C

    2012-10-15

    Intractable conflicts are omnipresent in environmental management. These conflicts do not necessarily resist resolution but need to be fundamentally transformed in order to reach agreement. Reframing, a process that allows disputants to create new alternative understandings of the problem, is one way of transforming these conflicts. Cognitive and interactional reframing are the two major approaches to conflict transformation. These approaches have some drawbacks. Cognitive reframing does not guarantee commensurate consideration of all disputants' views about the problem. Interactional reframing is prone to inter-disputant influences that interfere with presenting the problems as accurately as they exist in disputants' minds. Inadequate consideration of other disputants' views and inter-disputant influences often lead to inaccurate problem identification and definition. This in turn leads to solving the wrong problem, enabling intractability to persist. Proper problem identification and definition requires commensurate consideration of all sides of the conflict while minimizing inter-disputant influences. From a problem diagnosis perspective, we show how Q methodology is used to reframe environmental problems, rendering them more tractable to analysis while minimizing the influence of who disputants are talking with, and without ignoring the perspectives of other disputants. Using a case of contentious All-Terrain Vehicle (ATV) use in a state-administered public land, conflicting parties reframed the problem by prioritizing issues, outlining areas and levels of consensus and disagreement, and revealing inherent unrecognized and/or unspoken agendas. The reframing process surprisingly revealed several areas of common ground in disputants' diagnosis of the problem, including lack of emphasis on environmental protection and uncoordinated management factions. Emergent frames were misaligned on some issues, such as the behaviors of ATV riders and the role of management

  2. Some state vaccination laws contribute to greater exemption rates and disease outbreaks in the United States.

    PubMed

    Bradford, W David; Mandich, Anne

    2015-08-01

    Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Prevention's annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.

  3. Disparities in cardiovascular disease risk in the United States.

    PubMed

    Graham, Garth

    2015-01-01

    This is a comprehensive narrative review of the literature on the current science and evidence of population-level differences in risk factors for heart disease among different racial and ethnic population in the United States (U.S.). It begins by discussing the importance of population-level risk assessment of heart disease in light of the growth rate of specific minority populations in the U.S. It describes the population-level dynamics for racial and ethnic minorities: a higher overall prevalence of risk factors for coronary artery disease that are unrecognized and therefore not treated, which increases their likelihood of experiencing adverse outcome and, therefore, potentially higher morbidity and mortality. It discusses the rate of Acute Coronary Syndrome (ACS) in minority communities. Minority patients with ACS are at greater risk of myocardial infarction (MI), rehospitalization, and death from ACS. They also are less likely than non-minority patients to receive potentially beneficial treatments such as angiography or percutaneous coronary intervention. This paper looks at the data surrounding the increased rate of heart disease in racial and ethnic minorities, where the risk is related to the prevalence of comorbidities with hypertension or diabetes mellitus, which, in combination with environmental factors, may largely explain CHF disparity. The conclusion is that it is essential that healthcare providers understand these various communities, including nuances in disease presentation, risk factors, and treatment among different racial and ethnic groups. Awareness of these communities' attributes, as well as differences in incidence, risk factor burdens, prognosis and treatment are necessary to mitigate racial and ethnic disparities in heart disease.

  4. Atypical language laterality is associated with large-scale disruption of network integration in children with intractable focal epilepsy.

    PubMed

    Ibrahim, George M; Morgan, Benjamin R; Doesburg, Sam M; Taylor, Margot J; Pang, Elizabeth W; Donner, Elizabeth; Go, Cristina Y; Rutka, James T; Snead, O Carter

    2015-04-01

    Epilepsy is associated with disruption of integration in distributed networks, together with altered localization for functions such as expressive language. The relation between atypical network connectivity and altered localization is unknown. In the current study we tested whether atypical expressive language laterality was associated with the alteration of large-scale network integration in children with medically-intractable localization-related epilepsy (LRE). Twenty-three right-handed children (age range 8-17) with medically-intractable LRE performed a verb generation task in fMRI. Language network activation was identified and the Laterality index (LI) was calculated within the pars triangularis and pars opercularis. Resting-state data from the same cohort were subjected to independent component analysis. Dual regression was used to identify associations between resting-state integration and LI values. Higher positive values of the LI, indicating typical language localization were associated with stronger functional integration of various networks including the default mode network (DMN). The normally symmetric resting-state networks showed a pattern of lateralized connectivity mirroring that of language function. The association between atypical language localization and network integration implies a widespread disruption of neural network development. These findings may inform the interpretation of localization studies by providing novel insights into reorganization of neural networks in epilepsy.

  5. Impact of noncommunicable diseases in the State of Qatar

    PubMed Central

    Al-Kaabi, Salma Khalaf; Atherton, Andrew

    2015-01-01

    This study, commissioned by the Supreme Council of Health in the State of Qatar, focuses on the main noncommunicable diseases (NCDs) globally and regionally, in order to gauge their potential impact on Qatar. The research shows that the Gulf Cooperation Council is projected to be affected dramatically by NCDs in the coming years. The top five NCDs that will affect Qatar in terms of economic burden and disability-adjusted life years are cardiovascular diseases, mental health and behavioral disorders, cancer, respiratory diseases, and diabetes. Whilst these diseases have diverse effects on patients, their causes can be traced to “… common lifestyle-related, or behavioral, risk factors such as tobacco use, a diet heavy in fat, and physical inactivity”. The total direct and indirect costs to the Gulf Cooperation Council calculated for the above five NCDs were $36.2 billion in 2013, which equates to 150% of the officially recorded annual health care expenditure. If this trajectory is maintained, spending per head of population in Qatar will reach $2,778 by 2022. These figures demonstrate not only the potential financial impact of the main NCDs, but also give an idea of how the current health system is working to address them. PMID:26170702

  6. Acupuncture modulates resting state hippocampal functional connectivity in Alzheimer disease.

    PubMed

    Wang, Zhiqun; Liang, Peipeng; Zhao, Zhilian; Han, Ying; Song, Haiqing; Xu, Jianyang; Lu, Jie; Li, Kuncheng

    2014-01-01

    Our objective is to clarify the effects of acupuncture on hippocampal connectivity in patients with Alzheimer disease (AD) using functional magnetic resonance imaging (fMRI). Twenty-eight right-handed subjects (14 AD patients and 14 healthy elders) participated in this study. Clinical and neuropsychological examinations were performed on all subjects. MRI was performed using a SIEMENS verio 3-Tesla scanner. The fMRI study used a single block experimental design. We first acquired baseline resting state data during the initial 3 minutes and then performed acupuncture stimulation on the Tai chong and He gu acupoints for 3 minutes. Last, we acquired fMRI data for another 10 minutes after the needle was withdrawn. The preprocessing and data analysis were performed using statistical parametric mapping (SPM5) software. Two-sample t-tests were performed using data from the two groups in different states. We found that during the resting state, several frontal and temporal regions showed decreased hippocampal connectivity in AD patients relative to control subjects. During the resting state following acupuncture, AD patients showed increased connectivity in most of these hippocampus related regions compared to the first resting state. In conclusion, we investigated the effect of acupuncture on AD patients by combing fMRI and traditional acupuncture. Our fMRI study confirmed that acupuncture at Tai chong and He gu can enhance the hippocampal connectivity in AD patients.

  7. Subcellular compartmentation of ascorbate and its variation in disease states.

    PubMed

    Bánhegyi, Gábor; Benedetti, Angelo; Margittai, Eva; Marcolongo, Paola; Fulceri, Rosella; Németh, Csilla E; Szarka, András

    2014-09-01

    Beyond its general role as antioxidant, specific functions of ascorbate are compartmentalized within the eukaryotic cell. The list of organelle-specific functions of ascorbate has been recently expanded with the epigenetic role exerted as a cofactor for DNA and histone demethylases in the nucleus. Compartmentation necessitates the transport through intracellular membranes; members of the GLUT family and sodium-vitamin C cotransporters mediate the permeation of dehydroascorbic acid and ascorbate, respectively. Recent observations show that increased consumption and/or hindered entrance of ascorbate in/to a compartment results in pathological alterations partially resembling to scurvy, thus diseases of ascorbate compartmentation can exist. The review focuses on the reactions and transporters that can modulate ascorbate concentration and redox state in three compartments: endoplasmic reticulum, mitochondria and nucleus. By introducing the relevant experimental and clinical findings we make an attempt to coin the term of ascorbate compartmentation disease. PMID:24907663

  8. Intramedullary decompression with condylectomy for intractable plantar keratoma.

    PubMed

    Roven, M D

    1985-07-01

    A previously unreported method to relieve excessive plantargrade pressure which may create an intractable plantar keratoma associated with metatarsal head pain is presented. This method is referred to as an intramedullary metatarsal decompression with condylectomy and is performed through a dorsal minimum incision. The rotary action of the bur is demonstrated. This method has proved less traumatic than previous procedures, permitting immediate ambulation with little postoperative pain or edema. In a series of cases, I have compared this method with control studies on the same patient in which intramedullary metatarsal decompression was performed on one foot and a neck osteotomy on the opposite foot. Results with intramedullary metatarsal decompression have been comparable but have fewer postoperative sequelae. Exuberant bone callus formation dorsally and at the osteotomy site, lateral displacement of bone segments, frequency of transfer lesions, delayed healing or nonunion of the osteotomy site, and the possibility of synostosis when two adjacent bones were osteotomized are all decreased. A short review of the rationale, selection of cases, and criteria for orthotics is presented. The concept and simplified method of treatment applied in a series of cases is described. PMID:4028490

  9. A case of hypereosinophilic syndrome presenting with intractable gastric ulcers

    PubMed Central

    Park, Tae Young; Choi, Chang Hwan; Yang, Suh Yoon; Oh, In Soo; Song, In-Do; Lee, Hyun Woong; Kim, Hyung Joon; Do, Jae Hyuk; Chang, Sae Kyung; Cho, Ah Ra; Cha, Young Joo

    2009-01-01

    We report a rare case of hypereosinophilic syndrome (HES) presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacter pylori (H pylori) eradication therapy followed by proton pump inhibitor (PPI) therapy. However, follow-up endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% (total count: 7903/mm3). Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylori eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered. PMID:20027690

  10. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    SciTech Connect

    Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.

    1981-10-22

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweek mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

  11. Treatment of intractable rheumatoid arthritis with total lymphoid irradiation

    SciTech Connect

    Kotzin, B.L.; Strober, S.; Engleman, E.G.; Calin, A.; Hoppe, R.T.; Kansas, G.S.; Terrell, C.P.; Kaplan, H.S.

    1981-10-01

    Eleven patients with intractable rheumatoid arthritis were treated with total lymphoid irradiation (total dose, 2000 rad) in an uncontrolled feasibility study, as an alternative to long-term therapy with cytotoxic drugs such as cyclophosphamide and azathioprine. During a follow-up period of five to 18 months after total lymphoid irradiation, there was a profound and sustained suppression of the absolute lymphocyte count and in vitro lymphocyte function, as well as an increase in the ratio of Leu-2 (suppressor/cytotoxic) to Leu-3 (helper) T cells in the blood. Persistent circulating suppressor cells of the mixed leukocyte response and of pokeweed mitogen-induced immunoglobulin secretion developed in most patients. In nine of the 11 patients, these changes in immune status were associated with relief of joint tenderness and swelling and with improvement in function scores. Maximum improvement occurred approximately six months after irradiation and continued for the remainder of the observation period. Few severe or chronic side effects were associated with the radiotherapy.

  12. Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

    PubMed Central

    Chakrabortty, Shushovan; Kumar, Sanjeev; Gupta, Deepak; Rudraraju, Sruthi

    2016-01-01

    As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ablations (RFAs) for SIJ pain. We report our pain-clinic experience with peripheral nerve field stimulation (PNFS) for two patients of intractable SIJ pain. They had reported absence of long-term pain relief (pain relief >50% for at least 2 weeks postinjection and at least 3 months post-RFA) with SIJ injections and SIJ RFAs. Two parallel permanent 8-contact subcutaneous stimulating leads were implanted under the skin overlying their painful SIJ. Adequate stimulation in the entire painful area was confirmed. For implantable pulse generator placement, a separate subcutaneous pocket was made in the upper buttock below the iliac crest level ipsilaterally. During the pain-clinic follow-up period, the patients had reduced their pain medications requirements by half with an additional report of more than 50% improvement in their functional status. The first patient passed away 2 years after the PNFS procedure due to medical causes unrelated to his chronic pain. The second patient has been comfortable with PNFS-induced analgesic regimen during her pain-clinic follow-up during last 5 years. In summary, PNFS can be an effective last resort option for SIJ pain wherein conventional interventional pain techniques have failed, and analgesic medication requirements are escalating or causing unwarranted side-effects.

  13. Endovascular Treatment of Traumatic Pseudoaneurysm Presenting as Intractable Epistaxis

    PubMed Central

    Zhang, Chang wei; You, Chao; Mao, Bo yong; Wang, Chao hua; He, Min; Sun, Hong

    2010-01-01

    Objective To investigate the clinical efficacy of individual endovascular management for the treatment of different traumatic pseudoaneurysms presenting as intractable epistaxis. Materials and Methods For 14 consecutive patients with traumatic pseudoaneurysm presenting as refractory epistaxes, 15 endovascular procedures were performed. Digital subtraction angiography revealed that the pseudoaneurysms originated from the internal maxillary artery in eight patients; and all were treated with occlusion of the feeding artery. In six cases, they originated from the internal carotid artery (ICA); out of which, two were managed with detachable balloons, two with covered stents, one by means of cavity embolization, and the remaining one with parent artery occlusion. All of these cases were followed up clinically from six to 18 months, with a mean follow up time of ten months; moreover, three cases were also followed with angiography. Results Complete cessation of bleeding was achieved in all the 15 instances (100%) immediately after the endovascular therapies. Of the six patients who suffered from ICA pseudoaneurysms, one presented with a permanent stroke and one had an episode of rebleeding requiring intervention. Conclusion In patients presenting with a history of craniocerebral trauma, traumatic pseudoaneurysm must be considered as a differential diagnosis. Individual endovascular treatment is a relatively safe, plausible, and reliable means of managing traumatic pseudoaneurysms. PMID:21076585

  14. Intractable occipital lobe epilepsy: clinical characteristics and surgical treatment.

    PubMed

    Jobst, Barbara C; Williamson, Peter D; Thadani, Vijay M; Gilbert, Karen L; Holmes, Gregory L; Morse, Richard P; Darcey, Terrance M; Duhaime, Ann-Christine; Bujarski, Krysztof A; Roberts, David W

    2010-11-01

    Intractable occipital lobe epilepsy remains a surgical challenge. Clinical characteristics of 14 patients were analyzed. Twelve patients had surgery, seven patients had visual auras (50%) and only eight patients (57%) had posterior scalp EEG changes. Ictal single-proton emission computed tomography (SPECT) incorrectly localized in 7 of 10 patients. Six patients (50%) had Engel's class I outcome. Patients with inferior occipital seizure onset appeared to fare better (three of four class I) than patients with lateral or medial occipital seizure onset (three of eight class I). Patients who had all three occipital surfaces covered with electrodes had a better outcome (four of five class I) than patients who had limited electroencephalography (EEG) coverage (two of seven class I). Magnetic resonance imaging (MRI) lesions did not guarantee a seizure free outcome. In conclusion, visual auras, scalp EEG, and imaging findings are not reliable for correct identification of occipital onset. Occipital seizure onset can be easily missed in nonlesional epilepsy. Comprehensive intracranial EEG coverage of all three occipital surfaces leads to better outcomes.

  15. Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.

    PubMed

    Derrey, Stéphane; Lebas, Axel; Parain, Dominique; Baray, Marie Gilles; Marguet, Christophe; Freger, Pierre; Proust, François

    2012-12-01

    Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

  16. [Maggots of Lucilia sericata in treatment of intractable wounds].

    PubMed

    Orkiszewski, Marek

    2007-01-01

    Although beneficial effects of wound infestation with maggots had been known for many centuries, it was not until dr Zacharias recognized medical importance of maggots during the American Civil War. He intentionally introduced maggots into the wound for its debridement. Baer successfully used maggots in treatment of osteomyelitis in 4 children in the 1930'. After many successes in the 1930' maggots therapy had become limited to intractable wounds after introducing sulphonamides and mass-production of Flemming's penicillin. Present use of maggots came in the 1980' when better methods of sterilization both eggs and maggot were developed and clinical efficiency of antibiotics used for wound treatment decreased dramatically. Today maggots' therapy became less treatment of last resort but of first choice in leg ulcers, carbuncules, pressure ulcers and infected traumatic wounds. Its beneficial effect was noted in diabetic foot and in destroying malignant tissue as well. Easiness in application, safety, near no side effects and often exceptional efficiency in wound debridement makes maggots therapy the first line therapeutic tool in both hospital and out-patient surgery. Clinical experience has demonstrated that maggot therapy may reduce costs of treatment considerably by shortening hospital stay and decrease usage of antibiotics.

  17. Lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized study comparing 750-rad treatment with 2,000-rad treatment

    SciTech Connect

    Hanly, J.G.; Hassan, J.; Moriarty, M.; Barry, C.; Molony, J.; Casey, E.; Whelan, A.; Feighery, C.; Bresnihan, B.

    1986-01-01

    Twenty patients with intractable rheumatoid arthritis were treated with 750-rad or 2,000-rad lymphoid irradiation in a randomized double-blind comparative study. Over a 12-month followup period, there was a significant improvement in 4 of 7 and 6 of 7 standard parameters of disease activity following treatment with 750 rads and 2,000 rads, respectively. Transient, short-term toxicity was less frequent with the lower dose. In both groups, there was a sustained peripheral blood lymphopenia, a selective depletion of T helper (Leu-3a+) lymphocytes, and reduced in vitro mitogen responses. These changes did not occur, however, in synovial fluid. These results suggest that 750-rad lymphoid irradiation is as effective as, but less toxic than, that with 2,000 rads in the management of patients with intractable rheumatoid arthritis.

  18. Use of an Oral Elemental Diet in Infants with Severe Intractable Diarrhea

    ERIC Educational Resources Information Center

    Sherman, Joseph O.; And Others

    1975-01-01

    Evaluated was the use of an oral elemental diet consisting of crystalline amino acids, glucose, electrolytes, and vitamins to control severe intractable diarrhea in 27 infants (1-day to 9-months of age). (DB)

  19. Using the Disease State Fingerprint Tool for Differential Diagnosis of Frontotemporal Dementia and Alzheimer's Disease

    PubMed Central

    Muñoz-Ruiz, Miguel Ángel; Hall, Anette; Mattila, Jussi; Koikkalainen, Juha; Herukka, Sanna-Kaisa; Husso, Minna; Hänninen, Tuomo; Vanninen, Ritva; Liu, Yawu; Hallikainen, Merja; Lötjönen, Jyrki; Remes, Anne M.; Alafuzoff, Irina; Soininen, Hilkka; Hartikainen, Päivi

    2016-01-01

    Background Disease State Index (DSI) and its visualization, Disease State Fingerprint (DSF), form a computer-assisted clinical decision making tool that combines patient data and compares them with cases with known outcomes. Aims To investigate the ability of the DSI to diagnose frontotemporal dementia (FTD) and Alzheimer's disease (AD). Methods The study cohort consisted of 38 patients with FTD, 57 with AD and 22 controls. Autopsy verification of FTD with TDP-43 positive pathology was available for 14 and AD pathology for 12 cases. We utilized data from neuropsychological tests, volumetric magnetic resonance imaging, single-photon emission tomography, cerebrospinal fluid biomarkers and the APOE genotype. The DSI classification results were calculated with a combination of leave-one-out cross-validation and bootstrapping. A DSF visualization of a FTD patient is presented as an example. Results The DSI distinguishes controls from FTD (area under the receiver-operator curve, AUC = 0.99) and AD (AUC = 1.00) very well and achieves a good differential diagnosis between AD and FTD (AUC = 0.89). In subsamples of autopsy-confirmed cases (AUC = 0.97) and clinically diagnosed cases (AUC = 0.94), differential diagnosis of AD and FTD performs very well. Conclusions DSI is a promising computer-assisted biomarker approach for aiding in the diagnostic process of dementing diseases. Here, DSI separates controls from dementia and differentiates between AD and FTD. PMID:27703465

  20. Distinct Oral Neutrophil Subsets Define Health and Periodontal Disease States.

    PubMed

    Fine, N; Hassanpour, S; Borenstein, A; Sima, C; Oveisi, M; Scholey, J; Cherney, D; Glogauer, M

    2016-07-01

    Neutrophils exit the vasculature and swarm to sites of inflammation and infection. However, these cells are abundant in the healthy, inflammation-free human oral environment, suggesting a unique immune surveillance role within the periodontium. We hypothesize that neutrophils in the healthy oral cavity occur in an intermediary parainflammatory state that allows them to interact with and contain the oral microflora without eliciting a marked inflammatory response. Based on a high-throughput screen of neutrophil CD (cluster of differentiation) marker expression and a thorough literature review, we developed multicolor flow cytometry panels to determine the surface marker signatures of oral neutrophil subsets in periodontal health and disease. We define here 3 distinct neutrophil subsets: resting/naive circulatory neutrophils, parainflammatory neutrophils found in the healthy oral cavity, and proinflammatory neutrophils found in the oral cavity during chronic periodontal disease. Furthermore, parainflammatory neutrophils manifest as 2 distinct subpopulations-based on size, granularity, and expression of specific CD markers-and exhibit intermediate levels of activation as compared with the proinflammatory oral neutrophils. These intermediately activated parainflammatory populations occur in equal proportions in the healthy oral cavity, with a shift to one highly activated proinflammatory neutrophil population in chronic periodontal disease. This work is the first to identify and characterize oral parainflammatory neutrophils that interact with commensal biofilms without inducing an inflammatory response, thereby demonstrating that not all neutrophils trafficking through periodontal tissues are fully activated. In addition to establishing possible diagnostic and treatment monitoring biomarkers, this oral neutrophil phenotype model builds on existing literature suggesting that the healthy periodontium may be in a parainflammatory state. PMID:27270666

  1. Patients with intractable epilepsy have low melatonin, which increases following seizures

    PubMed Central

    Bazil, Carl W.; Short, Douglas; Crispin, David; Zheng, Wei

    2016-01-01

    Melatonin, which is used to treat sleep disorders, has anticonvulsant properties. The authors measured salivary melatonin and cortisol, at baseline and following seizures, in patients with intractable temporal lobe epilepsy and controls. Melatonin was reduced in patients with epilepsy at baseline compared with controls, and increased threefold following seizures. Cortisol also increased following seizures. Patients with intractable epilepsy have low baseline melatonin levels that increase dramatically following seizures. PMID:11113238

  2. Disparities in surgery among patients with intractable epilepsy in a universal health system

    PubMed Central

    Shariff, Salimah Z.; Liu, Kuan; Leonard, Sean; Saposnik, Gustavo; Garg, Amit X.

    2016-01-01

    Objective: To assess the use of epilepsy surgery in patients with medically intractable epilepsy in a publicly funded universal health care system. Methods: We performed a population-based retrospective cohort study using linked health care databases for Ontario, Canada, between 2001 and 2010. We identified all patients with medically intractable epilepsy, defined as those with seizures that did not respond to at least 2 adequate trials of seizure medications. We assessed the proportion of patients who had epilepsy surgery within the following 2 years. We further identified the characteristics associated with epilepsy surgery. Results: A total of 10,661 patients were identified with medically intractable epilepsy (mean age 47 years, 51% male); most (74%) did not have other comorbidities. Within 2 years of being defined as medically intractable, only 124 patients (1.2%) underwent epilepsy surgery. Death occurred in 12% of those with medically intractable epilepsy. Those who underwent the procedure were younger and had fewer comorbidities compared to those who did not. Conclusion: In our setting of publicly funded universal health care, more than 10% of patients died within 2 years of developing medically intractable epilepsy. Epilepsy surgery may be an effective treatment for some patients; however, fewer than 2% of patients who may have benefited from epilepsy surgery received it. PMID:26643546

  3. Melatonin and sleep-related problems in children with intractable epilepsy.

    PubMed

    Elkhayat, Hamed A; Hassanein, Sahar M; Tomoum, Hoda Y; Abd-Elhamid, Iman A; Asaad, Tarek; Elwakkad, Amany S

    2010-04-01

    Children with epilepsy have high rates of sleep problems. Melatonin has been advocated in treatment of sleep disorders, and its beneficial effect has been confirmed in insomnia. The aim of this study was to assess melatonin levels in children with intractable epilepsy and its relation to pattern of sleep and characteristics of seizure disorder, as well as the effect of melatonin therapy on those parameters. The study was conducted on 23 children with intractable epilepsy and 14 children with controlled seizures. Patients were evaluated by psychometric sleep assessment and assay of diurnal and nocturnal melatonin levels. Children with intractable epilepsy received oral melatonin before bedtime. They were reassessed after 3 months. Children with intractable epilepsy had higher scores for each category of sleep walking, forcible teeth grinding, and sleep apnea. At the end of therapeutic trial, patients with intractable epilepsy exhibited significant improvement in bedtime resistance, sleep duration, sleep latency, frequent nocturnal arousals, sleep walking, excessive daytime sleepiness, nocturnal enuresis, forcible teeth grinding, sleep apnea, and Epworth sleepiness scores. There was also significant reduction in seizure severity. Thus, use of melatonin in patients with intractable seizures was associated with improvement of both many sleep-related phenomena and the severity of seizures. PMID:20304327

  4. Characteristics and safety assessment of intractable proteins in genetically modified crops.

    PubMed

    Bushey, Dean F; Bannon, Gary A; Delaney, Bryan F; Graser, Gerson; Hefford, Mary; Jiang, Xiaoxu; Lee, Thomas C; Madduri, Krishna M; Pariza, Michael; Privalle, Laura S; Ranjan, Rakesh; Saab-Rincon, Gloria; Schafer, Barry W; Thelen, Jay J; Zhang, John X Q; Harper, Marc S

    2014-07-01

    Genetically modified (GM) crops may contain newly expressed proteins that are described as "intractable". Safety assessment of these proteins may require some adaptations to the current assessment procedures. Intractable proteins are defined here as those proteins with properties that make it extremely difficult or impossible with current methods to express in heterologous systems; isolate, purify, or concentrate; quantify (due to low levels); demonstrate biological activity; or prove equivalency with plant proteins. Five classes of intractable proteins are discussed here: (1) membrane proteins, (2) signaling proteins, (3) transcription factors, (4) N-glycosylated proteins, and (5) resistance proteins (R-proteins, plant pathogen recognition proteins that activate innate immune responses). While the basic tiered weight-of-evidence approach for assessing the safety of GM crops proposed by the International Life Sciences Institute (ILSI) in 2008 is applicable to intractable proteins, new or modified methods may be required. For example, the first two steps in Tier I (hazard identification) analysis, gathering of applicable history of safe use (HOSU) information and bioinformatics analysis, do not require protein isolation. The extremely low level of expression of most intractable proteins should be taken into account while assessing safety of the intractable protein in GM crops. If Tier II (hazard characterization) analyses requiring animal feeding are judged to be necessary, alternatives to feeding high doses of pure protein may be needed. These alternatives are discussed here.

  5. Norovirus and Foodborne Disease, United States, 1991–2000

    PubMed Central

    Sulka, Alana; Bulens, Sandra N.; Beard, R. Suzanne; Chaves, Sandra S.; Hammond, Roberta; Salehi, Ellen D.P.; Swanson, Ellen; Totaro, Jessica; Woron, Ray; Mead, Paul S.; Bresee, Joseph S.; Monroe, Stephan S.; Glass, Roger I.

    2005-01-01

    Efforts to prevent foodborne illness target bacterial pathogens, yet noroviruses (NoV) are suspected to be the most common cause of gastroenteritis. New molecular assays allow for better estimation of the role of NoV in foodborne illness. We analyzed 8,271 foodborne outbreaks reported to the Centers for Disease Control and Prevention from 1991 to 2000 and additional data from 6 states. The proportion of NoV-confirmed outbreaks increased from 1% in 1991 to 12% in 2000. However, from 1998 to 2000, 76% of NoV outbreaks were reported by only 11 states. In 2000, an estimated 50% of foodborne outbreaks in 6 states were attributable to NoV. NoV outbreaks were larger than bacterial outbreaks (median persons affected: 25 versus 15), and 10% of affected persons sought medical care; 1% were hospitalized. More widespread use of molecular assays will permit better estimates of the role of NoV illness and help direct efforts to control foodborne illness. PMID:15705329

  6. Intractable sacroiliac joint pain treated with peripheral nerve field stimulation.

    PubMed

    Chakrabortty, Shushovan; Kumar, Sanjeev; Gupta, Deepak; Rudraraju, Sruthi

    2016-01-01

    As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ablations (RFAs) for SIJ pain. We report our pain-clinic experience with peripheral nerve field stimulation (PNFS) for two patients of intractable SIJ pain. They had reported absence of long-term pain relief (pain relief >50% for at least 2 weeks postinjection and at least 3 months post-RFA) with SIJ injections and SIJ RFAs. Two parallel permanent 8-contact subcutaneous stimulating leads were implanted under the skin overlying their painful SIJ. Adequate stimulation in the entire painful area was confirmed. For implantable pulse generator placement, a separate subcutaneous pocket was made in the upper buttock below the iliac crest level ipsilaterally. During the pain-clinic follow-up period, the patients had reduced their pain medications requirements by half with an additional report of more than 50% improvement in their functional status. The first patient passed away 2 years after the PNFS procedure due to medical causes unrelated to his chronic pain. The second patient has been comfortable with PNFS-induced analgesic regimen during her pain-clinic follow-up during last 5 years. In summary, PNFS can be an effective last resort option for SIJ pain wherein conventional interventional pain techniques have failed, and analgesic medication requirements are escalating or causing unwarranted side-effects. PMID:27625495

  7. Recovery of heavy metals from intractable wastes: A thermal approach

    SciTech Connect

    Kirk, D.W.

    1996-12-31

    The generation of industrial solid wastes containing leachable species of environmental concern is a problem for developing and developed nations alike. These materials arise from direct processing of mineral ores, from production of metals and minerals, from manufacturing operations, and from air and water pollution treatment processes. The general characteristics that make these wastes intractable is that their content of hazardous species is not easily liberated from the waste yet is not bound so tightly that they are safe for landfill disposal or industrial use. The approach taken in this work is a thermal treatment that separates the inorganic contaminants from the wastes. The objective is to provide recovery and reuse of both the residual solids and liberated contaminants. The results from operating this technique using two very different types of waste are described. The reasons that the process will work for a wide variety of wastes are explored. By using the knowledge of the thermodynamic stability of the phases found from the characterization analyses, a thermal regime was found that allowed separation of the contaminants without capturing the matrix materials. Bench scale studies were carried out using a tube furnace. Samples of the wastes were heated in crucible boats from 750 to 1150{degrees}C in the presence of various chlorinating agents. The offgas contained 90{sup +}% of the targeted contaminants despite their complex matrix form. The residue was free of contamination. As a result of the efficient concentrating mechanism of the process, the contaminants in the offgas solids are attractive for reuse in metallurgical industries. As an additional benefit, the organic contaminants of the residues were eliminated. Dioxin traces in the solids before treatment were absent after treatment. 15 refs., 4 figs., 4 tabs.

  8. Intractable sacroiliac joint pain treated with peripheral nerve field stimulation

    PubMed Central

    Chakrabortty, Shushovan; Kumar, Sanjeev; Gupta, Deepak; Rudraraju, Sruthi

    2016-01-01

    As many as 62% low back pain patients can have sacroiliac joint (SIJ) pain. There is limited (to poor) evidence in regards to long-term pain relief with therapeutic intra-articular injections and/or conventional (heat or pulsed) radiofrequency ablations (RFAs) for SIJ pain. We report our pain-clinic experience with peripheral nerve field stimulation (PNFS) for two patients of intractable SIJ pain. They had reported absence of long-term pain relief (pain relief >50% for at least 2 weeks postinjection and at least 3 months post-RFA) with SIJ injections and SIJ RFAs. Two parallel permanent 8-contact subcutaneous stimulating leads were implanted under the skin overlying their painful SIJ. Adequate stimulation in the entire painful area was confirmed. For implantable pulse generator placement, a separate subcutaneous pocket was made in the upper buttock below the iliac crest level ipsilaterally. During the pain-clinic follow-up period, the patients had reduced their pain medications requirements by half with an additional report of more than 50% improvement in their functional status. The first patient passed away 2 years after the PNFS procedure due to medical causes unrelated to his chronic pain. The second patient has been comfortable with PNFS-induced analgesic regimen during her pain-clinic follow-up during last 5 years. In summary, PNFS can be an effective last resort option for SIJ pain wherein conventional interventional pain techniques have failed, and analgesic medication requirements are escalating or causing unwarranted side-effects. PMID:27625495

  9. Efficacy of total lymphoid irradiation in intractable rheumatoid arthritis. A double-blind, randomized trial

    SciTech Connect

    Strober, S.; Tanay, A.; Field, E.; Hoppe, R.T.; Calin, A.; Engleman, E.G.; Kotzin, B.; Brown, B.W.; Kaplan, H.S.

    1985-04-01

    Twenty-six patients participated in a randomized, double-blind study of the efficacy of total lymphoid irradiation in the treatment of intractable rheumatoid arthritis. All 26 patients, for whom therapy with gold compounds and penicillamine had failed, would ordinarily have been considered candidates for cytotoxic or antimetabolite drug therapy. Thirteen patients randomly assigned to receive full-dose total lymphoid irradiation (2000 rad) and 11 patients assigned to receive control low-dose total lymphoid irradiation (200 rad) completed radiotherapy. Alleviation of joint disease activity was significantly greater in the high-dose group as judged by morning stiffness, joint tenderness, and functional assessment (global composite score) at 3 and 6 months after radiotherapy. The high-dose group had a marked reduction in both T-lymphocyte function and numbers, but this finding was not observed in the low-dose group. Complications seen in the high-dose but not low-dose group included transient neutropenia, thrombocytopenia, pericarditis, and pleurisy.

  10. Risk of Importing Zoonotic Diseases through Wildlife Trade, United States

    PubMed Central

    Schloegel, Lisa M.; Daszak, Peter

    2009-01-01

    The United States is the world’s largest wildlife importer, and imported wild animals represent a potential source of zoonotic pathogens. Using data on mammals imported during 2000–2005, we assessed their potential to host 27 selected risk zoonoses and created a risk assessment that could inform policy making for wildlife importation and zoonotic disease surveillance. A total of 246,772 mammals in 190 genera (68 families) were imported. The most widespread agents of risk zoonoses were rabies virus (in 78 genera of mammals), Bacillus anthracis (57), Mycobacterium tuberculosis complex (48), Echinococcus spp. (41), and Leptospira spp. (35). Genera capable of harboring the greatest number of risk zoonoses were Canis and Felis (14 each), Rattus (13), Equus (11), and Macaca and Lepus (10 each). These findings demonstrate the myriad opportunities for zoonotic pathogens to be imported and suggest that, to ensure public safety, immediate proactive changes are needed at multiple levels. PMID:19891857

  11. Evaluating an interprofessional disease state and medication management review model.

    PubMed

    Hoti, Kreshnik; Forman, Dawn; Hughes, Jeffery

    2014-03-01

    There is lack of literature data reporting an incorporation of medication management reviews in students' interprofessional education (IPE) and practice programs in aged care settings. This pilot study reports how an interprofessional disease state and medication management review program (DSMMR) was established in a residential aged care facility in Perth, Western Australia. Students from the professions of nursing, pharmacy and physiotherapy focused on a wellness check in the areas of cognition, falls and continence while integrating a medication management review. Students' attitudes were explored using a pre- and post-placement questionnaire. Students indicated positive experience with the IPE DSMMR program which also resulted in their positive attitudinal shift towards IPE and practice. These findings indicated that aged care can be a suitable setting for student interprofessional programs focusing on DSMMR.

  12. Anonymous predictive testing for Huntington's disease in the United States.

    PubMed

    Visintainer, C L; Matthias-Hagen, V; Nance, M A

    2001-01-01

    The widespread use of a predictive genetic test for Huntington's disease (HD) since 1993 has brought to the forefront issues regarding genetic privacy. Although the possibility of anonymous genetic testing has been discussed, its use in the United States has not been described previously. We review the experiences of 11 genetics specialists with anonymous predictive testing for HD. We found that more men than women requested anonymous testing, for reasons that more often related to personal privacy than to insurance or discrimination concerns. A number of approaches to anonymity were used, and genetics specialists varied in the degree to which they were comfortable with the process. A number of legal, medical, and practical questions are raised, which will require resolution if anonymous testing is to be performed with a greater frequency in the future.

  13. Surveillance for foodborne disease outbreaks - United States, 2006.

    PubMed

    2009-06-12

    Foodborne illnesses are a major health burden in the United States. Most of these illnesses are preventable, and analysis of outbreaks helps identify control measures. Although most cases are sporadic, investigation of the portion that occur as part of recognized outbreaks can provide insights into the pathogens, food vehicles, and food-handling practices associated with foodborne infections. CDC collects data on foodborne disease outbreaks (FBDOs) from all states and territories through the Foodborne Disease Outbreak Surveillance System (FBDSS). This report summarizes epidemiologic data on FBDOs reported during 2006 (the most recent year for which data have been analyzed). A total of 1,270 FBDOs were reported, resulting in 27,634 cases and 11 deaths. Among the 624 FBDOs with a confirmed etiology, norovirus was the most common cause, accounting for 54% of outbreaks and 11,879 cases, followed by Salmonella (18% of outbreaks and 3,252 cases). Among the 11 reported deaths, 10 were attributed to bacterial etiologies (six Escherichia coli O157:H7, two Listeria monocytogenes, one Salmonella serotype Enteritidis, and one Clostridium botulinum), and one was attributed to a chemical (mushroom toxin). Among outbreaks caused by a single food vehicle, the most common food commodities to which outbreak-related cases were attributed were poultry (21%), leafy vegetables (17%), and fruits/nuts (16%). Public health professionals can use this information to 1) target control strategies for specific pathogens in particular foods along the farm-to-table continuum and 2) support good food-handling practices among restaurant workers and the public.

  14. Altered resting-state connectivity in Huntington's disease.

    PubMed

    Werner, Cornelius J; Dogan, Imis; Saß, Christian; Mirzazade, Shahram; Schiefer, Johannes; Shah, N Jon; Schulz, Jörg B; Reetz, Kathrin

    2014-06-01

    Huntington's disease (HD) is an autosomal dominantly inherited neurodegenerative disorder characterized by motor, cognitive, and psychiatric symptoms. Using resting-state fMRI (rs-fMRI) we investigated the functional integrity of resting-state networks (RSN) in HD. 17 HD and 19 matched control participants were examined at a 3 Tesla MR scanner. After controlling for structural degeneration by means of voxel-based morphometry, task-free rs-fMRI data were analyzed using Independent Component Analysis (ICA) and a dual-regression approach in the context of genetic and clinical parameters. Further, we evaluated HD-related differences in interregional connectivity between networks. RSN analysis showed a significant increase in intrinsic functional connectivity in the HD sample compared with controls, including the thalamus, striatum, prefrontal, premotor, and parietal maps. A subset of the Default Mode Network (DMN) was also affected. In the HD cohort, motor impairment correlated with higher network connectivity in mainly motor and parietal cortices. Deteriorating total functional capacity was additionally associated with higher connectivity in the striatum, thalamus, insular and frontal areas. This pattern of increased activity in intrinsic functional networks might suggest a reduced ability of intra-network differentiation with clinical disease progression in HD. Finally, results showed reduced long-range connectivity between parietal ICA components in HD compared to controls, indicating impaired functional coupling between interregional networks in HD. Our data demonstrates that functional connectivity is profoundly altered in HD, both within and between RSN. Rs-fMRI analysis may provide additional valuable insights into neuronal dysfunctions beyond HD-related structural degeneration and disruptions of functional circuits in HD.

  15. Immunohistochemical detection of gastric mucin in normal and disease states.

    PubMed

    Taylor, K L; Mall, A S; Barnard, R A; Ho, S B; Cruse, J P

    1998-01-01

    At least seven human mucin genes have been described, which express glycoproteins MUC1-7 in various tissues. It has been shown that different mucins are expressed in various gastric disease states compared to the normal. In this study we used histochemical and immunohistochemical methods to determine the type and pattern of mucin in 54 patients with a variety of gastric conditions [i.e., normal controls, fetal stomachs, gastritis, low-grade dysplasia, intestinal metaplasia (associated with gastritis, benign ulcers, dysplasia, and cancer), early and advanced intestinal type adenocarcinoma, and diffuse adenocarcinoma]. We report for the first time the use of all seven MUC antibodies in the various conditions. Normal controls were immunoreactive for MUC4, 5, and 6 , and gastritis specimens showed similar results, although the latter showed more MUC1 immunoreactivity. Whereas early fetal stomach showed no MUC immunoreactivity, MUC4, 5, and 6 were present from the early second trimester onwards. There was no significant difference between dysplasia and intestinal metaplasia, both categories showing the presence of MUC2 and 3 predominantly. Early intestinal type adenocarcinomas did not show any mucins in the majority of cases. Advanced intestinal type adenocarcinomas showed immunoreactivity predominantly for MUC1, 5, and 6, as well as MUC2 in some cases. Diffuse adenocarcinomas showed strong positive MUC2 and 6 staining, and in some cases MUC5 and 7. In conclusion, we have shown different patterns of mucin immunoreactivity in various gastric disease states. Specimens with dysplasia, intestinal metaplasia, late intestinal type adenocarcinoma, and diffuse gastric cancer were characterized by increased diversity of mucin types, whereas early intestinal cancer showed loss of mucin immunoreactivity.

  16. Cardiovascular Disease in Hispanics/Latinos in the United States

    PubMed Central

    Balfour, Pelbreton C.; Ruiz, John M.; Talavera, Gregory A.; Allison, Matthew A.; Rodriguez, Carlos J.

    2015-01-01

    Cardiovascular diseases (CVD) are the leading cause of mortality in the United States and Western world for all groups with one exception: CVDs are the number 2 cause of death for Hispanics/Latinos behind cancer with overall cancer rates lower for Latinos relative to non-Hispanic Whites (NHWs). Despite a significantly worse risk factor profile marked by higher rates of traditional and non-traditional determinants, some CVD prevalence and mortality rates are significantly lower among Latinos relative NHWs. These findings support a need for greater understanding of CVDs specifically among Latinos in order to better document prevalence, appropriately model risk and resilience, and improve targeting of intervention efforts. The current aim is to provide a state-of-the-science review of CVDs amongst Latinos including a review of the epidemiological evidence, risk factor prevalence, and evaluation of the breadth and quality of the data. Questions concerning the generalizability of current risk models, the Hispanic paradox as it relates to CVDs, contributing psychosocial and sociocultural factors, and future directions are discussed. PMID:27429866

  17. Tremor frequency characteristics in Parkinson's disease under resting-state and stress-state conditions.

    PubMed

    Lee, Hong Ji; Lee, Woong Woo; Kim, Sang Kyong; Park, Hyeyoung; Jeon, Hyo Seon; Kim, Han Byul; Jeon, Beom S; Park, Kwang Suk

    2016-03-15

    Tremor characteristics-amplitude and frequency components-are primary quantitative clinical factors for diagnosis and monitoring of tremors. Few studies have investigated how different patient's conditions affect tremor frequency characteristics in Parkinson's disease (PD). Here, we analyzed tremor characteristics under resting-state and stress-state conditions. Tremor was recorded using an accelerometer on the finger, under resting-state and stress-state (calculation task) conditions, during rest tremor and postural tremor. The changes of peak power, peak frequency, mean frequency, and distribution of power spectral density (PSD) of tremor were evaluated across conditions. Patients whose tremors were considered more than "mild" were selected, for both rest (n=67) and postural (n=25) tremor. Stress resulted in both greater peak powers and higher peak frequencies for rest tremor (p<0.001), but not for postural tremor. Notably, peak frequencies were concentrated around 5 Hz under stress-state condition. The distributions of PSD of tremor were symmetrical, regardless of conditions. Tremor is more evident and typical tremor characteristics, namely a lower frequency as amplitude increases, are different in stressful condition. Patient's conditions directly affect neural oscillations related to tremor frequencies. Therefore, tremor characteristics in PD should be systematically standardized across patient's conditions such as attention and stress levels.

  18. Single cell genomics reveals activation signatures of endogenous SCAR's networks in aneuploid human embryos and clinically intractable malignant tumors.

    PubMed

    Glinsky, Gennadi V

    2016-10-10

    cancer deaths occurred in patients whose tumors harbor the SNMs' signatures. Linear regression analysis of the cancer intractability in the United States population demonstrated that organ-specific cancer death rates are directly correlated with the percentages of patients whose tumors harbor the SNMs' signatures. Present analyses suggest that awakening of SCARs-regulated stemness networks in differentiated cells is associated with development of diverse spectrum of genomic aberrations in multiple types of clinically lethal malignant tumors contributing to emergence of therapy-resistant cancer phenotypes. PMID:27497790

  19. Helicobacter pylori and Antibiotic Resistance, A Continuing and Intractable Problem.

    PubMed

    Hu, Yue; Zhang, Meng; Lu, Bin; Dai, Jinfeng

    2016-10-01

    Helicobacter pylori, a human pathogen with a high global prevalence, is the causative pathogen for multiple gastrointestinal diseases, especially chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, and gastric malignancies. Antibiotic therapies remain the mainstay for H. pylori eradication; however, this strategy is hampered by the emergence and spread of H. pylori antibiotic resistance. Exploring the mechanistic basis of this resistance is becoming one of the major research questions in contemporary biomedical research, as such knowledge could be exploited to devise novel rational avenues for counteracting the existing resistance and devising strategies to avoid the development of a novel anti-H. pylori medication. Encouragingly, important progress in this field has been made recently. Here, we attempt to review the current state and progress with respect to the molecular mechanism of antibiotic resistance for H. pylori. A picture is emerging in which mutations of various genes in H. pylori, resulting in decreased membrane permeability, altered oxidation-reduction potential, and a more efficient efflux pump system. The increased knowledge on these mechanisms produces hope that antibiotic resistance in H. pylori can ultimately be countered.

  20. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water — United States 2011-2012

    EPA Science Inventory

    Advances in water management and sanitation have reduced waterborne disease in the United States, although outbreaks continue to occur. Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and ...

  1. Botulinum Toxin A Injection into the Subscapularis Muscle to Treat Intractable Hemiplegic Shoulder Pain

    PubMed Central

    2016-01-01

    Objective To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain. Methods Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks. Results Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001). Conclusion Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain.

  2. Botulinum Toxin A Injection into the Subscapularis Muscle to Treat Intractable Hemiplegic Shoulder Pain

    PubMed Central

    2016-01-01

    Objective To evaluate the beneficial effect of botulinum toxin A (Botox) injection into the subscapularis muscle on intractable hemiplegic shoulder pain. Methods Six stroke patients with intractable hemiplegic shoulder pain were included. Botulinum toxin A was injected into the subscapularis muscle. Intractable hemiplegic shoulder pain was evaluated using an 11-point numerical rating scale. Pain-free range of motion was assessed for shoulder abduction and external rotation. The spasticity of the shoulder internal rotator was measured using the modified Ashworth scale. Assessments were carried out at baseline and at 1, 2, 4, and, if possible, 8 weeks. Results Intractable hemiplegic shoulder pain was improved (p=0.004) after botulinum toxin injection into the subscapularis muscle. Restricted shoulder abduction (p=0.003), external rotation (p=0.005), and spasticity of the shoulder internal rotator (p=0.005) were also improved. Improved hemiplegic shoulder pain was correlated with improved shoulder abduction (r=–1.0, p<0.001), external rotation (r=–1.0, p<0.001), and spasticity of the internal rotator (r=1.0, p<0.001). Conclusion Botulinum toxin A injection into the subscapularis muscle appears to be valuable in the management of intractable hemiplegic shoulder pain. PMID:27606265

  3. Nutrient intake of children with intractable epilepsy compared with healthy children.

    PubMed

    Volpe, Stella L; Schall, Joan I; Gallagher, Paul R; Stallings, Virginia A; Bergqvist, A G Christina

    2007-06-01

    Growth retardation is common among children with epilepsy, and poor dietary intake may be one of the causes. The goal of this cross-sectional study was to compare the nutrient intake of children 1 to 8 years of age with intractable epilepsy to healthy children of the same age from the National Health and Nutrition Examination Survey 2001 to 2002 (N=1,718) and with the Dietary Reference Intakes. Children with intractable epilepsy were divided into two age groups: 1.0 to 3.9 and 4.0 to 8.9 years, to correspond with the Dietary Reference Intakes. Forty-three children with intractable epilepsy, mean age=4.7+/-2.2 years, had significantly lower intakes (P<0.05) of total energy; protein; carbohydrate; fat; dietary fiber; vitamins A, E, B-6, and B-12; riboflavin; niacin; folate; calcium; phosphorus; magnesium; zinc; copper; and selenium compared with healthy children. Thirty percent or more of the children with intractable epilepsy in both age groups had intakes below the Recommended Dietary Allowance or Adequate Intake for vitamins D, E, and K; folate; calcium; linoleic acid; and alpha-linolenic acid. Health care professionals caring for children with intractable epilepsy should be aware of this pattern of decreased nutrient intake and educate families to provide an adequate diet and/or consider vitamin/mineral supplementation. PMID:17524723

  4. Testing practices and volume of non-Lyme tickborne diseases in the United States.

    PubMed

    Connally, Neeta P; Hinckley, Alison F; Feldman, Katherine A; Kemperman, Melissa; Neitzel, David; Wee, Siok-Bi; White, Jennifer L; Mead, Paul S; Meek, James I

    2016-02-01

    Large commercial laboratories in the United States were surveyed regarding the number of specimens tested for eight tickborne diseases in 2008. Seven large commercial laboratories reported testing a total of 2,927,881 specimens nationally (including Lyme disease). Of these, 495,585 specimens (17%) were tested for tickborne diseases other than Lyme disease. In addition to large commercial laboratories, another 1051 smaller commercial, hospital, and government laboratories in four states (CT, MD, MN, and NY) were surveyed regarding tickborne disease testing frequency, practices, and results. Ninety-two of these reported testing a total of 10,091 specimens for four tickborne diseases other than Lyme disease. We estimate the cost of laboratory diagnostic testing for non-Lyme disease tickborne diseases in 2008 to be $9.6 million. These data provide a baseline to evaluate trends in tickborne disease test utilization and insight into the burden of these diseases.

  5. Precipitation and the occurrence of lyme disease in the Northeastern United States

    USGS Publications Warehouse

    McCabe, G.J.; Bunnell, J.E.

    2004-01-01

    The occurrence of Lyme disease is a growing concern in the United States, and various studies have been performed to understand the factors related to Lyme disease occurrence. In the United States, Lyme disease has occurred most frequently in the northeastern United States. Positive correlations between the number of cases of Lyme disease reported in the northeastern United States during the 1992-2002 period indicate that late spring/early summer precipitation was a significant climate factor affecting the occurrence of Lyme disease. When late spring/early summer precipitation was greater than average, the occurrence of Lyme disease was above average, possibly due to increased tick activity and survival rate during wet conditions. Temperature did not seem to explain the variability in Lyme disease reports for the northeastern United States. ?? Mary Ann Liebert, Inc.

  6. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water United States, 2007-2008

    EPA Science Inventory

    Problem/Condition: Since 1971, the Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists have maintained a collaborative Waterborne Disease and Outbreak Surveillance System (WBDOS...

  7. Use of paced respiration to alleviate intractable hiccups (Singultus): a case report.

    PubMed

    Hurst, Duane F; Purdom, Catherine L; Hogan, Michael J

    2013-06-01

    Heart rate variability (HRV) biofeedback is an emerging treatment for many health conditions involving dysregulation of the autonomic nervous system including hypertension, gastric pain, anxiety, and depression. Hiccups are frequently considered an annoyance. However, when intractable (lasting over 1 month), they can become debilitating, with some patients resorting to invasive treatments that often involve the phrenic nerve. Theoretically, HRV biofeedback should also provide a means to stimulate the phrenic nerve and could be an alternative option. We report the successful treatment of a 5 year-long case of intractable hiccups with one session of HRV biofeedback training. These results suggest that biofeedback may be a useful, non-invasive means of relieving intractable hiccups. No clear causality can be inferred from a single case, and further study is needed to determine if this finding has wider applicability. PMID:23568280

  8. A sterile-female technique proposed for control of Striga hermonthica and other intractable weeds: Advantages, shortcomings, and risk management

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Weeds have posed intractable challenges to farmers since the dawn of agriculture. This article describes in detail a proposed control strategy based on the introduction of genes conferring female-sterility into the genomes of intractable target weeds. Spread of these genes through target populations...

  9. Disease prioritization: what is the state of the art?

    PubMed

    Brookes, V J; Del Rio Vilas, V J; Ward, M P

    2015-10-01

    Disease prioritization is motivated by the need to ensure that limited resources are targeted at the most important problems to achieve the greatest benefit in improving and maintaining human and animal health. Studies have prioritized a range of disease types, for example, zoonotic and foodborne diseases, using a range of criteria that describe potential disease impacts. This review describes the progression of disease prioritization methodology from ad hoc techniques to decision science methods (including multi-criteria decision analysis, conjoint analysis and probabilistic inversion), and describes how these methods aid defensible resource allocation. We discuss decision science in the context of disease prioritization to then review the development of disease prioritization studies. Structuring the prioritization and assessing decision-makers' preferences through value trade-offs between criteria within the decision context are identified as key factors that ensure transparency and reproducibility. Future directions for disease prioritization include the development of validation techniques, guidelines for model selection and neuroeconomics to gain a deeper understanding of decision-making. PMID:25876939

  10. Lyme Disease in Hispanics, United States, 2000-2013.

    PubMed

    Nelson, Christina A; Starr, J Andrew; Kugeler, Kiersten J; Mead, Paul S

    2016-03-01

    Hispanics comprise a growing portion of the US population and might have distinct risk factors for tickborne diseases. During 2000-2013, a total of 5,473 Lyme disease cases were reported among Hispanics through national surveillance. Hispanics were more likely than non-Hispanics to have signs of disseminated infection and onset during fall months.

  11. Lyme Disease in Hispanics, United States, 2000–2013

    PubMed Central

    Starr, J. Andrew; Kugeler, Kiersten J.; Mead, Paul S.

    2016-01-01

    Hispanics comprise a growing portion of the US population and might have distinct risk factors for tickborne diseases. During 2000–2013, a total of 5,473 Lyme disease cases were reported among Hispanics through national surveillance. Hispanics were more likely than non-Hispanics to have signs of disseminated infection and onset during fall months. PMID:26889721

  12. Phenytoin (Dilantin) and acupuncture therapy in the treatment of intractable oral and facial pain.

    PubMed

    Lu, Dominic P; Lu, Winston I; Lu, Gabriel P

    2011-01-01

    Phenytoin is an anti-convulsant and anti-arrhythmic medication. Manufactured by various pharmaceutical companies with various brand names, phenytoin (PHT) is also known as Dilantain, Hydantoin or Phenytek in the United States; Dilantain or Remytoine in Canada; Epamin, Hidantoina in Mexico; and Fenidatoin or Fenitron or other names elsewhere in the world. Phenytoin (PHT) is especially useful for patients suffering from intractable oral and facial pain especially those who exhibit anger, stress, depression and irrational emotions commonly seen in the patients with oral and facial pain. When used properly, Phenytoin is also an effective anxiolysis drug in addition to its theraputic effects on pain and can be used alone or, even better, if combined with other compatible sedatives. Phenytoin is particularly valuable when combined with acupuncture for patients with trigeminal neuralgia, glossopharyneal neuralgia, Bell's palsy, and some other facial paralysis and pain. It also has an advantage of keeping the patient relatively lucid after treatment. Either PHT or acupuncture alone can benefit patients but the success of treatment outcome may be limited. We found by combining both acupuncture and PHT with Selective Drug Uptake Enhancement by stimulating middle finger at the first segment of ventral (palmar) and lateral surfaces, as well as prescribing PHT with the dosage predetermined for each patient by Bi-Digital O-Ring Test (BDORT), the treatment outcome was much better resulted with less recurrence and intensity of pain during episodes of attack. Patients with Bell's palsy were most benefited by acupuncture therapy that could completely get rid of the illness. PMID:21830351

  13. Safety and role of ketogenic parenteral nutrition for intractable childhood epilepsy.

    PubMed

    Jung, Da Eun; Kang, Hoon-Chul; Lee, Joon Soo; Lee, Eun Joo; Kim, Heung Dong

    2012-09-01

    To retrospectively evaluate the safety and role of ketogenic parenteral nutrition in patients with intractable childhood epilepsy. The ketogenic parenteral nutrition was given to 10 patients who were unable to absorb nutrients through the intestinal tract because of various gastrointestinal disorders and required complete bowel rest. This nutrition consisted of conventional intravenous fat emulsion (20% Lipision) plus dextrose and amino acid (6% Trophamine) hyperalimentation in a 4:1 (or 3:1) lipid to non-lipid ratio, infused during the bowel rest. If the ketogenic parenteral nutrition allowed normal daily functioning or resolved the underlying problems, we soon changed it to the enteral ketogenic diet (KD). The mean (±SD) duration of the ketogenic parenteral nutrition was 4.1 (±1.5) days. Although a brief span of several days, all patients could maintain ketosis and the efficacy of the previous enteral KD during the ketogenic parenteral nutrition. Complications included elevated aspartate aminotransferase and/or alanine aminotransferase in one patient. Amylase and lipase increased in one patient. Serum triglyceride level increased to the level of 1885 mg/dl in one patient, but normalized in one week after discontinuation of the ketogenic parenteral nutrition and resuming of the enteral KD. Nine patients (90%) remained on the enteral KD after the ketogenic parenteral nutrition (the mean follow-up period was 9 months), including 2 patients who successfully completed the diet with seizure free state. Only one patient discontinued the ketogenic parenteral nutrition because of persistent increase of the amylase and lipase levels. The ketogenic parenteral nutrition proved to be a relatively safe short-term method of continuing KD to maintain ketosis for seizure control, while patients were unable to absorb nutrients through their intestinal tract.

  14. Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset.

    PubMed Central

    Brookmeyer, R; Gray, S; Kawas, C

    1998-01-01

    OBJECTIVES: The goal of this study was to project the future prevalence and incidence of Alzheimer's disease in the United States and the potential impact of interventions to delay disease onset. METHODS: The numbers of individuals in the United States with Alzheimer's disease and the numbers of newly diagnosed cases that can be expected over the next 50 years were estimated from a model that used age-specific incidence rates summarized from several epidemiological studies, US mortality rates, and US Bureau of the Census projections. RESULTS: in 1997, the prevalence of Alzheimer's disease in the United States was 2.32 million (range: 1.09 to 4.58 million); of these individuals, 68% were female. It is projected that the prevalence will nearly quadruple in the next 50 years, by which time approximately 1 in 45 Americans will be afflicted with the disease. Currently, the annual number of new incident cases in 360,000. If interventions could delay onset of the disease by 2 years, after 50 years there would be nearly 2 million fewer cases than projected; if onset could be delayed by 1 year, there would be nearly 800,000 fewer prevalent cases. CONCLUSIONS: As the US population ages, Alzheimer's disease will become an enormous public health problem. interventions that could delay disease onset even modestly would have a major public health impact. PMID:9736873

  15. Developing Agency through Peacebuilding in the Midst of Intractable Conflict: The Case of Israel and Palestine

    ERIC Educational Resources Information Center

    Plonski, Sharri

    2005-01-01

    This paper discusses the presence of "peacebuilding islands" within civil society as potential agents of transformation in the midst of intractable conflict. Focusing on the particular case of the Israeli-Palestinian conflict, the argument stems from a deconstruction of the legacy of national myopia perpetuated through social and political…

  16. Intractable Postpartum Hemorrhage Resulting from Uterine Artery Pseudoaneurysm: Superselective Arteriographic Embolization via the Collateral Route

    SciTech Connect

    Doenmez, Halil Oztuerk, M. Halil; Guergen, Fatma; Soylu, Serra O.; Hekimoglu, Baki

    2007-04-15

    We present a patient with intractable postpartum hemorrhage resulting from uterine artery pseudoaneurysm despite bilateral hypogastric artery ligation who was successfully treated by an endovascular approach via the collateral route. Although there is a good argument for postponing surgery until transcatheter embolization has been attempted, this case shows that embolization can still be successful even if the iliac vessels have been ligated.

  17. Disentangling causal paths between obesity and in vitro fertilization outcomes: an intractable problem?

    PubMed

    Howards, Penelope P; Cooney, Maureen A

    2008-06-01

    Research questions should be appropriate for the available data. Disentangling causal paths between obesity and in vitro fertilization outcomes may be an intractable problem, but other research questions of clinical importance can be addressed through appropriate study designs and analytic methods.

  18. Surgically intractable epilepsy associated with focal cortical dysplasia and congenital cutaneous hemangiomas.

    PubMed

    Brzezinski, Anna; Cruz, Vincent B; Prayson, Richard A

    2014-11-01

    We describe a 6-month-old girl with medically intractable seizures, multiple congenital hemangiomas, and developmental delay. The patient underwent two surgical resections. Pathological findings at both the first and second resections were consistent with focal cortical dysplasia. The literature was reviewed on focal cortical dysplasia associated with cutaneous hemangiomas.

  19. Growth Failure in Children with Intractable Epilepsy Is Not Due to Increased Resting Energy Expenditure

    ERIC Educational Resources Information Center

    Bergqvist, A. G. Christina; Trabulsi, Jillian; Schall, Joan I.; Stallings, Virginia A.

    2008-01-01

    The aim of this study was to evaluate the resting energy expenditure (REE) of children with intractable epilepsy (IE) compared with healthy children, and to determine factors that contribute to the pattern of REE. REE, growth status, and body composition were assessed in 25 prepubertal children with IE (15 males, 10 females; mean age 5y 5mo [SD 2y…

  20. Lessons to Be Learned From Research on Peace Education in the Context of Intractable Conflict

    ERIC Educational Resources Information Center

    Kupermintz, Haggai; Salomon, Gavriel

    2005-01-01

    Recent research on peace education entails important practical lessons about educational work in regions of intractable conflict. Peace education in this context must deal with collective narratives and deeply rooted historical memories and societal beliefs. Research findings from a series of studies with Israeli and Palestinian students and…

  1. Hansen's disease control in the State of São Paulo: a historical analysis.

    PubMed

    Opromolla, Paula Araujo; Laurenti, Ruy

    2011-02-01

    Leprosy is an infectious contagious disease known since Biblical times. Global effort for disease control reveals intricate convergences of national history and of medical, governmental, and international policies. The study describes the history of Hansen's disease and control actions undertaken in the state of São Paulo starting in the 19th century and its connection with the development of public health in that state, by means of a bibliographic and documental analysis.

  2. A State-Wide Research Network for Alzheimer's Disease

    SciTech Connect

    Mintzer, Jacobo E.; Bachman, D. L.; Stuckey, M.; Ebeling, M.; Wagner, M. T.; Evans, W. J.; Hirth, V.; Walker, A.; Joglekar, R.; Faison, W.

    2014-03-13

    The Specific Aim of the proposal was to develop an administrative structure that will facilitate the development of AD research across the state of SC by providing key services such as (but not limited to) seeking funding research opportunities, financial tracking, regulatory management, central recruitment, training for investigators and coordinators, data collection, data storing, and data processing to researchers across the state.

  3. Economic Burden of Disease-Associated Malnutrition at the State Level

    PubMed Central

    Goates, Scott; Du, Kristy; Braunschweig, Carol A.; Arensberg, Mary Beth

    2016-01-01

    Background Disease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition. Methods Direct medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states’ demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition. Principal Findings Direct medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level. Conclusions Additional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs. PMID:27655372

  4. What do we need to know about disease ecology to prevent Lyme disease in the northeastern United States?

    PubMed

    Eisen, Rebecca J; Piesman, Joseph; Zielinski-Gutierrez, Emily; Eisen, Lars

    2012-01-01

    Lyme disease is the most commonly reported vector-borne disease in the United States, with the majority of cases occurring in the Northeast. It has now been three decades since the etiological agent of the disease in North America, the spirochete Borrelia burgdorferi, and its primary North American vectors, the ticks Ixodes scapularis Say and I. pacificus Cooley & Kohls, were identified. Great strides have been made in our understanding of the ecology of the vectors and disease agent, and this knowledge has been used to design a wide range of prevention and control strategies. However, despite these advances, the number of Lyme disease cases have steadily increased. In this article, we assess potential reasons for the continued lack of success in prevention and control of Lyme disease in the northeastern United States, and identify conceptual areas where additional knowledge could be used to improve Lyme disease prevention and control strategies. Some of these areas include: 1) identifying critical host infestation rates required to maintain enzootic transmission of B. burgdorferi, 2) understanding how habitat diversity and forest fragmentation impacts acarological risk of exposure to B. burgdorferi and the ability of interventions to reduce risk, 3) quantifying the epidemiological outcomes of interventions focusing on ticks or vertebrate reservoirs, and 4) refining knowledge of how human behavior influences Lyme disease risk and identifying barriers to the adoption of personal protective measures and environmental tick management.

  5. [The state of vector-borne diseases in Indonesia].

    PubMed

    Rodhain, F

    2000-01-01

    From epidemiological point of view, Indonesia is an extremely interesting area owing its insular structure and ecological, anthropological, cultural and economical diversity. As everywhere, vector-borne diseases are the result of complex and variable epidemiological systems, subject both to biogeographical rules and human activity. Two main arboviroses are present in Indonesia: dengue and Japanese encephalitis. Dengue appears as an endemoepidemic disease and is mostly circumscribed to urban areas. Haemorrhagic cases were first observed in 1968; since then, the incidence has been constantly increasing and the disease is now one of the principal causes of child lethality. Japanese encephalitis is a rural endemic disease transmitted by rice-field mosquitoes; its incidence remains relatively low since pigs, which are usual link-hosts for the virus, are uncommon in this mainly Muslem country. Human clinical cases are recorded from non-Muslem islands such as Bali or Irian Jaya which raises the question of immunisation for travellers. Recently, Japanese encephalitis was observed on east of the Wallace line which had been considered as the eastern cut-off line. Malaria is common throughout the country, Plasmodium vivax being the most frequent species. Some of the Anopheline vectors are related to brackish water as are coastal species; others have been favoured by rice growing. Several species bite and rest outdoors, rendering control measures complex. Moreover, chloroquine resistance is increasing in both P. falciparum and P. vivax. All three filaria species responsible for human lymphatic filariasis exist in Indonesia. Bancroft filariasis is present in rather limited foci on most of the islands; malayan filariasis is very prevalent on many islands, mostly in coastal areas, and Timor filariasis exist only on a few small islands. These parasitic diseases are cumulative and do not practically endanger the health of travellers. In the past, plague was common on Java island

  6. Intractable desquamative interstitial pneumonia in a tattooed man.

    PubMed

    Arai, Toru; Inoue, Yoshikazu; Hayashi, Seiji; Akira, Masanori; Yamamoto, Satoru; Travis, William D; Sakatani, Mitsunori

    2006-01-01

    A 20-year-old man with a 15 pack-year history of cigarette smoking had a tattoo outlined on his back with blue pigment. He noticed a dry cough and shortness of breath on exertion when the pigment of other colors was added at the age of 27. He visited our hospital two years later because of severe dyspnea. He was diagnosed with desquamative interstitial pneumonia by surgical lung biopsy. Steroid therapy with cessation of smoking was partially effective, however his disease worsened again and he died three and a half years after the diagnosis because of respiratory failure. PMID:17043377

  7. Gene therapy for Parkinson's disease: state-of-the-art treatments for neurodegenerative disease.

    PubMed

    Douglas, Michael R

    2013-06-01

    Pharmacological and surgical treatments offer symptomatic benefits to patients with Parkinson's disease; however, as the condition progresses, patients experience gradual worsening in symptom control, with the development of a range of disabling complications. In addition, none of the currently available therapies have convincingly shown disease-modifying effects - either in slowing or reversing the disease. These problems have led to extensive research into the possible use of gene therapy as a treatment for Parkinson's disease. Several treatments have reached human clinical trial stages, providing important information on the risks and benefits of this novel therapeutic approach, and the tantalizing promise of improved control of this currently incurable neurodegenerative disorder.

  8. Electrodiagnostic evidence of subclinical disease states in drug abusers.

    PubMed

    DiBenedetto, M

    1976-02-01

    One hundred drug abusers, free of clinical signs or symptoms of disease, were examined by electrodiagnostic techniques. Sensory conduction of median, ulnar and sural nerves was evaluated in terms of latency, velocity and amplitude of evoked potential. Motor nerve latencies and conduction velocities of median, ulnar and personeal nerves were determined. Definite changes in the evoked sensory potentials of median and sural nerves of subjects using heroin or LSD were demonstrated. The sensory amplitude changes were suggestive of axonal degreneration because of normal duration. Maximum motor conduction velocity was abnormal in one patient who admitted using a variety of drugs; five heroin and two barbiturate users showed dispersed motor responses suggesting small fiber involvement. No abnormality could be shown in marjuana smokers. Signifcance of these findings is explained, emphasizing important potential for recognition of subclinical abnormalities and the opportunity for disease prevention.

  9. Transglutaminase 2 Inhibitors and their Therapeutic Role in Disease States

    PubMed Central

    Siegel, Matthew; Khosla, Chaitan

    2007-01-01

    Transglutaminase 2 (TG2) is a multi-domain, multi-functional enzyme that post-translationally modifies proteins by catalyzing the formation of intermolecular isopeptide bonds between glutamine and lysine side-chains. It plays a role in diverse biological functions, including extracellular matrix formation, integrin mediated signaling, and signal transduction involving 7-transmembrane receptors. While some of the roles of TG2 under normal physiological conditions remain obscure, the protein is believed to participate in the pathogenesis of several unrelated diseases including celiac sprue, neurodegenerative diseases, and certain types of cancer. A variety of small molecule and peptidomimetic inhibitors of the TG2 active site have been identified. Here we summarize the biochemistry, biology, pharmacology and medicinal chemistry of human TG2. PMID:17582505

  10. Transcending intractable conflict in health care: an exploratory study of communication and conflict management among anesthesia providers.

    PubMed

    Jameson, Jessica Katz

    2003-01-01

    This paper explores the contrast between the longstanding, intractable conflict between two anesthesia providers and the cooperation of many individual nurse anesthetists and anesthesiologists working side-by-side to provide safe, effective anesthesia. Analysis of interview transcripts reveals that communication among anesthesia nurses and anesthesiologists may enact or transcend the conflict. This article proposes recommendations for improving communication between anesthesiologists and certified registered nurse anesthetists in particular and de-escalating intractable conflict in general. It also contributes to communication theory in intractable conflict by examining how individual, interpersonal conflict management interactions lead to either transcendence or enactment of the larger group conflict.

  11. Association of serum trace elements and minerals with genetic generalized epilepsy and idiopathic intractable epilepsy.

    PubMed

    Prasad, D K V; Shaheen, Uzma; Satyanarayana, U; Surya Prabha, T; Jyothy, A; Munshi, Anjana

    2014-12-01

    Certain minerals and trace elements are essential for the development of healthy nervous system. Altered serum levels of these elements may lead to the development of various diseases including epilepsy. The present study was designed to evaluate the association of serum calcium, magnesium, zinc and copper in the development of genetic generalized epilepsy [GGE; erstwhile known as idiopathic generalized epilepsy (IGE)] as well as idiopathic intractable epilepsy (IIE), in which seizures persist despite treatment with at least two or three antiepileptic drugs tolerated at reasonable dosage. 200 GGE patients and equal number of healthy controls were recruited for study with their written informed consent. The patients were further divided into responders and non-responders based on their response to antiepileptic drugs. Copper and zinc levels were assayed by atomic absorption spectrophotometer whereas calcium and magnesium were analyzed by Human Star 600 fully automated biochemistry analyzer. The patients with GGE had significant low levels of calcium, magnesium and zinc (1.85 ± 0.33, 0.69 ± 0.13 mmol/L and 11.33 ± 3.32 µmol/L respectively) and the corresponding values for controls were 2.27 ± 0.22, 0.89 ± 0.15, 12.71 ± 3.24 (p < 0.05). Significant high levels of copper were found in patients as compared to controls (26.69 ± 8.79 µmol/L; 16.64 ± 3.64) (p < 0.05). Significantly decreased levels of zinc were noted in non-responders (10.38 ± 2.99) compared to responders (12.62 ± 3.30) (p < 0.05). No significant difference was observed in serum calcium, magnesium and copper levels between responders and non-responders. In conclusion, low levels of calcium, magnesium, zinc and high levels of copper were found to be associated with GGE. Further, the patients with IIE were also found to have low levels of zinc.

  12. Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes.

    PubMed

    Mouyis, Kyriacos; Okonko, Darlington; Missouris, Constantinos G

    2016-01-01

    An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered. PMID:27313906

  13. Nanoimaging in cardiovascular diseases: Current state of the art

    PubMed Central

    Deb, Suryyani; Ghosh, Kanjaksha; Shetty, Shrimati Dharmapal

    2015-01-01

    Nanotechnology has been integrated into healthcare system in terms of diagnosis as well as therapy. The massive impact of imaging nanotechnology has a deeper intervention in cardiology i.e. as contrast agents, to target vulnerable plaques with site specificity and in a theranostic approach to treat these plaques, stem cell delivery in necrotic myocardium, etc. Thus cardiovascular nanoimaging is not limited to simple diagnosis but also can help real time tracking during therapy as well as surgery. The present review provides a comprehensive description of the molecular imaging techniques for cardiovascular diseases with the help of nanotechnology and the potential clinical implications of nanotechnology for future applications. PMID:25963489

  14. Quality of life and seizure outcome after vagus nerve stimulation in children with intractable epilepsy.

    PubMed

    Sherman, Elisabeth M S; Connolly, Mary B; Slick, Daniel J; Eyrl, Kim L; Steinbok, Paul; Farrell, Kevin

    2008-09-01

    This study examined the effect of vagus nerve stimulation on quality of life in children with epilepsy using a validated quality-of-life scale and an empirical technique that accounts for measurement error in assessing individual change (the reliable change index). Participants were 34 children with severe intractable epilepsy who underwent vagus nerve stimulation and 19 children with intractable epilepsy who received medical management. Parent-completed epilepsy-specific and global ratings at baseline and after 1 year indicated that most children had no changes in quality of life following vagus nerve stimulation (52%-77%), similar to the comparison group. There was a trend for decreases to be less common in the vagus nerve stimulation group (14% vs 37%, P < .07), but there was no relation between improved quality of life and seizure control. The results raise questions about the mechanisms that underlie changes in quality of life after vagus nerve stimulation in this group of children. PMID:18474931

  15. Mirror movements following cortical resection of polymicrogyria in a child with intractable epilepsy.

    PubMed

    RamachandranNair, Rajesh; Otsubo, Hiroshi; Ochi, Ayako; Rutka, James; Donner, Elizabeth J

    2006-02-01

    Mirror movements may be congenital or acquired. There are few reports of acquired mirror movements in pediatric patients. Further, mirror movements in children with epilepsy have rarely been reported. A 9-year old male, with intractable partial epilepsy resulting from polymicrogyria of the right hemisphere, underwent cortical resection of the right frontotemporoparietal region for a malformation of cortical development. He developed left hemiplegia and mirror movements in the left hand in the postoperative period. Four months after surgery, he remained seizure-free with mild residual left-sided hemiplegia and persistent mirror movements. Mechanisms postulated for mirror movements include aberrant pyramidal tract development and transcallosal inhibitory pathways. The latter mechanism might have contributed to the mirror movements observed in this child. This study is the first report of mirror movements following focal cortical resection for intractable epilepsy due to polymicrogyria. PMID:16458827

  16. Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

    PubMed Central

    Kang, Keum Nae; Park, In Kyung; Suh, Jeong Hun; Leem, Jeong Gill

    2010-01-01

    Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared. PMID:20830266

  17. SURVEILLANCE FOR WATERBORNE DISEASE AND OUTBREAK ASSOCIATED WITH RECREATIONAL WATER - UNITED STATES 2003-2004

    EPA Science Inventory

    Problem/Condition: Since 1971, the Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have maintained a collaborative surveillance system for collecting and periodically reporting da...

  18. Melanocortin signaling and anorexia in chronic disease states.

    PubMed

    Wisse, Brent E; Schwartz, Michael W; Cummings, David E

    2003-06-01

    Data from both rodent models and humans suggest that intact neuronal melanocortin signaling is essential to prevent obesity, as mutations that decrease the melanocortin signal within the brain induce hyperphagia and excess body fat accumulation. Melanocortins are also involved in the pathogenesis of disorders at the opposite end of the spectrum of energy homeostasis, the anorexia and weight loss associated with inflammatory and neoplastic disease processes. Studies using melanocortin antagonists (SHU9119 or agouti-related peptide) or genetic approaches (melanocortin-4 receptor null mice) suggest that intact melanocortin tone is required for anorexia and weight loss induced by injected lipopolysaccharide (an inflammatory gram-negative bacterial cell wall product) or by implantation of prostate or lung cancer cells. Although the precise mechanism whereby peripheral inflammatory/neoplastic factors activate the melanocortin system remains unknown, the proinflammatory cytokines (interleukin-1, interleukin-6, and tumor necrosis factor-alpha) that are produced in the hypothalamus of rodents during both inflammatory and neoplastic disease processes likely play a role. The data presented in this paper summarize findings that implicate neuronal melanocortin signaling in inflammatory anorexia.

  19. Challenges in designing a national surveillance program for inflammatory bowel disease in the United States.

    PubMed

    Long, Millie D; Hutfless, Susan; Kappelman, Michael D; Khalili, Hamed; Kaplan, Gilaad G; Bernstein, Charles N; Colombel, Jean Frederic; Gower-Rousseau, Corinne; Herrinton, Lisa; Velayos, Fernando; Loftus, Edward V; Nguyen, Geoffrey C; Ananthakrishnan, Ashwin N; Sonnenberg, Amnon; Chan, Andrew; Sandler, Robert S; Atreja, Ashish; Shah, Samir A; Rothman, Kenneth J; Leleiko, Neal S; Bright, Renee; Boffetta, Paolo; Myers, Kelly D; Sands, Bruce E

    2014-02-01

    This review describes the history of U.S. government funding for surveillance programs in inflammatory bowel diseases (IBD), provides current estimates of the incidence and prevalence of IBD in the United States, and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, to provide a greater understanding of the burden of IBD, disease etiology, and pathogenesis, is provided. Lessons learned from other countries are summarized, in addition to potential resources that may be used to optimize a new form of IBD surveillance in the United States. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus on "surveillance of the burden of disease," including (1) natural history of disease and (2) outcomes and complications of the disease and/or treatments.

  20. Local anaesthetic thoracoscopy for intractable pneumothorax in a high-risk patient.

    PubMed

    Yutaka, Yojiro; Katakura, Hiromichi; Kaneda, Shohei; Yamanaka, Akira

    2012-08-01

    The management of high-operative-risk patients with a pneumothorax is complicated. The case of a 79-year old man with an intractable secondary pneumothorax, who had taken oral steroids to control asthma, is presented. Since the patient could not tolerate general anaesthesia because of poor cardiac function, thoracoscopic surgery was performed under local anaesthesia. A successful lung fistula closure was achieved and the continuous air leakage disappeared immediately after the surgery. PMID:22527089

  1. Internal iliac artery embolisation for intractable bladder haemorrhage in the peri-operative phase

    PubMed Central

    Gujral, S.; Bell, R.; Kabala, J.; Persad, R.

    1999-01-01

    Intractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries in situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.


Keywords: embolisation; internal iliac artery; transurethral resection of bladder tumour PMID:10448498

  2. Internal iliac artery embolisation for intractable bladder haemorrhage in the peri-operative phase.

    PubMed

    Gujral, S; Bell, R; Kabala, J; Persad, R

    1999-03-01

    Intractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries is situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.

  3. Percutaneous Cyanoacrylate Glue Injection into the Renal Pseudoaneurysm to Control Intractable Hematuria After Percutaneous Nephrolithotomy

    SciTech Connect

    Lal, Anupam Kumar, Ajay; Prakash, Mahesh; Singhal, Manphool; Agarwal, Mayank Mohan; Sarkar, Debansu; Khandelwal, Niranjan

    2009-07-15

    We report a case of a 43-year-old man who developed intractable hematuria after percutaneous nephrolithotomy. Angiography detected a pseudoaneurysm arising from the lower polar artery; however, embolization could not be performed because of unfavorable vascular anatomy. A percutaneous thrombin injection under ultrasound guidance initially controlled the bleeding, but hematuria subsequently recurred as a result of recanalization of the aneurysm. The case was successfully managed with ultrasound- and fluoroscopic-guided direct injection of cyanoacrylate glue into the pseudoaneurysm.

  4. Nebulized lidocaine in the treatment of intractable cough.

    PubMed

    Truesdale, Kelly; Jurdi, Adham

    2013-09-01

    Cough is one of the most common symptoms prompting patients to be seen by health care providers in the United States. Persistent cough can disrupt daily activities such as conversation, eating, breathing, and sleeping, and it can become extremely debilitating both physically and mentally. Pharmacological treatments include dextramethorphan, opioid cough suppressants, benzonatate, inhaled ipratropium, and guaifenesin. Successful cough suppression has also been demonstrated in several studies with the use of nebulized lidocaine. Nebulized lidocaine also appears to be well tolerated by patients with minimal side effects including dysphonia, oropharyngeal numbness, and bitter taste. Studies conducted thus far have been small, so larger randomized control trials comparing nebulized lidocaine to placebo need to be conducted in the future. PMID:22964341

  5. Research Progress on the Role of ABC Transporters in the Drug Resistance Mechanism of Intractable Epilepsy

    PubMed Central

    Xiong, Jie; Mao, Ding-an; Liu, Li-qun

    2015-01-01

    The pathogenesis of intractable epilepsy is not fully clear. In recent years, both animal and clinical trials have shown that the expression of ATP-binding cassette (ABC) transporters is increased in patients with intractable epilepsy; additionally, epileptic seizures can lead to an increase in the number of sites that express ABC transporters. These findings suggest that ABC transporters play an important role in the drug resistance mechanism of epilepsy. ABC transporters can perform the funcions of a drug efflux pump, which can reduce the effective drug concentration at epilepsy lesions by reducing the permeability of the blood brain barrier to antiepileptic drugs, thus causing resistance to antiepileptic drugs. Given the important role of ABC transporters in refractory epilepsy drug resistance, antiepileptic drugs that are not substrates of ABC transporters were used to obtain ABC transporter inhibitors with strong specificity, high safety, and few side effects, making them suitable for long-term use; therefore, these drugs can be used for future clinical treatment of intractable epilepsy. PMID:26491660

  6. Drosophila as a Model for Intractable Epilepsy: Gilgamesh Suppresses Seizures in parabss1 Heterozygote Flies

    PubMed Central

    Howlett, Iris C.; Rusan, Zeid M.; Parker, Louise; Tanouye, Mark A.

    2013-01-01

    Intractable epilepsies, that is, seizure disorders that do not respond to currently available therapies, are difficult, often tragic, neurological disorders. Na+ channelopathies have been implicated in some intractable epilepsies, including Dravet syndrome (Dravet 1978), but little progress has been forthcoming in therapeutics. Here we examine a Drosophila model for intractable epilepsy, the Na+ channel gain-of-function mutant parabss1 that resembles Dravet syndrome in some aspects (parker et al. 2011a). In particular, we identify second-site mutations that interact with parabss1, seizure enhancers, and seizure suppressors. We describe one seizure-enhancer mutation named charlatan (chn). The chn gene normally encodes an Neuron-Restrictive Silencer Factor/RE1-Silencing Transcription factor transcriptional repressor of neuronal-specific genes. We identify a second-site seizure-suppressor mutation, gilgamesh (gish), that reduces the severity of several seizure-like phenotypes of parabss1/+ heterozygotes. The gish gene normally encodes the Drosophila ortholog of casein kinase CK1g3, a member of the CK1 family of serine-threonine kinases. We suggest that CK1g3 is an unexpected but promising new target for seizure therapeutics. PMID:23797108

  7. Spinal epidural neurostimulation for treatment of acute and chronic intractable pain: initial and long term results.

    PubMed

    Richardson, R R; Siqueira, E B; Cerullo, L J

    1979-09-01

    Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Hashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post-traumatic and postamputation neuroma. Long term follow-up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

  8. Nonalcoholic fatty liver disease and vascular disease: state-of-the-art.

    PubMed

    Fargion, Silvia; Porzio, Marianna; Fracanzani, Anna Ludovica

    2014-10-01

    Nonalcoholic fatty liver disease (NAFLD), the most common of chronic liver disease in Western Country, is closely related to insulin resistance and oxidative stress and includes a wide spectrum of liver diseases ranging from steatosis alone, usually a benign and non-progressive condition, to nonalcoholic steatohepatitis (NASH), which may progress to liver fibrosis and cirrhosis. NAFLD is considered the hepatic manifestation of the metabolic syndrome with which shares several characteristics, however recent data suggest that NAFLD is linked to increased cardiovascular risk independently of the broad spectrum of risk factors of metabolic syndrome. Accumulating evidence suggests that the clinical burden of NAFLD is not restricted to liver-related morbidity and mortality, with the majority of deaths in NAFLD patients related to cardiovascular disease and cancer and not to the progression of liver disease. Retrospective and prospective studies provide evidence of a strong association between NAFLD and subclinical manifestation of atherosclerosis (increased intima-media thickness, endothelial dysfunction, arterial stiffness, impaired left ventricular function and coronary calcification). A general agreement emerging from these studies indicates that patients with NASH are at higher risk of cardiovascular diseases than those with simple steatosis, emphasizing the role of chronic inflammation in the pathogenesis of atherosclerosis of these patients. It is very likely that the different mechanisms involved in the pathogenesis of atherosclerosis in patients with NAFLD have a different relevance in the patients according to individual genetic background. In conclusion, in the presence of NAFLD patients should undergo a complete cardiovascular evaluation to prevent future atherosclerotic complications. Specific life-style modification and aggressive pharmaceutical modification will not only reduce the progression of liver disease, but also reduce morbidity for cardiovascular

  9. Cancer tolerance, resistance, pathogenicity and virulence: deconstructing the disease state.

    PubMed

    van Niekerk, Gustav; Loos, Benjamin; Nell, Theo; Engelbrecht, Anna-Mart

    2016-06-01

    Immunologists have recently taken note of the fact that a host not only resists infection, but also exhibits a capacity to manage the pathology associated with such infection - a concept referred to as tolerance. Here we explore how the tolerance/resistance (T/R) framework can be implemented within an oncological context and explore a number of implications. In particular, the T/R framework distinguishes between pathology manifesting from extensive tumor burden, versus cancers intrinsically expressing a more pathogenic phenotype. Consequently, the T/R framework provides novel methodology in studying the nature of cancer pathology and for marker identification. Additionally, this framework may aid in redefining the therapeutic end point under suitable circumstances: establishing cancer as a chronic, manageable disease. PMID:27029525

  10. Kissing Bugs in the United States: Risk for Vector-Borne Disease in Humans

    PubMed Central

    Klotz, Stephen A; Dorn, Patricia L; Mosbacher, Mark; Schmidt, Justin O

    2014-01-01

    Eleven species of kissing bugs are found in the United States. Their home ranges may be expanding northward, perhaps as a consequence of climate change. At least eight of the species, perhaps all, are reported to harbor Trypanosoma cruzi, the parasite that causes Chagas disease. Because humans are encroaching on kissing bug habitat, there is concern for vector-transmitted Chagas disease in the United States. To date, documented autochthonous cases of Chagas in humans in the United States are rare. Kissing bugs are capable of adapting to new habitats such as human domiciles; however, they do not colonize homes in the United States as in Central and South America. We review the biology, behavior, and medical importance of kissing bugs and the risk they pose for transmission of Chagas disease in the United States. Where possible, descriptions of US species are compared to the epidemiologically important Latin American species. PMID:25574143

  11. Effects of landscape fragmentation and climate on Lyme disease incidence in the northeastern United States.

    PubMed

    Tran, Phoebe Minh; Waller, Lance

    2013-12-01

    Lyme disease is the most frequently reported vector borne illness in the United States, and incidences are increasing steadily year after year. This study explores the influence of landscape (e.g., land use pattern and landscape fragmentation) and climatic factors (e.g., temperature and precipitation) at a regional scale on Lyme disease incidence. The study area includes thirteen states in the Northeastern United States. Lyme disease incidence at county level for the period of 2002-2006 was linked with several key landscape and climatic variables in a negative binomial regression model. Results show that Lyme disease incidence has a relatively clear connection with regional landscape fragmentation and temperature. For example, more fragmentation between forests and residential areas results in higher local Lyme disease incidence. This study also indicates that, for the same landscape, some landscape variables derived at a particular scale show a clearer connection to Lyme disease than do others. In general, the study sheds more light on connections between Lyme disease incidence and climate and landscape patterns at the regional scale. Integrating findings of this regional study with studies at a local scale will further refine understanding of the pattern of Lyme disease as well as increase our ability to predict, prevent, and respond to disease.

  12. Trends in mortality from skin diseases in the United States: skin infectious diseases are claiming more lives.

    PubMed

    Fleischer, Alan B

    2016-01-01

    BackgroundAlthough there has been some excellent work published on the mortality from non-neoplastic skin disease In the United States, further analysis of trends is limited.MethodsData from the Centers for Disease Control and Prevention (CDC) for mortality abstracted from Death Certificates was obtained from the WONDER (wide-ranging online data for epidemiologic research) system from 1999 to 2014. Categorical variables were analyzed with Excel 2013 data analysis software using Chi-squared tests whereas regression was performed for trends.ResultsCrude death rates were highest in the South, especially in Mississippi and Louisiana. This work also confirmed that Blacks or African Americans had higher risk of death from skin disease, whereas Hispanic or Latinos had lower risk. Overall mortality from non-neoplastic diseases is increasing over time and significant increases in mortality from infectious and papulosquamous diseases were observed, whereas there appears to be decreasing mortality from dermatitis and miscellaneous skin disorders (ICD-10-CM L80-90).ConclusionsMortality is increasing from non-neoplastic diseases, especially infectious and papulosquamous diseases. Demographic factors such age race and Hispanic or Latino ethnicity also confer differential risk. PMID:27617717

  13. Climate change influences on the annual onset of Lyme disease in the United States

    PubMed Central

    Monaghan, Andrew J.; Moore, Sean M.; Sampson, Kevin M.; Beard, Charles B.; Eisen, Rebecca J.

    2015-01-01

    Lyme disease is the most commonly reported vector-borne illness in the United States. Lyme disease occurrence is highly seasonal and the annual springtime onset of cases is modulated by meteorological conditions in preceding months. A meteorological-based empirical model for Lyme disease onset week in the United States is driven with downscaled simulations from five global climate models and four greenhouse gas emissions scenarios to project the impacts of 21st century climate change on the annual onset week of Lyme disease. Projections are made individually and collectively for the 12 eastern States where >90% of cases occur. The national average annual onset week of Lyme disease is projected to become 0.4–0.5 weeks earlier for 2025–2040 (p < 0.05), and 0.7–1.9 weeks earlier for 2065–2080 (p < 0.01), with the largest shifts for scenarios with the highest greenhouse gas emissions. The more southerly mid-Atlantic States exhibit larger shifts (1.0–3.5 weeks) compared to the Northeastern and upper Midwestern States (0.2–2.3 weeks) by 2065–2080. Winter and spring temperature increases primarily cause the earlier onset. Greater spring precipitation and changes in humidity partially counteract the temperature effects. The model does not account for the possibility that abrupt shifts in the life cycle of Ixodes scapularis, the primary vector of the Lyme disease spirochete Borrelia burgdorferi in the eastern United States, may alter the disease transmission cycle in unforeseen ways. The results suggest 21st century climate change will make environmental conditions suitable for earlier annual onset of Lyme disease cases in the United States with possible implications for the timing of public health interventions. PMID:26025268

  14. Climate change influences on the annual onset of Lyme disease in the United States.

    PubMed

    Monaghan, Andrew J; Moore, Sean M; Sampson, Kevin M; Beard, Charles B; Eisen, Rebecca J

    2015-07-01

    Lyme disease is the most commonly reported vector-borne illness in the United States. Lyme disease occurrence is highly seasonal and the annual springtime onset of cases is modulated by meteorological conditions in preceding months. A meteorological-based empirical model for Lyme disease onset week in the United States is driven with downscaled simulations from five global climate models and four greenhouse gas emissions scenarios to project the impacts of 21st century climate change on the annual onset week of Lyme disease. Projections are made individually and collectively for the 12 eastern States where >90% of cases occur. The national average annual onset week of Lyme disease is projected to become 0.4-0.5 weeks earlier for 2025-2040 (p<0.05), and 0.7-1.9 weeks earlier for 2065-2080 (p<0.01), with the largest shifts for scenarios with the highest greenhouse gas emissions. The more southerly mid-Atlantic States exhibit larger shifts (1.0-3.5 weeks) compared to the Northeastern and upper Midwestern States (0.2-2.3 weeks) by 2065-2080. Winter and spring temperature increases primarily cause the earlier onset. Greater spring precipitation and changes in humidity partially counteract the temperature effects. The model does not account for the possibility that abrupt shifts in the life cycle of Ixodes scapularis, the primary vector of the Lyme disease spirochete Borrelia burgdorferi in the eastern United States, may alter the disease transmission cycle in unforeseen ways. The results suggest 21st century climate change will make environmental conditions suitable for earlier annual onset of Lyme disease cases in the United States with possible implications for the timing of public health interventions.

  15. Climate change influences on the annual onset of Lyme disease in the United States

    NASA Astrophysics Data System (ADS)

    Monaghan, A. J.; Moore, S. M.; Sampson, K. M.; Beard, C. B.; Eisen, R. J.

    2015-12-01

    Lyme disease is the most commonly reported vector-borne illness in the United States. Lyme disease occurrence is highly seasonal and the annual springtime onset of cases is modulated by meteorological conditions in preceding months. A meteorological-based empirical model for Lyme disease onset week in the United States is driven with downscaled simulations from five global climate models and four greenhouse gas emissions scenarios to project the impacts of 21st century climate change on the annual onset week of Lyme disease. Projections are made individually and collectively for the 12 eastern States where >90% of cases occur. The national average annual onset week of Lyme disease is projected to become 0.4-0.5 weeks earlier for 2025-2040 (p<0.05), and 0.7-1.9 weeks earlier for 2065-2080 (p<0.01), with the largest shifts for scenarios with the highest greenhouse gas emissions. The more southerly mid-Atlantic States exhibit larger shifts (1.0-3.5 weeks) compared to the Northeastern and upper Midwestern States (0.2-2.3 weeks) by 2065-2080. Winter and spring temperature increases primarily cause the earlier onset. Greater spring precipitation and changes in humidity partially counteract the temperature effects. The model does not account for the possibility that abrupt shifts in the life cycle of Ixodes scapularis, the primary vector of the Lyme disease spirochete Borrelia burgdorferi in the eastern United States, may alter the disease transmission cycle in unforeseen ways. The results suggest 21st century climate change will make environmental conditions suitable for earlier annual onset of Lyme disease cases in the United States with possible implications for the timing of public health interventions.

  16. Putting chronic disease on the map: building GIS capacity in state and local health departments.

    PubMed

    Miranda, Marie Lynn; Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-06-20

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants' experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments.

  17. Psychological states and neuropsychological performances in chronic Lyme disease.

    PubMed

    Elkins, L E; Pollina, D A; Scheffer, S R; Krupp, L B

    1999-01-01

    The neuropsychiatric sequelae of chronic Lyme disease remains unclear. This study sought to characterize the psychological status of a group of participants who met criteria for post-Lyme syndrome (PLS). These measures were then used to examine the influence of psychological status on neuropsychological performances. Thirty PLS participants completed a structured psychiatric interview, the Positive and Negative Affect Schedule, the Lyme Symptom Checklist, and a battery of neuropsychological tests. As a group, the PLS participants did not appear to have an elevated incidence of psychiatric disorders, and psychiatric history was not useful for understanding neuropsychological performances or symptom reports. The mood of the PLS participants was characterized by lowered levels of positive affect (PA) and typical levels of negative affect. This combination can be distinguished from depression and is consistent with previous findings of affect patterns in individuals with chronic fatigue syndrome. PA was also linked to both total symptom severity and severity of cognitive complaints, but not to duration of illness, neurological manifestations at initial diagnosis, or treatment history. Relative to published normative data, neuropsychological performances were not in the impaired range on any measure. Neither psychological status nor symptom report were useful for understanding any aspect of cognitive functioning. It is concluded that decreased PA is the most useful marker of psychological functioning in PLS.

  18. [State of the art in invasive diseases by filamentous fungi].

    PubMed

    Pemán, Javier; Quindós, Guillermo

    2014-01-01

    Invasive fungal infections have become a major cause of morbimortality in intensive care patients, persons suffering from cancer or immune deficiencies, and other diseases with impaired immunity. Candida albicans remains the most frequent fungal pathogen, but advances in the diagnosis, prevention and treatment of invasive candidiasis are leading to important etiological changes. Among the emerging invasive mycoses, are those caused by filamentous fungi, such as Aspergillus, Lomentospora/Scedosporium, Fusarium or the Mucorales. Invasive aspergillosis is difficult to diagnose, and although there are diagnostic tools available, their use is not widespread, and their effectiveness vary depending on the group of patients. Clinical suspicion in high-risk patients, radiological diagnosis and the use of biomarkers, such as 1,3-β-D-glucan and galactomannan, can be of great help. However, diagnostic resources are limited in other mycoses, but radiology, pathological studies and the microbiological diagnosis can be useful. The high mortality of these mycoses requires early empirical antifungal treatment in many cases. Voriconazole is the first choice for treatment of the majority of aspergillosis, scedosporiasis, fusariosis and other hyalohyphomycoses. The treatment of mucormycoses, Lomentospora prolificans infections or mycoses by dematiaceous fungi are more complicated. Amphotericin B is active against many mucoralean fungi, but the combination of two or more antifungal agents could be a therapeutic alternative in many amphotericin B-refractory mycoses. Current clinical challenges include improving the diagnosis and the treatment of these mycoses, along with improving the adequate prevention in patients at high risk of suffering from them.

  19. Alzheimer's Disease and Related Disorders in State Mental Hospitals: Data from a Nationwide Survey.

    ERIC Educational Resources Information Center

    Moak, Gary S.; Fisher, William H.

    1990-01-01

    Reports data from nationwide survey of state mental hospitals, providing exploratory look at patients with Alzheimer's disease and related disorders currently residing in state hospitals. Describes admissions trends, reasons for admission, and sources of referral. Discusses civil commitment of nursing home patients with dementing illnesses and…

  20. A Chronic Disease State Simulation in an Ambulatory Care Elective Course

    PubMed Central

    Roberson, Cindy Leslie A.; Prasad-Reddy, Lalita

    2015-01-01

    Objective. To implement a chronic disease state simulation in an ambulatory care elective course and to assess the simulation’s impact on students’ perceptions of their empathy toward patients and of their counseling skills. Design. The chronic disease state simulation occurred over 2 weeks. Students alternated playing the role of patient and pharmacist. As patients, students adhered to medication regimens, lifestyle modifications, and blood glucose or blood pressure monitoring. As pharmacists, students conducted patient interviews, and provided education and counseling. Empathy and counseling skills were assessed through course surveys, written reflections, and SOAP notes. Assessment. Results from a cohort of 130 students indicated the simulation enhanced students’ perceptions of their abilities to empathize with and counsel patients with chronic diseases. Conclusion. The chronic disease state simulation provides a novel approach to develop skills needed for working with complex patient cases in ambulatory care settings. PMID:26839423

  1. The thalamostriatal system in normal and diseased states

    PubMed Central

    Smith, Yoland; Galvan, Adriana; Ellender, Tommas J.; Doig, Natalie; Villalba, Rosa M.; Huerta-Ocampo, Icnelia; Wichmann, Thomas; Bolam, J. Paul

    2014-01-01

    Because of our limited knowledge of the functional role of the thalamostriatal system, this massive network is often ignored in models of the pathophysiology of brain disorders of basal ganglia origin, such as Parkinson’s disease (PD). However, over the past decade, significant advances have led to a deeper understanding of the anatomical, electrophysiological, behavioral and pathological aspects of the thalamostriatal system. The cloning of the vesicular glutamate transporters 1 and 2 (vGluT1 and vGluT2) has provided powerful tools to differentiate thalamostriatal from corticostriatal glutamatergic terminals, allowing us to carry out comparative studies of the synaptology and plasticity of these two systems in normal and pathological conditions. Findings from these studies have led to the recognition of two thalamostriatal systems, based on their differential origin from the caudal intralaminar nuclear group, the center median/parafascicular (CM/Pf) complex, or other thalamic nuclei. The recent use of optogenetic methods supports this model of the organization of the thalamostriatal systems, showing differences in functionality and glutamate receptor localization at thalamostriatal synapses from Pf and other thalamic nuclei. At the functional level, evidence largely gathered from thalamic recordings in awake monkeys strongly suggests that the thalamostriatal system from the CM/Pf is involved in regulating alertness and switching behaviors. Importantly, there is evidence that the caudal intralaminar nuclei and their axonal projections to the striatum partly degenerate in PD and that CM/Pf deep brain stimulation (DBS) may be therapeutically useful in several movement disorders. PMID:24523677

  2. Arginine de novo and nitric oxide production in disease states.

    PubMed

    Luiking, Yvette C; Ten Have, Gabriella A M; Wolfe, Robert R; Deutz, Nicolaas E P

    2012-11-15

    Arginine is derived from dietary protein intake, body protein breakdown, or endogenous de novo arginine production. The latter may be linked to the availability of citrulline, which is the immediate precursor of arginine and limiting factor for de novo arginine production. Arginine metabolism is highly compartmentalized due to the expression of the enzymes involved in arginine metabolism in various organs. A small fraction of arginine enters the NO synthase (NOS) pathway. Tetrahydrobiopterin (BH4) is an essential and rate-limiting cofactor for the production of NO. Depletion of BH4 in oxidative-stressed endothelial cells can result in so-called NOS3 "uncoupling," resulting in production of superoxide instead of NO. Moreover, distribution of arginine between intracellular transporters and arginine-converting enzymes, as well as between the arginine-converting and arginine-synthesizing enzymes, determines the metabolic fate of arginine. Alternatively, NO can be derived from conversion of nitrite. Reduced arginine availability stemming from reduced de novo production and elevated arginase activity have been reported in various conditions of acute and chronic stress, which are often characterized by increased NOS2 and reduced NOS3 activity. Cardiovascular and pulmonary disorders such as atherosclerosis, diabetes, hypercholesterolemia, ischemic heart disease, and hypertension are characterized by NOS3 uncoupling. Therapeutic applications to influence (de novo) arginine and NO metabolism aim at increasing substrate availability or at influencing the metabolic fate of specific pathways related to NO bioavailability and prevention of NOS3 uncoupling. These include supplementation of arginine or citrulline, provision of NO donors including inhaled NO and nitrite (sources), NOS3 modulating agents, or the targeting of endogenous NOS inhibitors like asymmetric dimethylarginine.

  3. Raccoon Roundworm Infection Associated with Central Nervous System Disease and Ocular Disease - Six States, 2013-2015.

    PubMed

    Sircar, Anita D; Abanyie, Francisca; Blumberg, Dean; Chin-Hong, Peter; Coulter, Katrina S; Cunningham, Dennis; Huskins, W Charles; Langelier, Charles; Reid, Michael; Scott, Brian J; Shirley, Debbie-Ann; Babik, Jennifer M; Belova, Aleksandra; Sapp, Sarah G H; McAuliffe, Isabel; Rivera, Hilda N; Yabsley, Michael J; Montgomery, Susan P

    2016-01-01

    Baylisascaris procyonis, predominantly found in raccoons, is a ubiquitous roundworm found throughout North America. Although raccoons are typically asymptomatic when infected with the parasite, the larval form of Baylisascaris procyonis can result in fatal human disease or severe neurologic outcomes if not treated rapidly. In the United States, Baylisascaris procyonis is more commonly enzootic in raccoons in the midwestern and northeastern regions and along the West Coast (1). However, since 2002, infections have been documented in other states (Florida and Georgia) and regions (2). Baylisascariasis is not a nationally notifiable disease in the United States, and little is known about how commonly it occurs or the range of clinical disease in humans. Case reports of seven human baylisascariasis cases in the United States diagnosed by Baylisascaris procyonis immunoblot testing at CDC are described, including review of clinical history and laboratory data. Although all seven patients survived, approximately half were left with severe neurologic deficits. Prevention through close monitoring of children at play, frequent handwashing, and clearing of raccoon latrines (communal sites where raccoons defecate) are critical interventions in curbing Baylisascaris infections. Early treatment of suspected cases is critical to prevent permanent sequelae.

  4. Raccoon Roundworm Infection Associated with Central Nervous System Disease and Ocular Disease - Six States, 2013-2015.

    PubMed

    Sircar, Anita D; Abanyie, Francisca; Blumberg, Dean; Chin-Hong, Peter; Coulter, Katrina S; Cunningham, Dennis; Huskins, W Charles; Langelier, Charles; Reid, Michael; Scott, Brian J; Shirley, Debbie-Ann; Babik, Jennifer M; Belova, Aleksandra; Sapp, Sarah G H; McAuliffe, Isabel; Rivera, Hilda N; Yabsley, Michael J; Montgomery, Susan P

    2016-01-01

    Baylisascaris procyonis, predominantly found in raccoons, is a ubiquitous roundworm found throughout North America. Although raccoons are typically asymptomatic when infected with the parasite, the larval form of Baylisascaris procyonis can result in fatal human disease or severe neurologic outcomes if not treated rapidly. In the United States, Baylisascaris procyonis is more commonly enzootic in raccoons in the midwestern and northeastern regions and along the West Coast (1). However, since 2002, infections have been documented in other states (Florida and Georgia) and regions (2). Baylisascariasis is not a nationally notifiable disease in the United States, and little is known about how commonly it occurs or the range of clinical disease in humans. Case reports of seven human baylisascariasis cases in the United States diagnosed by Baylisascaris procyonis immunoblot testing at CDC are described, including review of clinical history and laboratory data. Although all seven patients survived, approximately half were left with severe neurologic deficits. Prevention through close monitoring of children at play, frequent handwashing, and clearing of raccoon latrines (communal sites where raccoons defecate) are critical interventions in curbing Baylisascaris infections. Early treatment of suspected cases is critical to prevent permanent sequelae. PMID:27608169

  5. Coral transcriptome and bacterial community profiles reveal distinct Yellow Band Disease states in Orbicella faveolata

    PubMed Central

    Closek, Collin J; Sunagawa, Shinichi; DeSalvo, Michael K; Piceno, Yvette M; DeSantis, Todd Z; Brodie, Eoin L; Weber, Michele X; Voolstra, Christian R; Andersen, Gary L; Medina, Mónica

    2014-01-01

    Coral diseases impact reefs globally. Although we continue to describe diseases, little is known about the etiology or progression of even the most common cases. To examine a spectrum of coral health and determine factors of disease progression we examined Orbicella faveolata exhibiting signs of Yellow Band Disease (YBD), a widespread condition in the Caribbean. We used a novel combined approach to assess three members of the coral holobiont: the coral-host, associated Symbiodinium algae, and bacteria. We profiled three conditions: (1) healthy-appearing colonies (HH), (2) healthy-appearing tissue on diseased colonies (HD), and (3) diseased lesion (DD). Restriction fragment length polymorphism analysis revealed health state-specific diversity in Symbiodinium clade associations. 16S ribosomal RNA gene microarrays (PhyloChips) and O. faveolata complimentary DNA microarrays revealed the bacterial community structure and host transcriptional response, respectively. A distinct bacterial community structure marked each health state. Diseased samples were associated with two to three times more bacterial diversity. HD samples had the highest bacterial richness, which included components associated with HH and DD, as well as additional unique families. The host transcriptome under YBD revealed a reduced cellular expression of defense- and metabolism-related processes, while the neighboring HD condition exhibited an intermediate expression profile. Although HD tissue appeared visibly healthy, the microbial communities and gene expression profiles were distinct. HD should be regarded as an additional (intermediate) state of disease, which is important for understanding the progression of YBD. PMID:24950107

  6. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.

    PubMed

    Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul; Schriefer, Martin

    2016-07-01

    In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%-40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%-100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics.

  7. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States

    PubMed Central

    Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul

    2016-01-01

    In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%–40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%–100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. PMID:27314832

  8. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States.

    PubMed

    Moore, Andrew; Nelson, Christina; Molins, Claudia; Mead, Paul; Schriefer, Martin

    2016-07-01

    In the United States, Lyme disease is caused by Borrelia burgdorferi and transmitted to humans by blacklegged ticks. Patients with an erythema migrans lesion and epidemiologic risk can receive a diagnosis without laboratory testing. For all other patients, laboratory testing is necessary to confirm the diagnosis, but proper interpretation depends on symptoms and timing of illness. The recommended laboratory test in the United States is 2-tiered serologic analysis consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by reflexive immunoblotting. Sensitivity of 2-tiered testing is low (30%-40%) during early infection while the antibody response is developing (window period). For disseminated Lyme disease, sensitivity is 70%-100%. Specificity is high (>95%) during all stages of disease. Use of other diagnostic tests for Lyme disease is limited. We review the rationale behind current US testing guidelines, appropriate use and interpretation of tests, and recent developments in Lyme disease diagnostics. PMID:27314832

  9. DNA Modifications: Function and Applications in Normal and Disease States

    PubMed Central

    Liyanage, Vichithra R. B.; Jarmasz, Jessica S.; Murugeshan, Nanditha; Del Bigio, Marc R.; Rastegar, Mojgan; Davie, James R.

    2014-01-01

    Epigenetics refers to a variety of processes that have heritable effects on gene expression programs without changes in DNA sequence. Key players in epigenetic control are chemical modifications to DNA, histone, and non-histone chromosomal proteins, which establish a complex regulatory network that controls genome function. Methylation of DNA at the fifth position of cytosine in CpG dinucleotides (5-methylcytosine, 5mC), which is carried out by DNA methyltransferases, is commonly associated with gene silencing. However, high resolution mapping of DNA methylation has revealed that 5mC is enriched in exonic nucleosomes and at intron-exon junctions, suggesting a role of DNA methylation in the relationship between elongation and RNA splicing. Recent studies have increased our knowledge of another modification of DNA, 5-hydroxymethylcytosine (5hmC), which is a product of the ten-eleven translocation (TET) proteins converting 5mC to 5hmC. In this review, we will highlight current studies on the role of 5mC and 5hmC in regulating gene expression (using some aspects of brain development as examples). Further the roles of these modifications in detection of pathological states (type 2 diabetes, Rett syndrome, fetal alcohol spectrum disorders and teratogen exposure) will be discussed. PMID:25340699

  10. DNA modifications: function and applications in normal and disease States.

    PubMed

    Liyanage, Vichithra R B; Jarmasz, Jessica S; Murugeshan, Nanditha; Del Bigio, Marc R; Rastegar, Mojgan; Davie, James R

    2014-01-01

    Epigenetics refers to a variety of processes that have heritable effects on gene expression programs without changes in DNA sequence. Key players in epigenetic control are chemical modifications to DNA, histone, and non-histone chromosomal proteins, which establish a complex regulatory network that controls genome function. Methylation of DNA at the fifth position of cytosine in CpG dinucleotides (5-methylcytosine, 5mC), which is carried out by DNA methyltransferases, is commonly associated with gene silencing. However, high resolution mapping of DNA methylation has revealed that 5mC is enriched in exonic nucleosomes and at intron-exon junctions, suggesting a role of DNA methylation in the relationship between elongation and RNA splicing. Recent studies have increased our knowledge of another modification of DNA, 5-hydroxymethylcytosine (5hmC), which is a product of the ten-eleven translocation (TET) proteins converting 5mC to 5hmC. In this review, we will highlight current studies on the role of 5mC and 5hmC in regulating gene expression (using some aspects of brain development as examples). Further the roles of these modifications in detection of pathological states (type 2 diabetes, Rett syndrome, fetal alcohol spectrum disorders and teratogen exposure) will be discussed. PMID:25340699

  11. Intractable Posterior Epistaxis due to a Spontaneous Low-Flow Carotid-Cavernous Sinus Fistula: A Case Report and a Review of the Literature

    PubMed Central

    Giotakis, A.; Kral, F.; Riechelmann, H.; Freund, M.

    2015-01-01

    We report a case of a 90-year-old patient with intractable posterior epistaxis presenting as the only symptom of a nontraumatic low-flow carotid-cavernous sinus fistula. Purpose of this case report is to introduce low-flow carotid-cavernous sinus fistula in the differential diagnosis of intractable posterior epistaxis. We provide a literature review for the sequence of actions for the confrontation of posterior epistaxis. We also emphasize the significance of the radiological diagnostic and therapeutic procedures in the management of posterior epistaxis due to pathology of the cavernous sinus. The gold-standard diagnostic procedure of carotid-cavernous sinus fistula is digital subtraction angiography (DSA). DSA with coils is also the state-of-the-art therapy. By failure of DSA, neurosurgery or stereotactic radiosurgery (SRS) may be used as alternatives. SRS may also be used as enhancement procedure of the DSA. Considering the prognosis of a successfully closed carotid-cavernous sinus fistula, recanalization occurs only in a minority of patients. Close follow-up is advised. PMID:26839726

  12. Distal, intermediate, and proximal mediators of racial disparities in renal disease mortality in the United States

    PubMed Central

    Assari, Shervin

    2016-01-01

    Background: Kidney failure and associated mortality is one of the major components of racial disparities in the United States. Objectives: The current study aimed to investigate the role of distal (socioeconomic status, SES), intermediate (chronic medical diseases), and proximal (health behaviors) factors that may explain Black-White disparities in mortality due to renal diseases. Patients and Methods: This is a nationally representative prospective cohort with 25 years of follow up. Data came from the Americans’ Changing Lives (ACL) study, 1986 to 2011. The study included 3361 Black (n = 1156) or White (n = 2205) adults who were followed for up to 25 years. Race was the main predictor and death due to renal disease was the outcome. SES, chronic medical disease (diabetes, hypertension, obesity), and health behaviors (smoking, drinking, and exercise) at baseline were potential mediators. We used Cox proportional hazards models for data analysis. Results: In age and gender adjusted models, Blacks had higher risk of death due to renal disease over the follow up period. Separate models suggested that SES, health behaviors and chronic medical disease fully explained the effect of race on renal disease mortality. Conclusions: Black-White disparities in rate of death due to renal diseases in the United States are not genuine but secondary to racial differences in income, health behaviors, hypertension, and diabetes. As distal, intermediate, and proximal factors contribute to racial disparities in renal disease mortality, elimination of such disparities requires a wide range of policies and programs that target income, medical conditions, and health behaviors. PMID:27047811

  13. Challenges in Designing a National Surveillance Program for Inflammatory Bowel Disease in the United States

    PubMed Central

    Long, Millie D.; Hutfless, Susan; Kappelman, Michael D.; Khalili, Hamed; Kaplan, Gil; Bernstein, Charles N.; Colombel, Jean Frederic; Herrinton, Lisa; Velayos, Fernando; Loftus, Edward V.; Nguyen, Geoffrey C.; Ananthakrishnan, Ashwin N.; Sonnenberg, Amnon; Chan, Andrew; Sandler, Robert S.; Atreja, Ashish; Shah, Samir A.; Rothman, Kenneth; Leleiko, Neal S.; Bright, Renee; Boffetta, Paolo; Myers, Kelly D.; Sands, Bruce E.

    2015-01-01

    This review describes the history of US government funding for surveillance programs in IBD, provides current estimates of the incidence and prevalence of inflammatory bowel diseases (IBD) in the United States (US), and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, in order to provide a greater understanding of the burden of IBD, disease etiology and pathogenesis, is provided. Lessons learned from other countries are summarized, as well as potential resources that may be used to optimize a new form of IBD surveillance in the US. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus upon “surveillance of the burden of disease,” including 1) natural history of disease and 2) outcomes and complications of the disease and/or treatments. PMID:24280882

  14. A Qualitative Study of State-level Zoonotic disease surveillance in New England

    PubMed Central

    Scotch, Matthew; Mattocks, Kristin; Rabinowitz, Peter; Brandt, Cynthia

    2013-01-01

    Summary Zoonotic diseases are infectious diseases transmittable between animals and humans and outbreaks of these diseases in animals can signify that humans are also infected (or vice-versa). Thus, communication between animal and human health agencies is critical for surveillance. Understanding how these agencies conduct surveillance and share information is important for development of successful automated zoonotic monitoring systems. Individual interviews were conducted with 13 professionals who perform animal or human zoonotic disease surveillance in one of the New England states. Questions centered on existing surveillance methods, collaborations between animal and human health agencies, and technological and data needs. The results showed that agencies routinely communicate over suspected zoonotic disease cases yet there are barriers preventing automated electronic linking of health data of animals and humans. These include technological barriers and barriers due sensitivity and confidentiality of information. Addressing these will facilitate development of electronic systems for integrating animal and human zoonotic disease surveillance data. PMID:20163575

  15. Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

    PubMed Central

    Fox, Michael D.; Buckner, Randy L.; Liu, Hesheng; Chakravarty, M. Mallar; Lozano, Andres M.; Pascual-Leone, Alvaro

    2014-01-01

    Brain stimulation, a therapy increasingly used for neurological and psychiatric disease, traditionally is divided into invasive approaches, such as deep brain stimulation (DBS), and noninvasive approaches, such as transcranial magnetic stimulation. The relationship between these approaches is unknown, therapeutic mechanisms remain unclear, and the ideal stimulation site for a given technique is often ambiguous, limiting optimization of the stimulation and its application in further disorders. In this article, we identify diseases treated with both types of stimulation, list the stimulation sites thought to be most effective in each disease, and test the hypothesis that these sites are different nodes within the same brain network as defined by resting-state functional-connectivity MRI. Sites where DBS was effective were functionally connected to sites where noninvasive brain stimulation was effective across diseases including depression, Parkinson's disease, obsessive-compulsive disorder, essential tremor, addiction, pain, minimally conscious states, and Alzheimer’s disease. A lack of functional connectivity identified sites where stimulation was ineffective, and the sign of the correlation related to whether excitatory or inhibitory noninvasive stimulation was found clinically effective. These results suggest that resting-state functional connectivity may be useful for translating therapy between stimulation modalities, optimizing treatment, and identifying new stimulation targets. More broadly, this work supports a network perspective toward understanding and treating neuropsychiatric disease, highlighting the therapeutic potential of targeted brain network modulation. PMID:25267639

  16. Three decades of meningococcal disease in the state of Santa Catarina, Brazil.

    PubMed

    Puricelli, Rubens C B; Kupek, Emil; Westrupp, Maria Helena Bittencourt

    2004-06-01

    Consolidation of data on meningococcal disease surveillance for the state of Santa Catarina, Brazil, has provided new insight about the evolution of this disease during the period of 1971-2000. A descriptive epidemiological study, based on retrospective analysis of all cases of meningococcal disease notified in the state of Santa Catarina, linked the surveillance data from the Secretary of the State of Health, magnetic tape records and the data from the national surveillance of diseases of obligatory notification. Following World Health Organization guidelines, cumulative incidence exceeding five cases per 100,000 inhabitants was considered indicative of an epidemic. Official population data from the Fundação Instituto Brasileiro de Geografia e Estatística were used for the incidence denominator. During the 1971-2000 period, 7,893 cases and 1,354 deaths caused by meningococcal disease were reported. This corresponds to a mean of 263 cases and 45 deaths per year, with a mean incidence of 6.4 cases per 100,000 inhabitants and a fatality rate of 17.2%. Three distinct epidemiological periods were identified, two of which can be considered epidemic. Two of three distinct epidemiological periods were characterized by an epidemic of meningococcal disease, covering 20 of the 30 years analyzed. Identification of the epidemics and preventive actions, such as vaccination and health education, contributed to the reduction of morbidity and mortality due to this disease.

  17. No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001-2010.

    PubMed

    Forrester, Joseph D; Kugeler, Kiersten J; Perea, Anna E; Pastula, Daniel M; Mead, Paul S

    2015-11-01

    Associations between Lyme disease and certain neurodegenerative diseases have been proposed, but supportive evidence for an association is lacking. Similar geographic distributions would be expected if 2 conditions were etiologically linked. Thus, we compared the distribution of Lyme disease cases in the United States with the distributions of deaths due to Alzheimer disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson disease; no geographic correlations were identified. Lyme disease incidence per US state was not correlated with rates of death due to ALS, MS, or Parkinson disease; however, an inverse correlation was detected between Lyme disease and Alzheimer disease. The absence of a positive correlation between the geographic distribution of Lyme disease and the distribution of deaths due to Alzheimer disease, ALS, MS, and Parkinson disease provides further evidence that Lyme disease is not associated with the development of these neurodegenerative conditions.

  18. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000–2014

    PubMed Central

    Lantos, Paul M.; Nigrovic, Lise E.; Auwaerter, Paul G.; Fowler, Vance G.; Ruffin, Felicia; Brinkerhoff, R. Jory; Reber, Jodi; Williams, Carl; Broyhill, James; Pan, William K.; Gaines, David N.

    2015-01-01

    Background. The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods. We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results. There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions. The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years. PMID:26550580

  19. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.

    PubMed

    Lantos, Paul M; Nigrovic, Lise E; Auwaerter, Paul G; Fowler, Vance G; Ruffin, Felicia; Brinkerhoff, R Jory; Reber, Jodi; Williams, Carl; Broyhill, James; Pan, William K; Gaines, David N

    2015-12-01

    Background.  The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods.  We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results.  There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions.  The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years. PMID:26550580

  20. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.

    PubMed

    Lantos, Paul M; Nigrovic, Lise E; Auwaerter, Paul G; Fowler, Vance G; Ruffin, Felicia; Brinkerhoff, R Jory; Reber, Jodi; Williams, Carl; Broyhill, James; Pan, William K; Gaines, David N

    2015-12-01

    Background.  The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods.  We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results.  There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions.  The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.

  1. Jamestown Canyon Virus Disease in the United States-2000-2013.

    PubMed

    Pastula, Daniel M; Hoang Johnson, Diep K; White, Jennifer L; Dupuis, Alan P; Fischer, Marc; Staples, J Erin

    2015-08-01

    Jamestown Canyon virus (JCV) is a mosquito-borne orthobunyavirus in the California serogroup that can cause an acute febrile illness, meningitis, or meningoencephalitis. We describe epidemiologic and clinical features for JCV disease cases occurring in the United States during 2000-2013. A case of JCV disease was defined as an acute illness in a person with laboratory evidence of a recent JCV infection. During 2000-2013, we identified 31 cases of JCV disease in residents of 13 states. The median age was 48 years (range, 10-69) and 21 (68%) were male. Eleven (35%) case patients had meningoencephalitis, 6 (19%) meningitis, 7 (23%) fever without neurologic involvement, and 7 (23%) had an unknown clinical syndrome. Fifteen (48%) were hospitalized and there were no deaths. Health-care providers and public health officials should consider JCV disease in the differential diagnoses of viral meningitis and encephalitis, obtain appropriate specimens for testing, and report cases to public health authorities. PMID:26033022

  2. West Nile virus and other arboviral diseases--United States, 2012.

    PubMed

    2013-06-28

    Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States. However, several other arboviruses also cause sporadic cases and seasonal outbreaks of neuroinvasive disease (e.g., meningitis, encephalitis, and acute flaccid paralysis). In 2012, CDC received reports of 5,780 nationally notifiable arboviral disease cases (excluding dengue). A large multistate outbreak of WNV disease accounted for 5,674 (98%) of reported cases, the highest number reported since 2003. Other reported etiologies included Eastern equine encephalitis virus (EEEV), Powassan virus (POWV), St. Louis encephalitis virus (SLEV), and California serogroup viruses such as La Crosse virus (LACV) and Jamestown Canyon virus (JCV). Arboviruses continue to cause serious illness in substantial numbers of persons in the United States. Maintaining surveillance remains important to identify outbreaks and guide prevention efforts.

  3. Chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy

    PubMed Central

    Fiala, Milan; Avagyan, Hripsime; Merino, Jose Joaquin; Bernas, Michael; Valdivia, Juan; Espinosa-Jeffrey, Araceli; Witte, Marlys; Weinand, Martin

    2012-01-01

    To identify the upstream signals of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy (TLE), we evaluated by immunohistochemistry and confocal microscopy brain tissues of 13 TLE patients and 5 control patients regarding expression of chemokines and cell-cycle proteins. The chemokine RANTES (CCR5) and other CC-chemokines and apoptotic markers (caspase-3, -8, -9) were expressed in lateral temporal cortical and hippocampal neurons of TLE patients, but not in neurons of control cases. The chemokine RANTES is usually found in cytoplasmic and extracellular locations. However, in TLE neurons, RANTES was displayed in an unusual location, the neuronal nuclei. In addition, the cell-cycle regulatory transcription factor E2F1 was found in an abnormal location in neuronal cytoplasm. The pro-inflammatory enzyme cyclooxygenase-2 and cytokine interleukin-1β were expressed both in neurons of patients suffering from temporal lobe epilepsy and from cerebral trauma. The vessels showed fibrin leakage, perivascular macrophages and expression of IL-6 on endothelial cells. In conclusion, the cytoplasmic effects of E2F1 and nuclear effects of RANTES might have novel roles in neuronal apoptosis of TLE neurons and indicate a need to develop new medical and/or surgical neuroprotective strategies against apoptotic signaling by these molecules. Both RANTES and E2F1 signaling are upstream from caspase activation, thus the antagonists of RANTES and/or E2F1 blockade might be neuroprotective for patients with medically intractable temporal lobe epilepsy. The results have implications for the development of new medical and surgical therapies based on inhibition of chemotactic and mitogenic stimuli of neuronal apoptosis in patients with medically intractable temporal lobe epilepsy. PMID:22444245

  4. Scale dependence of disease impacts on quaking aspen (Populus tremuloides) mortality in the southwestern United States.

    PubMed

    Bell, David M; Bradford, John B; Lauenroth, William K

    2015-07-01

    Depending on how disease impacts tree exposure to risk, both the prevalence of disease and disease effects on survival may contribute to patterns of mortality risk across a species' range. Disease may accelerate tree species' declines in response to global change factors, such as drought, biotic interactions, such as competition, or functional traits, such as allometry. To assess the role of disease in mediating mortality risk in quaking aspen (Populus tremuloides), we developed hierarchical Bayesian models for both disease prevalence in live aspen stems and the resulting survival rates of healthy and diseased aspen near the species' southern range limit using 5088 individual trees on 281 United States Forest Service Forest Inventory and Analysis plots in the southwestern United States. We found that disease prevalence depended primarily on tree size, tree allometry, and spatial variation in precipitation, while mortality depended on tree size, allometry, competition, spatial variation in summer temperature, and both temporal and spatial variation in summer precipitation. Disease prevalence was highest in large trees with low slenderness found on dry sites. For healthy trees, mortality decreased with diameter, slenderness, and temporal variation in summer precipitation, but increased with competition and spatial variation in summer temperature. Mortality of diseased trees decreased with diameter and aspen relative basal area and increased with mean summer temperature and precipitation. Disease infection increased aspen mortality, especially in trees of intermediate size and trees on plots at climatic extremes (i.e., cool, wet and warm, dry climates). By examining variation in disease prevalence, mortality of healthy trees, and mortality of diseased trees, we showed that the role of disease in aspen tree mortality depended on the scale of inference. For variation among individuals in diameter, disease tended to expose intermediate-size trees experiencing moderate

  5. Effects of disease severity and medication state on postural control asymmetry during challenging postural tasks in individuals with Parkinson's disease.

    PubMed

    Barbieri, Fabio A; Polastri, Paula F; Baptista, André M; Lirani-Silva, Ellen; Simieli, Lucas; Orcioli-Silva, Diego; Beretta, Victor S; Gobbi, Lilian T B

    2016-04-01

    The aim of this study was to investigate the effects of disease severity and medication state on postural control asymmetry during challenging tasks in individuals with Parkinson's disease (PD). Nineteen people with PD and 11 neurologically healthy individuals performed three standing task conditions: bipedal standing, tandem and unipedal adapted standing; the individuals with PD performed the tasks in ON and OFF medication state. The participants with PD were distributed into 2 groups according to disease severity: unilateral group (n=8) and bilateral group (n=11). The two PD groups performed the evaluations both under and without the medication. Two force plates were used to analyze the posture. The symmetric index was calculated for various of center of pressure. ANOVA one-way (groups) and two-way (PD groups×medication), with repeated measures for medication, were calculated. For main effects of group, the bilateral group was more asymmetric than CG. For main effects of medication, only unipedal adapted standing presented effects of PD medication. There was PD groups×medication interaction. Under the effects of medication, the unilateral group presented lower asymmetry of RMS in anterior-posterior direction and area than the bilateral group in unipedal adapted standing. In addition, the unilateral group presented lower asymmetry of mean velocity, RMS in anterior-posterior direction and area in unipedal standing and area in tandem adapted standing after a medication dose. Postural control asymmetry during challenging postural tasks was dependent on disease severity and medication state in people with PD. The bilateral group presented higher postural control asymmetry than the control and unilateral groups in challenging postural tasks. Finally, the medication dose was able to reduce postural control asymmetry in the unilateral group during challenging postural tasks.

  6. Intractable seizures associated with proximal migration of a ventriculoperitoneal shunt. Case report.

    PubMed

    Yamazaki, Tomoya; Shimizu, Satoru; Sagiuchi, Takao; Iwasaki, Toshiyuki; Utsuki, Satoshi; Suzuki, Sachio; Fujii, Kiyotaka

    2005-11-01

    A 6-year-old girl, who had received a ventriculoperitoneal (VP) shunt using the Codman-Hakim programmable valve system at age 3 months, presented with intractable seizures. Neuroimaging studies showed migration of the proximal part of the system, including the prechamber, into the cranium through the right frontal burr hole. Electroencephalography showed spike-and-wave complexes in the right hemisphere including the site of the migration. The ictus was resolved following revision surgery. The clinical findings suggested the seizures were due to irritation of the brain parenchyma by the migrated system. Proximal migration of a VP shunt may cause both shunt failure and additional focal symptoms.

  7. Hot water irrigation as treatment for intractable posterior epistaxis in an out-patient setting.

    PubMed

    Novoa, E; Schlegel-Wagner, C

    2012-01-01

    The management of intractable posterior epistaxis is challenging for any physician. Nasal packing, often combined with use of an endonasal balloon system, is painful for the patient, and torturous to maintain for two to three days. If conservative treatment fails, the most commonly used treatment options are currently invasive procedures such as endoscopic coagulation of bleeding arteries, external ligation and, rarely, embolisation. This paper describes a simple, non-invasive technique of treating posterior epistaxis with hot water irrigation. Technical information is presented, and the benefits of the method are discussed. PMID:21888749

  8. Identifying Mutations of the Tetratricopeptide Repeat Domain 37 (TTC37) Gene in Infants With Intractable Diarrhea and a Comparison of Asian and Non-Asian Phenotype and Genotype

    PubMed Central

    Lee, Wen-I; Huang, Jing-Long; Chen, Chien-Chang; Lin, Ju-Li; Wu, Ren-Chin; Jaing, Tang-Her; Ou, Liang-Shiou

    2016-01-01

    Abstract Syndromic diarrhea/tricho-hepato-enteric syndrome (SD/THE) is a rare, autosomal recessive and severe bowel disorder mainly caused by mutations in the tetratricopeptide repeat domain 37 (TTC37) gene which act as heterotetrameric cofactors to enhance aberrant mRNAs decay. The phenotype and immune profiles of SD/THE overlap those of primary immunodeficiency diseases (PIDs). Neonates with intractable diarrhea underwent immunologic assessments including immunoglobulin levels, lymphocyte subsets, lymphocyte proliferation, superoxide production, and IL-10 signaling function. Candidate genes for PIDs predisposing to inflammatory bowel disease were sequencing in this study. Two neonates, born to nonconsanguineous parents, suffered from intractable diarrhea, recurrent infections, and massive hematemesis from esopharyngeal varices due to liver cirrhosis or accompanying Trichorrhexis nodosa that developed with age and thus guided the diagnosis of SD/THE compatible to TTC37 mutations (homozygous DelK1155H, Fs∗2; heterozygous Y1169Ter and InsA1143, Fs∗3). Their immunologic evaluation showed normal mitogen-stimulated lymphocyte proliferation, superoxide production, and IL-10 signaling, but low IgG levels, undetectable antibody to hepatitis B surface antigen and decreased antigen-stimulated lymphocyte proliferation. A PubMed search for bi-allelic TTC37 mutations and phenotypes were recorded in 14 Asian and 12 non-Asian cases. They had similar presentations of infantile onset refractory diarrhea, facial dysmorphism, hair anomalies, low IgG, low birth weight, and consanguinity. A higher incidence of heart anomalies (8/14 vs 2/12; P = 0.0344, Chi-square), nonsense mutations (19 in 28 alleles), and hot-spot mutations (W936Ter, 2779-2G>A, and Y1169Ter) were found in the Asian compared with the non-Asian patients. Despite immunoglobulin therapy in 20 of the patients, 4 died from liver cirrhosis and 1 died from sepsis. Patients of all ethnicities with SD/THE with the

  9. A retrospective study of disease in captive kangaroos from Oklahoma State University, 1995-2009.

    PubMed

    Stern, Adam W

    2010-03-01

    The antemortem biopsy records (5 cases) and necropsy records (34 cases) were reviewed from 39 kangaroo case submissions during a 14-year period to the Oklahoma State University and the Oklahoma Animal Disease Diagnostic Laboratory. The most common types of diseases in the kangaroos, based on necropsy examination, was disease of the alimentary tract (12 cases), pneumonia (6 cases), and disseminated toxoplasmosis (5 cases). The cause of disease was not determined in 6 case submissions. Based on histopathologic findings, clostridial enteritis/colitis was suspected in 2 kangaroos. Coccidian parasites were identified within histologic sections of the small intestine in 1 kangaroo. Pasteurella sp. (1 case) and Bacteroides sp. (1 case) were isolated from the lung in 2 cases of pneumonia. Most (77.3%) of disease in this study in the kangaroos with known ages occurred in animals older than 1 year. Two neoplasms were detected in the antemortem biopsy samples from 1 case.

  10. Access to care for Chagas disease in the United States: a health systems analysis.

    PubMed

    Manne-Goehler, Jennifer; Reich, Michael R; Wirtz, Veronika J

    2015-07-01

    There are 300,000 estimated cases of Chagas disease in the United States but limited data on access to care. This study analyzed trends in access to care for Chagas disease in the United States and assessed the national and state barriers to access. Data on cases in blood donors and drug releases were obtained from the AABB (formerly American Association of Blood Banks) and U.S. Centers for Disease Control and Prevention (CDC), respectively. Semi-structured in-depth interviews were conducted with 30 key informants at the national level and in five states where treatment had been released. Interview responses were analyzed according to the health systems dimensions of regulation, financing, payment, organization, and persuasion. Data indicate that 1,908 cases were identified in the blood donation system from 2007 to 2013 and that CDC released 422 courses of benznidazole or nifurtimox during this period. The barriers to access at the national level include limited diagnostic and institutionalized referral and care processes, lack of financing for patient-care activities, and limited awareness and training among providers. This study demonstrates that access to treatment of Chagas disease in the United States is limited. The lack of licensing is only one of several barriers to access, highlighting the need for a health systems perspective when scaling up access to these essential medicines.

  11. Virus diseases of the salmonidae in the western United States. I. Etiology and epizootiology

    USGS Publications Warehouse

    1965-01-01

    The history of fish diseases in western United States shows an increasing awareness that viruses could cause epizootics in fish. Fishery biologists bunked first, for protozoan and metazoan parasites, then for bacteria, and if none could be identified assumed that the mortalities were attributable to nutritional deficiency, Microbiologists in general were cognizant of virus diseases in other animals and investigators of fish diseases were alert to the possibility that piscine epizootics could be of similar cause. In 1950 an epizootic occurred in sockeye salmon (Gncorhynchus norkm) that was shown to have a viral etiologic agent.In recent years, with increasing frequency, we have been able to demonstrate a virus utiology for epizootics and panzootics in trout and salmon in several states in the West.  FIGURE 1 is a map showing the location of epizootics of infectious pancreatic necrosis (IPN), Sacramento River chinook disease (SRCD), Oregon sockeye disease (OSD), and Columbia River sockeye disease (CRSDJ. The pathology and immunopathology of these are discussed in detail in other reports. The present report was initiated as a review of the literature concerning the diseases and to present in brief a description of their etiologic agents.

  12. [Assessment and treatment of intractable pain: six months' experience in the relief of pain at the ludwig Boltzmann Institute of Clinical Oncology (author's transl)].

    PubMed

    Jenkner, F L

    1976-07-16

    A preliminary report is presented on the results achieved in the assessment and treatment of patients with intractable pain during the first six months experience gained following the appointment of a pain consultant at the Ludwig Boltzmann Institute of Clinical Oncology. Nerve blockade was carried out 106 times in 45 patients suffering from primary or secondary malignant disease and 71 times in 18 patients with other conditions; intrathecal instillation of 96% alcohol was performed once and 2 chordotomies were also performed. One patient needed antidepressive therapy. Major questions relating to this problem are discussed. Gratifyingly satisfactory results were observed in more than two thirds of the patients. These objective findings and the subjective impressions obtained from patients, their relatives and our personnel prompted us to continue with this type of treatment for pain and to increase our efforts in this direction.

  13. Ebola virus disease cluster in the United States--Dallas County, Texas, 2014.

    PubMed

    Chevalier, Michelle S; Chung, Wendy; Smith, Jessica; Weil, Lauren M; Hughes, Sonya M; Joyner, Sibeso N; Hall, Emily; Srinath, Divya; Ritch, Julia; Thathiah, Prea; Threadgill, Heidi; Cervantes, Diana; Lakey, David L

    2014-11-21

    Since March 10, 2014, Guinea, Liberia, and Sierra Leone have experienced the largest known Ebola virus disease (Ebola) epidemic with approximately 13,000 persons infected as of October 28, 2014. Before September 25, 2014, only four patients with Ebola had been treated in the United States; all of these patients had been diagnosed in West Africa and medically evacuated to the United States for care.

  14. 75 FR 3243 - NIH State-of-the-Science Conference: Preventing Alzheimer's Disease and Cognitive Decline; Notice

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... HUMAN SERVICES National Institutes of Health NIH State-of-the-Science Conference: Preventing Alzheimer's... the ``NIH State-of-the-Science Conference: Preventing Alzheimer's Disease and Cognitive Decline'' to... state of cognitive impairment or into various forms of dementia, including Alzheimer's disease....

  15. On disentangling states versus traits: demonstration of a new technique using the Alzheimer's disease assessment scale.

    PubMed

    Taylor, Joy L; Kraemer, Helena Chmura; Noda, Art; Friedman, Leah; Zarcone, Vincent; Tinklenberg, Jared R; Yesavage, Jerome A

    2002-01-01

    Part of the challenge in research on degenerative neurologic disease relates to distinguishing those measurements that essentially describe patient characteristics stable across the course of illness (traits) from those that vary systematically within subjects (states), particularly those specifically related to stage or duration of illness. A components-of-variance approach was used to examine the state versus trait aspects of the Alzheimer's Disease Assessment Scale (ADAS) Cognitive and Noncognitive subscales, a clinical instrument frequently used in research on Alzheimer disease. Subjects were 190 patients with probable AD followed longitudinally. Stage of illness was indexed by mental status scores. Analysis of variance was used to partition total variance into that associated with subjects (trait), stages (state: stage), subjects x stages (state: other), and error. ADAS Cognitive scores were strongly related to stage of illness (83% of true variance). ADAS Noncognitive scores were modestly related to stage (approximately 21% of true variance) and moderately related to state: other (47%). We discuss how state-trait analyses can be helpful in focusing attention on those areas of assessment most likely to accomplish specific objectives.

  16. Surveillance for Waterborne Disease Outbreaks and Other Health Events Associated with Recreational Water -United States, 2007-2008

    EPA Science Inventory

    Background: Since 1978, CDC, EPA, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) to capture data on waterborne disease outbreaks associated with recreational water. WBDOSS is the prima...

  17. Intrabronchial Infusion of Autologous Blood Plus Thrombin for Intractable Pneumothorax After Bronchial Occlusion Using Silicon Spigots

    PubMed Central

    Nakahara, Yasuharu; Kawamura, Tetsuji; Sasaki, Shin; Tsukamoto, Hiroaki; Mochiduki, Yoshiro

    2016-01-01

    Background: Bronchial occlusion therapy using silicon spigots is effective for intractable pneumothorax. However, sometimes the pneumothorax is refractory to bronchial occlusion because of collateral ventilation. For such difficult pneumothoraces, we attempted an intrabronchial infusion of autologous blood plus thrombin to control collateral ventilation and stop air leaks. Methods: We performed bronchial occlusions using silicon spigots in patients with spontaneous pneumothorax secondary to emphysema and refractory to chest drainage, but which was inoperable owing to each patient’s poor surgical candidacy and poor overall health condition. When bronchial occlusion proved ineffective, we undertook intrabronchial infusion of autologous blood plus thrombin, 2 to 4 days after bronchial occlusion. A catheter was inserted into the subpleural area, through a gap between the silicon spigot and the bronchial wall, using a flexible bronchoscope under fluoroscopic guidance. Autologous blood, followed by a thrombin solution, was infused using the catheter. We repeated the same infusion a total of 4 to 6 times while changing the target bronchi. All interventions were performed under local anesthesia. Results: The subjects were 9 men, aged from 61 to 88 years, with smoking histories. Three patients also had interstitial pneumonia, and 6 patients had undergone pleurodesis in vain before bronchial occlusion. For 4of the 9 patients, autologous blood plus thrombin infusions successfully stopped air leaks, and in 3 patients, intrabronchial infusions and pleurodesis halted leaks altogether. Conclusion: Intrabronchial infusion of autologous blood plus thrombin was effective for intractable pneumothoraces that could not be clinically managed, even by bronchial occlusion using silicon spigots. PMID:27454474

  18. Intractable Persistent Direction-Changing Geotropic Nystagmus Improved by Lateral Semicircular Canal Plugging

    PubMed Central

    Saito, Kazuya; Doi, Katsumi

    2015-01-01

    Antigravitational deviation of the cupula of the lateral semicircular canal, which is also called light cupula, evokes persistent direction-changing geotropic nystagmus with a neutral point. No intractable cases of this condition have been reported. In our case, a 67-year-old man complained of positional vertigo 3 months after developing idiopathic sudden hearing loss in the right ear with vertigo. He showed a persistent direction-changing geotropic nystagmus with a leftward beating nystagmus in the supine position. The nystagmus resolved when his head was turned approximately 30° to the right. He was diagnosed with light cupula of the right lateral semicircular canal and was subsequently treated with an antivertiginous agent. However, his symptoms and positional nystagmus did not improve, so the right lateral semicircular canal was plugged by surgery. One month after surgery, his positional vertigo and nystagmus were completely resolved. We speculated that the cause of the patient's intractable light cupula was an enlarged cupula caused by his idiopathic sudden hearing loss. PMID:25685577

  19. Intractable persistent direction-changing geotropic nystagmus improved by lateral semicircular canal plugging.

    PubMed

    Seo, Toru; Saito, Kazuya; Doi, Katsumi

    2015-01-01

    Antigravitational deviation of the cupula of the lateral semicircular canal, which is also called light cupula, evokes persistent direction-changing geotropic nystagmus with a neutral point. No intractable cases of this condition have been reported. In our case, a 67-year-old man complained of positional vertigo 3 months after developing idiopathic sudden hearing loss in the right ear with vertigo. He showed a persistent direction-changing geotropic nystagmus with a leftward beating nystagmus in the supine position. The nystagmus resolved when his head was turned approximately 30° to the right. He was diagnosed with light cupula of the right lateral semicircular canal and was subsequently treated with an antivertiginous agent. However, his symptoms and positional nystagmus did not improve, so the right lateral semicircular canal was plugged by surgery. One month after surgery, his positional vertigo and nystagmus were completely resolved. We speculated that the cause of the patient's intractable light cupula was an enlarged cupula caused by his idiopathic sudden hearing loss.

  20. FACTS ON THE MAJOR KILLING AND CRIPPLING DISEASES IN THE UNITED STATES TODAY.

    ERIC Educational Resources Information Center

    National Health Education Committee, Inc., New York, NY.

    MAJOR CAUSES OF DEATH AND DISABILITY, RESULTS OF MEDICAL RESEARCH, LIFE EXPECTANCY FIGURES, COST OF ILLNESS TO THE UNITED STATES, AND GOVERNMENT EXPENDITURES IN MEDICINE AND HEALTH ARE PRESENTED TABULARLY AND GRAPHICALLY IN QUESTION AND ANSWER FORM. FOR EACH OF 14 MAJOR DISEASES, PERTINENT FACTS ARE LISTED ABOUT INCIDENCE, COST, DEATH RATE,…

  1. GENOMIC ANALYSIS OF SURROGATE TISSUES FOR ASSESSING ENVIRONMENTAL EXPOSURES AND FUTURE DISEASE STATES

    EPA Science Inventory

    Genomic Analysis of Surrogate Tissues for Assessing Environmental Exposures and Future Disease States

    John C. Rockett, Chad R. Blystone, Amber K. Goetz, Rachel N. Murrell, Hongzu Ren, Judith E. Schmid, Jessica Stapelfeldt, Lillian F. Strader, Kary E. Thompson, Douglas B. T...

  2. SURVEILLANCE FOR WATERBORNE-DISEASE OUTBREAKS - UNITED STATES, 1999-2000

    EPA Science Inventory

    PROBLEM/CONDITION: Since 1971, CDC, the U.S. Environmental Protection Agency (EPA), and the Council of State and Territorial Epidemiologists (CSTE) have maintained a collaborative surveillance system for the occurrences and causes of waterborne-disease outbreaks (WBDOs).This surv...

  3. GENOMIC AND PROTEOMIC ANALYSIS OF SURROGATE TISSUES FOR ASSESSING TOXIC EXPOSURES AND DISEASE STATES

    EPA Science Inventory

    Genomic and Proteomic Analysis of Surrogate Tissues for Assessing Toxic Exposures and Disease States
    David J. Dix and John C. Rockett
    Reproductive Toxicology Division, National Health and Environmental Effects Research Laboratory, Office of Research and Development, USEPA, ...

  4. State of World Allergy Report 2008: Allergy and Chronic Respiratory Diseases

    PubMed Central

    2008-01-01

    It is widely recognized that the incidence of allergies and allergic diseases is on the rise globally. As an international umbrella organization for regional and national allergy and clinical immunology societies, the World Allergy Organization is at the forefront of a combined united effort across nations and organizations to address this global concern by promoting the science of allergy and clinical immunology, and advancing exchange of information. The World Allergy Organization's State of World Allergy Reports will provide a biennial review of allergic diseases worldwide, consider their medical and socioeconomic contexts, and propose effective approaches to addressing these problems. In this first State of World Allergy Report 2008, experts from different regions of the world have attempted to define the extent of the global allergy problem, examine recent trends, and provide a framework for the collaboration among world medicine, science, and government agencies that is needed to address the rapidly developing issues associated with allergy and allergic diseases. PMID:23282447

  5. Meteorological Influences on the Seasonality of Lyme Disease in the United States

    PubMed Central

    Moore, Sean M.; Eisen, Rebecca J.; Monaghan, Andrew; Mead, Paul

    2014-01-01

    Lyme disease (Borrelia burgdorferi infection) is the most common vector-transmitted disease in the United States. The majority of human Lyme disease (LD) cases occur in the summer months, but the timing of the peak occurrence varies geographically and from year to year. We calculated the beginning, peak, end, and duration of the main LD season in 12 highly endemic states from 1992 to 2007 and then examined the association between the timing of these seasonal variables and several meteorological variables. An earlier beginning to the LD season was positively associated with higher cumulative growing degree days through Week 20, lower cumulative precipitation, a lower saturation deficit, and proximity to the Atlantic coast. The timing of the peak and duration of the LD season were also associated with cumulative growing degree days, saturation deficit, and cumulative precipitation, but no meteorological predictors adequately explained the timing of the end of the LD season. PMID:24470565

  6. Resurgence of Vaccine-Preventable Diseases in the United States: Anesthetic and Critical Care Implications.

    PubMed

    Porteous, Grete H; Hanson, Neil A; Sueda, Lila Ann A; Hoaglan, Carli D; Dahl, Aaron B; Ohlson, Brooks B; Schmidt, Brian E; Wang, Chia C; Fagley, R Eliot

    2016-05-01

    Vaccine-preventable diseases (VPDs) such as measles and pertussis are becoming more common in the United States. This disturbing trend is driven by several factors, including the antivaccination movement, waning efficacy of certain vaccines, pathogen adaptation, and travel of individuals to and from areas where disease is endemic. The anesthesia-related manifestations of many VPDs involve airway complications, cardiovascular and respiratory compromise, and unusual neurologic and neuromuscular symptoms. In this article, we will review the presentation and management of 9 VPDs most relevant to anesthesiologists, intensivists, and other hospital-based clinicians: measles, mumps, rubella, pertussis, diphtheria, influenza, meningococcal disease, varicella, and poliomyelitis. Because many of the pathogens causing these diseases are spread by respiratory droplets and aerosols, appropriate transmission precautions, personal protective equipment, and immunizations necessary to protect clinicians and prevent nosocomial outbreaks are described. PMID:27088999

  7. Emerging Capripoxvirus disease outbreaks in Himachal Pradesh, a northern state of India.

    PubMed

    Verma, S; Verma, L K; Gupta, V K; Katoch, V C; Dogra, V; Pal, B; Sharma, M

    2011-02-01

    Both sheep and goat pox are contagious viral diseases and affect small ruminants and are caused by sheep pox virus and goat pox virus respectively that belong to genus Capripoxvirus of Poxviridae family. Huge economic losses emanating from the disease outbreaks are the results of the wool and hide damage, subsequent production losses and also the morbidities and mortalities associated with the disease. This communication highlights clinico-epidemiological observations from the two sheep pox and one goat pox outbreaks. Grossly, multisystemic nodular lesions, mucopurulent nasal discharges and respiratory symptoms were observed in the affected animals. The morbidity, mortality and case fatality rates were 5.18%, 2.45% and 32.37%, respectively. Histopathological, haematological, molecular and serological techniques and also isolation of virus in embryonated chicken eggs were used for the diagnosis of the diseases. The spatial distribution of the disease signifies the role of common pasturelands used for grazing the animals while temporally all three outbreaks occurred in winters and were probably associated with cold stress and fodder scarcity. This is the first recorded report of Capripoxvirus infection in recent times and it highlights the disease as one of the emerging diseases in the northern state of Himachal Pradesh in India.

  8. Chagas disease in the United States: a cause for concern in Louisiana?

    PubMed

    Diaz, James H

    2007-01-01

    Chagas disease, or American trypanosomiasis, is an arthropod-borne protozoan infectious disease, hyperendemic throughout Latin America, caused by Trypanosoma cruzi, and transmitted to man by reduviid or kissing bugs. Throughout the Americas, Chagas disease shares many life cycle features with malaria, including transmission of infectious stages by local arthropods, exacerbation or reactivation of subclinical infections by immunosuppression (particularly HIV/AIDS) and pregnancy, and both transplacental and transfusion-related transmission. Although most cases of Chagas disease in the United States (US) are imported, significant numbers of Latin American immigrants contribute to the US blood supply and donate cadaveric tissues and organs for human transplantation, thus increasing the risks of both transfusion and transplantation-transmitted Chagas disease from unscreened blood products and transplantable tissues and organs. In addition, the risks of local reduviid bug-transmitted autochthonous or indigenous Chagas disease are also increasing as more immigrant workers enter the displaced populations of the Gulf South, including Louisiana, to assist in rebuilding efforts after Hurricanes Katrina and Rita. Although screening donated blood products for malaria remains impractical, consideration should now be given to serologically screening all donated blood and organs for Chagas disease in the US, as in most countries of Latin America, especially in high risk areas of California and the southern US, including Louisiana.

  9. Noninfectious disease among the Bhutanese refugee population at a United States urban clinic.

    PubMed

    Kumar, Gayathri S; Varma, Selina; Saenger, Michael S; Burleson, Molly; Kohrt, Brandon A; Cantey, Paul

    2014-10-01

    A large number of Bhutanese are currently being resettled to the United States. A high prevalence of noninfectious diseases has been noted in some refugee groups, but data on the Bhutanese refugee population are lacking. A retrospective, chart review study was conducted to determine proportion of noninfectious disease among ethnically Nepali Bhutanese refugees (n = 66) seen at the Grady Refugee Clinic (GRC). GRC disease proportions included the following: 52 % of the patients were overweight/obese (n = 34), 23 % were hypertensive (n = 15), 12 % had vitamin B(12) deficiency (n = 8), 15 % had depression (n = 10), and 14 % had diabetes (n = 9). Nine (90 %) patients with depression had chronic disease compared to 30 (54 %) of the patients without depression. The study found a substantial burden of chronic disease, micronutrient deficiency, and depression in the GRC. Further research is needed to accurately describe the disease burden in refugee populations and to evaluate pre-resettlement disease prevention strategies to provide a framework for future public health interventions.

  10. Cryoanalgesia in the management of intractable pain in the temporomandibular joint: a five-year retrospective review.

    PubMed

    Sidebottom, A J; Carey, E C; Madahar, A K

    2011-12-01

    Cryoanalgesia is a controversial adjunct to the management of chronic pain, but we know of no studies that have investigated its effect in the management of temporomandibular joint (TMJ) pain. In this five-year retrospective study we treated 17 patients who had severe pain that had failed to respond to all forms of conventional conservative treatment and were not appropriate for simple open operation. None had a clear indication for open operation on the joint or had too severe disease to warrant a simple procedure. Preliminary diagnostic injections of bupivacaine to the TMJ relieved the pain. We applied the cryoprobe in the region of the auriculotemporal nerve and TMJ capsule. There was a small but insignificant improvement in mean mouth opening together with a significant (p=0.000) improvement in visual analogue pain scores (VAS) from 6.8 (range 4-10) to 2.0 (range 0-7). Two patients had no change in their pain scores, and 2 had complete resolution of their pain. The mean number of pain-free months after treatment was 7 (IQR 3-15). Three patients had long-term pain relief, and 12 temporary relief; 6 of these subsequently had successful relief after total replacement of the TMJ. One patient had further cryoanalgesia, one was referred for specialist pain management, and one controlled the pain with nortriptyline. Of the 17 cases studied, 2 had temporary complications after cryoanalgesia. Cryoanalgesia is a useful adjunct to the management of intractable pain in the TMJ. Short-term pain relief can be achieved, and long-term relief is possible in some, deferring more complex and costly treatments. PMID:21177004

  11. Validation of disease states in schizophrenia: comparison of cluster analysis between US and European populations

    PubMed Central

    Thokagevistk, Katia; Millier, Aurélie; Lenert, Leslie; Sadikhov, Shamil; Moreno, Santiago; Toumi, Mondher

    2016-01-01

    Background There is controversy as to whether use of statistical clustering methods to identify common disease patterns in schizophrenia identifies patterns generalizable across countries. Objective The goal of this study was to compare disease states identified in a published study (Mohr/Lenert, 2004) considering US patients to disease states in a European cohort (EuroSC) considering English, French, and German patients. Methods Using methods paralleling those in Mohr/Lenert, we conducted a principal component analysis (PCA) on Positive and Negative Syndrome Scale items in the EuroSC data set (n=1,208), followed by k-means cluster analyses and a search for an optimal k. The optimal model structure was compared to Mohr/Lenert by assigning discrete severity levels to each cluster in each factor based on the cluster center. A harmonized model was created and patients were assigned to health states using both approaches; agreement rates in state assignment were then calculated. Results Five factors accounting for 56% of total variance were obtained from PCA. These factors corresponded to positive symptoms (Factor 1), negative symptoms (Factor 2), cognitive impairment (Factor 3), hostility/aggression (Factor 4), and mood disorder (Factor 5) (as in Mohr/Lenert). The optimal number of cluster states was six. The kappa statistic (95% confidence interval) for agreement in state assignment was 0.686 (0.670–0.703). Conclusion The patterns of schizophrenia effects identified using clustering in two different data sets were reasonably similar. Results suggest the Mohr/Lenert health state model is potentially generalizable to other populations. PMID:27386054

  12. Epidemiology of Infant Meningococcal Disease in the United States, 2006–2012

    PubMed Central

    MacNeil, Jessica R.; Bennett, Nancy; Farley, Monica M.; Harrison, Lee H.; Lynfield, Ruth; Nichols, Megin; Petit, Sue; Reingold, Arthur; Schaffner, William; Thomas, Ann; Pondo, Tracy; Mayer, Leonard W.; Clark, Thomas A.; Cohn, Amanda C.

    2016-01-01

    BACKGROUND The incidence of meningococcal disease is currently at historic lows in the United States; however, incidence remains highest among infants aged <1 year. With routine use of Haemophilus influenzae type b and pneumococcal vaccines in infants and children in the United States, Neisseria meningitidis remains an important cause of bacterial meningitis in young children. METHODS Data were collected from active, population- and laboratory-based surveillance for N meningitidis conducted through Active Bacterial Core surveillance during 2006 through 2012. Expanded data collection forms were completed for infant cases identified in the surveillance area during 2006 through 2010. RESULTS An estimated 113 cases of culture-confirmed meningococcal disease occurred annually among infants aged <1 year in the United States from 2006 through 2012, for an overall incidence of 2.74 per 100 000 infants. Among these cases, an estimated 6 deaths occurred. Serogroup B was responsible for 64%, serogroup C for 12%, and serogroup Y for 16% of infant cases. Based on the expanded data collection forms, a high proportion of infant cases (36/58, 62%) had a smoker in the household and the socioeconomic status of the census tracts where infant meningococcal cases resided was lower compared with the other Active Bacterial Core surveillance areas and the United States as a whole. CONCLUSIONS The burden of meningococcal disease remains highest in young infants and serogroup B predominates. Vaccines that provide long-term protection early in life have the potential to reduce the burden of meningococcal disease, especially if they provide protection against serogroup B meningococcal disease. PMID:25583921

  13. [Preoperative evaluation of surgery for intractable aspiration based on the prognostic nutritional index].

    PubMed

    Uchida, Masaya; Hashimoto, Keiko; Mukudai, Shigeyuki; Ushijima, Chihisa; Dejima, Kenji

    2014-12-01

    Because there is no absolute indicator of the nutritional status and prognosis in patients with severe aspiration problems, it is quite difficult to arrive at a true long-time prognosis. By performing surgery for intractable aspiration on such patients, both the prognosis and QOL of the patients could be expected to improve. In our department, we have experienced patients dying within 6 months after surgery. In these cases, the patient's preoperative nutritional status was not good. Therefore, we consider that, when we adopt this procedure, there should be some indicators we should use which could have an effect on the prognosis of such nutritionally-challenged patients. In patients who underwent surgery for intractable aspiration; we examined the relationship between their survival and the prognostic nutritional index (PNI) which is an indicator of the risk of complications such as post-operative events in the surgical field. We investigated the relationship between the prognosis and the postoperative indicators of each of the following: WBC, CRP, serum albumin level, and PNI. Out of a total of 31 cases, the average O-PNI of eight cases in which death occurred was 29.45, and the average of six cases in which death occurred within 6 months after surgery was 28.26. The average O-PNI of the survivors was 36.01. A significant association was noted between the early postoperative deaths and some of the four indicators namely that serum albumin level and O-PNI. Based on the ROC curve, the O-PNI offered higher precision than the albumin level. The cut-off value of the O-PNI value for early postoperative mortality rate was 32. The early postoperative mortality rate was 44.4% in patients with less than 32 O-PNI in the preoperative examination, but if it were O-PNI 32 or more, the early postoperative mortality rate was 9.1%, significantly lower. Therefore, O-PNI could be useful as one of the prognostic evaluation factors in the case of preoperative surgery for intractable

  14. Intracerebroventricular Pain Treatment with Analgesic Mixtures including Ziconotide for Intractable Pain.

    PubMed

    Staquet, Héléne; Dupoiron, Denis; Nader, Edmond; Menei, Philippe

    2016-07-01

    Intracerebroventricular (ICV) administration of opioids for control of intractable cancer pain has been used since 1982. We present here our experience of intracerebroventricular administration of pain treatments including ziconotide associated with morphine and ropivacaine for patients resistant to a conventional approach, with nociceptive, neuropathic, or mixed pain. These clinical cases were conducted with patients suffering from refractory pain, more than 6/10 on a numerical pain rating scale (NPRS) while on high-dose medical treatment and/or intolerance with significant side effects from oral medication. The baseline study visit included a physical examination and an assessment of pain intensity on a NPRS. Under general anesthesia, a neuronavigation device was used to place the catheter on the floor of the third ventricle, supported by an endoscope. Then, drugs were injected in the cerebroventricular system, through a pump (external or subcutaneous). The primary objective was to measure pain evaluation with ICV treatment after a complete withdrawal of other medications.Four patients were enrolled: 3 with intractable cancer pain and one with central neuropathic pain. The median NPRS at baseline was 9.5 [8.5; 19]. The mean NPRS after one month was 3.5 [3; 4.5]. Ziconotide was initiated at 0.48 µg/d and up to a median of 1.2 µg/d [1.0; 1.56]. The median dose of morphine and ropivacaine used initially was respectively 0.36 mg/d [0.24; 0.66] up to 0.6 mg/d [0.45; 4.63] and 1.2 mg/d [0; 2.4] up to 2.23 mg/d [1.2; 3.35]. Minor side effects were initially observed but transiently. One psychiatric agitation required discontinuation of ziconotide infusion. For intractable pain, using ziconotide by intracerebroventricular infusion seems safe and efficient, specifically for chronic neoplastic pain of cervicocephalic, thoracic, or diffuse origin and also for pain arising from a central neuropathic mechanism. PMID:27454282

  15. Bupivacaine administered intrathecally versus rectally in the management of intractable rectal cancer pain in palliative care

    PubMed Central

    Zaporowska-Stachowiak, Iwona; Kowalski, Grzegorz; Łuczak, Jacek; Kosicka, Katarzyna; Kotlinska-Lemieszek, Aleksandra; Sopata, Maciej; Główka, Franciszek

    2014-01-01

    Background Unacceptable adverse effects, contraindications to and/or ineffectiveness of World Health Organization step III “pain ladder” drugs causes needless suffering among a population of cancer patients. Successful management of severe cancer pain may require invasive treatment. However, a patient’s refusal of an invasive procedure necessitates that clinicians consider alternative options. Objective Intrathecal bupivacaine delivery as a viable treatment of intractable pain is well documented. There are no data on rectal bupivacaine use in cancer patients or in the treatment of cancer tenesmoid pain. This study aims to demonstrate that bupivacaine administered rectally could be a step in between the current treatment options for intractable cancer pain (conventional/conservative analgesia or invasive procedures), and to evaluate the effect of the mode of administration (intrathecal versus rectal) on the bupivacaine plasma concentration. Cases We present two Caucasian, elderly inpatients admitted to hospice due to intractable rectal/tenesmoid pain. The first case is a female with vulvar cancer, and malignant infiltration of the rectum/vagina. Bupivacaine was used intrathecally (0.25–0.5%, 1–2 mL every 6 hours). The second case is a female with ovarian cancer and malignant rectal infiltration. Bupivacaine was adminstered rectally (0.05–0.1%, 100 mL every 4.5–11 hours). Methods Total bupivacaine plasma concentrations were determined using the high-performance liquid chromatography-ultraviolet method. Results Effective pain control was achieved with intrathecal bupivacaine (0.077–0.154 mg·kg−1) and bupivacaine in enema (1.820 mg·kg−1). Intrathecal bupivacaine (0.5%, 2 mL) caused a drop in blood pressure; other side effects were absent in both cases. Total plasma bupivacaine concentrations following intrathecal and rectal bupivacaine application did not exceed 317.2 ng·mL−1 and 235.7 ng·mL−1, respectively. Bupivacaine elimination was

  16. Historical Perspectives on the Epidemiology of Human Chagas Disease in Texas and Recommendations for Enhanced Understanding of Clinical Chagas Disease in the Southern United States

    PubMed Central

    Garcia, Melissa N.; Woc-Colburn, Laila; Aguilar, David; Hotez, Peter J.; Murray, Kristy O.

    2015-01-01

    Chagas disease (Trypanosoma cruzi infection) has recently been identified as an important neglected tropical disease in the United States. Anecdotally referred to as a “silent killer,” it leads to the development of potentially fatal cardiac disease in approximately 30% of those infected. In an attempt to better understand the potential of Chagas disease as a significant underlying cause of morbidity in Texas, we performed a historical literature review to assess disease burden. Human reports of triatomine bites and disease exposure were found to be prevalent in Texas. Despite current beliefs that Chagas disease is a recently emerging disease, we report historical references dating as far back as 1935. Both imported cases and autochthonous transmission contribute to the historical disease burden in Texas. We end by discussing the current knowledge gaps, and recommend priorities for advancing further epidemiologic studies and their policy implications. PMID:26540273

  17. Historical Perspectives on the Epidemiology of Human Chagas Disease in Texas and Recommendations for Enhanced Understanding of Clinical Chagas Disease in the Southern United States.

    PubMed

    Garcia, Melissa N; Woc-Colburn, Laila; Aguilar, David; Hotez, Peter J; Murray, Kristy O

    2015-11-01

    Chagas disease (Trypanosoma cruzi infection) has recently been identified as an important neglected tropical disease in the United States. Anecdotally referred to as a "silent killer," it leads to the development of potentially fatal cardiac disease in approximately 30% of those infected. In an attempt to better understand the potential of Chagas disease as a significant underlying cause of morbidity in Texas, we performed a historical literature review to assess disease burden. Human reports of triatomine bites and disease exposure were found to be prevalent in Texas. Despite current beliefs that Chagas disease is a recently emerging disease, we report historical references dating as far back as 1935. Both imported cases and autochthonous transmission contribute to the historical disease burden in Texas. We end by discussing the current knowledge gaps, and recommend priorities for advancing further epidemiologic studies and their policy implications.

  18. Influence of age and disease state in nonsteroidal antiinflammatory drug associated gastric bleeding.

    PubMed

    Llewellyn, J G; Pritchard, M H

    1988-04-01

    In our study of 552 acute admissions for gastrointestinal hemorrhage, 18% were found to be taking nonsteroidal antiinflammatory drugs (NSAID) at the time of the bleed; 49% of these were found at endoscopy to have a gastric or prepyloric lesion, compared with 20% of the non-NSAID control group. Prescription data was used to calculate the risk added by age and disease state to the NSAID associated bleeding. We found that patients with chronic inflammatory disease had 2-3 times the expected bleeding incidence, but while there was a definite trend towards an age related risk in older patients, this was not statistically significant.

  19. Assessment of Climate-sensitive Infectious Diseases in the Federated States of Micronesia

    PubMed Central

    McIver, Lachlan; Hashizume, Masahiro; Kim, Ho; Honda, Yasushi; Pretrick, Moses; Iddings, Steven; Pavlin, Boris

    2015-01-01

    Background: The health impacts of climate change are an issue of growing concern in the Pacific region. Prior to 2010, no formal, structured, evidence-based approach had been used to identify the most significant health risks posed by climate change in Pacific island countries. During 2010 and 2011, the World Health Organization supported the Federated States of Micronesia (FSM) in performing a climate change and health vulnerability and adaptation assessment. This paper summarizes the priority climate-sensitive health risks in FSM, with a focus on diarrheal disease, its link with climatic variables and the implications of climate change. Methods: The vulnerability and adaptation assessment process included a review of the literature, extensive stakeholder consultations, ranking of climate-sensitive health risks, and analysis of the available long-term data on climate and climate-sensitive infectious diseases in FSM, which involved examination of health information data from the four state hospitals in FSM between 2000 and 2010; along with each state’s rainfall, temperature and El Niño-Southern Oscillation data. Generalized linear Poisson regression models were used to demonstrate associations between monthly climate variables and cases of climate-sensitive diseases at differing temporal lags. Results: Infectious diseases were among the highest priority climate-sensitive health risks identified in FSM, particularly diarrheal diseases, vector-borne diseases and leptospirosis. Correlation with climate data demonstrated significant associations between monthly maximum temperature and monthly outpatient cases of diarrheal disease in Pohnpei and Kosrae at a lag of one month and 0 to 3 months, respectively; no such associations were observed in Chuuk or Yap. Significant correlations between disease incidence and El Niño-Southern Oscillation cycles were demonstrated in Kosrae state. Conclusions: Analysis of the available data demonstrated significant associations

  20. An evaluation of serum paraoxonase together with arylesterase activities and oxidative stress in children with intractable epilepsy: a cross-sectional study.

    PubMed

    Calik, Mustafa; Oguz, Elif; Sarikaya, Suna; Kocaturk, Ozcan; Koca, Bulent; Gungor, Hatice Eke; Aksoy, Nurten; Yoldas, Tahır Kurtulus; Iscan, Akin

    2014-11-01

    Epilepsy is the most common chronic neurological illness in childhood and adolescence. The aim of this study was to investigate paraoxonase and arylesterase activities along with oxidative status parameters in children with intractable epilepsy. The study comprised 42 subjects with intractable epilepsy and a control group of 35 healthy subjects. Serum paraoxonase and arylesterase activities, and lipid hydroperoxide levels were determined. All paraoxonase and arylesterase activities were significantly lower in the intractable epilepsy subjects than in the controls (P<0.001), whereas lipid hydroperoxide levels were significantly higher (P<0.05). In conclusion, paraoxonase and arylesterase activities were decreased and the lipid hydroperoxide level was increased in patients with intractable epilepsy. These results showed that intractable epilepsy subjects may be more prone to the development of atherosclerosis.

  1. The management and treatment of children with Fabry disease: A United States-based perspective.

    PubMed

    Hopkin, Robert J; Jefferies, John L; Laney, Dawn A; Lawson, Victoria H; Mauer, Michael; Taylor, Matthew R; Wilcox, William R

    2016-02-01

    Fabry disease is an inherited X-linked disorder that presents during childhood in male and female patients. Young patients may initially experience pain, hypohidrosis, and gastrointestinal symptoms. Other manifestations of Fabry disease, such as renal and cardiac disease, manifest later in adolescence or adulthood. In the pediatric population, renal damage is typically subclinical and identifiable only through biopsy. Specialists from the United States with expertise in Fabry disease convened during 2013-2014 in order to develop these consensus guidelines about the management and treatment of children with Fabry disease. The presence of symptoms in boys and girls of any age is an indication to begin therapy. Early treatment before the onset of potentially irreversible vital organ pathology is ideal. Asymptomatic children with Fabry mutations should be followed closely for the development of renal, cardiac, neurological, or gastrointestinal signs, symptoms, or laboratory changes, which would warrant treatment initiation. A comprehensive care plan should be implemented by the treating physicians to guide the management of children with Fabry disease. PMID:26546059

  2. Critical Care for Multiple Organ Failure Secondary to Ebola Virus Disease in the United States

    PubMed Central

    Sueblinvong, Viranuj; Johnson, Daniel W.; Weinstein, Gary L.; Connor, Michael J.; Crozier, Ian; Liddell, Allison M.; Franch, Harold A.; Wall, Bruce R.; Kalil, Andre C.; Feldman, Mark; Lisco, Steven J.; Sevransky, Jonathan E.

    2016-01-01

    Objective This report describes three patients with Ebola virus disease who were treated in the United States and developed for severe critical illness and multiple organ failure secondary to Ebola virus infection. The patients received mechanical ventilation, renal replacement therapy, invasive monitoring, vasopressor support, and investigational therapies for Ebola virus disease. Data Sources Patient medical records from three tertiary care centers (Emory University Hospital, University of Nebraska Medical Center, and Texas Health Presbyterian Dallas Hospital). Study Selection Not applicable. Data Extraction Not applicable. Data Synthesis Not applicable. Conclusion In the severe form, patients with Ebola virus disease may require life-sustaining therapy, including mechanical ventilation and renal replacement therapy. In conjunction with other reported cases, this series suggests that respiratory and renal failure may occur in severe Ebola virus disease, especially in patients burdened with high viral loads. Ebola virus disease complicated by multiple organ failure can be survivable with the application of advanced life support measures. This collective, multicenter experience is presented with the hope that it may inform future treatment of patients with Ebola virus disease requiring critical care treatment. PMID:26196353

  3. Perceptions of a changing world induce hope and promote peace in intractable conflicts.

    PubMed

    Cohen-Chen, Smadar; Crisp, Richard J; Halperin, Eran

    2015-04-01

    The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace.

  4. Pseudohypoparathyroidism type Ia manifesting as intractable epilepsy in a 23-year-old female

    PubMed Central

    Raghavan, Pooja; Katz, Charles M

    2012-01-01

    Pseudohypoparathyroidism is a rare disorder of calcium metabolism that involves target organ resistance to the action of the parathyroid hormone. As a result, calcium levels may become dangerously low, sometimes leading to seizures and other symptoms. We present a case of a 23-year-old Somalian female on antiepileptic therapy presenting with intractable epilepsy. She was subsequently found to have pseudohypoparathyroidism type Ia. She had multiple reasons accounting for loss of seizure control, including worsening hypocalcemia from resistance to the parathyroid hormone; vitamin D deficiency, which could have resulted from lack of exposure to direct sunlight and her antiepileptic medication; and extensive calcium deposition in the brain due to pseudohypoparathyroidism. The patient was stabilized with intravenous therapy and oral calcium, vitamin D, and calcitriol. Her antiepileptic therapy was changed to a medication that did not interfere with vitamin D metabolism or contribute to worsening hypocalcemia. PMID:23754923

  5. Perceptions of a Changing World Induce Hope and Promote Peace in Intractable Conflicts

    PubMed Central

    Cohen-Chen, Smadar; Crisp, Richard J.; Halperin, Eran

    2015-01-01

    The importance of hope in promoting conciliatory attitudes has been asserted in the field of conflict resolution. However, little is known about conditions inducing hope, especially in intractable conflicts, where reference to the outgroup may backfire. In the current research, five studies yielded convergent support for the hypothesis that hope for peace stems from a general perception of the world as changing. In Study 1, coders observed associations between belief in a changing world, hope regarding peace, and support for concessions. Study 2 revealed the hypothesized relations using self-reported measures. Studies 3 and 4 established causality by instilling a perception of the world as changing (vs. unchanging) using narrative and drawing manipulations. Study 5 compared the changing world message with a control condition during conflict escalation. Across studies, although the specific context was not referred to, the belief in a changing world increased support for concessions through hope for peace. PMID:25713171

  6. Sterilisation of Lucilia cuprina Wiedemann maggots used in therapy of intractable wounds.

    PubMed

    Mohd Masri, S; Nazni, W A; Lee, H L; T Rogayah, T A R; Subramaniam, S

    2005-12-01

    Three new techniques of sterilising maggots of Lucilia cuprina for the purpose of debriding intractable wounds were studied. These techniques were utilisation of ultra-violet C (UVC) and maggot sterilisation with disinfectants. The status of sterility was checked on nutrient agar and blood agar and confirmed with staining. The indicators for the effectiveness of the methods were sterility and survival rate of the eggs or larvae. Egg sterilisation with UVC had the lowest hatching rate (16+/-0.00%) while egg sterilisation with disinfectants showed high hatching rate (36.67+/-4.41%) but low maggot survival rate (31.67+/-1.67%). Sterilisation of the maggots was the most suitable, since the survival rate was the highest (88.67+/-0.88%). Complete sterility was achieved in all cases, except that Proteus mirabilis was consistently found. However, the presence of this microorganism was considered beneficial.

  7. Terlipressin as rescue therapy for intractable hypotension due to septic shock in children.

    PubMed

    Matok, Ilan; Vard, Amir; Efrati, Ori; Rubinshtein, Marina; Vishne, Tali; Leibovitch, Leah; Adam, Miriam; Barzilay, Zohar; Paret, Gideon

    2005-04-01

    Intractable hypotension due to septic shock is associated with high mortality rates in critically ill children worldwide. The use of terlipressin (triglycyl-lysine-vasopressin), an analog of vasopressin with a longer duration of action, recently emerged as a treatment of hypotension not responsive to vasopressors and inotropes. This was a retrospective study set in an 18-bed pediatric critical care department in a tertiary care children's hospital. We reviewed the files of all children with septic shock who were treated with terlipressin between January 2003 and February 2004. Fourteen children (mean age, 5.6 years; range, 4 days to 17.7 years) were treated with terlipressin in 16 septic shock episodes. Significant improvements in respiratory and hemodynamic indices were noted shortly after treatment. Mean arterial blood pressure increased significantly from 54 +/- 3 to 72 +/- 5 mmHg 10 min after terlipressin administration (P = 0.001). Heart rate decreased from 153.0 +/- 6.5 beats/min to 138.0 +/- 7.5 beats/min 12 h after treatment onset (P = 0.003). Epinephrine infusion was decreased or stopped in eight patients after terlipressin administration. Urine output increased from 1.6 +/- 0.5 mL/kg/h to 4.3 +/- 1.2 mL/kg/h 1 h after treatment onset (P = 0.011). PaO2 increased from 95.1 +/- 12.3 mmHg to 110.1 +/- 20.5 mmHg, and the oxygenation index decreased from 10.2 +/- 2.2 to 9.2 +/- 1.7. Terlipressin treatment of hypotension due to septic shock was successful in eight out of 16 episodes. Six of the 14 patients with poor prognosis for survival recovered. We conclude that terlipressin improves hemodynamic indices and renal function in critically ill children. Terlipressin should be considered as a rescue therapy in intractable shock not responsive to catecholamines in children.

  8. Management of intractable postpartum haemorrhage in a tertiary center: A 5-year experience

    PubMed Central

    Cengiz, Hüseyin; Yaşar, Levent; Ekin, Murat; Kaya, Cihan; Karakaş, Sema

    2012-01-01

    Background: The purpose of this study is to describe treatment alternatives to prevent postpartum hysterectomy after failure of conventional therapies. Prevention of hysterectomy was the main outcome studied. Materials and Methods: This is a retrospective study of 19 patients diagnosed to have intractable postpartum hemorrhage and not managed with medical treatment who were subsequently treated with operative interventions in our unit between January 2004 and January 2009. The cases were identified by review of medical records. Results: In the period under review, a total of 17,341 deliveries were conducted, out of which 19 women were managed for intractable PPH. The incidence of severe PPH unresponsive to standard medical treatment was 0.1%. The mean maternal age was 33.5±3.4 years (range 27–39 years). The mean gestational age was 38.3±1.3 weeks (range 37–41 weeks). Organ preserving surgery methods were utilized in all the patients with a success rate 78.9%. The mean duration of surgery was 95 minutes (range 50–130 minutes) and the mean hospital stay was for 5 days. The mean transfused blood volume was 2.4 units as packed red cells. Among these 19 cases, 4 cases were resorted to hysterectomy. Conclusions: In the presence of uncontrolled hemorrhage, this simple procedure should be tried before other complex treatment alternatives are undertaken. Our case series suggests that the combination of uterine artery ligation with B-Lynch sutures might be the best surgical approach because it preserves future fertility better than other methods and avoids high operative risks and morbidity. PMID:23271852

  9. Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette's syndrome

    PubMed Central

    Babel, T; Warnke, P; Ostertag, C

    2001-01-01

    OBJECTIVE—The surgical treatment of intractable Tourette's syndrome is controversial. Experience with 17 consecutive patients treated between 1970 and 1998 is reviewed and the efficacy and safety of surgical treatment is assessed.
METHODS—These patients were retrospectively reclassified into subtypes according to the protocol of the Tourette's Syndrome Study Group. One patient was excluded from the study. Ventriculography based stereotactic zona incerta (ZI) and ventrolateral/ lamella medialis thalamotomy (VL/LM) were performed on all patients. The preoperative, postoperative, and late tic severities were assessed by the tic severity rating scale. The median follow up of 11 patients (65%) was 7 years (range 3.5-17 years) and six patients were lost to long term follow up.
RESULTS—Median age was 23 years (range 11-40) at the time of surgery. Median duration of illness was 14 years (range 3-33). The mean preoperative motor and vocal tic severities were estimated to be 4.44 (SD 0.63) and 3.81 (SD 0.66), respectively. Unilateral ZI lesioning and VL/LM lesioning selected by asymmetry of symptoms provide an effective control of tic severity (p motor and vocal<0.001). In attenuation of contralateral symptoms, a second surgical intervention in the relevant side could reduce tic severity sufficiently (p motor<0.01; p vocal<0.005). Transient complications occurred in 68% of patients. Only one permanent complication was registered in six patients followed up after unilateral surgery. Two out of five patients followed up after bilateral surgery had disabling side effects of surgery.
CONCLUSIONS—ZI and VL/LM lesioning provide a significant long term reduction of tic severity in intractable Tourette's syndrome. Adequate selection of the side of first intervention might prevent the patient from increased risk of bilateral surgery.

 PMID:11309463

  10. Physical Feature Encoding and Word Recognition Abilities Are Altered in Children with Intractable Epilepsy: Preliminary Neuromagnetic Evidence

    PubMed Central

    Pardos, Maria; Korostenskaja, Milena; Xiang, Jing; Fujiwara, Hisako; Lee, Ki H.; Horn, Paul S.; Byars, Anna; Vannest, Jennifer; Wang, Yingying; Hemasilpin, Nat; Rose, Douglas F.

    2015-01-01

    Objective evaluation of language function is critical for children with intractable epilepsy under consideration for epilepsy surgery. The purpose of this preliminary study was to evaluate word recognition in children with intractable epilepsy by using magnetoencephalography (MEG). Ten children with intractable epilepsy (M/F 6/4, mean ± SD 13.4 ± 2.2 years) were matched on age and sex to healthy controls. Common nouns were presented simultaneously from visual and auditory sensory inputs in “match” and “mismatch” conditions. Neuromagnetic responses M1, M2, M3, M4, and M5 with latencies of ~100 ms, ~150 ms, ~250 ms, ~350 ms, and ~450 ms, respectively, elicited during the “match” condition were identified. Compared to healthy children, epilepsy patients had both significantly delayed latency of the M1 and reduced amplitudes of M3 and M5 responses. These results provide neurophysiologic evidence of altered word recognition in children with intractable epilepsy. PMID:26146459

  11. Insulin-resistant brain state: the culprit in sporadic Alzheimer's disease?

    PubMed

    Correia, Sónia C; Santos, Renato X; Perry, George; Zhu, Xiongwei; Moreira, Paula I; Smith, Mark A

    2011-04-01

    Severe abnormalities in brain glucose/energy metabolism and insulin signaling have been documented to take a pivotal role in early sporadic Alzheimer's disease (sAD) pathology. Indeed, the "insulin-resistant brain state" has been hypothesized to form the core of the neurodegenerative events that occur in sAD. In this vein, intracerebroventricular administration of subdiabetogenic doses of streptozotocin (STZ) in rats can induce an insulin-resistant brain state, which is proposed as a suitable experimental model of sAD. This review highlights the involvement of disturbed brain insulin metabolism in sAD etiopathogenesis. Furthermore, current knowledge demonstrates that central STZ administration produces brain pathology and behavioral changes that resemble changes found in sAD patients. The STZ-intracerebroventricularly treated rat represents a promising experimental tool in this field by providing new insights concerning early brain alterations in sAD, which can be translated in novel etiopathogenic and therapeutic approaches in this disease.

  12. The relationship between coagulation state and inflammatory bowel disease: current understanding and clinical implications.

    PubMed

    Koutroubakis, Ioannis E

    2015-04-01

    Inflammatory bowel disease (IBD) is associated with a hypercoagulable state and subsequently with an increased risk for venous thromboembolism (VTE). VTE in IBD is characterized by a high recurrence rate and is associated with the disease activity. Acquired endothelial dysfunction, abnormalities of platelets, activation of coagulation system and impaired fibrinolysis are the main changes in the coagulation state in IBD. The development of VTE in IBD has been considered to be the result of multiple interactions between acquired and inherited risk factors. The treatment of VTE in IBD patients is recommended to be similar and to follow the same protocols as for non-IBD patients. In the clinical practice, the management of IBD patients and especially the hospitalized patients should include thromboprophylaxis.

  13. 75 FR 19915 - Changes in Disease Status of the Brazilian State of Santa Catarina with Regard to Certain...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-16

    ... Animal and Plant Health Inspection Service 9 CFR Part 94 RIN 0579-AD12 Changes in Disease Status of the Brazilian State of Santa Catarina with Regard to Certain Ruminant and Swine Diseases AGENCY: Animal and... Santa Catarina to the list of regions we recognize as free of foot-and-mouth disease, rinderpest,...

  14. Human Risk of Infection with Borrelia burgdorferi, the Lyme Disease Agent, in Eastern United States

    PubMed Central

    Diuk-Wasser, Maria A.; Hoen, Anne Gatewood; Cislo, Paul; Brinkerhoff, Robert; Hamer, Sarah A.; Rowland, Michelle; Cortinas, Roberto; Vourc'h, Gwenaël; Melton, Forrest; Hickling, Graham J.; Tsao, Jean I.; Bunikis, Jonas; Barbour, Alan G.; Kitron, Uriel; Piesman, Joseph; Fish, Durland

    2012-01-01

    The geographic pattern of human risk for infection with Borrelia burgdorferi sensu stricto, the tick-borne pathogen that causes Lyme disease, was mapped for the eastern United States. The map is based on standardized field sampling in 304 sites of the density of Ixodes scapularis host-seeking nymphs infected with B. burgdorferi, which is closely associated with human infection risk. Risk factors for the presence and density of infected nymphs were used to model a continuous 8 km×8 km resolution predictive surface of human risk, including confidence intervals for each pixel. Discontinuous Lyme disease risk foci were identified in the Northeast and upper Midwest, with a transitional zone including sites with uninfected I. scapularis populations. Given frequent under- and over-diagnoses of Lyme disease, this map could act as a tool to guide surveillance, control, and prevention efforts and act as a baseline for studies tracking the spread of infection. PMID:22302869

  15. A Case Study Examination of Structure and Function in a State Health Department Chronic Disease Unit

    PubMed Central

    2015-01-01

    Objectives. I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. Methods. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Results. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Conclusions. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness. PMID:25689211

  16. International care models for chronic kidney disease: methods and economics--United States.

    PubMed

    Crooks, Peter

    2004-01-01

    In the United States, there is a major chronic kidney disease (CKD) problem with over 8 million adults having stage 3 or 4 CKD. There is good medical evidence that many of these patients can benefit from focused interventions. And while there are strong theoretical reasons to believe these interventions are cost-effective, there are little published data to back up this assertion. However, despite the lack of financial data proving cost-effectiveness and against the background of a disorganized health care system in the US, some models of CKD care are being employed. At the present time, the most comprehensive models of care in the US are emerging in vertically integrated health care programs. Other models of care are developing in the setting of managed care health plans that employ CKD disease management programs, either developed internally or in partnership with renal disease management companies.

  17. Human risk of infection with Borrelia burgdorferi, the Lyme disease agent, in eastern United States.

    PubMed

    Diuk-Wasser, Maria A; Hoen, Anne Gatewood; Cislo, Paul; Brinkerhoff, Robert; Hamer, Sarah A; Rowland, Michelle; Cortinas, Roberto; Vourc'h, Gwenaël; Melton, Forrest; Hickling, Graham J; Tsao, Jean I; Bunikis, Jonas; Barbour, Alan G; Kitron, Uriel; Piesman, Joseph; Fish, Durland

    2012-02-01

    The geographic pattern of human risk for infection with Borrelia burgdorferi sensu stricto, the tick-borne pathogen that causes Lyme disease, was mapped for the eastern United States. The map is based on standardized field sampling in 304 sites of the density of Ixodes scapularis host-seeking nymphs infected with B. burgdorferi, which is closely associated with human infection risk. Risk factors for the presence and density of infected nymphs were used to model a continuous 8 km×8 km resolution predictive surface of human risk, including confidence intervals for each pixel. Discontinuous Lyme disease risk foci were identified in the Northeast and upper Midwest, with a transitional zone including sites with uninfected I. scapularis populations. Given frequent under- and over-diagnoses of Lyme disease, this map could act as a tool to guide surveillance, control, and prevention efforts and act as a baseline for studies tracking the spread of infection.

  18. Zika Virus Disease in Travelers Returning to the United States, 2010-2014.

    PubMed

    Hennessey, Morgan J; Fischer, Marc; Panella, Amanda J; Kosoy, Olga I; Laven, Janeen J; Lanciotti, Robert S; Staples, J Erin

    2016-07-01

    Zika virus is an emerging mosquito-borne flavivirus that typically causes a mild febrile illness with rash, arthralgia, or conjunctivitis. Zika virus has recently caused large outbreaks of disease in southeast Asia, Pacific Ocean Islands, and the Americas. We identified all positive Zika virus test results performed at U.S. Centers for Disease Control and Prevention from 2010 to 2014. For persons with test results indicating a recent infection with Zika virus, we collected information on demographics, travel history, and clinical features. Eleven Zika virus disease cases were identified among travelers returning to the United States. The median age of cases was 50 years (range: 29-74 years) and six (55%) were male. Nine (82%) cases had their illness onset from January to April. All cases reported a travel history to islands in the Pacific Ocean during the days preceding illness onset, and all cases were potentially viremic while in the United States. Public health prevention messages about decreasing mosquito exposure, preventing sexual exposure, and preventing infection in pregnant women should be targeted to individuals traveling to or living in areas with Zika virus activity. Health-care providers and public health officials should be educated about the recognition, diagnosis, and prevention of Zika virus disease.

  19. West Nile Virus and Other Nationally Notifiable Arboviral Diseases - United States, 2014.

    PubMed

    Lindsey, Nicole P; Lehman, Jennifer A; Staples, J Erin; Fischer, Marc

    2015-09-01

    Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). However, several other arboviruses also cause sporadic cases and seasonal outbreaks. This report summarizes surveillance data reported to CDC in 2014 for WNV and other nationally notifiable arboviruses, excluding dengue. Forty-two states and the District of Columbia (DC) reported 2,205 cases of WNV disease. Of these, 1,347 (61%) were classified as WNV neuroinvasive disease (e.g., meningitis, encephalitis, or acute flaccid paralysis), for a national incidence of 0.42 cases per 100,000 population. After WNV, the next most commonly reported cause of arboviral disease was La Crosse virus (80 cases), followed by Jamestown Canyon virus (11), St. Louis encephalitis virus (10), Powassan virus (8), and Eastern equine encephalitis virus (8). WNV and other arboviruses cause serious illness in substantial numbers of persons each year. Maintaining surveillance programs is important to help direct prevention activities.

  20. Zika Virus Disease in Travelers Returning to the United States, 2010-2014.

    PubMed

    Hennessey, Morgan J; Fischer, Marc; Panella, Amanda J; Kosoy, Olga I; Laven, Janeen J; Lanciotti, Robert S; Staples, J Erin

    2016-07-01

    Zika virus is an emerging mosquito-borne flavivirus that typically causes a mild febrile illness with rash, arthralgia, or conjunctivitis. Zika virus has recently caused large outbreaks of disease in southeast Asia, Pacific Ocean Islands, and the Americas. We identified all positive Zika virus test results performed at U.S. Centers for Disease Control and Prevention from 2010 to 2014. For persons with test results indicating a recent infection with Zika virus, we collected information on demographics, travel history, and clinical features. Eleven Zika virus disease cases were identified among travelers returning to the United States. The median age of cases was 50 years (range: 29-74 years) and six (55%) were male. Nine (82%) cases had their illness onset from January to April. All cases reported a travel history to islands in the Pacific Ocean during the days preceding illness onset, and all cases were potentially viremic while in the United States. Public health prevention messages about decreasing mosquito exposure, preventing sexual exposure, and preventing infection in pregnant women should be targeted to individuals traveling to or living in areas with Zika virus activity. Health-care providers and public health officials should be educated about the recognition, diagnosis, and prevention of Zika virus disease. PMID:27139440

  1. Progression of the load of waterborne and intestinal parasitic diseases in the State of Amazonas.

    PubMed

    Martins, Marilaine; Lacerda, Marcus Vinícius Guimarães; Monteiro, Wuelton Marcelo; Moura, Marco Antonio Saboia; Santos, Eyde Cristianne Saraiva; Saraceni, Valéria; Saraiva, Maria Graças Gomes

    2015-01-01

    In the State of Amazonas, Brazil, urban expansion together with precarious basic sanitation conditions and human settlement on river banks has contributed to the persistence of waterborne and intestinal parasitic diseases. Time series of the recorded cases of cholera, typhoid fever, hepatitis A and leptospirosis are described, using data from different levels of the surveillance systems. The sources for intestinal parasitosis prevalence data (non-compulsory reporting in Brazil) were Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana (LILACS) and the annals of major scientific meetings. Relevant papers and abstracts in all languages were accessed by two independent reviewers. The references cited by each relevant paper were scrutinized to locate additional papers. Despite its initial dissemination across the entire State of Amazonas, cholera was controlled in 1998. The magnitude of typhoid fever has decreased; however, a pattern characterized by eventual outbreaks still remains. Leptospirosis is an increasing cause of concern in association with the annual floods. The overall prevalence of intestinal parasites is high regardless of the municipality and the characteristics of areas and populations. The incidence of hepatitis A has decreased over the past decade. A comparison of older and recent surveys shows that the prevalence of intestinal parasitic diseases has remained constant. The load of waterborne and intestinal parasitic diseases ranks high among the health problems present in the State of Amazonas. Interventions aiming at basic sanitation and vaccination for hepatitis A were formulated and implemented, but assessment of their effectiveness in the targeted populations is still needed.

  2. Importation of dogs into the United States: risks from rabies and other zoonotic diseases.

    PubMed

    McQuiston, J H; Wilson, T; Harris, S; Bacon, R M; Shapiro, S; Trevino, I; Sinclair, J; Galland, G; Marano, N

    2008-10-01

    The importation of dogs into the United States poses a risk for the introduction of rabies and other zoonotic diseases. Federal regulations (42 CFR 71.51) currently require proof of valid rabies vaccination for imported dogs, but allow the importation of some unvaccinated dogs, including dogs less than 3 months of age, provided certain requirements for confinement are met until the dog is vaccinated. Although there are no accurate surveillance data on the number of dogs imported each year, it is estimated based on extrapolated data that over 287,000 dogs were imported into the United States during 2006. Of these, approximately 25% were either too young to be vaccinated or lacked proof of valid rabies vaccination. Import trends suggest that an increasing number of unvaccinated puppies are being imported into the United States, many through commercial resale or rescue operations. Since 2004, foreign canine rabies virus variants have been documented in at least two imported puppies. Federal regulations are currently being reviewed by the Centers for Disease Control and Prevention to determine if they can be updated to address current import trends and disease risks, such as requiring a health screen and valid rabies vaccinations for all dogs prior to entry.

  3. Progression of the load of waterborne and intestinal parasitic diseases in the State of Amazonas.

    PubMed

    Martins, Marilaine; Lacerda, Marcus Vinícius Guimarães; Monteiro, Wuelton Marcelo; Moura, Marco Antonio Saboia; Santos, Eyde Cristianne Saraiva; Saraceni, Valéria; Saraiva, Maria Graças Gomes

    2015-01-01

    In the State of Amazonas, Brazil, urban expansion together with precarious basic sanitation conditions and human settlement on river banks has contributed to the persistence of waterborne and intestinal parasitic diseases. Time series of the recorded cases of cholera, typhoid fever, hepatitis A and leptospirosis are described, using data from different levels of the surveillance systems. The sources for intestinal parasitosis prevalence data (non-compulsory reporting in Brazil) were Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latino-Americana (LILACS) and the annals of major scientific meetings. Relevant papers and abstracts in all languages were accessed by two independent reviewers. The references cited by each relevant paper were scrutinized to locate additional papers. Despite its initial dissemination across the entire State of Amazonas, cholera was controlled in 1998. The magnitude of typhoid fever has decreased; however, a pattern characterized by eventual outbreaks still remains. Leptospirosis is an increasing cause of concern in association with the annual floods. The overall prevalence of intestinal parasites is high regardless of the municipality and the characteristics of areas and populations. The incidence of hepatitis A has decreased over the past decade. A comparison of older and recent surveys shows that the prevalence of intestinal parasitic diseases has remained constant. The load of waterborne and intestinal parasitic diseases ranks high among the health problems present in the State of Amazonas. Interventions aiming at basic sanitation and vaccination for hepatitis A were formulated and implemented, but assessment of their effectiveness in the targeted populations is still needed. PMID:26061370

  4. Identification of predictive biomarkers of disease state in transition dairy cows.

    PubMed

    Hailemariam, D; Mandal, R; Saleem, F; Dunn, S M; Wishart, D S; Ametaj, B N

    2014-05-01

    In dairy cows, periparturient disease states, such as metritis, mastitis, and laminitis, are leading to increasingly significant economic losses for the dairy industry. Treatments for these pathologies are often expensive, ineffective, or not cost-efficient, leading to production losses, high veterinary bills, or early culling of the cows. Early diagnosis or detection of these conditions before they manifest themselves could lower their incidence, level of morbidity, and the associated economic losses. In an effort to identify predictive biomarkers for postpartum or periparturient disease states in dairy cows, we undertook a cross-sectional and longitudinal metabolomics study to look at plasma metabolite levels of dairy cows during the transition period, before and after becoming ill with postpartum diseases. Specifically we employed a targeted quantitative metabolomics approach that uses direct flow injection mass spectrometry to track the metabolite changes in 120 different plasma metabolites. Blood plasma samples were collected from 12 dairy cows at 4 time points during the transition period (-4 and -1 wk before and 1 and 4 wk after parturition). Out of the 12 cows studied, 6 developed multiple periparturient disorders in the postcalving period, whereas the other 6 remained healthy during the entire experimental period. Multivariate data analysis (principal component analysis and partial least squares discriminant analysis) revealed a clear separation between healthy controls and diseased cows at all 4 time points. This analysis allowed us to identify several metabolites most responsible for separating the 2 groups, especially before parturition and the start of any postpartum disease. Three metabolites, carnitine, propionyl carnitine, and lysophosphatidylcholine acyl C14:0, were significantly elevated in diseased cows as compared with healthy controls as early as 4 wk before parturition, whereas 2 metabolites, phosphatidylcholine acyl-alkyl C42:4 and

  5. Infectious disease mortality among infants in the United States, 1983 through 1987.

    PubMed Central

    Read, J S; Troendle, J F; Klebanoff, M A

    1997-01-01

    OBJECTIVE: The purpose of this study was to determine the relative importance of infectious disease as a cause of infant mortality in the United States and to identify characteristics at birth associated with subsequent infectious disease mortality. METHODS: Birth and infant death certificate data from the National Center for Health Statistics (NCHS) 1983 through 1987 Linked Birth/ Infant Death Data Sets were analyzed. RESULTS: Infection was the underlying cause of death for over 16000 infants, representing the fourth leading cause of mortality in this cohort. Almost 90% of infectious disease deaths during infancy were due to noncongenital infections, and the majority of these deaths occurred during the postneonatal period. Low birthweight, preterm birth, and male gender were independently associated with postneonatal mortality due to noncongenital infection. CONCLUSIONS: NCHS should revise its classification system for causes of infant mortality to incorporate an "Infectious Diseases" category. Future research should be directed toward clarifying the low birthweight-infectious disease mortality relationship and determining the degree to which infection-related infant deaths might be prevented by existing vaccines or improved access to health care. Images FIGURE 3 PMID:9103096

  6. Prevalence of livestock diseases and their impact on livelihoods in Central Equatoria State, Southern Sudan.

    PubMed

    Malak, A K; Mpoke, L; Banak, J; Muriuki, S; Skilton, R A; Odongo, D; Sunter, J; Kiara, H

    2012-05-01

    A participatory epidemiological (PE) study was conducted in Kajo Keji and Yei Counties, Central Equatoria State, southern Sudan to assess the impact of livestock diseases on livelihoods. A serological survey of tick-borne diseases was conducted to supplement the PE study. PE data collection tools consisted primarily of focus group interviews and key informant interviews supplemented by observation. Information was collected on the social context, history and species of livestock kept. Constraints in livestock keeping were explored through description and probing. Proportional piling on the importance of different diseases and relative incidence scoring were also conducted. 243 sera were collected from cattle and tested for antibodies to Anaplasma marginale, Babesia bigemina, B. bovis, Theileria mutans and T. parva by ELISA. Additionally, 173 blood samples were collected for a PCR assay of T. parva. Livestock diseases were ranked as the most important constraint to livestock keeping. While East Coast fever was ranked as the most important disease in Kajo Keji, diarrhoea in small ruminants was reported as the most important disease in Yei. Serological analyses of the sera indicated that A. marginale, B. bigemina, T. mutans and T. parva were most prevalent. Prevalence of B. bovis was found to be low (4.0% and 7.4% in Kajo Keji and Yei, respectively). 35% of the samples screened with the T. parva p104 gene nested PCR assay were positive. The study concludes that while ECF is the most important disease in Kajo Keji, it was not the case in Yei. Additional epidemiological studies are proposed before control strategies are recommended. PMID:22244519

  7. Molecular Surveillance for Lymphoproliferative Disease Virus in Wild Turkeys (Meleagris gallopavo) from the Eastern United States.

    PubMed

    Thomas, Jesse M; Allison, Andrew B; Holmes, Edward C; Phillips, Jamie E; Bunting, Elizabeth M; Yabsley, Michael J; Brown, Justin D

    2015-01-01

    Lymphoproliferative disease virus (LPDV) is a poorly understood, oncogenic avian retrovirus of domestic turkeys that has historically been restricted to Europe and Israel. However, a recent study reported LPDV in multiple wild turkey diagnostic cases from throughout the eastern United States of America (USA). To better understand the distribution of LPDV in the eastern USA, we surveyed 1,164 reportedly asymptomatic hunter-harvested wild turkeys from 17 states for the presence of LPDV proviral DNA by PCR. In total, 564/1,164 (47%) turkeys were positive for LPDV. Wild turkeys from each state had a relatively high prevalence of LPDV, although statewide prevalence varied from 26 to 83%. Phylogenetic analysis revealed two major clades of LPDV in the USA, although one was at a low frequency suggesting restricted transmission, as well as significant clustering by state of isolation. To determine the best tissue to target for diagnostic purposes, liver, spleen, and bone marrow were tested from a subset of 15 hunter-harvested wild turkeys and 20 wild turkey diagnostic cases. Overall, bone marrow provided the highest level of detection for both hunter-harvested turkeys and diagnostic cases. The sensitivity of LPDV detection between tissues was not significantly different for diagnostic cases, but was for hunter-harvested birds. These results indicate that LPDV infection is common and widespread in wild turkey populations throughout the eastern USA, even without overt signs of disease.

  8. Molecular Surveillance for Lymphoproliferative Disease Virus in Wild Turkeys (Meleagris gallopavo) from the Eastern United States

    PubMed Central

    Thomas, Jesse M.; Allison, Andrew B.; Holmes, Edward C.; Phillips, Jamie E.; Bunting, Elizabeth M.; Yabsley, Michael J.; Brown, Justin D.

    2015-01-01

    Lymphoproliferative disease virus (LPDV) is a poorly understood, oncogenic avian retrovirus of domestic turkeys that has historically been restricted to Europe and Israel. However, a recent study reported LPDV in multiple wild turkey diagnostic cases from throughout the eastern United States of America (USA). To better understand the distribution of LPDV in the eastern USA, we surveyed 1,164 reportedly asymptomatic hunter-harvested wild turkeys from 17 states for the presence of LPDV proviral DNA by PCR. In total, 564/1,164 (47%) turkeys were positive for LPDV. Wild turkeys from each state had a relatively high prevalence of LPDV, although statewide prevalence varied from 26 to 83%. Phylogenetic analysis revealed two major clades of LPDV in the USA, although one was at a low frequency suggesting restricted transmission, as well as significant clustering by state of isolation. To determine the best tissue to target for diagnostic purposes, liver, spleen, and bone marrow were tested from a subset of 15 hunter-harvested wild turkeys and 20 wild turkey diagnostic cases. Overall, bone marrow provided the highest level of detection for both hunter-harvested turkeys and diagnostic cases. The sensitivity of LPDV detection between tissues was not significantly different for diagnostic cases, but was for hunter-harvested birds. These results indicate that LPDV infection is common and widespread in wild turkey populations throughout the eastern USA, even without overt signs of disease. PMID:25897755

  9. Addition of Multimodal Therapy to Standard Management of Steady State Sickle Cell Disease

    PubMed Central

    Ikefuna, Anthony; Duru, Augustine; Chukwu, Barth; Madu, Anazoeze; Nwagha, Theresa; Ocheni, Sunday; Ibegbulam, Obike; Emodi, Ifeoma; Anike, Uche; Nonyelu, Charles; Anigbo, Chukwudi; Agu, Kingsley; Ajuba, Ifeoma; Chukwura, Awele; Ugwu, Ogechukwu; Ololo, Uche

    2013-01-01

    Most people on folic acid to boost erythropoiesis and prophylactic antimicrobials, the standard management of steady state sickle cell disease (SCD), have unacceptable numbers of crises. The objective of this study was to evaluate the effects of adding multimodal therapy with potassium thiocyanate and omega-3 fatty acids to the standard management of steady state SCD. Pre- and post-treatment numbers of crises and other disease indices were compared in 16 HbSS individuals on folic acid and paludrine after 12 months of adding eicosapentaenoic acid 15 mg/kg/day, docosahexaenoic acid 10 mg/kg/day, and potassium thiocyanate 1-2 mL/day, each milliliter of which contained 250 mg of thiocyanate and 100 micrograms of iodine to prevent hypothyroidism: a possible side-effect due to competitive inhibition of the transport of iodide into the thyroid gland by thiocyanate. Median number of crises reduced from 3/yr to 1/yr (P < 0.0001). There was no evidence of impaired thyroid function. Plasma level of tri-iodothyronine improved (P < 0.0001). Steady state full blood count and bilirubin level did not change significantly. The findings suggest that addition of potassium thiocyanate and eicosapentaenoic and docosahexaenoic acids to standard management of steady state SCD reduces the number of crises. This observation needs to be evaluated in larger studies. PMID:24386573

  10. Addition of multimodal therapy to standard management of steady state sickle cell disease.

    PubMed

    Okpala, Iheanyi; Ezenwosu, Osita; Ikefuna, Anthony; Duru, Augustine; Chukwu, Barth; Madu, Anazoeze; Nwagha, Theresa; Ocheni, Sunday; Ibegbulam, Obike; Emodi, Ifeoma; Anike, Uche; Nonyelu, Charles; Anigbo, Chukwudi; Agu, Kingsley; Ajuba, Ifeoma; Chukwura, Awele; Ugwu, Ogechukwu; Ololo, Uche

    2013-01-01

    Most people on folic acid to boost erythropoiesis and prophylactic antimicrobials, the standard management of steady state sickle cell disease (SCD), have unacceptable numbers of crises. The objective of this study was to evaluate the effects of adding multimodal therapy with potassium thiocyanate and omega-3 fatty acids to the standard management of steady state SCD. Pre- and post-treatment numbers of crises and other disease indices were compared in 16 HbSS individuals on folic acid and paludrine after 12 months of adding eicosapentaenoic acid 15 mg/kg/day, docosahexaenoic acid 10 mg/kg/day, and potassium thiocyanate 1-2 mL/day, each milliliter of which contained 250 mg of thiocyanate and 100 micrograms of iodine to prevent hypothyroidism: a possible side-effect due to competitive inhibition of the transport of iodide into the thyroid gland by thiocyanate. Median number of crises reduced from 3/yr to 1/yr (P < 0.0001). There was no evidence of impaired thyroid function. Plasma level of tri-iodothyronine improved (P < 0.0001). Steady state full blood count and bilirubin level did not change significantly. The findings suggest that addition of potassium thiocyanate and eicosapentaenoic and docosahexaenoic acids to standard management of steady state SCD reduces the number of crises. This observation needs to be evaluated in larger studies.

  11. Rapid assessment of vectorborne diseases during the Midwest flood--United States, 1993.

    PubMed

    1994-07-01

    Heavy spring and summer rainfall during 1993 caused the most extensive flash and riverine flooding ever recorded in the upper midwestern United States. In portions of the flood region,* standing water provided large expanses of habitat capable of producing large populations of the mosquitoes Culex pipiens and Cx. tarsalis. These species can rapidly amplify transmission of the arboviruses that cause St. Louis encephalitis (SLE) and western equine encephalitis (WEE). Although information from state health departments in the disaster area indicated minimal SLE or WEE activity in the region before the flooding, large vector populations in certain areas following the flooding increased the potential for exposure of residents and emergency workers to arboviral infection. To determine the risk for arboviral disease in the disaster area, CDC, in collaboration with state and local health departments, conducted surveillance during August-September 1993. This report summarizes the results of the surveillance activity.

  12. The current and projected economic burden of Parkinson's disease in the United States.

    PubMed

    Kowal, Stacey L; Dall, Timothy M; Chakrabarti, Ritashree; Storm, Michael V; Jain, Anjali

    2013-03-01

    Parkinson's disease (PD), following Alzheimer's disease, is the second-most common neurodegenerative disorder in the United States. A lack of treatment options for changing the trajectory of disease progression, in combination with an increasing elderly population, portends a rising economic burden on patients and payers. This study combined information from nationally representative surveys to create a burden of PD model. The model estimates disease prevalence, excess healthcare use and medical costs, and nonmedical costs for each demographic group defined by age and sex. Estimated prevalence rates and costs were applied to the U.S. Census Bureau's 2010 to 2050 population data to estimate current and projected burden based on changing demographics. We estimate that approximately 630,000 people in the United States had diagnosed PD in 2010, with diagnosed prevalence likely to double by 2040. The national economic burden of PD exceeds $14.4 billion in 2010 (approximately $22,800 per patient). The population with PD incurred medical expenses of approximately $14 billion in 2010, $8.1 billion higher ($12,800 per capita) than expected for a similar population without PD. Indirect costs (e.g., reduced employment) are conservatively estimated at $6.3 billion (or close to $10,000 per person with PD). The burden of chronic conditions such as PD is projected to grow substantially over the next few decades as the size of the elderly population grows. Such projections give impetus to the need for innovative new treatments to prevent, delay onset, or alleviate symptoms of PD and other similar diseases.

  13. Surveillance for Waterborne Disease Outbreaks Associated with Drinking Water - United States, 2011-2012.

    PubMed

    Beer, Karlyn D; Gargano, Julia W; Roberts, Virginia A; Hill, Vincent R; Garrison, Laurel E; Kutty, Preeta K; Hilborn, Elizabeth D; Wade, Timothy J; Fullerton, Kathleen E; Yoder, Jonathan S

    2015-08-14

    Advances in water management and sanitation have substantially reduced waterborne disease in the United States, although outbreaks continue to occur. Public health agencies in the U.S. states and territories* report information on waterborne disease outbreaks to the CDC Waterborne Disease and Outbreak Surveillance System (http://www.cdc.gov/healthywater/surveillance/index.html). For 2011-2012, 32 drinking water-associated outbreaks were reported, accounting for at least 431 cases of illness, 102 hospitalizations, and 14 deaths. Legionella was responsible for 66% of outbreaks and 26% of illnesses, and viruses and non-Legionella bacteria together accounted for 16% of outbreaks and 53% of illnesses. The two most commonly identified deficiencies† leading to drinking water-associated outbreaks were Legionella in building plumbing§ systems (66%) and untreated groundwater (13%). Continued vigilance by public health, regulatory, and industry professionals to identify and correct deficiencies associated with building plumbing systems and groundwater systems could prevent most reported outbreaks and illnesses associated with drinking water systems.

  14. Effects of noise on a computational model for disease states of mood disorders

    NASA Astrophysics Data System (ADS)

    Tobias Huber, Martin; Krieg, Jürgen-Christian; Braun, Hans Albert; Moss, Frank

    2000-03-01

    Nonlinear dynamics are currently proposed to explain the progressive course of recurrent mood disorders starting with isolated episodes and ending with accelerated irregular (``chaotic") mood fluctuations. Such a low-dimensional disease model is attractive because of its principal accordance with biological disease models, i.e. the kindling and biological rhythms model. However, most natural systems are nonlinear and noisy and several studies in the neuro- and physical sciences have demonstrated interesting cooperative behaviors arising from interacting random and deterministic dynamics. Here, we consider the effects of noise on a recent neurodynamical model for the timecourse of affective disorders (Huber et al.: Biological Psychiatry 1999;46:256-262). We describe noise effects on temporal patterns and mean episode frequencies of various in computo disease states. Our simulations demonstrate that noise can cause unstructured randomness or can maximize periodic order. The frequency of episode occurence can increase with noise but it can also remain unaffected or even can decrease. We show further that noise can make visible bifurcations before they would normally occur under deterministic conditions and we quantify this behavior with a recently developed statistical method. All these effects depend critically on both, the dynamic state and the noise intensity. Implications for neurobiology and course of mood disorders are discussed.

  15. Electroencephalographic prodromal markers of dementia across conscious states in Parkinson's disease.

    PubMed

    Latreille, Véronique; Carrier, Julie; Gaudet-Fex, Benjamin; Rodrigues-Brazète, Jessica; Panisset, Michel; Chouinard, Sylvain; Postuma, Ronald B; Gagnon, Jean-François

    2016-04-01

    In Parkinson's disease, electroencephalographic abnormalities during wakefulness and non-rapid eye movement sleep (spindles) were found to be predictive biomarkers of dementia. Because rapid eye movement sleep is regulated by the cholinergic system, which shows early degeneration in Parkinson's disease with cognitive impairment, anomalies during this sleep stage might mirror dementia development. In this prospective study, we examined baseline electroencephalographic absolute spectral power across three states of consciousness (non-rapid eye movement sleep, rapid eye movement sleep, and wakefulness) in 68 non-demented patients with Parkinson's disease and 44 healthy controls. All participants underwent baseline polysomnographic recordings and a comprehensive neuropsychological assessment. Power spectral analyses were performed on standard frequency bands. Dominant occipital frequency during wakefulness and ratios of slow-to-fast frequencies during rapid eye movement sleep and wakefulness were also computed. At follow-up (an average 4.5 years after baseline), 18 patients with Parkinson's disease had developed dementia and 50 patients remained dementia-free. In rapid eye movement sleep, patients with Parkinson's disease who later developed dementia showed, at baseline, higher absolute power in delta and theta bands and a higher slowing ratio, especially in temporal, parietal, and occipital regions, compared to patients who remained dementia-free and controls. In non-rapid eye movement sleep, lower baseline sigma power in parietal cortical regions also predicted development of dementia. During wakefulness, patients with Parkinson's disease who later developed dementia showed lower dominant occipital frequency as well as higher delta and slowing ratio compared to patients who remained dementia-free and controls. At baseline, higher slowing ratios in temporo-occipital regions during rapid eye movement sleep were associated with poor performance on visuospatial tests in

  16. Vasopressin deficiency and vasodilatory state in end-stage liver disease

    PubMed Central

    Wagener, Gebhard; Kovalevskaya, Galina; Minhaz, Moury; Mattis, Fallon; Emond, Jean C.; Landry, Donald W.

    2010-01-01

    1. Objectives Relative vasopressin deficiency, a contributor to vasodilatory septic shock may also be a cause of the vasodilatory state in liver disease. This study assesses endogenous vasopressin levels in patients with liver disease and their hemodynamic response to exogenous vasopressin. 2. Design Prospective, observational study 3. Setting Single center, tertiary hospital 4. Participants Human subjects undergoing liver transplantation or major surgery 5. Interventions Vasopressin levels were measured in 28 patients with liver disease undergoing liver transplantation and 7 control patients with normal liver function. Additionally intravenous vasopressin was given to 20 liver transplant recipients and the hemodynamic response was observed. 6. Measurements and Main Results Patients with liver disease had significantly lower baseline vasopressin levels than controls (19.3 +/− 27.1 pg/mL versus 50.9 +/− 36.7 pg/mL, p=0.015). Patients with low vasopressin levels (• 20 pg/mL) were more likely to have low baseline mean blood pressure (• 80 mm Hg) than patients with high vasopressin levels (11 of 16 vs. 0 of 4, p=0.013). Systemic vascular resistance increased by 33% three minutes after intravenous vasopressin. Thirteen of 16 patients with low vasopressin levels compared to one of four patients with high vasopressin levels responded to exogenous vasopressin with an increase of mean blood pressure by more than 20% (p=0.028). 7. Conclusions Patients with liver disease have lower vasopressin levels than controls and respond with a brisk vasoconstrictor response to exogenous vasopressin. Relative endogenous vasopressin deficiency may therefore contribute to vasodilatory shock in liver disease similar to what has been observed in septic shock PMID:21126886

  17. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy.

    PubMed

    Wasade, Vibhangini S; Schultz, Lonni; Mohanarangan, Karthik; Gaddam, Aryamaan; Schwalb, Jason M; Spanaki-Varelas, Marianna

    2015-12-01

    Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable epilepsy. Most studies have demonstrated short-term seizure outcomes, usually for up to 5 years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term seizure and psychosocial outcomes in patients with intractable epilepsy on VNS therapy for more than 15 years. We identified patients who had VNS implantation for treatment of intractable epilepsy from 1997 to 2013 at our Comprehensive Epilepsy Program and gathered demographics including age at epilepsy onset and VNS implantation, epilepsy type, number of antiepilepsy drugs (AEDs) and seizure frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine patients' current seizure frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. Seizure outcomes were based on modified Engel classification (I: seizure-free/rare simple partial seizures; II: >90% seizure reduction (SR), III: 50-90% SR, IV: <50% SR; classes I to III (>50% SR)=favorable outcome). A total of 207 patients underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at epilepsy onset of 9.4 years (range: birth to 60 years). There were 35 (39%) patients with extratemporal epilepsy, 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) patients with an output current >2 mA and 14 (16%) with rapid cycling. Of the 80 patients with seizure frequency information, 16 (20%) had a modified Engel class I outcome, 14

  18. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy.

    PubMed

    Wasade, Vibhangini S; Schultz, Lonni; Mohanarangan, Karthik; Gaddam, Aryamaan; Schwalb, Jason M; Spanaki-Varelas, Marianna

    2015-12-01

    Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable epilepsy. Most studies have demonstrated short-term seizure outcomes, usually for up to 5 years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term seizure and psychosocial outcomes in patients with intractable epilepsy on VNS therapy for more than 15 years. We identified patients who had VNS implantation for treatment of intractable epilepsy from 1997 to 2013 at our Comprehensive Epilepsy Program and gathered demographics including age at epilepsy onset and VNS implantation, epilepsy type, number of antiepilepsy drugs (AEDs) and seizure frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine patients' current seizure frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. Seizure outcomes were based on modified Engel classification (I: seizure-free/rare simple partial seizures; II: >90% seizure reduction (SR), III: 50-90% SR, IV: <50% SR; classes I to III (>50% SR)=favorable outcome). A total of 207 patients underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at epilepsy onset of 9.4 years (range: birth to 60 years). There were 35 (39%) patients with extratemporal epilepsy, 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) patients with an output current >2 mA and 14 (16%) with rapid cycling. Of the 80 patients with seizure frequency information, 16 (20%) had a modified Engel class I outcome, 14

  19. State-of-the-Art Imaging of the Lung for Connective Tissue Disease (CTD).

    PubMed

    Ohno, Yoshiharu; Koyama, Hisanobu; Yoshikawa, Takeshi; Seki, Shinichiro

    2015-12-01

    Involvement of the respiratory system is common in connective tissue diseases (CTDs), and the resultant lung injury can affect every part of the lung: the pleura, alveoli, interstitium, vasculature, lymphatic tissue, and large and/or small airways. Most of the parenchymal manifestations of CTD are similar to those found in interstitial lung diseases (ILDs), especially idiopathic interstitial pneumonias, and can be classified using the same system. Although there is some overlap, each CTD is associated with a characteristic pattern of pulmonary involvement. For this reason, thin-section CT as well as pulmonary function tests and serum markers are utilized for diagnosis, disease severity assessment, and therapeutic efficacy evaluation of ILD associated with CTD. In addition, newly developed pulmonary magnetic resonance imaging (MRI) procedures have been recommended as useful alternative imaging options for patients with CTD. This review article will (1) address radiological findings for chest radiography and conventional or thin-section CT currently used for six major types of CTD, rheumatoid arthritis, scleroderma (progressive systemic sclerosis), polymyositis/dermatomyositis, systemic lupus erythematosus, Sjögren syndrome and mixed connective tissue disease; (2) briefly deal with radiation dose reduction for thin-section CT examination; and (3) discuss clinically applicable or state-of-the-art MR imaging for CTD patients.

  20. Systemic complement profiling in multiple sclerosis as a biomarker of disease state

    PubMed Central

    Ingram, G; Hakobyan, S; Hirst, CL; Harris, CL; Loveless, S; Mitchell, JP; Pickersgill, TP; Robertson, NP

    2012-01-01

    Background: There is increasing evidence of significant and dynamic systemic activation and upregulation of complement in multiple sclerosis (MS), which may contribute to disease pathogenesis. Objective: We aimed to investigate the pathological role of complement in MS and the potential role for complement profiling as a biomarker of MS disease state. Methods: Key components of the classical, alternative and terminal pathways of complement were measured in plasma and cerebrospinal fluid (CSF) of patients with MS in different clinical phases of disease and in matched controls. Results: Increased plasma levels of C3 (p<0.003), C4 (p<0.001), C4a (p<0.001), C1 inhibitor (p<0.001), and factor H (p<0.001), and reduced levels of C9 (p<0.001) were observed in MS patients compared with controls. Combined profiling of these analytes produced a statistical model with a predictive value of 97% for MS and 73% for clinical relapse when combined with selected demographic data. CSF-plasma correlations suggested that source of synthesis of these components was both systemic and central. Conclusion: These data provide further evidence of alterations in both local and systemic expression and activation of complement in MS and suggest that complement profiling may be informative as a biomarker of MS disease, although further work is needed to determine its use in distinguishing MS from its differential. PMID:22354735

  1. PREVALENCE OF CHAGAS DISEASE AMONG BLOOD DONOR CANDIDATES IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL.

    PubMed

    Lopes, Patrícia da Silva; Ramos, Eliezer Lucas Pires; Gómez-Hernández, César; Ferreira, Gabriela Lícia Santos; Rezende-Oliveira, Karine

    2015-12-01

    Despite public health campaigns and epidemiological surveillance activities, Chagas disease remains a major health problem in Latin America. According to data from the World Health Organization, there are approximately 7-8 million people infected with Trypanosoma cruzi worldwide, a large percentage of which in Latin America. This study aims to examine the serological profile of blood donors in blood banks of Hemominas hematology center, in the town of Ituiutaba, Minas Gerais State, Brazil. The study sample consisted of 53,941 blood donors, which were grouped according to gender and age. Sample collections were performed from January 1991 to December 2011, and 277 donors (0.5%) were considered serologically ineligible due to Chagas disease. Analysis of data showed no significant difference between genders. As for age, the highest proportion of ineligible donors was from 40 to 49 years (30%), and there was a positive correlation between increasing age and the percentage of patients seropositive for Chagas disease. Therefore, adopting strategies that allow the safe identification of donors with positive serology for Chagas disease is essential to reduce or eliminate indeterminate serological results.

  2. PREVALENCE OF CHAGAS DISEASE AMONG BLOOD DONOR CANDIDATES IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL.

    PubMed

    Lopes, Patrícia da Silva; Ramos, Eliezer Lucas Pires; Gómez-Hernández, César; Ferreira, Gabriela Lícia Santos; Rezende-Oliveira, Karine

    2015-12-01

    Despite public health campaigns and epidemiological surveillance activities, Chagas disease remains a major health problem in Latin America. According to data from the World Health Organization, there are approximately 7-8 million people infected with Trypanosoma cruzi worldwide, a large percentage of which in Latin America. This study aims to examine the serological profile of blood donors in blood banks of Hemominas hematology center, in the town of Ituiutaba, Minas Gerais State, Brazil. The study sample consisted of 53,941 blood donors, which were grouped according to gender and age. Sample collections were performed from January 1991 to December 2011, and 277 donors (0.5%) were considered serologically ineligible due to Chagas disease. Analysis of data showed no significant difference between genders. As for age, the highest proportion of ineligible donors was from 40 to 49 years (30%), and there was a positive correlation between increasing age and the percentage of patients seropositive for Chagas disease. Therefore, adopting strategies that allow the safe identification of donors with positive serology for Chagas disease is essential to reduce or eliminate indeterminate serological results. PMID:27049698

  3. PREVALENCE OF CHAGAS DISEASE AMONG BLOOD DONOR CANDIDATES IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL

    PubMed Central

    LOPES, Patrícia da Silva; RAMOS, Eliezer Lucas Pires; GÓMEZ-HERNÁNDEZ, César; FERREIRA, Gabriela Lícia Santos; REZENDE-OLIVEIRA, Karine

    2015-01-01

    Despite public health campaigns and epidemiological surveillance activities, Chagas disease remains a major health problem in Latin America. According to data from the World Health Organization, there are approximately 7-8 million people infected with Trypanosoma cruzi worldwide, a large percentage of which in Latin America. This study aims to examine the serological profile of blood donors in blood banks of Hemominas hematology center, in the town of Ituiutaba, Minas Gerais State, Brazil. The study sample consisted of 53,941 blood donors, which were grouped according to gender and age. Sample collections were performed from January 1991 to December 2011, and 277 donors (0.5%) were considered serologically ineligible due to Chagas disease. Analysis of data showed no significant difference between genders. As for age, the highest proportion of ineligible donors was from 40 to 49 years (30%), and there was a positive correlation between increasing age and the percentage of patients seropositive for Chagas disease. Therefore, adopting strategies that allow the safe identification of donors with positive serology for Chagas disease is essential to reduce or eliminate indeterminate serological results. PMID:27049698

  4. Resting-State Functional Connectivity in Patients with Long-Term Remission of Cushing's Disease

    PubMed Central

    van der Werff, Steven J A; Pannekoek, J Nienke; Andela, Cornelie D; Meijer, Onno C; van Buchem, Mark A; Rombouts, Serge A R B; van der Mast, Roos C; Biermasz, Nienke R; Pereira, Alberto M; van der Wee, Nic J A

    2015-01-01

    Glucocorticoid disturbance can be a cause of psychiatric symptoms. Cushing's disease represents a unique model for examining the effects of prolonged exposure to high levels of endogenous cortisol on the human brain as well as for examining the relation between these effects and psychiatric symptomatology. This study aimed to investigate resting-state functional connectivity (RSFC) of the limbic network, the default mode network (DMN), and the executive control network in patients with long-term remission of Cushing's disease. RSFC of these three networks of interest was compared between patients in remission of Cushing's disease (n=24; 4 male, mean age=44.96 years) and matched healthy controls (n=24; 4 male, mean age=46.5 years), using probabilistic independent component analysis to extract the networks and a dual regression method to compare both groups. Psychological and cognitive functioning was assessed with validated questionnaires and interviews. In comparison with controls, patients with remission of Cushing's disease showed an increased RSFC between the limbic network and the subgenual subregion of the anterior cingulate cortex (ACC) as well as an increased RSFC of the DMN in the left lateral occipital cortex. However, these findings were not associated with psychiatric symptoms in the patient group. Our data indicate that previous exposure to hypercortisolism is related to persisting changes in brain function. PMID:25652248

  5. Resting-State Functional Connectivity in Patients with Long-Term Remission of Cushing's Disease.

    PubMed

    van der Werff, Steven J A; Pannekoek, J Nienke; Andela, Cornelie D; Meijer, Onno C; van Buchem, Mark A; Rombouts, Serge A R B; van der Mast, Roos C; Biermasz, Nienke R; Pereira, Alberto M; van der Wee, Nic J A

    2015-07-01

    Glucocorticoid disturbance can be a cause of psychiatric symptoms. Cushing's disease represents a unique model for examining the effects of prolonged exposure to high levels of endogenous cortisol on the human brain as well as for examining the relation between these effects and psychiatric symptomatology. This study aimed to investigate resting-state functional connectivity (RSFC) of the limbic network, the default mode network (DMN), and the executive control network in patients with long-term remission of Cushing's disease. RSFC of these three networks of interest was compared between patients in remission of Cushing's disease (n=24; 4 male, mean age=44.96 years) and matched healthy controls (n=24; 4 male, mean age=46.5 years), using probabilistic independent component analysis to extract the networks and a dual regression method to compare both groups. Psychological and cognitive functioning was assessed with validated questionnaires and interviews. In comparison with controls, patients with remission of Cushing's disease showed an increased RSFC between the limbic network and the subgenual subregion of the anterior cingulate cortex (ACC) as well as an increased RSFC of the DMN in the left lateral occipital cortex. However, these findings were not associated with psychiatric symptoms in the patient group. Our data indicate that previous exposure to hypercortisolism is related to persisting changes in brain function.

  6. The burden of disease due to tuberculosis in the state of Santa Catarina, Brazil*, **

    PubMed Central

    Ferrer, Glênio César Nunes; da Silva, Rosemeri Maurici; Ferrer, Kelian Tenfen; Traebert, Jefferson

    2014-01-01

    OBJECTIVE: To estimate the burden of disease due to tuberculosis in the state of Santa Catarina, Brazil, in 2009. METHODS: This was an epidemiological study with an ecological design. Data on tuberculosis incidence and mortality were collected from specific Brazilian National Ministry of Health databases. The burden of disease due to tuberculosis was based on the calculation of disability-adjusted life years (DALYs). The DALYs were estimated by adding the years of life lost (YLLs) and years lived with disability (YLDs). Absolute values were transformed into rates per 100,000 population. The rates were calculated by gender, age group, and health care macroregion. RESULTS: The burden of disease due to tuberculosis was 5,644.27 DALYs (92.25 DALYs/100,000 population), YLLs and YLDs respectively accounting for 78.77% and 21.23% of that total. The highest rates were found in males in the 30-44 and 45-59 year age brackets, although that was not true in every health care macroregion. Overall, the highest estimated burden was in the Planalto Norte macroregion (179.56 DALYs/100,000 population), followed by the Nordeste macroregion (167.07 DALYs/100,000 population). CONCLUSIONS: In the majority of the health care macroregions of Santa Catarina, the burden of disease due to tuberculosis was concentrated in adult males, the level of that concentration varying among the various macroregions. PMID:24626271

  7. Ebola virus disease: What clinicians in the United States need to know

    PubMed Central

    Fischer, William A.; Uyeki, Timothy M.; Tauxe, Robert V.

    2015-01-01

    In March 2014 the World Health Organization was notified of an outbreak of Ebola virus disease (EVD) in the forest region of Guinea. Over the subsequent 8 months, this outbreak has become the most devastating Ebola epidemic in history with 21,296 infections and 8,429 deaths. The recent introduction of Ebola into noncontiguous countries including the United States from infected travelers highlights the importance of preparedness of all healthcare providers. Early identification and rapid isolation of patients suspected of being infected with Ebola virus is critical to limiting the spread of this virus. Additionally, enhanced understanding of Ebola case definitions, clinical presentation, treatment and infection control strategies will improve the ability of healthcare providers to safe care for patients with Ebola virus disease. PMID:26116335

  8. Self, cortical midline structures and the resting state: Implications for Alzheimer's disease.

    PubMed

    Weiler, Marina; Northoff, Georg; Damasceno, Benito Pereira; Balthazar, Marcio Luiz Figueredo

    2016-09-01

    Different aspects of the self have been reported to be affected in many neurological or psychiatric diseases such as Alzheimer's disease (AD), including mainly higher-level cognitive self-unawareness. This higher sense of self-awareness is most likely related to and dependent on episodic memory, due to the proper integration of ourselves in time, with a permanent conservation of ourselves (i.e., sense of continuity across time). Reviewing studies in this field, our objective is thus to raise possible explanations, especially with the help of neuroimaging studies, for where such self-awareness deficits originate in AD patients. We describe not only episodic (and autobiographical memory) impairment in patients, but also the important role of cortical midline structures, the Default Mode Network, and the resting state (intrinsic brain activity) for the processing of self-related information.

  9. FIRST REPORT OF ACUTE CHAGAS DISEASE BY VECTOR TRANSMISSION IN RIO DE JANEIRO STATE, BRAZIL

    PubMed Central

    SANGENIS, Luiz Henrique Conde; DE SOUSA, Andréa Silvestre; SPERANDIO DA SILVA, Gilberto Marcelo; XAVIER, Sérgio Salles; MACHADO, Carolina Romero Cardoso; BRASIL, Patrícia; DE CASTRO, Liane; DA SILVA, Sidnei; GEORG, Ingebourg; SARAIVA, Roberto Magalhães; do BRASIL, Pedro Emmanuel Alvarenga Americano; HASSLOCHER-MORENO, Alejandro Marcel

    2015-01-01

    SUMMARY Chagas disease (CD) is an endemic anthropozoonosis from Latin America of which the main means of transmission is the contact of skin lesions or mucosa with the feces of triatomine bugs infected by Trypanosoma cruzi. In this article, we describe the first acute CD case acquired by vector transmission in the Rio de Janeiro State and confirmed by parasitological, serological and PCR tests. The patient presented acute cardiomyopathy and pericardial effusion without cardiac tamponade. Together with fever and malaise, a 3 cm wide erythematous, non-pruritic, papule compatible with a "chagoma" was found on his left wrist. This case report draws attention to the possible transmission of CD by non-domiciled native vectors in non-endemic areas. Therefore, acute CD should be included in the diagnostic workout of febrile diseases and acute myopericarditis in Rio de Janeiro. PMID:26422165

  10. Self, cortical midline structures and the resting state: Implications for Alzheimer's disease.

    PubMed

    Weiler, Marina; Northoff, Georg; Damasceno, Benito Pereira; Balthazar, Marcio Luiz Figueredo

    2016-09-01

    Different aspects of the self have been reported to be affected in many neurological or psychiatric diseases such as Alzheimer's disease (AD), including mainly higher-level cognitive self-unawareness. This higher sense of self-awareness is most likely related to and dependent on episodic memory, due to the proper integration of ourselves in time, with a permanent conservation of ourselves (i.e., sense of continuity across time). Reviewing studies in this field, our objective is thus to raise possible explanations, especially with the help of neuroimaging studies, for where such self-awareness deficits originate in AD patients. We describe not only episodic (and autobiographical memory) impairment in patients, but also the important role of cortical midline structures, the Default Mode Network, and the resting state (intrinsic brain activity) for the processing of self-related information. PMID:27235083

  11. Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

    PubMed Central

    Sista, Akhilesh K.; Vedantham, Suresh; Kaufman, John A.

    2015-01-01

    The societal and individual burden caused by acute and chronic lower extremity venous disease is considerable. In the past several decades, minimally invasive endovascular interventions have been developed to reduce thrombus burden in the setting of acute deep venous thrombosis to prevent both short- and long-term morbidity and to recanalize chronically occluded or stenosed postthrombotic or nonthrombotic veins in symptomatic patients. This state-of-the-art review provides an overview of the techniques and challenges, rationale, patient selection criteria, complications, postinterventional care, and outcomes data for endovascular intervention in the setting of acute and chronic lower extremity deep venous disease. Online supplemental material is available for this article. © RSNA, 2015 PMID:26101920

  12. Regulation of hepatic ABCC transporters by xenobiotics and in disease states

    PubMed Central

    Gu, Xinsheng; Manautou, Jose E.

    2015-01-01

    The subfamily of ABCC transporters consists of 13 members in mammals, including the multidrug resistance-associated proteins (MRPs), sulfonylurea receptors (SURs), and the cystic fibrosis transmembrane conductance regulator (CFTR). These proteins play roles in chemical detoxification, disposition, and normal cell physiology. ABCC transporters are expressed differentially in the liver and are regulated at the transcription and translation level. Their expression and function are also controlled by post-translational modification and membrane-trafficking events. These processes are tightly regulated. Information about alterations in the expression of hepatobiliary ABCC transporters could provide important insights into the pathogenesis of diseases and disposition of xenobiotics. In this review, we describe the regulation of hepatic ABCC transporters in humans and rodents by a variety of xenobiotics, under disease states and in genetically modified animal models deficient in transcription factors, transporters, and cell-signaling molecules. PMID:20233023

  13. [On the Differential Diagnosis of Intractable Psychogenic Chronic Cough: Neuropathic Larynx Irritable - Gabapentin's Antitussive Action].

    PubMed

    Bonnet, U; Ossowski, A; Schubert, M; Gall, H; Steinkamp, I; Richter, L E; Khalil-Boutros, Y; Nefedev, A; Kuhlmann, R

    2015-10-01

    We present the case of a 76 year old female inpatient who suffered from a chronic intractable cough which arose simultaneously to a severe major depression and was secondary to an exorbitant psychological distress. Chronic cough had never been experienced before and was initially considered to have a mere psychogenic origin since a comprehensive and guideline-based diagnostic screening did not reveal any underlying somatic cause. However, several factors cast doubt on the solitary psychic genesis of the chronic cough: i) occurrence immediately after a penetrant cold, ii) embedding in other complaints of laryngeal hyperreagibility (larynx irritable), such as persistent globus pharyngeus sensation, throat clearing and episodic dysphonia, iii) first occurrence on old life, iv) erupting from sleep as well, v) persistence despite remission of the major depression, and v) no sustaining benefit from specific psychotherapy and speech therapy. Therefore, diagnostics were extended to apparative tools for objective evaluation of swallowing by using fiberoptic videoendoscopic (FEES) and videofluoroscopic (VFS) techniques, which revealed signs of laryngeal neuropathy but without evidence of penetration or aspiration. A co-existing small goiter and an impaired glucose tolerance along with a putative intracellular vitamin B12 or folate deficiency (as indirectly derived from an apparent hyperhomocysteinemia) were assumed to be responsible for the neuropathy and underwent specific treatments. The impaired glucose tolerance and putative vitamin deficit were compatible with a distal symmetric sensorimotoric, even subclinical polyneuropathy of the lower extremities. The larynx irritable improved under gabapentin being confirmed by drug removals several times, and finally calmed down almost completely under gabapentin, which was in line with the scant literature of this topic. Re-examination of the larynx per FEES nine months later showed no deficits any more under the well

  14. Kinetics of drug action in disease states: towards physiology-based pharmacodynamic (PBPD) models.

    PubMed

    Danhof, Meindert

    2015-10-01

    Gerhard Levy started his investigations on the "Kinetics of Drug Action in Disease States" in the fall of 1980. The objective of his research was to study inter-individual variation in pharmacodynamics. To this end, theoretical concepts and experimental approaches were introduced, which enabled assessment of the changes in pharmacodynamics per se, while excluding or accounting for the cofounding effects of concomitant changes in pharmacokinetics. These concepts were applied in several studies. The results, which were published in 45 papers in the years 1984-1994, showed considerable variation in pharmacodynamics. These initial studies on kinetics of drug action in disease states triggered further experimental research on the relations between pharmacokinetics and pharmacodynamics. Together with the concepts in Levy's earlier publications "Kinetics of Pharmacologic Effects" (Clin Pharmacol Ther 7(3): 362-372, 1966) and "Kinetics of pharmacologic effects in man: the anticoagulant action of warfarin" (Clin Pharmacol Ther 10(1): 22-35, 1969), they form a significant impulse to the development of physiology-based pharmacodynamic (PBPD) modeling as novel discipline in the pharmaceutical sciences. This paper reviews Levy's research on the "Kinetics of Drug Action in Disease States". Next it addresses the significance of his research for the evolution of PBPD modeling as a scientific discipline. PBPD models contain specific expressions to characterize in a strictly quantitative manner processes on the causal path between exposure (in terms of concentration at the target site) and the drug effect (in terms of the change in biological function). Pertinent processes on the causal path are: (1) target site distribution, (2) target binding and activation and (3) transduction and homeostatic feedback.

  15. Predicting Falls in Parkinson Disease: What Is the Value of Instrumented Testing in OFF Medication State?

    PubMed Central

    Hoskovcová, Martina; Dušek, Petr; Sieger, Tomáš; Brožová, Hana; Zárubová, Kateřina; Bezdíček, Ondřej; Šprdlík, Otakar; Jech, Robert; Štochl, Jan; Roth, Jan; Růžička, Evžen

    2015-01-01

    Background Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The objective of this prospective study was to investigate clinical and instrumented tests of balance and gait in both OFF and ON medication states and to verify their utility in the prediction of future falls in PD patients. Methods Forty-five patients with idiopathic PD were examined in defined OFF and ON medication states within one examination day including PD-specific clinical tests, instrumented Timed Up and Go test (iTUG) and computerized dynamic posturography. The same gait and balance tests were performed in 22 control subjects of comparable age and sex. Participants were then followed-up for 6 months using monthly fall diaries and phone calls. Results During the follow-up period, 27/45 PD patients and 4/22 control subjects fell one or more times. Previous falls, fear of falling, more severe motor impairment in the OFF state, higher PD stage, more pronounced depressive symptoms, higher daily levodopa dose and stride time variability in the OFF state were significant risk factors for future falls in PD patients. Increased stride time variability in the OFF state in combination with faster walking cadence appears to be the most significant predictor of future falls, superior to clinical predictors. Conclusion Incorporating instrumented gait measures into the baseline assessment battery as well as accounting for both OFF and ON medication states might improve future fall prediction in PD patients. However, instrumented testing in the OFF state is not routinely performed in clinical practice and has not been used in the development of fall prevention programs in PD. New assessment methods for daylong monitoring of gait, balance and falls are thus required to more effectively address the risk of falling in PD patients. PMID:26443998

  16. Widening Geographical Disparities in Cardiovascular Disease Mortality in the United States, 1969-2011

    PubMed Central

    Singh, Gopal K.; Azuine, Romuladus E.; Siahpush, Mohammad; Williams, Shanita D.

    2015-01-01

    Objectives: This study examined trends in geographical disparities in cardiovascular-disease (CVD) mortality in the United States between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate regional, state, and county-level disparities in CVD mortality over time. Log-linear, weighted least squares, and Cox regression were used to analyze mortality trends and differentials. Results: During 1969-2011, CVD mortality rates declined fastest in New England and Mid-Atlantic regions and slowest in the Southeast and Southwestern regions. In 1969, the mortality rate was 9% higher in the Southeast than in New England, but the differential increased to 48% in 2011. In 2011, Southeastern states, Mississippi and Alabama, had the highest CVD mortality rates, nearly twice the rates for Minnesota and Hawaii. Controlling for individual-level covariates reduced state differentials. State- and county-level differentials in CVD mortality rates widened over time as geographical disparity in CVD mortality increased by 50% between 1969 and 2011. Area deprivation, smoking, obesity, physical inactivity, diabetes prevalence, urbanization, lack of health insurance, and lower access to primary medical care were all significant predictors of county-level CVD mortality rates and accounted for 52.7% of the county variance. Conclusions and Global Health Implications: Although CVD mortality has declined for all geographical areas in the United States, geographical disparity has widened over time as certain regions and states, particularly those in the South, have lagged behind in mortality reduction. Geographical disparities in CVD mortality reflect inequalities in socioeconomic conditions and behavioral risk factors. With the global CVD burden on the rise, monitoring geographical disparities, particularly in low- and middle-income countries, could indicate the extent to which reductions in CVD mortality are achievable and may

  17. End state renal disease among Native Americans, 1983-86.

    PubMed Central

    Newman, J M; Marfin, A A; Eggers, P W; Helgerson, S D

    1990-01-01

    We used data reported to Medicare from 1983 through 1986 to determine the incidence of end-stage renal disease (ESRD) among Native Americans and Whites in the United States. The 1,075 Native American cases represented an annual incidence, age-adjusted to the White population, of 269 per million, 2.8 times the rate for Whites. Fifty-six percent of Native American cases and 27 percent of the White cases were attributed to diabetes, indicating that ESRD is a major problem. Diabetes control provides the greatest opportunity for prevention. PMID:2305914

  18. Clinical care of two patients with Ebola virus disease in the United States.

    PubMed

    Lyon, G Marshall; Mehta, Aneesh K; Varkey, Jay B; Brantly, Kent; Plyler, Lance; McElroy, Anita K; Kraft, Colleen S; Towner, Jonathan S; Spiropoulou, Christina; Ströher, Ute; Uyeki, Timothy M; Ribner, Bruce S

    2014-12-18

    West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients' condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma.

  19. Mortality from Circulatory System Diseases and Malformations in Children in the State of Rio de Janeiro

    PubMed Central

    Salim, Thais Rocha; Soares, Gabriel Porto; Klein, Carlos Henrique; de Oliveira, Glaucia Maria Moraes

    2016-01-01

    Background The epidemiological profile of mortality in a population is important for the institution of measures to improve health care and reduce mortality Objective To estimate mortality rates and the proportional mortality from cardiovascular diseases and malformations of the circulatory system in children and adolescents. Methods This is a descriptive study of mortality from cardiovascular diseases, malformations of the circulatory system, from all causes, ill-defined causes and external causes in children and adolescents in the state of Rio de Janeiro from 1996 to 2012. Populations were obtained from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE) and deaths obtained from the Department of Informatics of the Unified Health System (DATASUS)/Ministry of Health. Results There were 115,728 deaths from all causes, 69,757 in males. The annual mortality from cardiovascular diseases was 2.7/100,000 in men and 2.6/100,000 in women. The annual mortality from malformations of the circulatory system was 7.5/100,000 in men and 6.6/100,000 in women. Among the specific causes of circulatory diseases, cardiomyopathies had the highest rates of annual proportional mortality, and from malformations of the circulatory system, it occurred due to unspecified malformations of the circulatory system, at all ages and in both genders. Conclusion Mortality from malformations of the circulatory system was most striking in the first years of life, while cardiovascular diseases were more relevant in adolescents. Low access to prenatal diagnosis or at birth probably prevented the proper treatment of malformations of the circulatory system. PMID:27192384

  20. Pathogens and diseases of freshwater mussels in the United States: Studies on bacterial transmission and depuration

    USGS Publications Warehouse

    Starliper, Clifford E.; Cipriano, R.C.; Bruckner, A.W.; Shchelkunov, I.S.

    2011-01-01

    Unionid mussels are recognized as important contributors to healthy aquatic ecosystems, as well as bioindicators of environmental perturbations. Because they are sedentary, filter feeding animals and require hosts (i.e., fishes) to transform embryonic glochidia, mussels are susceptible to direct adverse environmental parameters, and indirect parameters that restrict the timely presence of the host(s). Their numbers have declined in recent decades to a point that this fauna is regarded as one of the most imperiled in North America. The most significant threat to populations of native unionids in recent years has been the introduction and spread of zebra mussels Dreissena polymorpha. Many federal and state agencies, and private interests are now engaged in mussel conservation efforts, including collecting selected imperiled species from impacted rivers and lakes and propagating them at refuges for future population augmentations. One essential consideration with mussel propagation and their intensive culture at refugia is the prevention of pathogen introductions and control of diseases. Currently, there are few reports of etiological agents causing diseases among freshwater mussels; however, because of increased observations of mussel die-offs in conjunction with transfers of live animals between natural waters and refugia, disease problems can be anticipated to emerge. This review summarizes research to develop bacterial isolation techniques, study pathogen transmission between fish and mussels, identify causes of seasonal mussel die-offs, and develop non-destructive methods for pathogen detection. These efforts were done to develop disease preventative techniques for use by resource managers to avoid potential large-scale disease problems in restoration and population augmentation efforts among imperiled populations.

  1. [RELATIONSHIP BETWEEN THE PREVALENCE OF CHRONIC NONINFECTIOUS DISEASES AND ELECTROPHYSICAL STATE OF THE ENVIRONMENT].

    PubMed

    Rakhmanin, Yu A; Stekhin, A A; Yakovleva, G V; Karasev, A K; Marasanov, A V; Iksanova, T I; Ryabikov, V V

    2015-01-01

    In the paper there is evaluated the relationship of features of electronic state of the environment with a level of chronic, noninfectious diseases (CNID) in the regions of Russia, obtained on the basis of the monitoring measurements of the intensity of natural background electronic Bose condensate (BEBC) of natural ecosystems in a number of Russian regions and seas of the Arctic Ocean. The assessment of BEBC was implemented on results of measurements of redox state of distilled water being in the contact with natural water. The equilibrium redox state of distilled water, determined by the influx of electrons (quantum reduction) outside, is proportional to the intensity of BEBC. The obtained data attest to an increase in the intensity of the background of EBC in Siberia regions and, especially, within the limits ofwaters of Lake Baikal (the redox potential of the surface water in the lake ~ -70mV). Also there is observed a strong dependence of the background EBC in the latitudinal direction. Low levels of background EBC were noted in the Arkhangelsk region and the north-eastern Chukotka. Functioning of international systems of plasma sounding of ionosphere (such systems as HAARP) were established to have a detrimental effect on the background EBC in these regions. According to the results of measurements of the relative values of intensities of natural background of Bose condensate of electrons there was constructed the dependence reflecting the relationship of the prevalence of noninfectious diseases in the regions of Russia with the redox state of distilled water which can be characterized as a significant (regression coefficient R2 = 0.78). The relationship between noninfectious diseases (NID, %) with the intensity of the background of EBC (Ib rel. units) is estimated by the equation: NID [%] = 0.24Eh [mV]-25, where Eh ~ I/Ib. Numerical evaluations show that an increase in the biosphere redox potential of water by 90mV leads to an increase of the primary

  2. Ultrasound-guided pulsed radiofrequency ablation of the genital branch of the genitofemoral nerve for treatment of intractable orchalgia

    PubMed Central

    Terkawi, Abdullah Sulieman; Romdhane, Kamel

    2014-01-01

    Chronic orchalgia is a frustrating clinical problem for both the patient and the physician. We present a 17-year-old boy with a bilateral idiopathic chronic intractable orchalgia with failed conservative treatment. For 2 years, he suffered from severe attacks of scrotal pain that affected his daily activities and caused frequent absence from school. Ultrasound-guided pulsed radiofrequency ablation (PRF) of the genital branches of the genitofemoral nerve performed after local anesthetic nerve block confirmed the diagnosis and yielded 6 weeks of symptom relief. Seven-month follow-up revealed complete satisfactory analgesia. The use of PRF is an effective and non-invasive approach to treat intractable chronic orchalgia. PMID:24843352

  3. Regional Differences in the Association Between Land Cover and West Nile Virus Disease Incidence in Humans in the United States

    PubMed Central

    Bowden, Sarah E.; Magori, Krisztian; Drake, John M.

    2011-01-01

    West Nile virus (WNV) is generally considered to be an urban pathogen in the United States, but studies associating land cover and disease incidence, seroprevalence, or infection rate in humans, birds, domesticated and wild mammals, and mosquitoes report varying and sometimes contradictory results at an array of spatial extents. Human infection can provide insight about basic transmission activity; therefore, we analyzed data on the incidence of WNV disease in humans to obtain a comprehensive picture of how human disease and land cover type are associated across the United States. Human WNV disease incidence in Northeastern regions was positively associated with urban land covers, whereas incidence in the Western United States was positively associated with agricultural land covers. We suggest that these regional associations are explained by the geographic distributions of prominent WNV vectors: Culex pipiens complex (including Cx. pipiens and Cx. quinquefasciatus) in the Northeast and Cx. tarsalis in the Western United States. PMID:21292890

  4. Regional differences in the association between land cover and West Nile virus disease incidence in humans in the United States.

    PubMed

    Bowden, Sarah E; Magori, Krisztian; Drake, John M

    2011-02-01

    West Nile virus (WNV) is generally considered to be an urban pathogen in the United States, but studies associating land cover and disease incidence, seroprevalence, or infection rate in humans, birds, domesticated and wild mammals, and mosquitoes report varying and sometimes contradictory results at an array of spatial extents. Human infection can provide insight about basic transmission activity; therefore, we analyzed data on the incidence of WNV disease in humans to obtain a comprehensive picture of how human disease and land cover type are associated across the United States. Human WNV disease incidence in Northeastern regions was positively associated with urban land covers, whereas incidence in the Western United States was positively associated with agricultural land covers. We suggest that these regional associations are explained by the geographic distributions of prominent WNV vectors: Culex pipiens complex (including Cx. pipiens and Cx. quinquefasciatus) in the Northeast and Cx. tarsalis in the Western United States.

  5. Amoeba-inspired nanoarchitectonic computing: solving intractable computational problems using nanoscale photoexcitation transfer dynamics.

    PubMed

    Aono, Masashi; Naruse, Makoto; Kim, Song-Ju; Wakabayashi, Masamitsu; Hori, Hirokazu; Ohtsu, Motoichi; Hara, Masahiko

    2013-06-18

    Biologically inspired computing devices and architectures are expected to overcome the limitations of conventional technologies in terms of solving computationally demanding problems, adapting to complex environments, reducing energy consumption, and so on. We previously demonstrated that a primitive single-celled amoeba (a plasmodial slime mold), which exhibits complex spatiotemporal oscillatory dynamics and sophisticated computing capabilities, can be used to search for a solution to a very hard combinatorial optimization problem. We successfully extracted the essential spatiotemporal dynamics by which the amoeba solves the problem. This amoeba-inspired computing paradigm can be implemented by various physical systems that exhibit suitable spatiotemporal dynamics resembling the amoeba's problem-solving process. In this Article, we demonstrate that photoexcitation transfer phenomena in certain quantum nanostructures mediated by optical near-field interactions generate the amoebalike spatiotemporal dynamics and can be used to solve the satisfiability problem (SAT), which is the problem of judging whether a given logical proposition (a Boolean formula) is self-consistent. SAT is related to diverse application problems in artificial intelligence, information security, and bioinformatics and is a crucially important nondeterministic polynomial time (NP)-complete problem, which is believed to become intractable for conventional digital computers when the problem size increases. We show that our amoeba-inspired computing paradigm dramatically outperforms a conventional stochastic search method. These results indicate the potential for developing highly versatile nanoarchitectonic computers that realize powerful solution searching with low energy consumption.

  6. Role of cortisol in mood and memory in patients with intractable temporal lobe epilepsy

    PubMed Central

    Frazier, T.; Chapin, J.S.; Hamrahian, A.H.; Diehl, B.; Alexopoulos, A.; Unnwongse, K.; Naugle, R.I.; Kubu, C.S.; Tesar, G.E.; Najm, I.M.

    2012-01-01

    Objective: This study prospectively examined the relationships among late night salivary cortisol (NSC) levels and depressive symptoms, memory performance, and hippocampal volumes in patients with medically intractable temporal lobe epilepsy (TLE) and the potential mediating effects of cortisol in the relationships between these variables. Methods: Participants included 24 adults with well-characterized medically refractory TLE (right = 11; left = 12; bitemporal = 1). All patients provided saliva samples and completed measures of mood, anxiety, and memory (objective and subjective). MRI-based volumetric analyses of the hippocampi were also conducted. Results: As hypothesized, cortisol was found to be negatively related to several memory measures such that patients with higher cortisol levels demonstrated lower memory performance. However, unexpectedly, cortisol was not related to current symptoms of depression or anxiety, subjective memory ratings, or hippocampal volumes. Consistent with previous findings in the literature, a number of other relationships among the study variables were observed (objective memory and hippocampal volume; subjective memory and mood/anxiety). Results of mediator analyses suggested that cortisol does not mediate the relationship between depression and memory dysfunction or the relationship between depression and hippocampal atrophy. Conclusions: While cortisol may play a role in memory performance in patients with TLE, it does not fully explain the relationship between depression and mesial temporal dysfunction, likely reflecting the complex and multifactorial relationships among these variables. Results confirm the relationship between memory performance and structural brain integrity and provide further support for a role of depression in subjective memory complaints. PMID:22442430

  7. Supernumerary tricentric derivative chromosome 15 in two boys with intractable epilepsy: another mechanism for partial hexasomy.

    PubMed

    Mann, S M; Wang, N J; Liu, D H; Wang, L; Schultz, R A; Dorrani, N; Sigman, M; Schanen, N C

    2004-07-01

    Rearrangements of chromosome 15q, including isodicentric 15 chromosomes and interstitial duplications and triplications, have been previously reported in association with autism spectrum disorders. We have identified two boys with exceptionally large der(15) chromosomes that are tricentric and contain four copies of the proximal long arm, including the Prader Willi/Angelman critical region, and leading to hexasomy of the involved segment. Biallelic inheritance of maternal alleles and methylation analysis indicate that the markers are maternally derived. Clinical assessment of the boys indicated severe cognitive impairment associated with marked delays in gross and fine motor skills. Social and language deficits were present in both, although the severity of the mental retardation precluded diagnosis of autism (both were considered to have pervasive developmental disorder-not otherwise specified). Neurologic manifestations included infantile spasms evolving into intractable early-onset myoclonic seizures, psychomotor regression, and profound diffuse hypotonia. These patients represent the most severe end of the spectrum of phenotypes associated with segmental aneuploidy for chromosome 15q11-q13.

  8. Amoeba-inspired nanoarchitectonic computing: solving intractable computational problems using nanoscale photoexcitation transfer dynamics.

    PubMed

    Aono, Masashi; Naruse, Makoto; Kim, Song-Ju; Wakabayashi, Masamitsu; Hori, Hirokazu; Ohtsu, Motoichi; Hara, Masahiko

    2013-06-18

    Biologically inspired computing devices and architectures are expected to overcome the limitations of conventional technologies in terms of solving computationally demanding problems, adapting to complex environments, reducing energy consumption, and so on. We previously demonstrated that a primitive single-celled amoeba (a plasmodial slime mold), which exhibits complex spatiotemporal oscillatory dynamics and sophisticated computing capabilities, can be used to search for a solution to a very hard combinatorial optimization problem. We successfully extracted the essential spatiotemporal dynamics by which the amoeba solves the problem. This amoeba-inspired computing paradigm can be implemented by various physical systems that exhibit suitable spatiotemporal dynamics resembling the amoeba's problem-solving process. In this Article, we demonstrate that photoexcitation transfer phenomena in certain quantum nanostructures mediated by optical near-field interactions generate the amoebalike spatiotemporal dynamics and can be used to solve the satisfiability problem (SAT), which is the problem of judging whether a given logical proposition (a Boolean formula) is self-consistent. SAT is related to diverse application problems in artificial intelligence, information security, and bioinformatics and is a crucially important nondeterministic polynomial time (NP)-complete problem, which is believed to become intractable for conventional digital computers when the problem size increases. We show that our amoeba-inspired computing paradigm dramatically outperforms a conventional stochastic search method. These results indicate the potential for developing highly versatile nanoarchitectonic computers that realize powerful solution searching with low energy consumption. PMID:23565603

  9. Radiofrequency catheter ablation of intractable ventricular tachycardia in an infant following arterial switch operation.

    PubMed

    Costello, John P; He, Dingchao; Greene, Elizabeth A; Berul, Charles I; Moak, Jeffrey P; Nath, Dilip S

    2014-01-01

    A full-term male neonate presented with cyanosis upon delivery and was subsequently diagnosed with d-transposition of the great arteries, ventricular septal defect, and restrictive atrial septal defect. Following initiation of intravenous prostaglandins and balloon atrial septostomy, an arterial switch operation was performed on day 3 of life. The postoperative course was complicated by intractable ventricular tachycardia that was refractory to lidocaine, amiodarone, esmolol, fosphenytoin, and mexiletine drug therapy. Ventricular tachycardia was suppressed with overdrive atrial pacing but recurred upon discontinuation. Seven weeks postoperatively, radiofrequency catheter ablation was performed due to hemodynamically compromising persistent ventricular tachycardia refractory to medical therapy. The ventricular tachycardia was localized to the inferior-lateral right ventricular outlet septum. The procedure was successful without complications or recurrence. Antiarrhythmics were discontinued after the ablation procedure. Seven days after the ablation, a different, slower fascicular rhythm was noted to compete with the infant's sinus rhythm. This was consistent with the preablation amiodarone having reached subtherapeutic levels given its very long half-life. The patient was restarted on oral beta blockers and amiodarone. The patient was subsequently discharged home in predominantly sinus rhythm with intermittent fascicular rhythm. PMID:23647934

  10. Modified Atkins diet to children and adolescents with medical intractable epilepsy.

    PubMed

    Weber, Susanne; Mølgaard, Christian; Karentaudorf; Uldall, Peter

    2009-05-01

    The aim of the present study was to evaluate the tolerability and efficacy of the modified Atkins diet given to children and adolescents with antiepileptic drug (AED) treatment resistant epilepsy. 15 children with medically intractable epilepsy were enrolled in the study. Inclusion criteria were at least one seizure a week and a trial of at least two AEDs without obtaining seizure freedom documented in a seizure calendar. At baseline subjects initiated a diet with carbohydrates restricted to make up 10 energy percent. If seizures were reduced by less than 50% after 7-14 days carbohydrates were further restricted to 10g per day. No change in AED treatment was allowed. The diet was well tolerated. After 3 months six out of the fifteen children (40%) had a seizure reduction of more than 50%, which was seen in different epileptic syndromes and different age groups. The responders reported an increase in quality of life and cognition. At 12 months follow-up 3 (20%) continued the diet with an unchanged marked seizure reduction. The present study confirms the high tolerability and effect of the modified Atkins diet on seizure control in AED treatment resistant epilepsy. Further larger prospective studies are however needed to confirm these results.

  11. Tactile Electrosurgical Ablation: A Technique for the Treatment of Intractable Heavy and Prolonged Menstrual Bleeding

    PubMed Central

    El Saman, Ali M.; AbdelHafez, Faten F.; Zahran, Kamal M.; Saad, Hazem; Khalaf, Mohamed; Hussein, Mostafa; Hassanin, Ibrahim M. A.; Shugaa Al Deen, Saba M.

    2015-01-01

    Objective. To study the efficacy and safety of tactile electrosurgical ablation (TEA) in stopping a persistent attack of abnormal uterine bleeding not responding to medical and hormonal therapy. Methods. This is a case series of 19 cases with intractable abnormal uterine bleeding, who underwent TEA at the Women's Health Center of Assiut University. The outcomes measured were; patient's acceptability, operative time, complications, menstrual outcomes, and reintervention. Results. None of the 19 counseled cases refused the TEA procedure which took 6–10 minutes without intraoperative complications. The procedure was successful in the immediate cessation of bleeding in 18 out of 19 cases. During the 24-month follow-up period, 9 cases developed amenorrhea, 5 had scanty menstrual bleeding, 3 were regularly menstruating, 1 case underwent repeat TEA ablation, and one underwent a hysterectomy. Conclusions. TEA represents a safe, inexpensive, and successful method for management of uterine bleeding emergencies with additional long-term beneficial effects. However, more studies with more cases and longer follow-up periods are warranted. PMID:26294969

  12. Packing of renal fossa: useful technique for intractable bleeding after open pyelolithotomy surgery.

    PubMed

    Malhotra, Mohinder Kumar; Malhotra, Suchitra

    2012-01-01

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU) is also described in trauma but not in controlling bleeding after open pyelolithotomy. This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications. PMID:24027393

  13. Packing of Renal Fossa: Useful Technique for Intractable Bleeding after Open Pyelolithotomy Surgery

    PubMed Central

    Malhotra, Mohinder Kumar; Malhotra, Suchitra

    2012-01-01

    There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone surgery in peripheral hospitals. Several studies have shown the usefulness of temporary packing to control bleeding in liver injuries and following open heart operations. Packing of the renal fossa with laparotomy pads in unstable patients, and transferring the patient to the surgical intensive care unit (ICU) is also described in trauma but not in controlling bleeding after open pyelolithotomy. This study comprises of three such patients whose kidneys were salvaged by a simple procedure of temporary packing of renal fossa for period of 24-48 hours who had developed life threatening haemorrhage after open pyelolithotomy. This technique is simple and worth trying especially for surgeons who are contemplating nephrectomy as prolonged packing has not lead to any compromise in renal functions. The aim of this manuscript is very limited and clear. Packing is not a licence to carry out open pyelolithotomy without proper expertise and local backup or resources. Principles of safe and ethical surgical practice should never be violated as it can lead to medico legal complications. PMID:24027393

  14. Surgical Outcomes after Total Colectomy with Ileorectal Anastomosis in Patients with Medically Intractable Slow Transit Constipation

    PubMed Central

    Sohn, Guiyun; Kim, Chan Wook; Kwak, Jae Young; Jang, Tae Young; Kim, Kyung Ho; Yang, Song Soo; Yoon, Yong Sik; Lim, Seok-Byung; Kim, Jin Cheon

    2011-01-01

    Purpose The aim of this study was to evaluate outcomes of a total colectomy with ileorectal anastomosis in patients with slow transit constipation. Methods A retrospective review of 37 consecutive patients with slow transit constipation who underwent a total colectomy between 1994 and 2008 was undertaken. Preoperative and postoperative Wexner's constipation scores were collected and used to evaluate the outcomes after surgical treatment. Also patients' postoperative satisfaction scores were collected using a 4-point scale. Results The 37 patients consisted of 31 women and 6 men, with a median age of 41 years (range, 17 to 71 years). Pre- and post-operative Wexner's scores were collected from 33 patients (89.1%), and the mean preoperative Wexner's score was 19.3 (range, 11 to 24), which decreased to an average post-operative score of 2.3 (range, 0 to 8). Neither intraoperative complications nor postoperative mortalities were noted. Five patients (13.5%) had early postoperative complications, and the most common complication was postoperative ileus (10.8%). Seven patients (18.9%) had late postoperative complications, and postoperative ileus (10.8%) was also the most common. Twenty seven of 33 patients were satisfied with their surgical outcome (81.8%). Conclusion A total colectomy with ileorectal anastomosis might be an effective surgical procedure with acceptable morbidity to treat medically intractable slow transit constipation. PMID:21980588

  15. Combining stereo-electroencephalography and subdural electrodes in the diagnosis and treatment of medically intractable epilepsy.

    PubMed

    Enatsu, Rei; Bulacio, Juan; Najm, Imad; Wyllie, Elaine; So, Norman K; Nair, Dileep R; Foldvary-Schaefer, Nancy; Bingaman, William; Gonzalez-Martinez, Jorge

    2014-08-01

    Stereo-electroencephalography (SEEG) has advantages for exploring deeper epileptic foci. Nevertheless, SEEG can only sample isolated cortical areas and its spatial limitation, with the inability to record contiguous cortical regions, may cause difficulties in interpretation. In light of these limitations, the authors describe the hybrid technique of SEEG and subdural strip electrode placement. The hybrid technique was used for a presurgical evaluation in four patients with intractable epilepsy. Initially, the depth electrodes were inserted with a robotic stereotactic system. Thereafter, a skin incision and a small craniectomy were performed at the entry point of the strip electrode trajectory. The dura was opened and, under live fluoroscopic guidance, strip electrodes were slid into the subdural space. In these patients, the additional subdural strip electrodes provided (1) information regarding the precise description of seizure spread in the cortical surface adjacent to the subdural space, (2) identification of epileptogenic zones located near the crown, (3) more precise definition of functional cortex and (4) a better delineation of the interface between epileptogenic zones and functional cortex. This hybrid technique provides additional data compared to either technique alone, offering superior understanding of the dynamics of the epileptic activity and its interaction with functional cortical areas.

  16. Altered expression of neuropeptide Y receptors caused by focal cortical dysplasia in human intractable epilepsy

    PubMed Central

    Luo, Hanjiang; Guan, Yuguang; Zhou, Jian; Qi, Xueling; Li, Tianfu; Xu, Zhiqing David; Luan, Guo-Ming

    2016-01-01

    Focal cortical dysplasia (FCD) is a common cause of pharmacologically-intractable epilepsy, however, the precise mechanisms underlying the epileptogenicity of FCD remains to be determined. Neuropeptide Y (NPY), an endogenous anticonvulsant in the central nervous system, plays an important role in the regulation of neuronal excitability. Increased expression of NPY and its receptors has been identified in the hippocampus of patients with mesial temporal lobe epilepsy, presumed to act as an endogenous anticonvulsant mechanism. Therefore, we investigated whether expression changes in NPY receptors occurs in patients with FCD. We specifically investigated the expression of seizure-related NPY receptor subtypes Y1, Y2, and Y5 in patients with FCD versus autopsy controls. We found that Y1R and Y2R were up-regulated at the mRNA and protein levels in the temporal and frontal lobes in FCD lesions. By contrast, there was no significant change in either receptor detected in parietal lesions. Notably, overexpression of Y5R was consistently observed in all FCD lesions. Our results demonstrate the altered expression of Y1R, Y2R and Y5R occurs in FCD lesions within the temporal, frontal and parietal lobe. Abnormal NPY receptor subtype expression may be associated with the onset and progression of epileptic activity and may act as a therapeutic candidate for the treatment of refractory epilepsy caused by FCD. PMID:26943580

  17. The transition between immune and disease states in a cellular automaton model of clonal immune response

    NASA Astrophysics Data System (ADS)

    Bezzi, Michele; Celada, Franco; Ruffo, Stefano; Seiden, Philip E.

    1997-02-01

    In this paper we extend the Celada-Seiden (CS) model of the humoral immune response to include infections virus and killer T cells (cellular response). The model represents molecules and cells with bitstrings. The response of the system to virus involves a competition between the ability of the virus to kill the host cells and the host's ability to eliminate the virus. We find two basins of attraction in the dynamics of this system, one is identified with disease and the other with the immune state. There is also an oscillating state that exists on the border of these two stable states. Fluctuations in the population of virus or antibody can end the oscillation and drive the system into one of the stable states. The introduction of mechanisms of cross-regulation between the two responses can bias the system towards one of them. We also study a mean field model, based on coupled maps, to investigate virus-like infections. This simple model reproduces the attractors for average populations observed in the cellular automaton. All the dynamical behavior connected to spatial extension is lost, as is the oscillating feature. Thus the mean field approximation introduced with coupled maps destroys oscillations.

  18. Cat-Scratch Disease in the United States, 2005–2013

    PubMed Central

    Saha, Shubhayu; Mead, Paul S.

    2016-01-01

    Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005–2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5–9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50–64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children. PMID:27648778

  19. Cat-Scratch Disease in the United States, 2005-2013.

    PubMed

    Nelson, Christina A; Saha, Shubhayu; Mead, Paul S

    2016-10-01

    Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5-9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50-64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children. PMID:27648778

  20. Cat-Scratch Disease in the United States, 2005-2013.

    PubMed

    Nelson, Christina A; Saha, Shubhayu; Mead, Paul S

    2016-10-01

    Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005-2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5-9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50-64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children.

  1. Review of the 2012 Epizootic Hemorrhagic Disease Outbreak in Domestic Ruminants in the United States.

    PubMed

    Stevens, G; McCluskey, B; King, A; O'Hearn, E; Mayr, G

    2015-01-01

    An unusually large number of cases of Epizootic hemorrhagic disease (EHD) were observed in United States cattle and white-tailed deer in the summer and fall of 2012. USDA APHIS Veterinary Services area offices were asked to report on foreign animal disease investigations and state diagnostic laboratory submissions which resulted in a diagnosis of EHD based on positive PCR results. EHD was reported in the following species: cattle (129 herds), captive white-tailed deer (65 herds), bison (8 herds), yak (6 herds), elk (1 herd), and sheep (1 flock). A majority of the cases in cattle and bison were found in Nebraska, South Dakota, and Iowa. The majority of cases in captive white-tailed deer were found in Ohio, Iowa, Michigan, and Missouri. The most common clinical sign observed in the cattle and bison herds was oral lesions. The major observation in captive white-tailed deer herds was death. Average within-herd morbidity was 7% in cattle and bison herds, and 46% in captive white-tailed deer herds. The average within-herd mortality in captive white-tailed deer herds was 42%. PMID:26244773

  2. Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States

    PubMed Central

    Phadke, Varun K.; Bednarczyk, Robert A.; Salmon, Daniel A.; Omer, Saad B.

    2016-01-01

    IMPORTANCE Parents hesitant to vaccinate their children may delay routine immunizations or seek exemptions from state vaccine mandates. Recent outbreaks of vaccine-preventable diseases in the United States have drawn attention to this phenomenon. Improved understanding of the association between vaccine refusal and the epidemiology of these diseases is needed. OBJECTIVE To review the published literature to evaluate the association between vaccine delay, refusal, or exemption and the epidemiology of measles and pertussis, 2 vaccine-preventable diseases with recent US outbreaks. EVIDENCE REVIEW Search of PubMed through November 30, 2015, for reports of US measles outbreaks that have occurred since measles was declared eliminated in the United States (after January 1, 2000), endemic and epidemic pertussis since the lowest point in US pertussis incidence (after January 1, 1977), and for studies that assessed disease risk in the context of vaccine delay or exemption. FINDINGS We identified 18 published measles studies (9 annual summaries and 9 outbreak reports), which described 1416 measles cases (individual age range, 2 weeks-84 years; 178 cases younger than 12 months) and more than half (56.8%) had no history of measles vaccination. Of the 970 measles cases with detailed vaccination data, 574 cases were unvaccinated despite being vaccine eligible and 405 (70.6%) of these had nonmedical exemptions (eg, exemptions for religious or philosophical reasons, as opposed to medical contraindications; 41.8%of total). Among 32 reports of pertussis outbreaks, which included 10 609 individuals for whom vaccination status was reported (age range, 10 days-87 years), the 5 largest statewide epidemics had substantial proportions (range, 24%–45%) of unvaccinated or undervaccinated individuals. However, several pertussis outbreaks also occurred in highly vaccinated populations, indicating waning immunity. Nine reports (describing 12 outbreaks) provided detailed vaccination data on

  3. Divergent cellular responses during asymptomatic subclinical and clinical states of disease in cows naturally infected with Mycobacterium avium subsp. paratuberculosis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Infection of the host with Mycobacterium avium subsp. paratuberculosis (MAP) results in a chronic and progressive enteritis that traverses both subclinical and clinical stages. The mechanism(s) for the shift from asymptomatic subclinical disease state to advanced clinical disease are not fully under...

  4. Drosophila as a model for intractable epilepsy: gilgamesh suppresses seizures in para(bss1) heterozygote flies.

    PubMed

    Howlett, Iris C; Rusan, Zeid M; Parker, Louise; Tanouye, Mark A

    2013-08-01

    Intractable epilepsies, that is, seizure disorders that do not respond to currently available therapies, are difficult, often tragic, neurological disorders. Na(+) channelopathies have been implicated in some intractable epilepsies, including Dravet syndrome (Dravet 1978), but little progress has been forthcoming in therapeutics. Here we examine a Drosophila model for intractable epilepsy, the Na(+) channel gain-of-function mutant para(bss1) that resembles Dravet syndrome in some aspects (parker et al. 2011a). In particular, we identify second-site mutations that interact with para(bss1), seizure enhancers, and seizure suppressors. We describe one seizure-enhancer mutation named charlatan (chn). The chn gene normally encodes an Neuron-Restrictive Silencer Factor/RE1-Silencing Transcription factor transcriptional repressor of neuronal-specific genes. We identify a second-site seizure-suppressor mutation, gilgamesh (gish), that reduces the severity of several seizure-like phenotypes of para(bss1)/+ heterozygotes. The gish gene normally encodes the Drosophila ortholog of casein kinase CK1g3, a member of the CK1 family of serine-threonine kinases. We suggest that CK1g3 is an unexpected but promising new target for seizure therapeutics. PMID:23797108

  5. P-glycoprotein alters blood–brain barrier penetration of antiepileptic drugs in rats with medically intractable epilepsy

    PubMed Central

    Ma, Aimei; Wang, Cuicui; Chen, Yinghui; Yuan, Weien

    2013-01-01

    P-glycoprotein is one of the earliest known multidrug transporters and plays an important role in resistance to chemotherapeutic drugs. In this study, we detected levels of P-glycoprotein and its mRNA expression in a rat brain model of medically intractable epilepsy established by amygdala kindling and drug selection. We investigated whether inhibition of P-glycoprotein affects the concentration of antiepileptic drugs in cortical extracellular fluid. We found that levels of P-glycoprotein and its mRNA expression were upregulated in epileptic cerebral tissue compared with cerebral tissue from normal rats. The concentrations of two antiepileptic drugs, carbamazepine and phenytoin, were very low in the cortical extracellular fluid of rats with medically intractable epilepsy, and were restored after blockade of P-glycoprotein by verapamil. These results show that increased P-glycoprotein levels alter the ability of carbamazepine and phenytoin to penetrate the blood–brain barrier and reduce the concentrations of these agents in extracellular cortical fluid. High P-glycoprotein levels may be involved in resistance to antiepileptic drugs in medically intractable epilepsy. PMID:24348021

  6. A step-by-step resection guided by electrocorticography for nonmalignant brain tumors associated with long-term intractable epilepsy.

    PubMed

    Mikuni, Nobuhiro; Ikeda, Akio; Takahashi, Jun A; Nozaki, Kazuhiko; Miyamoto, Susumu; Taki, Waro; Hashimoto, Nobuo

    2006-05-01

    To delineate a surgical strategy for long-term intractable epilepsy associated with nonmalignant brain tumor, we developed a protocol for 25 patients whereby removal of tumor alone and additional irritative peritumoral tissue between sulci (gyrectomy), as well as further resectioning, was performed based on intraoperative electrocorticogram results. In five patients, no irritative zones were observed that required resectioning following complete removal of tumors. Additional gyrectomy was indicated in 18 patients who demonstrated gliosis or cortical dysplasia in the peritumoral residual irritative zone. Remote irritative zone observed in two patients was correlated with long-term and frequent seizures. During a follow-up period of at least 5 years, seizure outcome was Engel category I in 92%, and all patients have remained tumor-free. Peritumoral gyrectomy as a means of removing likely epileptic tissue following tumor resection appears to be a useful method for treating long-term intractable tumoral epilepsy. Further resectioning of remote tissue should be considered in patients with severely intractable seizures.

  7. Phosphoprotein enriched in astrocytes (PEA)-15: A potential therapeutic target in multiple disease states

    PubMed Central

    Greig, Fiona H.; Nixon, Graeme F.

    2014-01-01

    Phosphoprotein enriched in astrocytes-15 (PEA-15) is a cytoplasmic protein that sits at an important junction in intracellular signalling and can regulate diverse cellular processes, such as proliferation and apoptosis, dependent upon stimulation. Regulation of these processes occurs by virtue of the unique interaction of PEA-15 with other signalling proteins. PEA-15 acts as a cytoplasmic tether for the mitogen-activated protein kinases, extracellular signal-regulated kinase 1/2 (ERK1/2) preventing nuclear localisation. In order to release ERK1/2, PEA-15 requires to be phosphorylated via several potential pathways. PEA-15 (and its phosphorylation state) therefore regulates many ERK1/2-dependent processes, including proliferation, via regulating ERK1/2 nuclear translocation. In addition, PEA-15 contains a death effector domain (DED) which allows interaction with other DED-containing proteins. PEA-15 can bind the DED-containing apoptotic adaptor molecule, Fas-associated death domain protein (FADD) which is also dependent on the phosphorylation status of PEA-15. PEA-15 binding of FADD can inhibit apoptosis as bound FADD cannot participate in the assembly of apoptotic signalling complexes. Through these protein–protein interactions, PEA-15-regulated cellular effects have now been investigated in a number of disease-related studies. Changes in PEA-15 expression and regulation have been observed in diabetes mellitus, cancer, neurological disorders and the cardiovascular system. These changes have been suggested to contribute to the pathology related to each of these disease states. As such, new therapeutic targets based around PEA-15 and its associated interactions are now being uncovered and could provide novel avenues for treatment strategies in multiple diseases. PMID:24657708

  8. Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013

    PubMed Central

    Singh, Gopal K.; Siahpush, Mohammad; Azuine, Romuladus E.; Williams, Shanita D.

    2015-01-01

    Objectives: This study examined trends and socioeconomic and racial/ethnic disparities in cardiovascular disease (CVD) mortality in the United States between 1969 and 2013. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate racial/ethnic and area- and individual-level socioeconomic disparities in CVD mortality over time. Rate ratios and log-linear regression were used to model mortality trends and differentials. Results: Between 1969 and 2013, CVD mortality rates decreased by 2.66% per year for whites and 2.12% for blacks. Racial disparities and socioeconomic gradients in CVD mortality increased substantially during the study period. In 2013, blacks had 30% higher CVD mortality than whites and 113% higher mortality than Asians/Pacific Islanders. Compared to those in the most affluent group, individuals in the most deprived area group had 11% higher CVD mortality in 1969 but 40% higher mortality in 2007-2011. Education, income, and occupation were inversely associated with CVD mortality in both men and women. Men and women with low education and incomes had 46-76% higher CVD mortality risks than their counterparts with high education and income levels. Men in clerical, service, farming, craft, repair, construction, and transport occupations, and manual laborers had 30-58% higher CVD mortality risks than those employed in executive and managerial occupations. Conclusions and Global Health Implications: Socioeconomic and racial disparities in CVD mortality are marked and have increased over time because of faster declines in mortality among the affluent and majority populations. Disparities in CVD mortality may reflect inequalities in the social environment, behavioral risk factors such as smoking, obesity, physical inactivity, disease prevalence, and healthcare access and treatment. With rising prevalence of many chronic disease risk factors, the global burden of cardiovascular diseases is expected to increase

  9. The politics of health mobilization in the United States: The promise and pitfalls of "disease constituencies".

    PubMed

    Epstein, Steven

    2016-09-01

    A critical review of recent literature on U.S. social movements concerned with matters of health and illness prompts reconsideration of the prevailing conception of such movements as necessarily isolated and particularistic. With a focus on disease-constituency-based mobilization-presently the most potent model of efficacious activism to be found in the domain of health and illness in the United States-I argue that such activism may tend in two directions: a specific response to an imminent disease threat, and a bridging of collective action frames and identities that can lead to connections across differences and broader mobilization. Case studies have demonstrated how patient activism has affected the management of illness, attitudes and practices of health professionals, research practices, processes of innovation, state policies, and corporate behavior. Through close analysis of patient group mobilization and its distinctive orientation toward knowledge and expertise, I argue that patient groups in practice may connect with or influence one another or a range of other forms of mobilization in relation to health, and I examine the "linkage mechanisms"-spillover, coalition, and frame amplification-by which this can occur. Rather than imagine a stark opposition between particularistic, single-issue health politics, on the one hand, and universalistic efforts to transform the meaning and practice of health and health care in the United States, on the other, I propose closer attention to the potentially Janus-faced character of many health movement organizations and the ways in which they may look either inward or outward.

  10. Ozone, Fine Particulate Matter, and Chronic Lower Respiratory Disease Mortality in the United States

    PubMed Central

    Hao, Yongping; Balluz, Lina; Strosnider, Heather; Wen, Xiao Jun; Li, Chaoyang; Qualters, Judith R.

    2016-01-01

    Rationale Short-term effects of air pollution exposure on respiratory disease mortality are well established. However, few studies have examined the effects of long-term exposure, and among those that have, results are inconsistent. Objectives To evaluate long-term association between ambient ozone, fine particulate matter (PM2.5, particles with an aerodynamic diameter of 2.5 µm or less), and chronic lower respiratory disease (CLRD) mortality in the contiguous United States. Methods We fit Bayesian hierarchical spatial Poisson models, adjusting for five county-level covariates (percentage of adults aged ≥65 years, poverty, lifetime smoking, obesity, and temperature), with random effects at state and county levels to account for spatial heterogeneity and spatial dependence. Measurements and Main Results We derived county-level average daily concentration levels for ambient ozone and PM2.5 for 2001–2008 from the U.S. Environmental Protection Agency’s down-scaled estimates and obtained 2007–2008 CLRD deaths from the National Center for Health Statistics. Exposure to ambient ozone was associated with an increased rate of CLRD deaths, with a rate ratio of 1.05 (95% credible interval, 1.01–1.09) per 5-ppb increase in ozone; the association between ambient PM2.5 and CLRD mortality was positive but statistically insignificant (rate ratio, 1.07; 95% credible interval, 0.99–1.14). Conclusions This study links air pollution exposure data with CLRD mortality for all 3,109 contiguous U.S. counties. Ambient ozone may be associated with an increased rate of death from CLRD in the contiguous United States. Although we adjusted for selected county-level covariates and unobserved influences through Bayesian hierarchical spatial modeling, the possibility of ecologic bias remains. PMID:26017067

  11. Employment and activity limitations among adults with chronic obstructive pulmonary disease--United States, 2013.

    PubMed

    Wheaton, Anne G; Cunningham, Timothy J; Ford, Earl S; Croft, Janet B

    2015-03-27

    Chronic obstructive pulmonary disease (COPD) is a group of progressive respiratory conditions, including emphysema and chronic bronchitis, characterized by airflow obstruction and symptoms such as shortness of breath, chronic cough, and sputum production. COPD is an important contributor to mortality and disability in the United States. Healthy People 2020 has several COPD-related objectives,* including to reduce activity limitations among adults with COPD. To assess the state-level prevalence of COPD and the association of COPD with various activity limitations among U.S. adults, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). Among U.S. adults in all 50 states, the District of Columbia (DC), and two U.S. territories, 6.4% (an estimated 15.7 million adults) had been told by a physician or other health professional that they have COPD. Adults who reported having COPD were more likely to report being unable to work (24.3% versus 5.3%), having an activity limitation caused by health problems (49.6% versus 16.9%), having difficulty walking or climbing stairs (38.4% versus 11.3%), or using special equipment to manage health problems (22.1% versus 6.7%), compared with adults without COPD. Smokers who have been diagnosed with COPD are encouraged to quit smoking, which can slow the progression of the disease and reduce mobility impairment. In addition, COPD patients should consider participation in a pulmonary rehabilitation program that combines patient education and exercise training to address barriers to physical activity, such as respiratory symptoms and muscle wasting.

  12. Identification of resting and active state EEG features of Alzheimer's disease using discrete wavelet transform.

    PubMed

    Ghorbanian, Parham; Devilbiss, David M; Verma, Ajay; Bernstein, Allan; Hess, Terry; Simon, Adam J; Ashrafiuon, Hashem

    2013-06-01

    Alzheimer's disease (AD) is associated with deficits in a number of cognitive processes and executive functions. Moreover, abnormalities in the electroencephalogram (EEG) power spectrum develop with the progression of AD. These features have been traditionally characterized with montage recordings and conventional spectral analysis during resting eyes-closed and resting eyes-open (EO) conditions. In this study, we introduce a single lead dry electrode EEG device which was employed on AD and control subjects during resting and activated battery of cognitive and sensory tasks such as Paced Auditory Serial Addition Test (PASAT) and auditory stimulations. EEG signals were recorded over the left prefrontal cortex (Fp1) from each subject. EEG signals were decomposed into sub-bands approximately corresponding to the major brain frequency bands using several different discrete wavelet transforms and developed statistical features for each band. Decision tree algorithms along with univariate and multivariate statistical analysis were used to identify the most predictive features across resting and active states, separately and collectively. During resting state recordings, we found that the AD patients exhibited elevated D4 (~4-8 Hz) mean power in EO state as their most distinctive feature. During the active states, however, the majority of AD patients exhibited larger minimum D3 (~8-12 Hz) values during auditory stimulation (18 Hz) combined with increased kurtosis of D5 (~2-4 Hz) during PASAT with 2 s interval. When analyzed using EEG recording data across all tasks, the most predictive AD patient features were a combination of the first two feature sets. However, the dominant discriminating feature for the majority of AD patients were still the same features as the active state analysis. The results from this small sample size pilot study indicate that although EEG recordings during resting conditions are able to differentiate AD from control subjects, EEG activity

  13. The Geographic Distribution of Genetic Risk as Compared to Social Risk for Chronic Diseases in the United States.

    PubMed

    Rehkopf, David H; Domingue, Benjamin W; Cullen, Mark R

    2016-01-01

    There is an association between chronic disease and geography, and there is evidence that the environment plays a critical role in this relationship. Yet at the same time, there is known to be substantial geographic variation by ancestry across the United States. Resulting geographic genetic variation-that is, the extent to which single nucleotide polymorphisms (SNPs) related to chronic disease vary spatially-could thus drive some part of the association between geography and disease. We describe the variation in chronic disease genetic risk by state of birth by taking risk SNPs from genome-wide association study meta-analyses for coronary artery disease, diabetes, and ischemic stroke and creating polygenic risk scores. We compare the amount of variability across state of birth in these polygenic scores to the variability in parental education, own education, earnings, and wealth. Our primary finding is that the polygenic risk scores are only weakly differentially distributed across U.S. states. The magnitude of the differences in geographic distribution is very small in comparison to the distribution of social and economic factors and thus is not likely sufficient to have a meaningful effect on geographic disease differences by U.S. state. PMID:27050037

  14. Oxidative stress markers in hypertensive states of pregnancy: preterm and term disease

    PubMed Central

    Kurlak, Lesia O.; Green, Amanda; Loughna, Pamela; Broughton Pipkin, Fiona

    2014-01-01

    Discussion continues as to whether de novo hypertension in pregnancy with significant proteinuria (pre-eclampsia; PE) and non-proteinuric new hypertension (gestational hypertension; GH) are parts of the same disease spectrum or represent different conditions. Non-pregnant hypertension, pregnancy and PE are all associated with oxidative stress. We have established a 6 weeks postpartum clinic for women who experienced a hypertensive pregnancy. We hypothesized that PE and GH could be distinguished by markers of oxidative stress; thiobarbituric acid reactive substances (TBARS) and antioxidants (ferric ion reducing ability of plasma; FRAP). Since the severity of PE and GH is greater pre-term, we also compared pre-term and term disease. Fifty-eight women had term PE, 23 pre-term PE, 60 had term GH and 6 pre-term GH, 11 pre-existing (essential) hypertension (EH) without PE. Limited data were available from normotensive pregnancies (n = 7) and non-pregnant controls (n = 14). There were no differences in postpartum TBARS or FRAP between hypertensive states; TBARS (P = 0.001) and FRAP (P = 0.009) were lower in plasma of non-pregnant controls compared to recently-pregnant women. Interestingly FRAP was higher in preterm than term GH (P = 0.013). In PE and GH, TBARS correlated with low density lipoprotein (LDL)-cholesterol (P = 0.036); this association strengthened with inclusion of EH (P = 0.011). The 10 year Framingham index for cardiovascular risk was positively associated with TBARS (P = 0.003). Oxidative stress profiles do not differ between hypertensive states but appear to distinguish between recently-pregnant and non-pregnant states. This suggests that pregnancy may alter vascular integrity with changes remaining 6 weeks postpartum. LDL-cholesterol is a known determinant of oxidative stress in cardiovascular disease and we have shown this association to be present in hypertensive pregnancy further emphasizing that such a pregnancy may be revealing a pre

  15. Detection of Lesions Underlying Intractable Epilepsy on T1-Weighted MRI as an Outlier Detection Problem

    PubMed Central

    El Azami, Meriem; Hammers, Alexander; Jung, Julien; Costes, Nicolas; Bouet, Romain; Lartizien, Carole

    2016-01-01

    Pattern recognition methods, such as computer aided diagnosis (CAD) systems, can help clinicians in their diagnosis by marking abnormal regions in an image. We propose a machine learning system based on a one-class support vector machine (OC-SVM) classifier for the detection of abnormalities in magnetic resonance images (MRI) applied to patients with intractable epilepsy. The system learns the features associated with healthy control subjects, allowing a voxelwise assessment of the deviation of a test subject pattern from the learned patterns. While any number of various features can be chosen and learned, here we focus on two texture parameters capturing image patterns associated with epileptogenic lesions on T1-weighted brain MRI e.g. heterotopia and blurred junction between the grey and white matter. The CAD output consists of patient specific 3D maps locating clusters of suspicious voxels ranked by size and degree of deviation from control patterns. System performance was evaluated using realistic simulations of challenging detection tasks as well as clinical data of 77 healthy control subjects and of eleven patients (13 lesions). It was compared to that of a mass univariate statistical parametric mapping (SPM) single subject analysis based on the same set of features. For all simulations, OC-SVM yielded significantly higher values of the area under the ROC curve (AUC) and higher sensitivity at low false positive rate. For the clinical data, both OC-SVM and SPM successfully detected 100% of the lesions in the MRI positive cases (3/13). For the MRI negative cases (10/13), OC-SVM detected 7/10 lesions and SPM analysis detected 5/10 lesions. In all experiments, OC-SVM produced fewer false positive detections than SPM. OC-SVM may be a versatile system for unbiased lesion detection. PMID:27603778

  16. [Reduction cranioplasty for a case of intractable chronic subdural hematoma in infancy].

    PubMed

    Tsutsumi, K; Asano, T; Shigeno, T; Matsui, T; Ito, S; Nakaguti, H

    1994-01-01

    Although almost all infants suffering chronic subdural hematomas (CSDH) are successfully treated by established methods such as a subdural puncture, burr holes and shunting procedures, infantile CSDH with progressive craniocerebral disproportion requires a special therapeutical regimen. Clinical efforts such as reduction cranioplasty have been made as a treatment for these cases. This is a case report of a 9-month-old male infant with an intractable CSDH, bilateral and large, and subsequent brain atrophy caused by traumatic head injury. Excellent results were obtained by a modified reduction cranioplasty. In brief, the patient was supine-positioned with a 20-degree flexion of the head in an attempt to obtain a large operative field. Bicoronal skin incision was combined with an additional linear one on the midline (T-shaped incision). Bilateral frontoparietal craniotomy with periosteum was made to keep the midline bony bridge overlying the superior sagittal sinus (SSS). The resulting extensive dural opening allowed complete evacuation of the subdural hematoma. Thereafter, the anterior part, ca. 4cm in width, of the bony bridge was removed in order to make the remaining bone able to be manipulated and connected to the frontal bone. Prior to this stage, SSS close to the crista galli was ligated and cut with the falx to avoid postoperative kinking. The dura mater was sutured so as not to leave an excessive subdural space. The bone flaps were trimmed to complete a good-shaped reconstruction. Finally, the excessive scalp was removed because the original scalp was too large for the reconstructed skull.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8295704

  17. Detection of Lesions Underlying Intractable Epilepsy on T1-Weighted MRI as an Outlier Detection Problem.

    PubMed

    El Azami, Meriem; Hammers, Alexander; Jung, Julien; Costes, Nicolas; Bouet, Romain; Lartizien, Carole

    2016-01-01

    Pattern recognition methods, such as computer aided diagnosis (CAD) systems, can help clinicians in their diagnosis by marking abnormal regions in an image. We propose a machine learning system based on a one-class support vector machine (OC-SVM) classifier for the detection of abnormalities in magnetic resonance images (MRI) applied to patients with intractable epilepsy. The system learns the features associated with healthy control subjects, allowing a voxelwise assessment of the deviation of a test subject pattern from the learned patterns. While any number of various features can be chosen and learned, here we focus on two texture parameters capturing image patterns associated with epileptogenic lesions on T1-weighted brain MRI e.g. heterotopia and blurred junction between the grey and white matter. The CAD output consists of patient specific 3D maps locating clusters of suspicious voxels ranked by size and degree of deviation from control patterns. System performance was evaluated using realistic simulations of challenging detection tasks as well as clinical data of 77 healthy control subjects and of eleven patients (13 lesions). It was compared to that of a mass univariate statistical parametric mapping (SPM) single subject analysis based on the same set of features. For all simulations, OC-SVM yielded significantly higher values of the area under the ROC curve (AUC) and higher sensitivity at low false positive rate. For the clinical data, both OC-SVM and SPM successfully detected 100% of the lesions in the MRI positive cases (3/13). For the MRI negative cases (10/13), OC-SVM detected 7/10 lesions and SPM analysis detected 5/10 lesions. In all experiments, OC-SVM produced fewer false positive detections than SPM. OC-SVM may be a versatile system for unbiased lesion detection. PMID:27603778

  18. The TAR model: use of therapeutic state transitions for quality assurance reporting in chronic disease management.

    PubMed

    Gaikwad, R; Warren, J; Kenealy, T

    2007-01-01

    Chronic disease management represents one of the challenges for health informatics and demands the appropriate application of information technology for improved patient care. This paper presents an approach to quality assurance reporting wherein the recommendations of evidence-based clinical practice guidelines are considered in the context of empirical therapeutic state-transitions (in terms of changes in individual patient prescriptions over time). We apply a Transition-based Audit Report (TAR) model to antihypertensive prescribing and related data as stored in a New Zealand General Practice Management System database. The results provide a set of quality indicators and specific patient cohorts for potential practice quality improvement with strong linkage to the selected guidelines and observed practice patterns. We see the TAR model primarily as a tool to enable internal quality improvement efforts, but also to be of relevance for focusing pay-for-performance programs.

  19. Prediction of Outcome after Traumatic Brain Injury: Comparison of Disease State Index and IMPACT Calculator.

    PubMed

    Liedes, Hilkka; Mattila, Jussi; Lingsma, Hester; Lötjönen, Jyrki; Menon, David; Tenovuo, Olli; van Gils, Mark

    2016-01-01

    Traumatic brain injury (TBI) is a major cause of death and disability, especially in young adults. A reliable prediction of outcome after TBI is of great importance in clinical practice and research. We aimed to compare performance of the well-established IMPACT calculator and an alternative method, Disease State Index (DSI), in the prediction of six-month outcome after TBI. Performance of the models was evaluated using 2036 patients with moderate or severe TBI from the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) database. Prediction performance of both models was similar. The models with more variables provided better performance than the simpler models. This study showed that the DSI is a valid tool with efficient visualizations that can help clinicians with their decision making process in clinical practice. PMID:27225575

  20. State of the Art Review: Depression, Stress, Anxiety, and Cardiovascular Disease.

    PubMed

    Cohen, Beth E; Edmondson, Donald; Kronish, Ian M

    2015-11-01

    The notion that psychological states can influence physical health is hardly new, and perhaps nowhere has the mind-body connection been better studied than in cardiovascular disease (CVD). Recently, large prospective epidemiologic studies and smaller basic science studies have firmly established a connection between CVD and several psychological conditions, including depression, chronic psychological stress, posttraumatic stress disorder (PTSD), and anxiety. In addition, numerous clinical trials have been conducted to attempt to prevent or lessen the impact of these conditions on cardiovascular health. In this article, we review studies connecting depression, stress/PTSD, and anxiety to CVD, focusing on findings from the last 5 years. For each mental health condition, we first examine the epidemiologic evidence establishing a link with CVD. We then describe studies of potential underlying mechanisms and finally discuss treatment trials and directions for future research.

  1. [The state of the larynx in the patients presenting with chronic obstructive pulmonary disease].

    PubMed

    Gilifanov, E A; Nevzorova, V A; Artyushkin, S A; Ivanets, I V

    2016-01-01

    The objective of the present study was to evaluate the clinical state of the larynx and its microbial population in 49 patients examined at the stage of stable condition of chronic obstructive pulmonary disease. Examination of the larynx was carried out with the use of a rigid laryngoscope having a visual angle of 70 degrees, videofibrolaryngoscopy, and stroboscopy using a «TelePac» videocomplex (Karl Storz, Germany). It was supplemented by the study of the bacteriological and mycological paysage. The acoustic analysis of the voice was performed with the help of the Specta PLUS computer program. It was shown that more than 70% of the examined patients presented with various forms of chronic laryngitis. Potentially pathogenic St. pyogenes and yeast-like fungi C. albicans were isolated from 59% and 29% of the patients respectively.

  2. Imaging of degenerative spine disease--the state of the art.

    PubMed

    Sasiadek, Marek J; Bladowska, Joanna

    2012-01-01

    The authors review the current state of imaging of degenerative spinal disease (DSD), which is one of the most common disorders in humans. The most important definitions as well as short descriptions of the etiopathology and clinical presentation of DSD are provided first, followed by an overview of conventional and advanced imaging methods that are used in DSD. The authors then discuss in detail the imaging patterns of particular types of degenerative changes. Finally, the current imaging algorithm in DSD is presented. The imaging method of choice is magnetic resonance, including advanced techniques--especially diffusion tensor imaging. Other imaging methods (plain radiography, computed tomography, vascular studies, scintigraphy, positron emission tomography, discography) play a supplementary role ).

  3. Diseases diagnosed in wild turkeys (Meleagris gallopavo) of the southeastern United States.

    PubMed

    Davidson, W R; Nettles, V F; Couvillion, C E; Howerth, E W

    1985-10-01

    Diagnostic findings are presented on 139 sick or dead wild turkeys examined during the period 1972 through 1984. Turkeys originated from eight southeastern states (Alabama, Arkansas, Florida, Georgia, South Carolina, Tennessee, Virginia, West Virginia) and included 31 turkeys categorized as capture-related mortalities and 108 turkeys categorized as natural mortalities. Frequent diagnoses (greater than or equal to 10% of case accessions) in the natural mortality group were trauma, avian pox, and histomoniasis. Less frequent diagnoses (less than or equal to 4% of case accessions) included malnutrition/environmental stress syndrome, coligranuloma-like condition, crop impaction, bumblefoot, organophosphate toxicosis, infectious sinusitis, a lympho-proliferative disease, salmonellosis, aspergillosis, toxoplasmosis, crop trichomoniasis, and melorheostosis.

  4. Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States

    PubMed Central

    Plantinga, Laura; Grubbs, Vanessa; Sarkar, Urmimala; Hsu, Chi-yuan; Hedgeman, Elizabeth; Robinson, Bruce; Saran, Rajiv; Geiss, Linda; Burrows, Nilka Ríos; Eberhardt, Mark; Powe, Neil

    2011-01-01

    PURPOSE Because avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States. METHODS A total of 12,065 adult (aged 20 years or older) participants in the cross-sectional National Health and Nutrition Examination Survey (1999–2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAIDs. NSAIDs (excluding aspirin and acetaminophen) were defined by self-report. CKD was categorized as no CKD, mild CKD (stages 1 and 2; urinary albumin-creatinine ratio of ≥30 mg/g) and moderate to severe CKD (stages 3 and 4; estimated glomerular filtration rate of 15–59 mL/min/1.73 m2). Adjusted prevalence was calculated using multivariable logistic regression with appropriate population-based weighting. RESULTS Current use (nearly every day for 30 days or longer) of any NSAID was reported by 2.5%, 2.5%, and 5.0% of the US population with no, mild, and moderate to severe CKD, respectively; nearly all of the NSAIDs used were available over-the-counter. Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use: (3.8% vs 3.9%, aware vs unaware; P=.979). CONCLUSIONS Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients. PMID:21911761

  5. A Framework to Reduce Infectious Disease Risk from Urban Poultry in the United States

    PubMed Central

    Tobin, Molly R.; Goldshear, Jesse L.; Price, Lance B.; Graham, Jay P.

    2015-01-01

    Objectives Backyard poultry ownership is increasingly common in U.S. cities and is regulated at the local level. Human contact with live poultry is a well-known risk for infection with zoonotic pathogens, notably Salmonella, yet the ability of local jurisdictions to reduce the risk of infectious disease transmission from poultry to humans is unstudied. We reviewed urban poultry ordinances in the United States and reported Salmonella outbreaks from backyard poultry to identify regulatory gaps in preventing zoonotic pathogen transmission. Based on this analysis, we propose regulatory guidelines for U.S. cities to reduce infectious disease risk from backyard poultry ownership. Methods We assessed local ordinances in the 150 most populous U.S. jurisdictions for content related to noncommercial poultry ownership using online resources and communications with government officials. We also performed a literature review using publicly available data sources to identify human infectious disease outbreaks caused by contact with backyard poultry. Results Of the cities reviewed, 93% (n=139) permit poultry in some capacity. Most urban poultry ordinances share common characteristics focused on reducing nuisance to neighbors. Ordinances do not address many pathways of transmission relevant to poultry-to-human transmission of pathogens, such as manure management. Conclusions To reduce the risk of pathogen exposure from backyard poultry, urban ordinances should incorporate the following seven components: limited flock size, composting of manure in sealed containers, prohibition of slaughter, required veterinary care to sick birds, appropriate disposal of dead birds, annual permits linked to consumer education, and a registry of poultry owners. PMID:26346104

  6. Fluctuations of spontaneous EEG topographies predict disease state in relapsing-remitting multiple sclerosis.

    PubMed

    Gschwind, Markus; Hardmeier, Martin; Van De Ville, Dimitri; Tomescu, Miralena I; Penner, Iris-Katharina; Naegelin, Yvonne; Fuhr, Peter; Michel, Christoph M; Seeck, Margitta

    2016-01-01

    Spontaneous fluctuations of neuronal activity in large-scale distributed networks are a hallmark of the resting brain. In relapsing-remitting multiple sclerosis (RRMS) several fMRI studies have suggested altered resting-state connectivity patterns. Topographical EEG analysis reveals much faster temporal fluctuations in the tens of milliseconds time range (termed "microstates"), which showed altered properties in a number of neuropsychiatric conditions. We investigated whether these microstates were altered in patients with RRMS, and if the microstates' temporal properties reflected a link to the patients' clinical features. We acquired 256-channel EEG in 53 patients (mean age 37.6 years, 45 females, mean disease duration 9.99 years, Expanded Disability Status Scale ≤ 4, mean 2.2) and 49 healthy controls (mean age 36.4 years, 33 females). We analyzed segments of a total of 5 min of EEG during resting wakefulness and determined for both groups the four predominant microstates using established clustering methods. We found significant differences in the temporal dynamics of two of the four microstates between healthy controls and patients with RRMS in terms of increased appearance and prolonged duration. Using stepwise multiple linear regression models with 8-fold cross-validation, we found evidence that these electrophysiological measures predicted a patient's total disease duration, annual relapse rate, disability score, as well as depression score, and cognitive fatigue measure. In RRMS patients, microstate analysis captured altered fluctuations of EEG topographies in the sub-second range. This measure of high temporal resolution provided potentially powerful markers of disease activity and neuropsychiatric co-morbidities in RRMS. PMID:27625987

  7. Modular reorganization of brain resting state networks and its independent validation in Alzheimer's disease patients.

    PubMed

    Chen, Guangyu; Zhang, Hong-Ying; Xie, Chunming; Chen, Gang; Zhang, Zhi-Jun; Teng, Gao-Jun; Li, Shi-Jiang

    2013-01-01

    Previous studies have demonstrated disruption in structural and functional connectivity occurring in the Alzheimer's Disease (AD). However, it is not known how these disruptions alter brain network reorganization. With the modular analysis method of graph theory, and datasets acquired by the resting-state functional connectivity MRI (R-fMRI) method, we investigated and compared the brain organization patterns between the AD group and the cognitively normal control (CN) group. Our main finding is that the largest homotopic module (defined as the insula module) in the CN group was broken down to the pieces in the AD group. Specifically, it was discovered that the eight pairs of the bilateral regions (the opercular part of inferior frontal gyrus, area triangularis, insula, putamen, globus pallidus, transverse temporal gyri, superior temporal gyrus, and superior temporal pole) of the insula module had lost symmetric functional connection properties, and the corresponding gray matter concentration (GMC) was significant lower in AD group. We further quantified the functional connectivity changes with an index (index A) and structural changes with the GMC index in the insula module to demonstrate their great potential as AD biomarkers. We further validated these results with six additional independent datasets (271 subjects in six groups). Our results demonstrated specific underlying structural and functional reorganization from young to old, and for diseased subjects. Further, it is suggested that by combining the structural GMC analysis and functional modular analysis in the insula module, a new biomarker can be developed at the single-subject level.

  8. Occupational class and ischemic heart disease mortality in the United States and 11 European countries.

    PubMed Central

    Kunst, A E; Groenhof, F; Andersen, O; Borgan, J K; Costa, G; Desplanques, G; Filakti, H; Giraldes, M do R; Faggiano, F; Harding, S; Junker, C; Martikainen, P; Minder, C; Nolan, B; Pagnanelli, F; Regidor, E; Vågerö, D; Valkonen, T; Mackenbach, J P

    1999-01-01

    OBJECTIVES: Twelve countries were compared with respect to occupational class differences in ischemic heart disease mortality in order to identify factors that are associated with smaller or larger mortality differences. METHODS: Data on mortality by occupational class among men aged 30 to 64 years were obtained from national longitudinal or cross-sectional studies for the 1980s. A common occupational class scheme was applied to most countries. Potential effects of the main data problems were evaluated quantitatively. RESULTS: A north-south contrast existed within Europe. In England and Wales, Ireland, and Nordic countries, manual classes had higher mortality rates than nonmanual classes. In France, Switzerland, and Mediterranean countries, manual classes had mortality rates as low as, or lower than, those among nonmanual classes. Compared with Northern Europe, mortality differences in the United States were smaller (among men aged 30-44 years) or about as large (among men aged 45-64 years). CONCLUSIONS: The results underline the highly variable nature of socioeconomic inequalities in ischemic heart disease mortality. These inequalities appear to be highly sensitive to social gradients in behavioral risk factors. These risk factor gradients are determined by cultural as well as socioeconomic developments. PMID:9987464

  9. Bluetongue disease and seroprevalence in South American camelids from the northwestern region of the United States.

    PubMed

    Allen, Andrew J; Stanton, James B; Evermann, James F; Fry, Lindsay M; Ackerman, Melissa G; Barrington, George M

    2015-03-01

    In late summer/early fall of 2013, 2 South American camelids from central Washington were diagnosed with fatal bluetongue viral disease, an event which is rarely reported. A 9-year-old intact male llama (Lama glama), with a 1-day history of anorexia, recumbency, and dyspnea before death. Abundant foam discharged from the mouth and nostrils, and the lungs were severely edematous on postmortem examination. Histologically, there was abundant intra-alveolar edema with fibrin. Hemorrhage and edema disrupted several other organs. Bluetongue viral RNA was detected by reverse transcription polymerase chain reaction (RT-PCR), and serotype 11 was identified by sequencing a segment of the VP2 outer capsid gene. Approximately 1 month later, at a site 150 miles north of the index case, a 2-year-old female alpaca with similar, acutely progressive clinical signs was reported. A postmortem examination was performed, and histologic lesions from the alpaca were similar to those of the llama, and again serotype 11 was detected by PCR. The occurrence of bluetongue viral infection and disease is described in the context of seasonal Bluetongue virus activity within the northwestern United States and southwestern Canada.

  10. Relationship between protein C antigen and anticoagulant activity during oral anticoagulation and in selected disease states.

    PubMed Central

    Vigano D'Angelo, S; Comp, P C; Esmon, C T; D'Angelo, A

    1986-01-01

    Protein C is a natural vitamin K-dependent plasma anticoagulant, deficiencies of which have been found in patients with recurrent thrombosis and warfarin-induced skin necrosis. To appreciate more fully the role of protein C in disease states and during oral anticoagulation, a new functional assay for protein C involving adsorption of plasma protein C on a Ca+2-dependent monoclonal antibody, elution, quantitative activation, and assessment of plasma anticoagulant activity, has been developed. When oral anticoagulation is initiated, the anticoagulant activity of protein C decreases to a greater extent than either the amidolytic or immunologic levels. During stabilized warfarin treatment, there is no correlation between either amidolytic or antigenic levels and the functional protein C activity, suggesting that measurement of protein C anticoagulant activity may be necessary to reflect adequately the anticoagulant protection afforded by this protein. In contrast, there was a strong correlation between anticoagulant and amidolytic and immunologic levels in liver failure and disseminated intravascular coagulation. Two patients with thromboembolic disease have been identified who exhibit a marked decrease in anticoagulant activity, but who have normal immunologic and amidolytic levels. Thus, this assay permits assessment of protein C in individuals who have received anticoagulant treatment and identification of a new class of protein C-deficient individuals. PMID:3511097

  11. Bacterial Infection in Chronic Obstructive Pulmonary Disease in 2000: a State-of-the-Art Review

    PubMed Central

    Sethi, Sanjay; Murphy, Timothy F.

    2001-01-01

    Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. The precise role of bacterial infection in the course and pathogenesis of COPD has been a source of controversy for decades. Chronic bacterial colonization of the lower airways contributes to airway inflammation; more research is needed to test the hypothesis that this bacterial colonization accelerates the progressive decline in lung function seen in COPD (the vicious circle hypothesis). The course of COPD is characterized by intermittent exacerbations of the disease. Studies of samples obtained by bronchoscopy with the protected specimen brush, analysis of the human immune response with appropriate immunoassays, and antibiotic trials reveal that approximately half of exacerbations are caused by bacteria. Nontypeable Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae are the most common causes of exacerbations, while Chlamydia pneumoniae causes a small proportion. The role of Haemophilus parainfluenzae and gram-negative bacilli remains to be established. Recent progress in studies of the molecular mechanisms of pathogenesis of infection in the human respiratory tract and in vaccine development guided by such studies promises to lead to novel ways to treat and prevent bacterial infections in COPD. PMID:11292642

  12. [Association between air pollution and respiratory and cardiovascular diseases in Itabira, Minas Gerais State, Brazil].

    PubMed

    Braga, Alfésio Luís Ferreira; Pereira, Luiz Alberto Amador; Procópio, Marly; André, Paulo Afonso de; Saldiva, Paulo Hilário do Nascimento

    2007-01-01

    The city of Itabira, Minas Gerais State, Brazil, is located in the Espinhaço Mountain Range, an area that features large-scale mechanized iron ore pit mines. The current study evaluates the acute effects of inhalable particulate matter (PM10) in terms of emergency room visits due to respiratory and cardiovascular diseases in Itabira. Generalized additive Poisson regression models were adopted, controlling for temperature, humidity, and both short and long-term seasonality. Increases of 10mg/m(3) in PM10 were associated with increases in respiratory emergency room visits of 4% (95%CI: 2.2-5.8), at lags 0 and 1 for children and adolescents younger than 13 years of age, and of 12% (95%CI: 8.5-15.5) on the three subsequent days for adolescents (13 to 19 years of age). For cardiovascular diseases, the effect was acute (4%; 95%CI: 0.8-8.5) and mainly for the 45 to 64 age group. These results show that PM10 generated by open pit mining can lead to health problems in the exposed population. PMID:18038038

  13. Recent change in the annual pattern of sexually transmitted diseases in the United States.

    PubMed

    Shah, Ami P; Smolensky, Michael H; Burau, Keith D; Cech, Irina M; Lai, Dejian

    2007-01-01

    This study analyzed the 1999 to 2003 database of the Center for Disease Control and Prevention (CDC) for seasonal and longer-term time trends in the sexually transmitted diseases (STDs) of chlamydia, gonorrhea, and syphilis in the United States. Linear regression was used to ascertain time trends, and a linear mixed auto-regression model was applied to determine the statistical significance of the major peaks relative to the annualized time series mean. A statistically significant increasing trend during the 5 yr span was documented only in the incidence of chlamydia. No clear annual periodicity was detected in any of the STDs; instead, significant three-month cycles were documented in all the STDs, with prominent peaks evident in March, May, August, and November. The March and May peaks could be associated with the sexual activities of young adults during spring break, which for different colleges and universities, commences as early as mid- to late-February and concludes as late as early- to mid-April, when huge numbers of sexually active youth congregate at beach resort settings. We propose the August peak is representative of summer sexual activity, in particular, of youths during school recess when adult supervision is poor. Finally, the autumn peak seems to be an expression of an endogenous annual rhythm in human reproductive biology, exemplified by elevated levels of testosterone in young males and sexual activity at this time of the year.

  14. [Association between air pollution and respiratory and cardiovascular diseases in Itabira, Minas Gerais State, Brazil].

    PubMed

    Braga, Alfésio Luís Ferreira; Pereira, Luiz Alberto Amador; Procópio, Marly; André, Paulo Afonso de; Saldiva, Paulo Hilário do Nascimento

    2007-01-01

    The city of Itabira, Minas Gerais State, Brazil, is located in the Espinhaço Mountain Range, an area that features large-scale mechanized iron ore pit mines. The current study evaluates the acute effects of inhalable particulate matter (PM10) in terms of emergency room visits due to respiratory and cardiovascular diseases in Itabira. Generalized additive Poisson regression models were adopted, controlling for temperature, humidity, and both short and long-term seasonality. Increases of 10mg/m(3) in PM10 were associated with increases in respiratory emergency room visits of 4% (95%CI: 2.2-5.8), at lags 0 and 1 for children and adolescents younger than 13 years of age, and of 12% (95%CI: 8.5-15.5) on the three subsequent days for adolescents (13 to 19 years of age). For cardiovascular diseases, the effect was acute (4%; 95%CI: 0.8-8.5) and mainly for the 45 to 64 age group. These results show that PM10 generated by open pit mining can lead to health problems in the exposed population.

  15. Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States

    PubMed Central

    Calvert, G; Rice, F; Boiano, J; Sheehy, J; Sanderson, W

    2003-01-01

    Background: Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease. Methods: Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis. Results: Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis. Conclusions: This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary

  16. Meteorological conditions associated with increased incidence of West Nile virus disease in the United States, 2004-2012.

    PubMed

    Hahn, Micah B; Monaghan, Andrew J; Hayden, Mary H; Eisen, Rebecca J; Delorey, Mark J; Lindsey, Nicole P; Nasci, Roger S; Fischer, Marc

    2015-05-01

    West Nile virus (WNV) is a leading cause of mosquito-borne disease in the United States. Annual seasonal outbreaks vary in size and location. Predicting where and when higher than normal WNV transmission will occur can help direct limited public health resources. We developed models for the contiguous United States to identify meteorological anomalies associated with above average incidence of WNV neuroinvasive disease from 2004 to 2012. We used county-level WNV data reported to ArboNET and meteorological data from the North American Land Data Assimilation System. As a result of geographic differences in WNV transmission, we divided the United States into East and West, and 10 climate regions. Above average annual temperature was associated with increased likelihood of higher than normal WNV disease incidence, nationally and in most regions. Lower than average annual total precipitation was associated with higher disease incidence in the eastern United States, but the opposite was true in most western regions. Although multiple factors influence WNV transmission, these findings show that anomalies in temperature and precipitation are associated with above average WNV disease incidence. Readily accessible meteorological data may be used to develop predictive models to forecast geographic areas with elevated WNV disease risk before the coming season. PMID:25802435

  17. Meteorological Conditions Associated with Increased Incidence of West Nile Virus Disease in the United States, 2004–2012

    PubMed Central

    Hahn, Micah B.; Monaghan, Andrew J.; Hayden, Mary H.; Eisen, Rebecca J.; Delorey, Mark J.; Lindsey, Nicole P.; Nasci, Roger S.; Fischer, Marc

    2015-01-01

    West Nile virus (WNV) is a leading cause of mosquito-borne disease in the United States. Annual seasonal outbreaks vary in size and location. Predicting where and when higher than normal WNV transmission will occur can help direct limited public health resources. We developed models for the contiguous United States to identify meteorological anomalies associated with above average incidence of WNV neuroinvasive disease from 2004 to 2012. We used county-level WNV data reported to ArboNET and meteorological data from the North American Land Data Assimilation System. As a result of geographic differences in WNV transmission, we divided the United States into East and West, and 10 climate regions. Above average annual temperature was associated with increased likelihood of higher than normal WNV disease incidence, nationally and in most regions. Lower than average annual total precipitation was associated with higher disease incidence in the eastern United States, but the opposite was true in most western regions. Although multiple factors influence WNV transmission, these findings show that anomalies in temperature and precipitation are associated with above average WNV disease incidence. Readily accessible meteorological data may be used to develop predictive models to forecast geographic areas with elevated WNV disease risk before the coming season. PMID:25802435

  18. Zika Virus Disease Cases - 50 States and the District of Columbia, January 1-July 31, 2016.

    PubMed

    Walker, William L; Lindsey, Nicole P; Lehman, Jennifer A; Krow-Lucal, Elisabeth R; Rabe, Ingrid B; Hills, Susan L; Martin, Stacey W; Fischer, Marc; Staples, J Erin

    2016-01-01

    Zika virus is a mosquito-borne flavivirus primarily transmitted to humans by Aedes aegypti mosquitoes (1). Zika virus infections have also been documented through intrauterine transmission resulting in congenital infection; intrapartum transmission from a viremic mother to her newborn; sexual transmission; blood transfusion; and laboratory exposure (1-5). Most Zika virus infections are asymptomatic (1,6). Clinical illness, when it occurs, is generally mild and characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. However, Zika virus infection during pregnancy can cause adverse outcomes such as fetal loss, and microcephaly and other serious brain anomalies (1-3). Guillain-Barré syndrome, a rare autoimmune condition affecting the peripheral nervous system, also has been associated with Zika virus infection (1). Following the identification of local transmission of Zika virus in Brazil in May 2015, the virus has continued to spread throughout the Region of the Americas, and travel-associated cases have increased (7). In 2016, Zika virus disease and congenital infections became nationally notifiable conditions in the United States (8). As of September 3, 2016, a total of 2,382 confirmed and probable cases of Zika virus disease with symptom onset during January 1-July 31, 2016, had been reported from 48 of 50 U.S. states and the District of Columbia. Most cases (2,354; 99%) were travel-associated, with either direct travel or an epidemiologic link to a traveler to a Zika virus-affected area. Twenty-eight (1%) cases were reported as locally acquired, including 26 associated with mosquito-borne transmission, one acquired in a laboratory, and one with an unknown mode of transmission. Zika virus disease should be considered in patients with compatible clinical signs or symptoms who traveled to or reside in areas with ongoing Zika virus transmission or who had unprotected sex with someone who traveled to those areas. Health

  19. Zika Virus Disease Cases - 50 States and the District of Columbia, January 1-July 31, 2016.

    PubMed

    Walker, William L; Lindsey, Nicole P; Lehman, Jennifer A; Krow-Lucal, Elisabeth R; Rabe, Ingrid B; Hills, Susan L; Martin, Stacey W; Fischer, Marc; Staples, J Erin

    2016-09-16

    Zika virus is a mosquito-borne flavivirus primarily transmitted to humans by Aedes aegypti mosquitoes (1). Zika virus infections have also been documented through intrauterine transmission resulting in congenital infection; intrapartum transmission from a viremic mother to her newborn; sexual transmission; blood transfusion; and laboratory exposure (1-5). Most Zika virus infections are asymptomatic (1,6). Clinical illness, when it occurs, is generally mild and characterized by acute onset of fever, maculopapular rash, arthralgia, or nonpurulent conjunctivitis. However, Zika virus infection during pregnancy can cause adverse outcomes such as fetal loss, and microcephaly and other serious brain anomalies (1-3). Guillain-Barré syndrome, a rare autoimmune condition affecting the peripheral nervous system, also has been associated with Zika virus infection (1). Following the identification of local transmission of Zika virus in Brazil in May 2015, the virus has continued to spread throughout the Region of the Americas, and travel-associated cases have increased (7). In 2016, Zika virus disease and congenital infections became nationally notifiable conditions in the United States (8). As of September 3, 2016, a total of 2,382 confirmed and probable cases of Zika virus disease with symptom onset during January 1-July 31, 2016, had been reported from 48 of 50 U.S. states and the District of Columbia. Most cases (2,354; 99%) were travel-associated, with either direct travel or an epidemiologic link to a traveler to a Zika virus-affected area. Twenty-eight (1%) cases were reported as locally acquired, including 26 associated with mosquito-borne transmission, one acquired in a laboratory, and one with an unknown mode of transmission. Zika virus disease should be considered in patients with compatible clinical signs or symptoms who traveled to or reside in areas with ongoing Zika virus transmission or who had unprotected sex with someone who traveled to those areas. Health

  20. Infectious disease surveillance in the United States and the United Kingdom: from public goods to the challenges of new technologies.

    PubMed

    Barnett, Tony; Sorenson, Corinna

    2011-02-01

    Infectious diseases are a long-standing and continuing threat to health and welfare, with their containment dependent on national disease surveillance and response capacities. This article discusses infectious disease surveillance in the United States and the United Kingdom, examining historical national traditions for identifying and controlling infectious disease risks and how globalization and technical advances have influenced the evolution of their respective approaches. The two systems developed in different but parallel ways. In the United States, surveillance remained quite localized at the state level until the early twentieth century and still retains many of those features. The U.K. approach became centralized from the latter part of the nineteenth century and has principally remained so. In both cases, disease surveillance was traditionally conceived as a public good, where national or local authorities held sovereign rights and power to protect public health. With the increasing globalized nature of infectious disease, such notions shifted toward surveillance as a global public good, with countries responding in turn by creating new global health governance arrangements and regulations. However, the limitations of current surveillance systems and the strong hold of national interests place into question the provision of surveillance as a global public good. These issues are further highlighted with the introduction of new surveillance technologies, which offer opportunities for improved disease detection and identification but also create potential tensions between individual rights, corporate profit, equitable access to technology, and national and global public goods. PMID:21498799

  1. SIR model on a dynamical network and the endemic state of an infectious disease

    NASA Astrophysics Data System (ADS)

    Dottori, M.; Fabricius, G.

    2015-09-01

    In this work we performed a numerical study of an epidemic model that mimics the endemic state of whooping cough in the pre-vaccine era. We considered a stochastic SIR model on dynamical networks that involve local and global contacts among individuals and analysed the influence of the network properties on the characterization of the quasi-stationary state. We computed probability density functions (PDF) for infected fraction of individuals and found that they are well fitted by gamma functions, excepted the tails of the distributions that are q-exponentials. We also computed the fluctuation power spectra of infective time series for different networks. We found that network effects can be partially absorbed by rescaling the rate of infective contacts of the model. An explicit relation between the effective transmission rate of the disease and the correlation of susceptible individuals with their infective nearest neighbours was obtained. This relation quantifies the known screening of infective individuals observed in these networks. We finally discuss the goodness and limitations of the SIR model with homogeneous mixing and parameters taken from epidemiological data to describe the dynamic behaviour observed in the networks studied.

  2. A Mathematical Model with Quarantine States for the Dynamics of Ebola Virus Disease in Human Populations.

    PubMed

    Ngwa, Gideon A; Teboh-Ewungkem, Miranda I

    2016-01-01

    A deterministic ordinary differential equation model for the dynamics and spread of Ebola Virus Disease is derived and studied. The model contains quarantine and nonquarantine states and can be used to evaluate transmission both in treatment centres and in the community. Possible sources of exposure to infection, including cadavers of Ebola Virus victims, are included in the model derivation and analysis. Our model's results show that there exists a threshold parameter, R 0, with the property that when its value is above unity, an endemic equilibrium exists whose value and size are determined by the size of this threshold parameter, and when its value is less than unity, the infection does not spread into the community. The equilibrium state, when it exists, is locally and asymptotically stable with oscillatory returns to the equilibrium point. The basic reproduction number, R 0, is shown to be strongly dependent on the initial response of the emergency services to suspected cases of Ebola infection. When intervention measures such as quarantining are instituted fully at the beginning, the value of the reproduction number reduces and any further infections can only occur at the treatment centres. Effective control measures, to reduce R 0 to values below unity, are discussed. PMID:27579053

  3. 10-minute delayed recall from the modified mini-mental state test predicts Alzheimer's disease pathology.

    PubMed

    Lyness, Scott A; Lee, Ae Young; Zarow, Chris; Teng, Evelyn L; Chui, Helena C

    2014-01-01

    We compared the sensitivity and specificity of two delayed recall scores from the Modified Mini-Mental State (3MS) test with consensus clinical diagnosis to differentiate cognitive impairment due to Alzheimer's disease (AD) versus non-AD pathologies. At a memory disorders clinic, 117 cognitively impaired patients were administered a baseline 3MS test and received a contemporaneous consensus clinical diagnosis. Their brains were examined after death about 5 years later. Using logistic regression with forward selection to predict pathologically defined AD versus non-AD, 10-min delayed recall entered first (p = 0.001), followed by clinical diagnosis (p = 0.02); 1-min delayed recall did not enter. 10-min delayed recall scores ≤4 (score range = 0-9) were 87% sensitive and 47% specific in predicting AD pathology; consensus clinical diagnosis was 82% sensitive and 45% specific. For the 57 patients whose initial Mini-Mental State Examination scores were ≥19 (the median), 3MS 10-min delayed recall scores ≤4 showed some loss of sensitivity (80%) but a substantial gain in specificity (77%). In conclusion, 10-min delayed recall score on the brief 3MS test distinguished between AD versus non-AD pathology about 5 years before death at least as well as consensus clinical diagnosis that requires much more comprehensive information and complex deliberation.

  4. [Particular evolution of the thyroid state in Grave's disease: two cases].

    PubMed

    Cherif, Lotfi; Ben Abdallah, Néjib; Khairi, Karima; Hadj Ali, Inçaf; Turki, Sami; Ben Maïz, Hédi

    2003-09-01

    We report two cases of Grave's disease (GD) caracterized by the succession of hypothyroid and hyperthyroid states. Case 1: A 32 years old woman, has presented initially a typical GD with hyperthyroidism. Grave's ophtalmopathy and homogenous goiter. Four months later, she presented a spontaneous hypothyroidism necessiting treatment with thyroxine and a severe myasthenia gravis. More later (6 months), she experienced symptoms of hyperthyroidism after thymectomy. The level of anti-thyrotropin-receptor antibodies (TSab) was very high (141 UI/I, NV < 10). Case 2: A 29 years old woman has been treated by thyroxine (150 microg/day) for a primary hypothyroidism. Ten months later, she presented symptoms of hyperthyroidism even after stoppage of thyroxine. TSH value was decreased (TSH < 0.05 microU/ml) and FT4 level was raised (FT4 = 25.5 pmol/l). The thyroid antibodies were positive. We discuss, after review of the litterature, the physiopathological mecanisms of these changes in the thyroid state, particularly the role of the blocking and stimulating anti-thyrotropin-receptor antibodies.

  5. Relation between Resting State Front-Parietal EEG Coherence and Executive Function in Parkinson's Disease

    PubMed Central

    Teramoto, Hiroko; Akimoto, Takayoshi; Shiota, Hiroshi; Kamei, Satoshi

    2016-01-01

    Objective. To assess the relation between executive dysfunction (ED) in Parkinson's disease (PD) and resting state functional connectivity evaluated using electroencephalography (EEG) coherence. Methods. Sixty-eight nondemented sporadic PD patients were assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to evaluate executive function. EEG coherence in the left frontoparietal electrode pair (F3-P3) and the right frontoparietal electrode pair (F4-P4) was analyzed in the alpha and theta range. The BADS scores were compared across the coherence groups, and the multiple logistic regression analysis was performed to assess the contribution of confounders. Results. The standardized BADS score was significantly lower in the low F3-P3 coherence group in the alpha range (Mann-Whitney U test, p = 0.032), though there was no difference between F4-P4 coherence group in the alpha range, F3-P3, and F4-P4 coherence groups in the theta range and the standardized BADS score. The multiple logistic regression analysis revealed the significant relation between the F3-P3 coherence group in alpha range and age-controlled standardized BADS score (p = 0.039, 95% CI = 1.002–1.062). Conclusion. The decrease in resting state functional connectivity between the frontal and parietal cortices especially in the left side is related to ED in PD. PMID:27433473

  6. A Mathematical Model with Quarantine States for the Dynamics of Ebola Virus Disease in Human Populations

    PubMed Central

    Ngwa, Gideon A.

    2016-01-01

    A deterministic ordinary differential equation model for the dynamics and spread of Ebola Virus Disease is derived and studied. The model contains quarantine and nonquarantine states and can be used to evaluate transmission both in treatment centres and in the community. Possible sources of exposure to infection, including cadavers of Ebola Virus victims, are included in the model derivation and analysis. Our model's results show that there exists a threshold parameter, R 0, with the property that when its value is above unity, an endemic equilibrium exists whose value and size are determined by the size of this threshold parameter, and when its value is less than unity, the infection does not spread into the community. The equilibrium state, when it exists, is locally and asymptotically stable with oscillatory returns to the equilibrium point. The basic reproduction number, R 0, is shown to be strongly dependent on the initial response of the emergency services to suspected cases of Ebola infection. When intervention measures such as quarantining are instituted fully at the beginning, the value of the reproduction number reduces and any further infections can only occur at the treatment centres. Effective control measures, to reduce R 0 to values below unity, are discussed. PMID:27579053

  7. Adults Eligible for Cardiovascular Disease Prevention Counseling and Participation in Aerobic Physical Activity - United States, 2013.

    PubMed

    Omura, John D; Carlson, Susan A; Paul, Prabasaj; Watson, Kathleen B; Loustalot, Fleetwood; Foltz, Jennifer L; Fulton, Janet E

    2015-09-25

    Cardiovascular disease (CVD) is the leading cause of death in the United States, and physical inactivity is a major risk factor (1). Health care professionals have a role in counseling patients about physical activity for CVD prevention. In August 2014, the U.S. Preventive Services Task Force (USPSTF) recommended that adults who are overweight or obese and have additional CVD risk factors be offered or referred to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Although the USPSTF recommendation does not specify an amount of physical activity, the 2008 Physical Activity Guidelines for Americans state that for substantial health benefits adults should achieve ≥150 minutes per week of moderate-intensity aerobic physical activity or ≥75 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. To assess the proportion of adults eligible for intensive behavioral counseling and not meeting the aerobic physical activity guideline, CDC analyzed data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). This analysis indicated that 36.8% of adults were eligible for intensive behavioral counseling for CVD prevention. Among U.S. states and the District of Columbia (DC), the prevalence of eligible adults ranged from 29.0% to 44.6%. Nationwide, 19.9% of all adults were eligible and did not meet the aerobic physical activity guideline. These data can inform the planning and implementation of health care interventions for CVD prevention that are based on physical activity.

  8. 9 CFR 53.2 - Determination of existence of disease; agreements with States.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Determination of existence of disease... SERVICE, DEPARTMENT OF AGRICULTURE COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES FOOT-AND-MOUTH DISEASE, PLEUROPNEUMONIA, RINDERPEST, AND CERTAIN OTHER COMMUNICABLE DISEASES...

  9. 9 CFR 53.2 - Determination of existence of disease; agreements with States.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Determination of existence of disease... SERVICE, DEPARTMENT OF AGRICULTURE COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES FOOT-AND-MOUTH DISEASE, PLEUROPNEUMONIA, RINDERPEST, AND CERTAIN OTHER COMMUNICABLE DISEASES...

  10. 9 CFR 53.2 - Determination of existence of disease; agreements with States.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Determination of existence of disease... SERVICE, DEPARTMENT OF AGRICULTURE COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES FOOT-AND-MOUTH DISEASE, PLEUROPNEUMONIA, RINDERPEST, AND CERTAIN OTHER COMMUNICABLE DISEASES...

  11. 9 CFR 53.2 - Determination of existence of disease; agreements with States.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Determination of existence of disease... SERVICE, DEPARTMENT OF AGRICULTURE COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES FOOT-AND-MOUTH DISEASE, PLEUROPNEUMONIA, RINDERPEST, AND CERTAIN OTHER COMMUNICABLE DISEASES...

  12. 9 CFR 53.2 - Determination of existence of disease; agreements with States.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Determination of existence of disease... SERVICE, DEPARTMENT OF AGRICULTURE COOPERATIVE CONTROL AND ERADICATION OF LIVESTOCK OR POULTRY DISEASES FOOT-AND-MOUTH DISEASE, PLEUROPNEUMONIA, RINDERPEST, AND CERTAIN OTHER COMMUNICABLE DISEASES...

  13. Virus diseases of salmonidae in the western United States. II. Aspects of pathogenesis

    USGS Publications Warehouse

    Yasutake, W.T.; Parisot, T.J.; Klontz, G.W.

    1965-01-01

    This study was undertaken to initiate a series concerning pathogeneses of infectious diseases of salmonids.  The two viral diseases covered in this paper are the Oregon sockeye disease (OSD) and Sacramento River chinook disease (SRCD). Some preliminary data on pathology of the corresponding material from the hatchery epizootics will also be described and discussed.

  14. Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States, 2013

    PubMed Central

    Croft, Janet B.; Wheaton, Anne G.; Kanny, Dafna; Cunningham, Timothy J.; Lu, Hua; Onufrak, Stephen; Malarcher, Ann M.; Greenlund, Kurt J.; Giles, Wayne H.

    2016-01-01

    Introduction Five key health-related behaviors for chronic disease prevention are never smoking, getting regular physical activity, consuming no alcohol or only moderate amounts, maintaining a normal body weight, and obtaining daily sufficient sleep. The objective of this study was to estimate the clustering of these 5 health-related behaviors among adults aged 21 years or older in each state and the District of Columbia and to assess geographic variation in clustering. Methods We used data from the 2013 Behavioral Risk Factor Surveillance System (BRFSS) to assess the clustering of the 5 behaviors among 395,343 BRFSS respondents aged 21 years or older. The 5 behaviors were defined as currently not smoking cigarettes, meeting the aerobic physical activity recommendation, consuming no alcohol or only moderate amounts, maintaining a normal body mass index (BMI), and sleeping at least 7 hours per 24-hour period. Prevalence of having 4 or 5 of these behaviors, by state, was also examined. Results Among US adults, 81.6% were current nonsmokers, 63.9% obtained 7 hours or more sleep per day, 63.1% reported moderate or no alcohol consumption, 50.4% met physical activity recommendations, and 32.5% had a normal BMI. Only 1.4% of respondents engaged in none of the 5 behaviors; 8.4%, 1 behavior; 24.3%, 2 behaviors; 35.4%, 3 behaviors; and 24.3%, 4 behaviors; only 6.3% reported engaging in all 5 behaviors. The highest prevalence of engaging in 4 or 5 behaviors was clustered in the Pacific and Rocky Mountain states. Lowest prevalence was in the southern states and along the Ohio River. Conclusion Additional efforts are needed to increase the proportion of the population that engages in all 5 health-related behaviors and to eliminate geographic variation. Collaborative efforts in health care systems, communities, work sites, and schools can promote all 5 behaviors and produce population-wide changes, especially among the socioeconomically disadvantaged. PMID:27236381

  15. Intradural approach to selective stimulation in the spinal cord for treatment of intractable pain: design principles and wireless protocol

    NASA Astrophysics Data System (ADS)

    Howard, M. A.; Utz, M.; Brennan, T. J.; Dalm, B. D.; Viljoen, S.; Jeffery, N. D.; Gillies, G. T.

    2011-08-01

    We introduce an intradural approach to spinal cord stimulation for the relief of intractable pain, and describe the biophysical rationale that underlies its design and performance requirements. The proposed device relies on wireless, inductive coupling between a pial surface implant and its epidural controller, and we present the results of benchtop experiments that demonstrate the ability to transmit and receive a frequency-modulated 1.6 MHz carrier signal between micro-coil antennae scaled to the ≈ 1 cm dimensions of the implant, at power levels of about 5 mW. Plans for materials selection, microfabrication, and other aspects of future development are presented and discussed.

  16. Proinflammatory and Prothrombotic State in Subjects with Different Glucose Tolerance Status before Cardiovascular Disease

    PubMed Central

    Isordia-Salas, Irma; Galván-Plata, María Eugenia; Leaños-Miranda, Alfredo; Aguilar-Sosa, Eberth; Anaya-Gómez, Francisco; Majluf-Cruz, Abraham; Santiago-Germán, David

    2014-01-01

    Background. Inflammation has been associated with insulin resistance, type 2 diabetes mellitus (T2DM), and atherothrombosis. Aim. To determine differences in levels of proinflammatory and prothrombotic markers such as high sensitivity C-reactive protein (hs-CRP) and fibrinogen in subjects with normal glucose tolerance (NGT), prediabetes, and T2DM and to establish their relationship with other cardiovascular risk factors before clinical manifestations of cardiovascular disease. Methods. We conducted a nonrandomized, cross-sectional assay in a hospital at México City. The levels of hs-CRP and fibrinogen were measured and compared according to glucose tolerance status. Results. We enrolled 1047 individuals and they were distributed into NGT n = 473, pre-DM n = 250, and T2DM n = 216. There was a statistical difference between NGT and T2DM groups for fibrinogen (P = 0.01) and hs-CRP (P = 0.05). Fibrinogen and hs-CRP showed a significant positive correlation coefficient (r = 0.53, P<0.0001). In a multiple stepwise regression analysis, the variability in fibrinogen levels was explained by age, HbA1c, and hs-CRP (adjusted R2 = 0.31, P<0.0001), and for hs-CRP it was explained by BMI and fibrinogen (adjusted R2 = 0.33, P<0.0001). Conclusion. Inflammation and prothrombotic state are present in people with T2DM lacking cardiovascular disease. Fibrinogen and Hs-CRP are positively correlated. Fibrinogen and hs-CRP concentrations are predominantly determined by BMI rather than glucose levels. PMID:24772446

  17. The Prevalence of Peyronie's Disease in the United States: A Population-Based Study

    PubMed Central

    Stuntz, Mark; Perlaky, Anna; des Vignes, Franka; Kyriakides, Tassos; Glass, Dan

    2016-01-01

    Peyronie’s disease (PD) is a connective tissue disorder which can result in penile deformity. The prevalence of diagnosed PD in the United States (US) has been estimated to be 0.5% in adult males, but there is limited additional information comparing definitive and probable PD cases. We conducted a population-based survey to assess PD prevalence using a convenience-sample of adult men participating in the ResearchNow general population panel. Respondents were categorized according to PD status (definitive, probable, no PD) and segmented by US geographic region, education, and income levels. Of the 7,711 respondents, 57 (0.7%) had definitive PD while 850 (11.0%) had probable PD. Using univariate logistic regression modeling, older age (18–24 vs 24+) (OR = 0.721; 95% CI = 0.570,0.913), Midwest/Northeast/West geographic region (South vs Midwest/Northeast/West) (OR = 0.747; 95% CI = 0.646,0.864), and higher income level (<25K vs 25K+) (OR = 0.820; 95% CI = 0.673,0.997) were each significantly associated with reduced odds of having a definitive/probable PD diagnosis compared with no PD diagnosis. When all three variables were entered in a stepwise multivariable logistic regression, only age (OR = 0.642; 95% CI = 0.497, 0.828) and region (OR = 0.752; 95% CI = 0.647, 0.872) remained significant. This study is the first to report PD prevalence by geographic region and income, and it advocates that the prevalence of PD in the US may be higher than previously cited. Further, given the large discrepancy between definitive PD cases diagnosed by a physician and probable cases not diagnosed by a physician, much more needs to be done to raise awareness of this disease. PMID:26907743

  18. Renal cell cancer: a shift in approaches for treatment of advanced disease in the United States.

    PubMed

    Banegas, Matthew P; Harlan, Linda C; Mann, Bhupinder; Yabroff, K Robin

    2014-09-01

    Several new agents have become available to treat renal cell cancer (RCC) in recent years, although evidence on their dissemination is limited. This study examined recent trends in RCC treatment in US community practices. Data from the population-based National Cancer Institute's Patterns of Care studies were used to evaluate treatment of patients with RCC newly diagnosed in 2004 and 2009 (N=2357). Descriptive statistics and logistic and Cox proportional hazards regression analyses were used to assess treatment patterns and the associations among demographic, clinical, and hospital characteristics, with receipt of systemic therapy and time-to-systemic treatment. Between 2004 and 2009, systemic therapy use increased among patients with stage III and IV RCC, from 3.8% to 15.7% and 35.2% to 57.4%, respectively. Among patients with stage IV disease, the most commonly used therapies changed from interleukin-2 (16.3%) and interferon-alfa (16.6%) in 2004 to sunitinib (39.2%) and temsirolimus (15.2%) in 2009. Further, notable decreases were seen in the use of surgery and time-to-systemic treatment for patients with stage IV disease. Patients who were older, living in areas with lower educational attainment, and diagnosed in 2004 were significantly less likely to receive systemic therapy and had longer time-to-systemic treatment (P<.05). The findings indicate that over the past decade, treatment for RCC in the United States has evolved toward increased use of systemic therapy. As the diffusion of new therapies continues, it will be imperative to understand how variation in care for RCC will impact health outcomes and costs of care. PMID:25190695

  19. An observational study of the temporal and spatial patterns of Marek's-disease-associated leukosis condemnation of young chickens in the United States of America

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Marek's disease, a disease primarily affecting immature chickens, is a worldwide problem that has on at least three occasions threatened the poultry industry in the United States. A rich dataset to study the epidemiology of this disease is available because the United States Department of Agricultu...

  20. Information processing in micro and meso-scale neural circuits during normal and disease states

    NASA Astrophysics Data System (ADS)

    Luongo, Francisco

    techniques. We show that we can further reduce the dimensionality of these networks by identifying 'key-interactions' that are informative of the overall subnetwork state at any given point in time. This study highlights that redundancy in ECoG data can be exploited to identify low-dimensional representation of brain-wide subnetworks. Taken together, these studies represent the development of multiple technological and analytical techniques aimed at understanding how information is processed and modulated at emergent circuit and network levels as well as understanding their dysfunction in a neuropsychiatric disease state.

  1. Seroprevalence of infectious bursal disease virus in local chickens in Udu Local Government Area of Delta State, South East Nigeria.

    PubMed

    Abraham-Oyiguh, J; Adewumi, M O; Onoja, A B; Suleiman, I; Sulaiman, L K; Ahmed, S J; Jagboro, S T

    2015-01-01

    Infectious Bursal Disease Virus (IBDV) poses a great global threat to the poultry industry. Knowledge of the occurrence of the disease is important in the design and implementation of a control program, therefore this study determines the seroprevalence of IBDV in local chickens in Udu Local Government Area of Delta State. 250 chickens were bled by exsanguination and sera obtained were screened using Agar Gel Immunodiffusion (AGID) test. The seropositivity was 51.6%, which is indicates endemicity of the disease. Biosecurity and good sanitary measures are recommended. Molecular characterization of the strains should be carried out for inclusion in generic vaccines.

  2. The Discovery of Novel Genomic, Transcriptomic, and Proteomic Biomarkers in Cardiovascular and Peripheral Vascular Disease: The State of the Art

    PubMed Central

    de Franciscis, Stefano; Metzinger, Laurent; Serra, Raffaele

    2016-01-01

    Cardiovascular disease (CD) and peripheral vascular disease (PVD) are leading causes of mortality and morbidity in western countries and also responsible of a huge burden in terms of disability, functional decline, and healthcare costs. Biomarkers are measurable biological elements that reflect particular physiological or pathological states or predisposition towards diseases and they are currently widely studied in medicine and especially in CD. In this context, biomarkers can also be used to assess the severity or the evolution of several diseases, as well as the effectiveness of particular therapies. Genomics, transcriptomics, and proteomics have opened new windows on disease phenomena and may permit in the next future an effective development of novel diagnostic and prognostic medicine in order to better prevent or treat CD. This review will consider the current evidence of novel biomarkers with clear implications in the improvement of risk assessment, prevention strategies, and medical decision making in the field of CD. PMID:27298828

  3. Low-frequency fluctuation amplitude analysis of resting-state fMRI in sickle cell disease

    NASA Astrophysics Data System (ADS)

    Coloigner, Julie; Kim, Yeun; Bush, Adam; Borzage, Matt; Rajagopalan, Vidya; Lepore, Natasha; Wood, John

    2015-12-01

    Sickle cell disease may result in neurological damage and strokes, leading to morbidity and mortality. Currently, there are no dependable biomarkers to predict impending strokes. In this study, we analyzed neuronal processes at resting state and more particularly how this disease affects the default mode network. The amplitude of low frequency fluctuations was used to reflect areas of spontaneous BOLD signal across brain regions. We compared the activations of sickle cell disease patients to a control group using variance analysis and t-test. Significant regional differences among the two groups were observed, especially in the default mode network areas and cortical regions near large cerebral arteries. These findings suggest that sickle cell disease causes activation modifications near vessels, and these changes could be used as a biomarker of the disease.

  4. Ambient humidity and the skin: the impact of air humidity in healthy and diseased states.

    PubMed

    Goad, N; Gawkrodger, D J

    2016-08-01

    studies are needed to better delineate the interactions that can occur in normal and diseased states. Therapeutic measures might be forthcoming especially for skin diseases such as eczema, which are regarded as being characterized by 'skin dryness'. Further research examining the interaction between different environmental exposures thought to impact the skin, and indeed the interplay between genetic, environmental and immunological influences, are required. PMID:27306376

  5. Early-Life State-of-Residence Characteristics and Later Life Hypertension, Diabetes, and Ischemic Heart Disease

    PubMed Central

    Eisen, Ellen A.; Modrek, Sepideh; Mokyr Horner, Elizabeth; Goldstein, Benjamin; Costello, Sadie; Cantley, Linda F.; Slade, Martin D.; Cullen, Mark R.

    2015-01-01

    Objectives. We examined how state characteristics in early life are associated with individual chronic disease later in life. Methods. We assessed early-life state of residence using the first 3 digits of social security numbers from blue- and white-collar workers from a US manufacturing company. Longitudinal data were available from 1997 to 2012, with 305 936 person-years of observation. Disease was assessed using medical claims. We modeled associations using pooled logistic regression with inverse probability of censoring weights. Results. We found small but statistically significant associations between early-state-of-residence characteristics and later life hypertension, diabetes, and ischemic heart disease. The most consistent associations were with income inequality, percentage non-White, and education. These associations were similar after statistically controlling for individual socioeconomic and demographic characteristics and current state characteristics. Conclusions. Characteristics of the state in which an individual lives early in life are associated with prevalence of chronic disease later in life, with a strength of association equivalent to genetic associations found for these same health outcomes. PMID:26066927

  6. Climate variability and change in the United States: potential impacts on vector- and rodent-borne diseases.

    PubMed

    Gubler, D J; Reiter, P; Ebi, K L; Yap, W; Nasci, R; Patz, J A

    2001-05-01

    Diseases such as plague, typhus, malaria, yellow fever, and dengue fever, transmitted between humans by blood-feeding arthropods, were once common in the United States. Many of these diseases are no longer present, mainly because of changes in land use, agricultural methods, residential patterns, human behavior, and vector control. However, diseases that may be transmitted to humans from wild birds or mammals (zoonoses) continue to circulate in nature in many parts of the country. Most vector-borne diseases exhibit a distinct seasonal pattern, which clearly suggests that they are weather sensitive. Rainfall, temperature, and other weather variables affect in many ways both the vectors and the pathogens they transmit. For example, high temperatures can increase or reduce survival rate, depending on the vector, its behavior, ecology, and many other factors. Thus, the probability of transmission may or may not be increased by higher temperatures. The tremendous growth in international travel increases the risk of importation of vector-borne diseases, some of which can be transmitted locally under suitable circumstances at the right time of the year. But demographic and sociologic factors also play a critical role in determining disease incidence, and it is unlikely that these diseases will cause major epidemics in the United States if the public health infrastructure is maintained and improved.

  7. Climate variability and change in the United States: potential impacts on vector- and rodent-borne diseases.

    PubMed Central

    Gubler, D J; Reiter, P; Ebi, K L; Yap, W; Nasci, R; Patz, J A

    2001-01-01

    Diseases such as plague, typhus, malaria, yellow fever, and dengue fever, transmitted between humans by blood-feeding arthropods, were once common in the United States. Many of these diseases are no longer present, mainly because of changes in land use, agricultural methods, residential patterns, human behavior, and vector control. However, diseases that may be transmitted to humans from wild birds or mammals (zoonoses) continue to circulate in nature in many parts of the country. Most vector-borne diseases exhibit a distinct seasonal pattern, which clearly suggests that they are weather sensitive. Rainfall, temperature, and other weather variables affect in many ways both the vectors and the pathogens they transmit. For example, high temperatures can increase or reduce survival rate, depending on the vector, its behavior, ecology, and many other factors. Thus, the probability of transmission may or may not be increased by higher temperatures. The tremendous growth in international travel increases the risk of importation of vector-borne diseases, some of which can be transmitted locally under suitable circumstances at the right time of the year. But demographic and sociologic factors also play a critical role in determining disease incidence, and it is unlikely that these diseases will cause major epidemics in the United States if the public health infrastructure is maintained and improved. PMID:11359689

  8. Lyme Disease Testing by Large Commercial Laboratories in the United States

    PubMed Central

    HINCKLEY, ALISON F.; CONNALLY, NEETA P.; MEEK, JAMES I.; JOHNSON, BARBARA J.; KEMPERMAN, MELISSA M.; FELDMAN, KATHERINE A.; WHITE, JENNIFER L.; MEAD, PAUL S.

    2015-01-01

    Background Laboratory testing is helpful when evaluating patients with suspected Lyme disease (LD). A two-tiered antibody testing approach is recommended, but single-tier and non-validated tests are also used. We conducted a survey of large commercial laboratories in the United States to assess laboratory practices. We used these data to estimate the cost of testing and number of infections among patients from whom specimens were submitted. Methods Large commercial laboratories were asked to report the type and volume of testing conducted nationwide in 2008, as well as the percent of positive tests for four LD endemic states. The total direct cost of testing was calculated for each test type. These data and test-specific performance parameters available in published literature were used to estimate the number of infections among source patients. Results Seven participating laboratories performed ~3.4 million LD tests on ~2.4 million specimens nationwide at an estimated cost of $492 million. Two-tiered testing accounted for at least 62% of assays performed; alternative testing accounted for less than 3% of assays. The estimated frequency of infection among patients from whom specimens were submitted ranged from 10% to 18.5%. Applied to the total numbers of specimens, this yielded an estimated 240,000 to 444,000 infected source patients in 2008. Discussion LD testing is common and costly, with most testing in accordance with diagnostic recommendations. These results highlight the importance of considering clinical and exposure history when interpreting laboratory results for diagnostic and surveillance purposes. PMID:24879782

  9. Refsum disease diagnostic marker phytanic acid alters the physical state of membrane proteins of liver mitochondria.

    PubMed

    Schönfeld, P; Struy, H

    1999-08-27

    Phytanic acid (3,7,11,15-tetramethylhexadecanoic acid), a branched chain fatty acid accumulating in Refsum disease to high levels throughout the body, induces uncoupling of rat liver mitochondria similar to non-branched fatty acids (e.g. palmitic acid), but the contribution of the ADP/ATP carrier or the aspartate/glutamate carrier in phytanic acid-induced uncoupling is of minor importance. Possible deleterious effects of phytanic acid on membrane-linked energy coupling processes were studied by ESR spectroscopy using rat liver mitochondria and a membrane preparation labeled with the lipid-specific spin probe 5-doxylstearic acid (5-DSA) or the protein-specific spin probe MAL-TEMPO (4-maleimido-2,2,6, 6-tetramethyl-piperidine-1-oxyl). The effects of phytanic acid on phospholipid molecular dynamics and on the physical state of membrane proteins were quantified by estimation of the order parameter or the ratio of the amplitudes of the weakly to strongly immobilized MAL-TEMPO binding sites (W/S ratio), respectively. It was found, that phytanic acid (1) increased the mobility of phospholipid molecules (indicated by a decrease in the order parameter) and (2) altered the conformational state and/or the segmental mobility of membrane proteins (indicated by a drastic decrease in the W/S ratio). Unsaturated fatty acids with multiple cis-double bonds (e.g. linolenic or arachidonic acid), but not non-branched FFA (ranging from chain length C10:0 to C18:0), also decrease the W/S ratio. It is hypothesized that the interaction of phytanic acid with transmembrane proteins might stimulate the proton permeability through the mitochondrial inner membrane according to a mechanism, different to a protein-supported fatty acid cycling.

  10. Classification of Single Normal and Alzheimer's Disease Individuals from Cortical Sources of Resting State EEG Rhythms

    PubMed Central

    Babiloni, Claudio; Triggiani, Antonio I.; Lizio, Roberta; Cordone, Susanna; Tattoli, Giacomo; Bevilacqua, Vitoantonio; Soricelli, Andrea; Ferri, Raffaele; Nobili, Flavio; Gesualdo, Loreto; Millán-Calenti, José C.; Buján, Ana; Tortelli, Rosanna; Cardinali, Valentina; Barulli, Maria Rosaria; Giannini, Antonio; Spagnolo, Pantaleo; Armenise, Silvia; Buenza, Grazia; Scianatico, Gaetano; Logroscino, Giancarlo; Frisoni, Giovanni B.; del Percio, Claudio

    2016-01-01

    Previous studies have shown abnormal power and functional connectivity of resting state electroencephalographic (EEG) rhythms in groups of Alzheimer's disease (AD) compared to healthy elderly (Nold) subjects. Here we tested the best classification rate of 120 AD patients and 100 matched Nold subjects using EEG markers based on cortical sources of power and functional connectivity of these rhythms. EEG data were recorded during resting state eyes-closed condition. Exact low-resolution brain electromagnetic tomography (eLORETA) estimated the power and functional connectivity of cortical sources in frontal, central, parietal, occipital, temporal, and limbic regions. Delta (2–4 Hz), theta (4–8 Hz), alpha 1 (8–10.5 Hz), alpha 2 (10.5–13 Hz), beta 1 (13–20 Hz), beta 2 (20–30 Hz), and gamma (30–40 Hz) were the frequency bands of interest. The classification rates of interest were those with an area under the receiver operating characteristic curve (AUROC) higher than 0.7 as a threshold for a moderate classification rate (i.e., 70%). Results showed that the following EEG markers overcame this threshold: (i) central, parietal, occipital, temporal, and limbic delta/alpha 1 current density; (ii) central, parietal, occipital temporal, and limbic delta/alpha 2 current density; (iii) frontal theta/alpha 1 current density; (iv) occipital delta/alpha 1 inter-hemispherical connectivity; (v) occipital-temporal theta/alpha 1 right and left intra-hemispherical connectivity; and (vi) parietal-limbic alpha 1 right intra-hemispherical connectivity. Occipital delta/alpha 1 current density showed the best classification rate (sensitivity of 73.3%, specificity of 78%, accuracy of 75.5%, and AUROC of 82%). These results suggest that EEG source markers can classify Nold and AD individuals with a moderate classification rate higher than 80%. PMID:26941594

  11. The adjuvant use of lansoprazole, clonazepam and dimenhydrinate for treating intractable hiccups in a patient with gastritis and reflux esophagitis complicated with myocardial infarction: a case report

    PubMed Central

    2013-01-01

    Background Hiccup (Singultus) is a sudden and involuntary contraction of the diaphragm followed by a sharp closure of the epiglottis which results in the production of a specific “hic” sound. Normally, hiccups are treated without intervention. Intractable hiccups occur rarely but are a disturbing symptom underlying other health related disorders. Case presentation We report the clinical case of a 67-year-old male patient with myocardial infarction accompanied by intractable hiccups during the course of 8 months, and who was non-responsive to chlorpromazine or metoclopramide, and baclofen; drugs routinely used to treat this condition. This sustained hiccup had severely restricted the patient's ability to intake food and sleep. To explore alternative treatments, we investigated the adjuvant administration of lansoprazole, dimenhydrinate and clonazepam in this patient. We discovered that this drug combination was capable of successfully terminating his intractable hiccups, with no further evidence of recurrence. No similar treatment is previously reported for intractable hiccups. We further suggest a hypothesis concerning a potential mechanism on the anti-hiccup effect of dimenhydrinate. Conclusion We identified that the adjuvant use of lansoprazole, clonazepam and dimenhydrinate was capable of attenuating the symptoms of our patient with intractable hiccups. PMID:23954069

  12. Seven Strains of Enterovirus D68 Detected in the United States during the 2014 Severe Respiratory Disease Outbreak

    PubMed Central

    Brown, B. A.; Nix, W. A.; Sheth, M.; Frace, M.

    2014-01-01

    Clusters of severe respiratory disease in the United States were reported to the CDC beginning in August 2014. Enterovirus D68 (EV-D68) was identified from 83% (30/36) of initial severe cases. Investigations in August and September found severe EV-D68 cases to be widespread across the United States. We report seven EV-D68 genomes from the outbreak. PMID:25414503

  13. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States.

    PubMed

    Kamali, Amanda; Jamieson, Denise J; Kpaduwa, Julius; Schrier, Sarah; Kim, Moon; Green, Nicole M; Ströher, Ute; Muehlenbachs, Atis; Bell, Michael; Rollin, Pierre E; Mascola, Laurene

    2016-07-01

    Many of the survivors of the 2014-2015 epidemic of Ebola virus disease (EVD) in western Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women's pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors.

  14. Total antioxidants status and some hematological values in sickle cell disease patients in steady state.

    PubMed Central

    Fasola, Foluke; Adedapo, Kayode; Anetor, John; Kuti, Modupe

    2007-01-01

    Congenital hemoglobin mutations may alter the delicate balance of free-radical generation and antioxidant defense systems in the red cell. Oxidative stress may thus play a role in the pathophysiology of the clinical manifestations of the disease. We assessed the total antioxidant status in steady-state sickle cell anemia (SCA) patients and related it to certain hematological parameters and their recent clinical history. Forty (25 males/15 females) adult SCA patients and 30 age-matched controls were studied. All patients and control subjects had total antioxidant status (TAS), hematocrit, white blood cells, platelets and reticulocyte count done. The results showed that TAS levels were about 50% lower in the SCA patients compared with the controls. Among the SCA patients, 57.1% of those with TAS levels <1.00 mmol/L had bone pain crisis >3 times in the past year, compared with 16% in those with TAS levels >1.00 mmol/L. Total leukocyte count and platelets were also significantly higher in the SCA patients than controls. Our data support the growing evidence that oxidative stress has a role to play in the pathophysiology of SCA and intervention aimed at increasing the antioxidant capacity of these patients may be beneficial. PMID:17722666

  15. Emotional state affects gait initiation in individuals with Parkinson’s disease

    PubMed Central

    Hass, Chris J.; Bowers, Dawn; Janelle, Christopher M.

    2013-01-01

    The purpose of the present study was to determine the impact of manipulating emotional state on gait initiation in persons with Parkinson’s disease (PD) and healthy older adults. Following the presentation of pictures that are known to elicit specific emotional responses, participants initiated gait and continued to walk for several steps at their normal pace. Reaction time, the displacement and velocity of the center of pressure (COP) trajectory during the preparatory postural adjustments, and length and velocity of the first two steps were measured. Analysis of the gait initiation measures revealed that exposure to (1) threatening pictures, relative to all other pictures, speeded the initiation of gait for PD patients and healthy older adults; (2) approach-oriented emotional pictures (erotic and happy people), relative to withdrawal-oriented pictures, facilitated the anticipatory postural adjustments of gait initiation for PD patients and healthy older adults, as evidenced by greater displacement and velocity of the COP movement; and (3) emotional pictures modulated gait initiation parameters in PD patients to the same degree as in healthy older adults. Collectively, these findings hold significant implications for understanding the circuitry underlying the manner by which emotions modulate movement and for the development of emotion-based interventions designed to maximize improvements in gait initiation for individuals with PD. PMID:22194236

  16. Role of cilia in normal pancreas function and in diseased states.

    PubMed

    diIorio, Philip; Rittenhouse, Ann R; Bortell, Rita; Jurczyk, Agata

    2014-06-01

    Primary cilia play an essential role in modulating signaling cascades that shape cellular responses to environmental cues to maintain proper tissue development. Mutations in primary cilium proteins have been linked to several rare developmental disorders, collectively known as ciliopathies. Together with other disorders associated with dysfunctional cilia/centrosomes, affected individuals have increased risk of developing metabolic syndrome, neurologic disorders, and diabetes. In pancreatic tissues, cilia are found exclusively in islet and ductal cells where they play an essential role in pancreatic tissue organization. Their absence or disorganization leads to pancreatic duct abnormalities, acinar cell loss, polarity defects, and dysregulated insulin secretion. Cilia in pancreatic tissues are hubs for cellular signaling. Many signaling components, such as Hh, Notch, and Wnt, localize to pancreatic primary cilia and are necessary for proper development of pancreatic epithelium and β-cell morphogenesis. Receptors for neuroendocrine hormones, such as Somatostatin Receptor 3, also localize to the cilium and may play a more direct role in controlling insulin secretion due to somatostatin's inhibitory function. Finally, unique calcium signaling, which is at the heart of β-cell function, also occurs in primary cilia. Whereas voltage-gated calcium channels trigger insulin secretion and serve a variety of homeostatic functions in β-cells, transient receptor potential channels regulate calcium levels within the cilium that may serve as a feedback mechanism, regulating insulin secretion. This review article summarizes our current understanding of the role of primary cilia in normal pancreas function and in the diseased state. PMID:24861006

  17. Prevalence and Morbidity of Primary Immunodeficiency Diseases, United States 2001–2007

    PubMed Central

    Kobrynski, Lisa; Powell, Rachel Waltenburg; Bowen, Scott

    2016-01-01

    Purpose Few studies have estimated population prevalence and morbidity of primary immunodeficiency diseases (PIDD). We used administrative healthcare databases to estimate the prevalence of PIDD diagnoses in the United States from 2001 to 2007. Methods MarketScan databases compile claims from commercial health insurance plans and Medicaid, recording individual diagnoses for outpatient encounters and hospital stays. We used a cross sectional survey to estimate prevalence of PIDD using related ICD-9 codes (279.0, 279.1, 279.2, 279.8, 279.9, 288.1 and 288.2). Persons with secondary immunodeficiency diagnoses were excluded from analysis. Results Between 2001 and 2007, prevalence of any PIDD diagnosis increased from 38.9 to 50.5 per 100,000 among privately insured and from 29.1 to 41.1 per 100,000 among publicly insured persons. B cell defects predominated. Prevalence was more than twice as high among Whites as among Blacks or Hispanics. Conclusion In this large database, we found a higher prevalence of diagnosed PIDD than has been reported previously from registries. Increased awareness may have contributed to the increasing prevalence. PMID:25257253

  18. Multiscale entropy analysis of resting-state magnetoencephalogram with tensor factorisations in Alzheimer's disease.

    PubMed

    Escudero, Javier; Acar, Evrim; Fernández, Alberto; Bro, Rasmus

    2015-10-01

    Tensor factorisations have proven useful to model amplitude and spectral information of brain recordings. Here, we assess the usefulness of tensor factorisations in the multiway analysis of other brain signal features in the context of complexity measures recently proposed to inspect multiscale dynamics. We consider the "refined composite multiscale entropy" (rcMSE), which computes entropy "profiles" showing levels of physiological complexity over temporal scales for individual signals. We compute the rcMSE of resting-state magnetoencephalogram (MEG) recordings from 36 patients with Alzheimer's disease and 26 control subjects. Instead of traditional simple visual examinations, we organise the entropy profiles as a three-way tensor to inspect relationships across temporal and spatial scales and subjects with multiway data analysis techniques based on PARAFAC and PARAFAC2 factorisations. A PARAFAC2 model with two factors was appropriate to account for the interactions in the entropy tensor between temporal scales and MEG channels for all subjects. Moreover, the PARAFAC2 factors had information related to the subjects' diagnosis, achieving a cross-validated area under the ROC curve of 0.77. This confirms the suitability of tensor factorisations to represent electrophysiological brain data efficiently despite the unsupervised nature of these techniques. This article is part of a Special Issue entitled 'Neural data analysis'.

  19. Undernutrition state in patients with chronic obstructive pulmonary disease. A critical appraisal on diagnostics and treatment.

    PubMed

    Akner, Gunnar; Larsson, Kjell

    2016-08-01

    'Undernutrition state' (UNS) is an ominous condition, in particular when associated with chronic obstructive pulmonary disease (COPD). In this review we discuss pathophysiological mechanisms and how UNS is defined and diagnosed. It seems unlikely that COPD-patients with established UNS have similar potential of reversibility (treatability) upon nutrition interventions as patients at a risk of developing such a condition, i.e. patients with low energy/nutrient intake, since pathophysiological, biochemical and metabolic conditions may differ substantially. We summarize the results of 7 of 17 published randomized controlled trials of nutritional supplementation in COPD-patients with defined UNS in the latest Cochrane review (2012). We thus excluded 10 of 17 trials included in review (2012), mostly because those studies also included patients with 'risk of' UNS. The seven included trials exhibit extensive heterogeneity for all studied variables. Most studies did not show beneficial effects of nutritional supplementation, although some reported minor increase in body weight and physical function of unclear clinical relevance. In contrast to the Cochrane review we conclude that it is difficult to draw firm conclusions regarding the effect of nutritional supplements in patients with COPD and UNS. Improved knowledge in this area is of utmost importance and some factors which should be considered in future studies are suggested. PMID:27492517

  20. Oral immunotherapy for allergic diseases using transgenic rice seeds: current state and future prospects.

    PubMed

    Saeki, Mayumi; Nishimura, Tomoe; Kaminuma, Osamu; Mori, Akio; Hiroi, Takachika

    2013-01-01

    Allergen-specific immunotherapy (IT) has been shown to provide clinical benefit for patients with allergic diseases. At present, subcutaneous and sublingual ITs are mainly authorized for clinical treatment. Oral administration of allergens seems to be the easiest way to achieve IT, though it has yet to be translated to the clinical setting, mainly due to the requirement of a large amount of allergens. Plants, especially rice seeds, have recently been recognized as superior allergen carriers for oral administration, because of their high productivity, stability and safety. Therefore, in order to establish clinically applicable oral IT, we have been developing transgenic rice seeds (Tg rice), in which major epitopes of cedar pollen allergens or house-dust mites (HDM) are expressed. The efficacy of this orally administered Tg rice was confirmed in murine models of allergic rhinitis and bronchial asthma. In the safety study of the Tg rice, no adverse effects on cynomolgus macaques were observed. In this review, we summarized the current state and future prospects of allergen-specific IT, focusing particularly on oral IT with allergen-expressing Tg rice.

  1. The Foot-and-Mouth Disease Carrier State Divergence in Cattle

    PubMed Central

    Eschbaumer, Michael; Rekant, Steven I.; Pacheco, Juan M.; Smoliga, George R.; Hartwig, Ethan J.; Rodriguez, Luis L.

    2016-01-01

    . IMPORTANCE The existence of a prolonged, asymptomatic carrier state is a political impediment for control and potential eradication of foot-and-mouth disease (FMD). When FMD outbreaks occur, they are often extinguished by massive depopulation of livestock due to the fear that some animals may have undiagnosed subclinical infection, despite uncertainty over the biological relevance of FMD virus (FMDV) persistence. The work described here elucidates aspects of the FMDV carrier state in cattle which may facilitate identification and/or abrogation of asymptomatic FMDV infection. The divergence between animals that clear infection and those that develop persistent infection was demonstrated to occur earlier than previously established. The host antiviral response in tissues maintaining persistent FMDV was downregulated, whereas upregulation of IFN-λ mRNA was found in the epithelium of cattle that had recently cleared the infection. This suggests that the clearing of FMDV infection is associated with an enhanced mucosal antiviral response, whereas FMDV persistence is associated with suppression of the host antiviral response. PMID:27147736

  2. Clinical Management of Ebola Virus Disease in the United States and Europe

    PubMed Central

    Uyeki, Timothy M.; Mehta, Aneesh K.; Davey, Richard T.; Liddell, Allison M.; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R.; Evans, Laura; Hewlett, Angela L.; Brantsaeter, Arne B.; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I.M.; Gutman, Julie

    2016-01-01

    Background Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. Methods We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. Results A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had

  3. Surveillance and monitoring of white-tailed deer for chronic wasting disease in the northeastern United States

    USGS Publications Warehouse

    Evans, Tyler S.; Schuler, Krysten L.; Walter, William D.

    2014-01-01

    Chronic wasting disease (CWD) is a prion disease that affects both wild and captive cervid populations. In the past 45 y, CWD has spread from northern Colorado to all bordering states, as well as the midwestern United States (Midwest) and northeastern United States (Northeast), Canada, and South Korea. Because CWD is a relatively new issue for wildlife management agencies in the Northeast, we surveyed a representative (e.g., cervid biologist, wildlife veterinarian) from 14 states to gain a better understanding of state-specific surveillance measures. Between 2002 and 2012, New York (37,093) and Pennsylvania (35,324) tested the greatest number of harvested white-tailed deer Odocoileus virginianus in the Northeast. Additionally, the 14 states surveyed have tested 121,730 harvested deer, or approximately 15,216/y, since CWD was first detected in 2005. The most common tissues used by agencies in the Northeast for testing were retropharyngeal lymph nodes, which have been determined to be the most reliable in detecting CWD in cervids. Understanding CWD surveillance efforts at a regional scale can help to provide guidance for the development of new surveillance plans or the improvement of existing ones. Furthermore, collaborations among state and regional agencies in the Northeast may attempt to identify deficiencies in surveillance by state or subregion.

  4. Increasing Area Deprivation and Socioeconomic Inequalities in Heart Disease, Stroke, and Cardiovascular Disease Mortality Among Working Age Populations, United States, 1969-2011

    PubMed Central

    Singh, Gopal K.; Siahpush, Mohammad; Azuine, Romuladus E.; Williams, Shanita D.

    2015-01-01

    Objectives: We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Results: Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Conclusions and Global Health Implications: Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low

  5. Identification of lymphoproliferative disease virus in wild turkeys (Meleagris gallopavo) in the United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Viral-associated lymphoproliferative neoplasia in domestic poultry is caused by infection with a herpesvirus (Marek’s disease virus) or three species of retroviruses [Reticuloendotheliosis virus (REV), Avian leukosis/sarcoma virus, lymphoproliferative disease virus (LPDV)]. Previously, retroviral n...

  6. Chagas Disease Screening in Maternal Donors of Publicly Banked Umbilical Cord Blood, United States.

    PubMed

    Edwards, James M; Gilner, Jennifer B; Hernandez, Jose; Kurtzberg, Joanne; Heine, R Phillips

    2016-08-01

    To assess patterns of Chagas disease, we reviewed results of screening umbilical cord blood from a US public cord blood bank during 2007-2014. Nineteen maternal donors tested positive for Trypanosoma cruzi parasites (0.04%). Because perinatal transmission of Chagas disease is associated with substantial illness, targeted prenatal programs should screen for this disease. PMID:27433974

  7. Chagas Disease Screening in Maternal Donors of Publicly Banked Umbilical Cord Blood, United States

    PubMed Central

    Gilner, Jennifer B.; Hernandez, Jose; Kurtzberg, Joanne; Heine, R. Phillips

    2016-01-01

    To assess patterns of Chagas disease, we reviewed results of screening umbilical cord blood from a US public cord blood bank during 2007–2014. Nineteen maternal donors tested positive for Trypanosoma cruzi parasites (0.04%). Because perinatal transmission of Chagas disease is associated with substantial illness, targeted prenatal programs should screen for this disease. PMID:27433974

  8. Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

    PubMed Central

    Lee, Pil Moo; So, Yun; Park, Jung Min; Park, Chul Min; Kim, Hae Kyoung

    2016-01-01

    Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain. PMID:27103968

  9. Microorganism Nutrition Processes as a General Route for the Preparation of Bionic Nanocomposites Based on Intractable Polymers.

    PubMed

    Valentini, L; Bon, S Bittolo; Pugno, N M

    2016-08-31

    In this paper the fermentation process activated by living microorganisms of the baker's yeast is proposed as a facile assembly method of hybrid nanoparticles at liquid interface. Water dispersion of commercial baker's yeast extract used for bread production, graphene nanoplatelets (GNPs), and carbon nanotubes (CNTs) were added to oil/water interface; when the yeast is activated by adding sugar, the byproduct carbon dioxide bubbles migrate from the water phase to the oil/water interface generating a floating nanostructured film at liquid interface where it is trapped. Starting from this simple method, we propose a general approach for the stabilization of intractable poly(etheretherketone) polymeric particles with GNPs and CNTs at immiscible liquid interface. This process allowed the formation of sintered porous composites with improved mechanical properties. The porous structure of the composites gave rise to a low thermal conductivity making them good candidates for thermal insulating applications. Liquid absorption by these porous composites has been also reported. We believe that this new approach may have applications in the large scale fabrication of nanomaterials and is particularly suited for the preparation of nanocomposites starting from polymers that are intractable by solvent casting. PMID:27529441

  10. Pilot study of sphenopalatine injection of onabotulinumtoxinA for the treatment of intractable chronic cluster headache

    PubMed Central

    Nordgård, Ståle; Stovner, Lars Jacob; Linde, Mattias; Folvik, Mari; Bugten, Vegard; Tronvik, Erling

    2015-01-01

    Objective The main object of this pilot study was to investigate the safety of administering onabotulinumtoxinA (BTA) towards the sphenopalatine ganglion (SPG) in intractable chronic cluster headache. Efficacy data were also collected to provide indication on whether future placebo-controlled studies should be performed. Method In a prospective, open-label, uncontrolled study, we performed a single injection of 25 IU (n = 5) or 50 IU BTA (n = 5) towards the SPG in 10 patients with intractable chronic cluster headache with a follow-up of 24 weeks. The primary outcome was adverse events (AEs) and the main efficacy outcome was attack frequency in weeks 3 and 4 post-treatment. Results A total of 11 AEs were registered. There was one severe adverse event (SAE): posterior epistaxis. The number of cluster headache attacks (main efficacy outcome) was statistically significantly reduced in the intention-to-treat analysis from 18 ± 12 per week in baseline to 11 ± 14 (p = 0.038) in weeks 3 and 4, and five out of 10 patients had at least 50% reduction of attack frequency compared to baseline. The cluster attack frequency was significantly reduced for five out of six months post-treatment. Conclusion Randomised, placebo-controlled studies are warranted to establish the potential of this possible novel treatment of cluster headache. PMID:26232105

  11. Microorganism Nutrition Processes as a General Route for the Preparation of Bionic Nanocomposites Based on Intractable Polymers.

    PubMed

    Valentini, L; Bon, S Bittolo; Pugno, N M

    2016-08-31

    In this paper the fermentation process activated by living microorganisms of the baker's yeast is proposed as a facile assembly method of hybrid nanoparticles at liquid interface. Water dispersion of commercial baker's yeast extract used for bread production, graphene nanoplatelets (GNPs), and carbon nanotubes (CNTs) were added to oil/water interface; when the yeast is activated by adding sugar, the byproduct carbon dioxide bubbles migrate from the water phase to the oil/water interface generating a floating nanostructured film at liquid interface where it is trapped. Starting from this simple method, we propose a general approach for the stabilization of intractable poly(etheretherketone) polymeric particles with GNPs and CNTs at immiscible liquid interface. This process allowed the formation of sintered porous composites with improved mechanical properties. The porous structure of the composites gave rise to a low thermal conductivity making them good candidates for thermal insulating applications. Liquid absorption by these porous composites has been also reported. We believe that this new approach may have applications in the large scale fabrication of nanomaterials and is particularly suited for the preparation of nanocomposites starting from polymers that are intractable by solvent casting.

  12. Primary non-Hodgkin’s lymphoma of the prostate with intractable hematuria: A case report and review of the literature

    PubMed Central

    HU, SHANBIAO; WANG, YINHUAI; YANG, LUOYAN; YI, LU; NIAN, YEQI

    2015-01-01

    Cases of primary non-Hodgkin’s lymphoma of the prostate are globally rare. The present study reports a case of prostatic diffuse large B-cell lymphoma (DLBCL) with intractable hematuria in a 75-year-old male. The patient presented with difficulties in urination and gross hematuria. A prostate biopsy was performed immediately, followed by conservative treatment for bleeding. A bilateral iliac arteriography and chemoembolization were then performed as emergency procedures under local anesthesia due to significant bleeding and a sharply decreased blood pressure, indicating the failure of the conservative treatment. Consequently, the bleeding was effectively controlled. Pathological examination of the prostate biopsy confirmed the presence of a DLBCL of non-germinal center B-cell origin. Immunohistochemical examination demonstrated cluster of differentiation (CD)20(++), CD3(+), leukocyte common antigen(+++), B-cell lymphoma-2(+) and prostate-specific antigen(−) results. Due to the poor general condition and low hemoglobin levels of the patient, a low-dose Rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy regimen was administered. Subsequent to three courses of chemotherapy, the patient achieved complete remission. In conclusion, combining R-CHOP and bilateral selective iliac arterial chemoembolization could be a safe and effective way to treat patients with non-Hodgkin’s lymphoma of the prostate and intractable hematuria. PMID:25663879

  13. The influence of design and definition on the proportion of general epilepsy cohorts with remission and intractability.

    PubMed

    Abimbola, Seye; Martiniuk, Alexandra L C; Hackett, Maree L; Anderson, Craig S

    2011-01-01

    Remission while on anti-epileptic drug (AED) therapy and remission off AED are the only prognostic criteria defined by the International League against Epilepsy (ILAE), defining remission as 5 seizure-free years. Prognosis studies in epilepsy have investigated other prognostic categories using different designs and definitions. This systematic review explores factors that explain discrepancies in the proportion of patients reported with commonly studied prognostic categories in general epilepsy cohorts. Thirty publications (reporting 37 studies) were included. The outcome categories were classified as immediate remission (5 studies), remission off medication (7 studies), remission on or off medication (15 studies), intractability (9 studies) and no remission after relapse (1 study). The findings show the importance of qualifying estimates specifically by how they were defined in each study, study design, setting and patient population as these have implications for patient management and counselling. The ILAE should define the outcome measures and terminology to which researchers should be required to adhere in subsequent updates of their guidelines on research related to remission and intractability.

  14. Surveillance for Waterborne Disease Outbreaks and Other Health Events Associated with Recreational Water -United States, 2007-2008*

    EPA Science Inventory

    Problem/Condition: Since 1978, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have collaborated on the Waterborne Disease and Outbreak Surveillance System (WBDOSS) for collecting and reporting data on occurrences and causes...

  15. Virulent Newcastle disease viruses isolated from cormorant and gull species in the states of the Atlantic Flyway in 2010

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Newcastle disease viruses (NDV) have been the causative agent for die-offs of juvenile double-crested cormorants (Phalacrocorax auritus) in the northern border-states focused around the Great Lakes of the U.S. in years past. However, the most recent die-off has included not only great cormorants (P...

  16. Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.

    PubMed

    Price, James H; Khubchandani, Jagdish; McKinney, Molly; Braun, Robert

    2013-01-01

    Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services. PMID:24175301

  17. Scale dependence of disease impacts on quaking aspen (Populus tremuloides) mortality in the southwestern United States

    USGS Publications Warehouse

    Bell, David M.; Bradford, John B.; Lauenroth, William K.

    2015-01-01

    By examining variation in disease prevalence, mortality of healthy trees, and mortality of diseased trees, we showed that the role of disease in aspen tree mortality depended on the scale of inference. For variation among individuals in diameter, disease tended to expose intermediate-size trees experiencing moderate risk to greater risk. For spatial variation in summer temperature, disease exposed lower risk populations to greater mortality probabilities, but the magnitude of this exposure depended on summer precipitation. Furthermore, the importance of diameter and slenderness in mediating responses to climate supports the increasing emphasis on trait variation in studies of ecological responses to global change.

  18. Deep brain stimulation modulates synchrony within spatially and spectrally distinct resting state networks in Parkinson's disease.

    PubMed

    Oswal, Ashwini; Beudel, Martijn; Zrinzo, Ludvic; Limousin, Patricia; Hariz, Marwan; Foltynie, Tom; Litvak, Vladimir; Brown, Peter

    2016-05-01

    Chronic dopamine depletion in Parkinson's disease leads to progressive motor and cognitive impairment, which is associated with the emergence of characteristic patterns of synchronous oscillatory activity within cortico-basal-ganglia circuits. Deep brain stimulation of the subthalamic nucleus is an effective treatment for Parkinson's disease, but its influence on synchronous activity in cortico-basal-ganglia loops remains to be fully characterized. Here, we demonstrate that deep brain stimulation selectively suppresses certain spatially and spectrally segregated resting state subthalamic nucleus-cortical networks. To this end we used a validated and novel approach for performing simultaneous recordings of the subthalamic nucleus and cortex using magnetoencephalography (during concurrent subthalamic nucleus deep brain stimulation). Our results highlight that clinically effective subthalamic nucleus deep brain stimulation suppresses synchrony locally within the subthalamic nucleus in the low beta oscillatory range and furthermore that the degree of this suppression correlates with clinical motor improvement. Moreover, deep brain stimulation relatively selectively suppressed synchronization of activity between the subthalamic nucleus and mesial premotor regions, including the supplementary motor areas. These mesial premotor regions were predominantly coupled to the subthalamic nucleus in the high beta frequency range, but the degree of deep brain stimulation-associated suppression in their coupling to the subthalamic nucleus was not found to correlate with motor improvement. Beta band coupling between the subthalamic nucleus and lateral motor areas was not influenced by deep brain stimulation. Motor cortical coupling with subthalamic nucleus predominantly involved driving of the subthalamic nucleus, with those drives in the higher beta frequency band having much shorter net delays to subthalamic nucleus than those in the lower beta band. These observations raise the

  19. Rheumatic diseases induced by drugs and environmental factors: the state-of-the-art - part one.

    PubMed

    Niklas, Karolina; Niklas, Arkadiusz A; Majewski, Dominik; Puszczewicz, Mariusz

    2016-01-01

    The majority of rheumatic diseases belong to the group of autoimmune diseases and are associated with autoantibody production. Their etiology is not fully understood. Certain medications and environmental factors may have an influence on the occurrence of rheumatic diseases. Establishing a cause-effect relationship between a certain factor and disease induction is not always simple. It is important to administer the drug continuously or monitor exposure to a given factor in the period preceding the onset of symptoms. The lack of previously diagnosed autoimmune disease, or finally the lack of symptoms within a few weeks/months after discontinuation of the drug/cessation of exposure, is also important. The most frequently mentioned rheumatic diseases caused by drugs and environmental factors include systemic lupus erythematosus, scleroderma, systemic vasculitis, polymyositis, dermatomyositis, and Sjögren's syndrome. The objective of this study is to summarize current knowledge on rheumatic diseases induced by drugs and environmental factors. PMID:27504022

  20. An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Federated States of Micronesia, State of Kosrae: A Systems Perspective

    PubMed Central

    Tolenoa, Nena; Taulung, Livinson; Mongkeya, Maria; Lippwe, Kipier; Aitaoto, Nia

    2013-01-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State. PMID:23900387

  1. An assessment of non-communicable diseases, diabetes, and related risk factors in the Federated States of Micronesia, State of Kosrae: a systems perspective.

    PubMed

    Ichiho, Henry M; Tolenoa, Nena; Taulung, Livinson; Mongkeya, Maria; Lippwe, Kipier; Aitaoto, Nia

    2013-05-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI). This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Kosrae and describes the burdens due to NCDs, including diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 13.9% decline in the population between 2000 and 2010. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. Leading causes of death were due to nutrition and metabolic diseases followed by diseases of the circulatory system. Data from selected community programs show that the prevalence of overweight and obese participants ranged between 82% and 95% and the rate of reported diabetes ranged from 13% to 14%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no functional data system that is able to identify, register, or track patients with diabetes. Priority administrative and clinical issues were identified that need to be addressed to begin to mitigate the burdens of NCDs among the residents of Kosrae State.

  2. The epigenome in Alzheimer's disease: current state and approaches for a new path to gene discovery and understanding disease mechanism.

    PubMed

    Klein, Hans-Ulrich; Bennett, David A; De Jager, Philip L

    2016-10-01

    The advent of new technologies and analytic approaches is beginning to provide an unprecedented look at features of the human genome that affect RNA expression. These "epigenomic" features are found in a number of different forms: they include DNA methylation, covalent modifications of histone proteins and non-coding RNAs. Some of these features have now been implicated in Alzheimer's disease (AD). Here, we focus on recent studies that have identified robust observations relating to DNA methylation and chromatin in human brain tissue; these findings will ground the next generation of studies and provide a model for the design of such studies. Stemming from observations that compounds with histone deacetylase activity may be beneficial in AD, epigenome-wide studies in cortical samples from large numbers of human subjects have now shown that AD-associated epigenomic changes are reproducible, are not driven by genetic risk factors, and are widespread at specific locations in the genome. A fundamental question of whether such changes are causal remains to be demonstrated, but it is already clear that well-powered investigations of the human epigenome in the target organ of a neurodegenerative disease are feasible, are implicating new areas of the genome in the disease, and will be an important tool for future studies. We are now at an inflection point: as genome-wide association studies of genetic variants come to an end, a new generation of studies exploring the epigenome will provide an important new layer of information with which to enrich our understanding of AD pathogenesis and to possibly guide development of new therapeutic targets.

  3. The epigenome in Alzheimer's disease: current state and approaches for a new path to gene discovery and understanding disease mechanism.

    PubMed

    Klein, Hans-Ulrich; Bennett, David A; De Jager, Philip L

    2016-10-01

    The advent of new technologies and analytic approaches is beginning to provide an unprecedented look at features of the human genome that affect RNA expression. These "epigenomic" features are found in a number of different forms: they include DNA methylation, covalent modifications of histone proteins and non-coding RNAs. Some of these features have now been implicated in Alzheimer's disease (AD). Here, we focus on recent studies that have identified robust observations relating to DNA methylation and chromatin in human brain tissue; these findings will ground the next generation of studies and provide a model for the design of such studies. Stemming from observations that compounds with histone deacetylase activity may be beneficial in AD, epigenome-wide studies in cortical samples from large numbers of human subjects have now shown that AD-associated epigenomic changes are reproducible, are not driven by genetic risk factors, and are widespread at specific locations in the genome. A fundamental question of whether such changes are causal remains to be demonstrated, but it is already clear that well-powered investigations of the human epigenome in the target organ of a neurodegenerative disease are feasible, are implicating new areas of the genome in the disease, and will be an important tool for future studies. We are now at an inflection point: as genome-wide association studies of genetic variants come to an end, a new generation of studies exploring the epigenome will provide an important new layer of information with which to enrich our understanding of AD pathogenesis and to possibly guide development of new therapeutic targets. PMID:27573688

  4. Effect of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease.

    PubMed

    Nakamura, Akihiro; Monma, Yuto; Kajitani, Shoko; Noda, Kazuki; Nakajima, Sota; Endo, Hideaki; Takahashi, Tohru; Nozaki, Eiji

    2016-09-01

    Both postprandial hyperlipidemia and hyperinsulinemia have been thought to play an important role in the development of atherosclerosis, and to be a potent risk factor for cardiovascular event. To examine effects of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease (CAD), a total of 112 consecutive male pati ents with angiographically confirmed CAD were loaded with a high-fat and high-glucose test meal. CAD patients were divided into three groups as "non-diabetic", "prediabetic", and "diabetic" CAD groups. The serum triglyceride (TG) and remnant-like particle cholesterol (RLP-C) levels at the 6th hour in diabetic CAD group showed significantly higher than non-diabetic CAD group, and the incremental area under the curves (iAUCs) of these levels in diabetic CAD group were significantly greater than non-diabetic CAD group (TG, P = 0.0194; RLP-C, P = 0.0219). There were no significant differences in the iAUCs of TG or RLP-C between prediabetic and non-diabetic CAD group. The AUCs of plasma insulin levels or insulin resistance index (IRI): (AUCs of insulin) × (AUCs of glucose) as the insulin resistance marker were greater in diabetic CAD group than non-diabetic CAD group (insulin, P = 0.0373; IRI, P = 0.0228). The AUCs of serum TG or RLP-C levels showed a correlation with the AUCs of plasma insulin (AUC-TG, r = 0.5437, P < 0.0001; AUC-RLP-C, r = 0.6847, P < 0.0001), and they correlated well with the insulin resistance index (AUC-TG, r = 0.7724, P < 0.0001; AUC-RLP-C, r = 0.7645, P < 0.0001). We found that the insulin resistance showed a close relationship with postprandial hyperlipidemia in CAD patients. Diabetic, but not prediabetic state, may be a risk for postprandial impaired lipid metabolism in CAD patients. PMID:26439243

  5. Effect of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease.

    PubMed

    Nakamura, Akihiro; Monma, Yuto; Kajitani, Shoko; Noda, Kazuki; Nakajima, Sota; Endo, Hideaki; Takahashi, Tohru; Nozaki, Eiji

    2016-09-01

    Both postprandial hyperlipidemia and hyperinsulinemia have been thought to play an important role in the development of atherosclerosis, and to be a potent risk factor for cardiovascular event. To examine effects of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease (CAD), a total of 112 consecutive male pati ents with angiographically confirmed CAD were loaded with a high-fat and high-glucose test meal. CAD patients were divided into three groups as "non-diabetic", "prediabetic", and "diabetic" CAD groups. The serum triglyceride (TG) and remnant-like particle cholesterol (RLP-C) levels at the 6th hour in diabetic CAD group showed significantly higher than non-diabetic CAD group, and the incremental area under the curves (iAUCs) of these levels in diabetic CAD group were significantly greater than non-diabetic CAD group (TG, P = 0.0194; RLP-C, P = 0.0219). There were no significant differences in the iAUCs of TG or RLP-C between prediabetic and non-diabetic CAD group. The AUCs of plasma insulin levels or insulin resistance index (IRI): (AUCs of insulin) × (AUCs of glucose) as the insulin resistance marker were greater in diabetic CAD group than non-diabetic CAD group (insulin, P = 0.0373; IRI, P = 0.0228). The AUCs of serum TG or RLP-C levels showed a correlation with the AUCs of plasma insulin (AUC-TG, r = 0.5437, P < 0.0001; AUC-RLP-C, r = 0.6847, P < 0.0001), and they correlated well with the insulin resistance index (AUC-TG, r = 0.7724, P < 0.0001; AUC-RLP-C, r = 0.7645, P < 0.0001). We found that the insulin resistance showed a close relationship with postprandial hyperlipidemia in CAD patients. Diabetic, but not prediabetic state, may be a risk for postprandial impaired lipid metabolism in CAD patients.

  6. Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States

    PubMed Central

    Rodriguez, Carlos J.; Allison, Matthew; Daviglus, Martha L.; Isasi, Carmen R.; Keller, Colleen; Leira, Enrique C.; Palaniappan, Latha; Piña, Ileana L.; Ramirez, Sarah M.; Rodriguez, Beatriz; Sims, Mario

    2015-01-01

    Background and Purpose This American Heart Association (AHA) scientific statement provides a comprehensive overview of current evidence on the burden cardiovascular disease (CVD) among Hispanics in the United States. Hispanics are the largest minority ethnic group in the United States, and their health is vital to the public health of the nation and to achieving the AHA’s 2020 goals. This statement describes the CVD epidemiology and related personal beliefs and the social and health issues of US Hispanics, and it identifies potential prevention and treatment opportunities. The intended audience for this statement includes healthcare professionals, researchers, and policy makers. Methods Writing group members were nominated by the AHA’s Manuscript Oversight Committee and represent a broad range of expertise in relation to Hispanic individuals and CVD. The writers used a general framework outlined by the committee chair to produce a comprehensive literature review that summarizes existing evidence, indicate gaps in current knowledge, and formulate recommendations. Only English-language studies were reviewed, with PubMed/MEDLINE as our primary resource, as well as the Cochrane Library Reviews, Centers for Disease Control and Prevention, and the US Census data as secondary resources. Inductive methods and descriptive studies that focused on CVD outcomes incidence, prevalence, treatment response, and risks were included. Because of the wide scope of these topics, members of the writing committee were responsible for drafting individual sections selected by the chair of the writing committee, and the group chair assembled the complete statement. The conclusions of this statement are the views of the authors and do not necessarily represent the official view of the AHA. All members of the writing group had the opportunity to comment on the initial drafts and approved the final version of this document. The manuscript underwent extensive AHA internal peer review before

  7. Regional Disparities in Mortality after Ischemic Heart Disease in a Brazilian State from 2006 to 2010

    PubMed Central

    de Andrade, Luciano; Zanini, Vanessa; Batilana, Adelia Portero; de Carvalho, Elias Cesar Araujo; Pietrobon, Ricardo; Nihei, Oscar Kenji; de Barros Carvalho, Maria Dalva

    2013-01-01

    Background High technology in the field of interventional cardiology applied in tertiary hospitals has brought enormous benefits in the treatment of ischemic heart disease (IHD). However, IHD mortality rates remain high. We analyzed the relationship between IHD mortality rate and the socioeconomic, demographic, and geographic conditions in 399 cities in Parana state, Brazil, from 2006 to 2010. Methods and Results Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics and evaluated through Exploratory Spatial Data Analysis. GeoDa™ was used to analyze 29.351 deaths across 399 cities. We found a positive spatial autocorrelation regarding IHD mortality (I = 0.5913, p = 0.001). There was a significant positive association between each of three socioeconomic and demographic indicators and IHD mortality rate: Population Elderly Index (I = 0.3436), Illiteracy Rate (I = 0.1873) and City Development Index (I = 0.0900). In addition, two indicators presented significant negative association with IHD mortality rate: Adjusted Population Size (I = −0.1216) and Gross Domestic Product (I = −0.0864). We also found a positive association between IHD mortality rates and the geographic distances between patients’ city of residence and their corresponding regional referral centers in interventional cardiology (I = 0.3368). Cities located within Regional Health Units with Reference Interventional Cardiology Center presented a significantly lower average specific mortality rate by IHD. The high mortality rate by IHD within the Regional Health Units was not restricted to socioeconomic and demographic variables, but dependent on the distance between each city and their reference interventional cardiology center. Conclusions We conclude that geographic factors play a significant role in IHD mortality within cities. These findings have important policy implications regarding the geographic

  8. Detection and molecular characterization of Newcastle disease virus in peafowl (Pavo cristatus) in Haryana State, India.

    PubMed

    Kumar, Aman; Maan, Sushila; Mahajan, Nand Kishore; Rana, Virender Pratap; Jindal, Naresh; Batra, Kanisht; Ghosh, Arnab; Mishra, Shiv Kumar; Kapoor, Sanjay; Maan, Narender Singh

    2013-12-01

    Present study was undertaken to investigate the cause of deaths of peafowls in Haryana State. In total, 145 birds were sick and 28 birds were reported dead during July to September 2012. Some of the sick birds were showing signs of shaking of heads, torticollis and paresis. Blood and cloacal swab samples from sick birds along with brain and intestinal tissues from dead birds were collected for further investigation. Although post-mortem examination showed no typical lesions of Newcastle disease virus (NDV) yet raised HI tires against NDV in some serum samples and clinical signs indicated the presence of NDV. One of the brain tissues (NDV/IND2012/01) from the field case was processed and adapted to Vero cell line for virus isolation. The fusion (F) gene based nested RT-PCR (RT-nPCR) confirmed the presence of NDV in all field samples and cell culture isolate. Sequencing of the partial F gene amplicons (216 bp) using the PCR primers as sequencing primers confirmed the PCR results. The deduced amino acid sequences of partial F gene were found to have the amino acid motif (111)GRRQKR/F(117) in the fusion protein cleavage site (FPCS). This amino acid motif is indicative of the velogenic nature of these NDVs. Phylogenetic studies have shown that the virus belonged to class II genotype VII very closely related to virus isolates originated from outbreaks in Western Europe, Israel, Indonesia, Taiwan and India. Phylogenetic grouping of the virus and sequence of FPCS is indicative of pathogenic potential of virus strain circulating in peacocks in Haryana.

  9. Million hearts: prevalence of leading cardiovascular disease risk factors--United States, 2005-2012.

    PubMed

    Ritchey, Matthew D; Wall, Hilary K; Gillespie, Cathleen; George, Mary G; Jamal, Ahmed

    2014-05-30

    Each year, approximately 1.5 million U.S. adults have a heart attack or stroke, resulting in approximately 30 deaths every hour and, for nonfatal events, often leading to long-term disability. Overall, an estimated 14 million survivors of heart attacks and strokes are living in the United States. In 2011, the U.S. Department of Health and Human Services, in collaboration with nonprofit and private organizations, launched Million Hearts (http://www.millionhearts.hhs.gov), an initiative focused on implementing clinical and community-level evidence-based strategies to reduce cardiovascular disease (CVD) risk factors and prevent a total of 1 million heart attacks and strokes during the 5-year period 2012-2016. From 2005-2006 to the period with the most current data, analysis of the Million Hearts four "ABCS" clinical measures (for aspirin, blood pressure, cholesterol, and smoking) showed 1) no statistically significant change in the prevalence of aspirin use for secondary prevention (53.8% in 2009-2010), 2) an increase to 51.9% in the prevalence of blood pressure control (in 2011-2012), 3) an increase to 42.8% in the prevalence of cholesterol management (in 2011-2012), and 4) no statistically significant change in the prevalence of smoking assessment and treatment (22.2% in 2009-2010). In addition, analysis of two community-level indicators found 1) a decrease in current tobacco product smoking (including cigarette, cigar, or pipe use) prevalence to 25.1% in 2011-2012 and 2) minimal change in mean daily sodium intake (3,594 mg/day in 2009-2010). Although trends in some measures are encouraging, further reductions of CVD risk factors will be needed to meet Million Hearts goals by 2017.

  10. Safety Profile of Nifurtimox for Treatment of Chagas Disease in the United States

    PubMed Central

    Forsyth, Colin J.; Hernandez, Salvador; Olmedo, Wilman; Abuhamidah, Adieb; Traina, Mahmoud I.; Sanchez, Daniel R.; Soverow, Jonathan; Meymandi, Sheba K.

    2016-01-01

    Background. Nifurtimox is 1 of only 2 medications available for treating Chagas disease (CD) and currently the only drug available in the United States, but its safety and tolerance have not been extensively studied. This is the first study to evaluate tolerance of nifurtimox in US patients with CD. Methods. This investigation assessed side effects in a sample of 53 patients with CD, all Latin American immigrants, who underwent treatment with nifurtimox (8–10 mg/kg in 3 daily doses for 12 weeks) from March 2008 to July 2012. The frequency and severity of adverse events (AEs) was recorded. Results. A total of 435 AEs were recorded; 93.8% were mild, 3.0% moderate, and 3.2% severe. Patients experienced a mean of 8.2 AEs; the most frequent were anorexia (79.2%), nausea (75.5%), headache (60.4%), amnesia (58.5%), and >5% weight loss (52.8%). Eleven patients (20.8%) were unable to complete treatment. Experiencing a moderate or severe AE (odds ratio [OR], 3.82; P < .05) and Mexican nationality (OR, 2.29; P < .05) were significant predictors of treatment discontinuation, but sex and cardiac progression at baseline were not. Patients who did not complete treatment experienced nearly 3 times more AEs per 30-day period (P = .05). Conclusions. Nifurtimox produces frequent side effects, but the majority are mild and can be managed with dose reduction and/or temporary suspension of medication. The high frequency of gastrointestinal symptoms and weight loss mirrors results from prior investigations. Special attention should be paid during the early stages of treatment to potentially severe symptoms including depression, rash, and anxiety. PMID:27432838

  11. Detection and molecular characterization of Newcastle disease virus in peafowl (Pavo cristatus) in Haryana State, India.

    PubMed

    Kumar, Aman; Maan, Sushila; Mahajan, Nand Kishore; Rana, Virender Pratap; Jindal, Naresh; Batra, Kanisht; Ghosh, Arnab; Mishra, Shiv Kumar; Kapoor, Sanjay; Maan, Narender Singh

    2013-12-01

    Present study was undertaken to investigate the cause of deaths of peafowls in Haryana State. In total, 145 birds were sick and 28 birds were reported dead during July to September 2012. Some of the sick birds were showing signs of shaking of heads, torticollis and paresis. Blood and cloacal swab samples from sick birds along with brain and intestinal tissues from dead birds were collected for further investigation. Although post-mortem examination showed no typical lesions of Newcastle disease virus (NDV) yet raised HI tires against NDV in some serum samples and clinical signs indicated the presence of NDV. One of the brain tissues (NDV/IND2012/01) from the field case was processed and adapted to Vero cell line for virus isolation. The fusion (F) gene based nested RT-PCR (RT-nPCR) confirmed the presence of NDV in all field samples and cell culture isolate. Sequencing of the partial F gene amplicons (216 bp) using the PCR primers as sequencing primers confirmed the PCR results. The deduced amino acid sequences of partial F gene were found to have the amino acid motif (111)GRRQKR/F(117) in the fusion protein cleavage site (FPCS). This amino acid motif is indicative of the velogenic nature of these NDVs. Phylogenetic studies have shown that the virus belonged to class II genotype VII very closely related to virus isolates originated from outbreaks in Western Europe, Israel, Indonesia, Taiwan and India. Phylogenetic grouping of the virus and sequence of FPCS is indicative of pathogenic potential of virus strain circulating in peacocks in Haryana. PMID:24426301

  12. Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion

    PubMed Central

    Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

    2016-01-01

    A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, al-though the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC) therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds. PMID:27194978

  13. Intractable Postoperative Wounds Caused by Self-Inflicted Trauma in a Patient with Cutaneous Munchausen Syndrome Presenting as a Pyoderma Gangrenosum-Like Lesion.

    PubMed

    Inui, Keiko; Hanafusa, Takaaki; Namiki, Takeshi; Ueno, Makiko; Igawa, Ken; Yokozeki, Hiroo

    2016-01-01

    A 50-year-old Japanese woman consulted the emergency department of our hospital for bleeding due to an intractable postoperative wound on the lower abdomen; the postoperative wound was owing to a laparoscopic cholecystectomy performed 1 year previously for acute cholecystitis. She presented with a painful ulcer on her right lower abdomen. She also presented with multiple scars, skin grafts on the extremities, and a missing left lower leg, the causes for all of which were unexplained. The results of her blood test were normal, except for the hemoglobin level. Histology of the skin biopsy specimen from the ulcer did not show any specific findings. The previous surgeon who had performed the laparoscopic cholecystectomy revealed that surgical wound dehiscence had occurred during her admission. After a body restraint had been applied, the ulcer improved. Medical records indicated that she had been admitted to the department of plastic surgery at our hospital for skin grafting of a leg ulcer. During that admission, she refused to consult with the department of psychiatry, al-though the staff suspected mental disorders. Therefore, we diagnosed her with cutaneous Munchausen syndrome. After vacuum-assisted closure (VAC) therapy had been performed to prevent her from traumatizing the ulcer again, it rapidly became granulated and reepithelialized. Munchausen syndrome is characterized by feigning physical symptoms to seek attention. Patients self-inflict numerous lesions, keep getting admitted to different hospitals, and feign acute illness, usually spectacular diseases. VAC therapy may be effective for preventing patients with cutaneous Munchausen syndrome from traumatizing their wounds. PMID:27194978

  14. State of the art; microbiology in health and disease. Intestinal bacterial flora in autism.

    PubMed

    Finegold, Sydney M

    2011-12-01

    Autism of the regressive variety is selected as an example of the importance of intestinal bacterial microflora in disease other than classical infection. Our studies have indicated that intestinal bacteria play a role in this disease since it responds to oral vancomycin, a drug that is not absorbed from the GI tract. Pyrosequencing studies document an abnormal gut microflora in regressive autism subjects as compared to controls. Finally, we present preliminary evidence suggesting that Desulfovibrio may play a key role in this disease.

  15. Stem cell transplantation improves aging-related diseases

    PubMed Central

    Ikehara, Susumu; Li, Ming

    2014-01-01

    Aging is a complex process of damage accumulation, and has been viewed as experimentally and medically intractable. The number of patients with age-associated diseases such as type 2 diabetes mellitus (T2DM), osteoporosis, Alzheimer's disease (AD), Parkinson's disease, atherosclerosis, and cancer has increased recently. Aging-related diseases are related to a deficiency of the immune system, which results from an aged thymus and bone marrow cells. Intra bone marrow-bone marrow transplantation (IBM-BMT) is a useful method to treat intractable diseases. This review summarizes findings that IBM-BMT can improve and treat aging-related diseases, including T2DM, osteoporosis and AD, in animal models. PMID:25364723

  16. Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

    PubMed Central

    Leon, Kristoffer E.; Jacob, Jesse T.; Franco-Paredes, Carlos; Kozarsky, Phyllis E.; Wu, Henry M.; Fairley, Jessica K.

    2016-01-01

    Background. Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods. A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results. Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease “reactions”, severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1–96), but no single factor was associated with a delay in diagnosis. Conclusions. The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage. PMID:27186586

  17. Combined vitrectomy and intravitreal injection versus combined laser and injection for treatment of intractable diffuse diabetic macular edema

    PubMed Central

    Saeed, Ahmed M

    2013-01-01

    Background The purpose of this study was to compare the safety and efficacy of combined vitrectomy, intravitreal triamcinolone acetonide (IVTA), and bevacizumab injection with that of IVTA and bevacizumab injection and subsequent macular grid laser photocoagulation for the treatment of intractable diffuse diabetic macular edema. Methods This randomized controlled clinical trial was performed at Benha University Hospital, Benha, Egypt, and included 34 eyes from 34 diabetic patients diagnosed with intractable diffuse diabetic macular edema without vitreomacular traction. The patients were divided into two groups. In group 1, pars plana vitrectomy with removal of the posterior hyaloid was performed, and at the end of the procedure, IVTA 0.1 mL (40 mg/mL) and bevacizumab 1.25 mg were injected. In group 2, macular grid laser photocoagulation was performed 2 weeks after the same intravitreal injection combination as used in group 1. The main outcome measures were best-corrected visual acuity (BCVA) and central foveal thickness, which were measured using optical coherence tomography at 3, 6, and 12 months. Results Changes in BCVA and central foveal thickness at 3, 6, and 12 months from baseline were highly statistically significant (P < 0.01). Mean BCVA was better in group 1 at 3 months, nearly equal at 6 months, and less at 12 months. Mean central foveal thickness was more improved in group 1 than in group 2 at 3 months, and was better in group 2 at subsequent measurement points. The major adverse events were development of cataract (more common in group 1) and elevation of intraocular pressure (more common in group 2). Conclusion The combined therapy described here could represent a solution for the treatment of intractable diabetic macular edema, and could have a favorable long-term outcome. Combined treatment of IVTA and bevacizumab plus grid laser resulted in a more favorable reduction in central foveal thickness and improvement in BCVA at 12 months than vitrectomy

  18. Hispanic Americans living in the United States and their risk for obesity, diabetes and kidney disease: Genetic and environmental considerations.

    PubMed

    Yracheta, Joseph M; Alfonso, Javier; Lanaspa, Miguel A; Roncal-Jimenez, Carlos; Johnson, Sarah B; Sánchez-Lozada, Laura G; Johnson, Richard J

    2015-06-01

    The Hispanic American, the largest minority population in the United States, is at increased risk for obesity, diabetes and end-stage renal disease. Here we review genetic and environmental factors that might account for their increased risk for these conditions. Whereas many environmental and genetic factors have important roles in driving the increased risk for obesity and kidney disease in this population, a case is made that excessive intake of sugary beverages is a contributory cause. Studies focusing on decreasing intake of sugary beverages among the Hispanic American could potentially reduce renal and cardiovascular complications in this population.

  19. Announcement: 20th Anniversary of PulseNet: the National Molecular Subtyping Network for Foodborne Disease Surveillance - United States, 2016.

    PubMed

    2016-01-01

    PulseNet is celebrating 20 years of public health achievements in transforming the way foodborne disease outbreaks are detected and investigated. PulseNet is a national surveillance network of federal, state, and local public health laboratories that work together to detect foodborne disease outbreaks by connecting DNA fingerprints of bacteria that cause illness (1). The network facilitates the early identification of common sources of foodborne outbreaks and helps regulatory agencies identify areas where implementation of new measures are likely to improve the safety of the food supply. PMID:27337605

  20. Software for generating liability distributions for pedigrees conditional on their observed disease states and covariates.

    PubMed

    Campbell, Desmond D; Sham, Pak C; Knight, Jo; Wickham, Harvey; Landau, Sabine

    2010-02-01

    For many multifactorial diseases, aetiology is poorly understood. A major research aim is the identification of disease predictors (environmental, biological, and genetic markers). In order to achieve this, a two-stage approach is proposed. The initial or synthesis stage combines observed pedigree data with previous genetic epidemiological research findings, to produce estimates of pedigree members' disease risk and predictions of their disease liability. A further analysis stage uses the latter as inputs to look for associations with potential disease markers. The incorporation of previous research findings into an analysis should lead to power gains. It also allows separate predictions for environmental and genetic liabilities to be generated. This should increase power for detecting disease predictors that are environmental or genetic in nature. Finally, the approach brings pragmatic benefits in terms of data reduction and synthesis, improving comprehensibility, and facilitating the use of existing statistical genetics tools. In this article we present a statistical model and Gibbs sampling approach to generate liability predictions for multifactorial disease for the synthesis stage. We have implemented the approach in a software program. We apply this program to a specimen disease pedigree, and discuss the results produced, comparing its results with those generated under a more naïve model. We also detail simulation studies that validate the software's operation. PMID:19771574

  1. Software for generating liability distributions for pedigrees conditional on their observed disease states and covariates.

    PubMed

    Campbell, Desmond D; Sham, Pak C; Knight, Jo; Wickham, Harvey; Landau, Sabine

    2010-02-01

    For many multifactorial diseases, aetiology is poorly understood. A major research aim is the identification of disease predictors (environmental, biological, and genetic markers). In order to achieve this, a two-stage approach is proposed. The initial or synthesis stage combines observed pedigree data with previous genetic epidemiological research findings, to produce estimates of pedigree members' disease risk and predictions of their disease liability. A further analysis stage uses the latter as inputs to look for associations with potential disease markers. The incorporation of previous research findings into an analysis should lead to power gains. It also allows separate predictions for environmental and genetic liabilities to be generated. This should increase power for detecting disease predictors that are environmental or genetic in nature. Finally, the approach brings pragmatic benefits in terms of data reduction and synthesis, improving comprehensibility, and facilitating the use of existing statistical genetics tools. In this article we present a statistical model and Gibbs sampling approach to generate liability predictions for multifactorial disease for the synthesis stage. We have implemented the approach in a software program. We apply this program to a specimen disease pedigree, and discuss the results produced, comparing its results with those generated under a more naïve model. We also detail simulation studies that validate the software's operation.

  2. Identification of lymphoproliferative disease virus in wild turkeys (Meleagris gallopavo) in the southeastern United States

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The eight cases described herein represent the first reports of lymphoproliferative disease virus (LPDV) infection in wild turkeys and the first identification of LPDV in North America. Systemic lymphoproliferative disease was presumably the cause of morbidity and mortality in five of the eight turk...

  3. Cat scratch disease in the United States: an analysis of three national databases.

    PubMed Central

    Jackson, L A; Perkins, B A; Wenger, J D

    1993-01-01

    OBJECTIVES. Current knowledge of the epidemiology of cat scratch disease is based primarily on information from case series. We used three national databases to obtain more representative data to determine the incidence and demographics of cat scratch disease. METHODS. Records coded with the diagnosis of cat scratch disease from two hospital discharge databases and an ambulatory care database were analyzed. Costs of diagnostic tests and hospitalization were obtained from a sample of providers and published data. RESULTS. The incidence of patients discharged from hospitals with a diagnosis of cat scratch disease was between 0.77 and 0.86 per 100,000 population per year. Fifty-five percent of the case patients were 18 years of age or younger. Males accounted for 60% of cases. Incidence varied by season; approximately 60% of case patients were discharged in the months September through January. The estimated incidence of disease in ambulatory patients was 9.3 per 100,000 population per year. On the basis of these rates, we estimated the annual health care cost of the disease to be more than $12 million. CONCLUSIONS. The rates and seasonality of cat scratch disease found in this study were consistent with previous reports. Adults represented a higher percentage of the total than reported in previous case series, suggesting that the disease may affect more adults than previously recognized. PMID:8259799

  4. Physician preferences in the diagnosis and treatment of Lyme disease in the United States.

    PubMed

    Ziska, M H; Donta, S T; Demarest, F C

    1996-01-01

    To assess physician preferences in the diagnosis and treatment of Lyme disease, questionnaires were sent to physicians in various Lyme disease endemic areas in the U.S. Seventy-eight responses were analyzed. Both ELISA and Western blot were ordered by 86% of responders. Fifty percent of responders believed that 25% or more of patients who have Lyme disease were seronegative. The treatment was influenced by physician specialty. Antibiotic treatment for tick bite was prescribed by 20% of responders. Erythema migrans rash was treated by all responders without serologic confirmation. The median treatment duration of erythema migrans was 4 weeks. For post-erythema migrans Lyme disease, 43% of responders treat 3 months or more; for chronic Lyme disease, 57% of responders treat 3 months or more. Our survey documents significant differences between published recommendations and actual practices. Physician education and clinical trials are needed to clarify the reasons for these differences.

  5. Monitoring the Spread of Swine Enteric Coronavirus Diseases in the United States in the Absence of a Regulatory Framework

    PubMed Central

    Perez, Andres M.; Alba, Anna; Goede, Dane; McCluskey, Brian; Morrison, Robert

    2016-01-01

    The reporting and monitoring of swine enteric coronavirus diseases (SECD), including porcine epidemic diarrhea virus and porcine delta coronavirus, in the United States have been challenging because of the initial absence of a regulatory framework and the emerging nature of these diseases. The National Animal Health Laboratory Network, the Emergency Management and Response System, and the Swine Health Monitoring Project were used to monitor the disease situation between May 2013 and March 2015. Important differences existed between and among them in terms of nature and extent of reporting. Here, we assess the implementation of these systems from different perspectives, including a description and comparison of collected data, disease metrics, usefulness, simplicity, flexibility, acceptability, representativeness, timeliness, and stability. This assessment demonstrates the limitations that the absence of premises identification imposes on certain animal health surveillance and response databases, and the importance of federally regulated frameworks in collecting accurate information in a timely manner. This study also demonstrates the value that the voluntary and producer-organized systems may have in monitoring emerging diseases. The results from all three data sources help to establish the baseline information on SECD epidemiological dynamics after almost 3 years of disease occurrence in the country. PMID:27014703

  6. Multidrug-resistant nontyphoidal Salmonella in New York state's foodborne diseases active surveillance network counties.

    PubMed

    Solghan, Suzanne M; Dumas, Nellie B; Root, Timothy P; Quinlan, Tammy M; Armstrong, Leeanna R; Spina, Nancy L; Zansky, Shelley M

    2010-02-01

    With the emergence of multidrug-resistant nontyphoidal (NT) Salmonella, knowledge of resistance patterns is critical for appropriate presumptive treatment. This report describes the prevalence and trends of NT Salmonella antimicrobial susceptibility within the New York State (NYS) Foodborne Diseases Active Surveillance Network (FoodNet). The NYS Department of Health, Wadsworth Center Public Health Laboratory tested all Salmonella isolates from the NYS FoodNet catchment area between May 2003 and December 2007 for antimicrobial susceptibility to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, tetracycline, nalidixic acid, and ciprofloxacin. Isolate susceptibility results were linked to their corresponding demographic and clinical data and analyzed. Multidrug-resistant isolates were defined as resistant to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (R-type ACSSuT). Antimicrobial susceptibility for 2189 FoodNet cases (98.5% of total cases) showed 79.6% pansusceptible, 6.9% R-type ACSSuT, and 13.5% resistant to at least one antimicrobial agent but not R-type ACSSuT. Four (0.2%) isolates were resistant to ciprofloxacin. From 2004 to 2007, cases with R-type ACSSuT significantly decreased from 8.7% (37/424) to 4.8% (24/499) (p < 0.01). Serotypes with the highest proportion of R-type ACSSuT included Salmonella Typhimurium 17.9% (79/444), and Salmonella Newport 29.1% (51/175). Among Salmonella Typhimurium isolates, over 40% of the African-American cases (19/46) had R-type ACSSuT isolates, compared with 15.7% of the Caucasian cases (58/369) (p < 0.01). R-type ACSSuT Salmonella Typhimurium cases were hospitalized (41.8%) more frequently than pansusceptible Salmonella Typhimurium cases (24.9%), after controlling for age (p < 0.05). Length of hospitalization was not significantly different. Although R-type ACSSuT NT Salmonella has decreased since 2003 within the NYS FoodNet catchment area, monitoring resistance patterns remains important

  7. Gene suppression strategies for dominantly inherited neurodegenerative diseases: lessons from Huntington's disease and spinocerebellar ataxia.

    PubMed

    Keiser, Megan S; Kordasiewicz, Holly B; McBride, Jodi L

    2016-04-15

    RNA-targeting approaches are emerging as viable therapeutics that offer an alternative method to modulate traditionally 'undrugable' targets. In the case of dominantly inherited neurodegenerative diseases, gene suppression strategies can target the underlying cause of these intractable disorders. Polyglutamine diseases are caused by CAG expansions in discrete genes, making them ideal candidates for gene suppression therapies. Here, we discuss the current state of gene suppression approaches for Huntington's disease and the spinocerebellar ataxias, including the use of antisense oligonucleotides, short-interfering RNAs, as well as viral vector-mediated delivery of short hairpin RNAs and artificial microRNAs. We focus on lessons learned from preclinical studies investigating gene suppression therapies for these disorders, particularly in rodent models of disease and in non-human primates. In animal models, recent advances in gene suppression technologies have not only prevented disease progression in a number of cases, but have also reversed existing disease, providing evidence that reducing the expression of disease-causing genes may be of benefit in symptomatic patients. Both allele- and non-allele-specific approaches to gene suppression have made great strides over the past decade, showing efficacy and safety in both small and large animal models. Advances in delivery techniques allow for broad and durable suppression of target genes, have been validated in non-human primates and in some cases, are currently being evaluated in human patients. Finally, we discuss the challenges of developing and delivering gene suppression constructs into the CNS and recent advances of potential therapeutics into the clinic.

  8. Addressing emerging infectious disease threats: a prevention strategy for the United States. Executive summary.

    PubMed

    1994-04-15

    The spectrum of infectious disease is changing rapidly in conjunction with dramatic societal and environmental changes. Worldwide, explosive population growth with expanding poverty and urban migration is occurring; international travel and commerce are increasing; and technology is rapidly changing-all of which affect the risk of exposure to infectious agents. Recent examples of important emerging infectious diseases include prolonged diarrheal illness due to waterborne cryptosporidium, hemorrhagic colitis and renal failure from foodborne Escherichia coli O157:H7, pneumonia and middle-ear infections caused by drug-resistant pneumococci, and rodentborne hantavirus pulmonary syndrome. These diseases as well as resurgent diseases (e.g., tuberculosis and cholera) illustrate human vulnerability to microorganisms in the environment. Three recent reports by the Institute of Medicine document the need to address emerging infectious disease threats. In partnership with representatives from health departments, other federal agencies, medical and public health professional associations, and international organizations, CDC has developed a strategic plan to address emerging infectious disease threats. The plain contains four goals that emphasize surveillance, applied research, prevention and control, and public health infrastructure. To ensure sustainability, plan implementation will be approached in stages, as a long-term endeavor with emphasis on extramural programs. As health-care reform proceeds, priority should be given to strengthening partnerships between health-care providers, microbiologists, and public health professionals to detect and control emerging infectious diseases.

  9. Impact of metabolic syndrome on the risk of cardiovascular disease mortality in the United States and in Japan.

    PubMed

    Liu, Longjian; Miura, Katsuyuki; Fujiyoshi, Akira; Kadota, Aya; Miyagawa, Naoko; Nakamura, Yasuyuki; Ohkubo, Takayoshi; Okayama, Akira; Okamura, Tomonori; Ueshima, Hirotsugu

    2014-01-01

    The United States has a higher prevalence of metabolic syndrome (MS) and cardiovascular disease (CVD) mortality than Japan, but it is unknown how much of the difference in MS accounts for the mortality difference. The aim of this study was to examine the impact of MS on the excess CVD mortality in the United States compared with that in Japan. Data from the United States Third National Health and Nutrition Examination Survey (NHANES III; n = 12,561) and the Japanese National Integrated Project for Prospective Observation of Noncommunicable Disease and Its Trends in Aged (NIPPON DATA; n = 7,453) were analyzed. MS was defined as ≥3 of 5 risk factors (obesity, high blood pressure, decreased high-density lipoprotein cholesterol, elevated glycosylated hemoglobin, and elevated triglycerides). The results show that after a median of 13.8 years of follow-up in the United States, 1,683 patients died from CVD (11.75 per 1,000 person-years), and after a median of 15 years of follow-up in Japan, 369 patients died from CVD (3.56 per 1,000 person-years). The age-adjusted prevalence of MS was 26.7% in the United States and 19.3% in Japan. Of 5 MS factors, obesity, high blood pressure, elevated triglycerides, and glycosylated hemoglobin in the United States, and high blood pressure and elevated glycosylated hemoglobin in Japan were significant risk factors for CVD mortality. Estimates of 13.3% and 44% of the excess CVD mortality for the United States could be explained by the higher prevalence of MS and MS plus baseline CVD history than in Japan. In conclusion, the present study is the first to quantitatively demonstrate that MS and MS plus baseline CVD history may significantly contribute to the explanation of excess CVD mortality in the United States compared with Japan.

  10. Effective management of intractable neuropathic pain using an intrathecal morphine pump in a patient with acute transverse myelitis

    PubMed Central

    Wu, Wei-Ting; Huang, Yu-Hui; Chen, Der-Cherng; Huang, Yu-Hsuan; Chou, Li-Wei

    2013-01-01

    Transverse myelitis is a rare inflammatory myelopathy characterized by loss of motor and sensory function below the affected level of the spinal cord, and causes neurogenic bowel and bladder. Occasionally, it also causes neuropathic pain with spasticity. Traditional therapies for neuropathic pain are multiple, including multimodal analgesic regimens, antiepileptic or antidepressant medications, opioids, sympathetic blocks, and spinal cord stimulation. Persistent neuropathic pain can cause emotional distress by affecting sleep, work, recreation, and emotional well-being. Here we report the case of a patient suffering from intractable neuropathic pain following acute transverse myelitis that was not relieved by combinations of nonsteroidal anti-inflammatory, anti-epileptic, antidepressant, and opioid medications, or by acupuncture. Implantation of an intrathecal morphine pump controlled the pain successfully without side effects, and enabled the patient to embark on intensive rehabilitation. The patient’s muscle strength has improved significantly and the patient may soon be able to use a walker with minimal assistance. PMID:23935366

  11. Repeated pancreatitis-induced splenic vein thrombosis leads to intractable gastric variceal bleeding: A case report and review.

    PubMed

    Tang, Shan-Hong; Zeng, Wei-Zheng; He, Qian-Wen; Qin, Jian-Ping; Wu, Xiao-Ling; Wang, Tao; Wang, Zhao; He, Xuan; Zhou, Xiao-Lei; Fan, Quan-Shui; Jiang, Ming-De

    2015-10-16

    Gastric varices (GV) are one of the most common complications for patients with portal hypertension. Currently, histoacryl injection is recommended as the initial treatment for bleeding of GV, and this injection has been confirmed to be highly effective for most patients in many studies. However, this treatment might be ineffective for some types of GV, such as splenic vein thrombosis-related localized portal hypertension (also called left-sided, sinistral, or regional portal hypertension). Herein, we report a case of repeated pancreatitis-induced complete splenic vein thrombosis that led to intractable gastric variceal bleeding, which was treated by splenectomy. We present detailed radiological and pathological data and blood rheology analysis (the splenic artery - after a short gastric vein or stomach vein - gastric coronary vein - portal vein). The pathophysiology can be explained by the abnormal direction of blood flow in this patient. To our knowledge, this is the first reported case for which detailed pathology and blood rheology data are available.

  12. Ultrasonography Guided Excision of Isolated Cysticercosis of the Temporalis Muscle Causing Intractable Headache: A Rare Case Report.

    PubMed

    Kumar, Vivek; Bhavana, Kranti; Kumar, Prem; Kumar, Subhash

    2016-09-01

    Cysticercosis cellulosae is a systemic parasitic infection caused by the larval stage of pork tapeworm, Taenia solium which involve humans as either a definitive or secondary hosts. The central nervous system is the most important primary site of involvement. Cases of cysticercosis presenting as an isolated muscle mass is an extremely rare entity and demands documentation. We report an extremely unusual case of isolated cysticercosis of the temporalis muscle causing intractable headache which presented a diagnostic challenge. The condition was surgically treated by ultrasonography guided excision of the cysticercosis swelling in the temporalis muscle. We also emphasize on the role of proper imaging modalities in the diagnosis and treatment of such unique cases. PMID:27508147

  13. Successful Treatment of Intractable Bleeding Caused by Radiation-Induced Hemorrhagic Gastritis Using Oral Prednisolone: A Case Report

    PubMed Central

    Yun, Hyong Geun; Kim, Hong Yong; Kim, Do Yeun; Lim, Yun Jeong

    2015-01-01

    Radiation-induced hemorrhagic gastritis is an intractable and dangerous condition. We describe a 59-year-old female patient with radiation-induced hemorrhagic gastritis. The patient underwent postoperative radiation therapy with a dose of 54 Gy in 30 fractions after a radical operation for a Klatskin tumor. Radiation volume included the gastric antrum. Approximately three months after radiation therapy, she was admitted for melena and anemia. Esophagogastroduodenoscopy showed an area of bleeding in the gastric antrum that was so diffuse that effective laser coagulation was not feasible. After failure of various treatments and transfusion of 7,040 mL of packed red blood cells, we successfully stopped the hemorrhage using oral prednisolone treatment. Based on this case, we think that oral prednisolone treatment can be tried as a first treatment for potentially life-threatening radiation-induced hemorrhagic gastritis. PMID:25327495

  14. Effects of Kamishoyosan, a Traditional Japanese Kampo Medicine, on Pain Conditions in Patients with Intractable Persistent Dentoalveolar Pain Disorder

    PubMed Central

    Arai, Young-Chang P.; Makino, Izumi; Aono, Shuichi; Yasui, Hiromichi; Isai, Hideya; Nishihara, Makoto; Hatakeyama, Noboru; Kawai, Takashi; Ikemoto, Tatsunori; Inoue, Shinsuke; Ushida, Takahiro

    2015-01-01

    There are patients who suffer from persistent dentoalveolar pain disorder (PDAP) which is a pain of the teeth, either dentoalveolar pain or nonodontogenic toothache, and its cause has not yet been identified. An effective intervention for PDAP has not yet been established. Interventions for patients with PDAP are generally pharmacological treatments such as antidepressants, anticonvulsants, and pregabalin. However, these medicines are not always effective for patients. The pain disorder in the orofacial region including temporomandibular disorder (TMD) and PDAP was effectively treated with our original exercise therapy. However, we did observe some intractable cases of PDAP even when our original exercise therapy was used. This paper presents our findings in which Kamishoyosan improved the pain intensity in 14 out of 15 PDAP patients refractory to our original exercise therapy. PMID:26495024

  15. Botulinum toxin type-A injection to treat patients with intractable anismus unresponsive to simple biofeedback training

    PubMed Central

    Zhang, Yong; Wang, Zhen-Ning; He, Lei; Gao, Ge; Zhai, Qing; Yin, Zhi-Tao; Zeng, Xian-Dong

    2014-01-01

    AIM: To evaluate the efficacy of botulinum toxin type A injection to the puborectalis and external sphincter muscle in the treatment of patients with anismus unresponsive to simple biofeedback training. METHODS: This retrospective study included 31 patients suffering from anismus who were unresponsive to simple biofeedback training. Diagnosis was made by anorectal manometry, balloon expulsion test, surface electromyography of the pelvic floor muscle, and defecography. Patients were given botulinum toxin type A (BTX-A) injection and pelvic floor biofeedback training. Follow-up was conducted before the paper was written. Improvement was evaluated using the chronic constipation scoring system. RESULTS: BTX-A injection combined with pelvic floor biofeedback training achieved success in 24 patients, with 23 maintaining persistent satisfaction during a mean period of 8.4 mo. CONCLUSION: BTX-A injection combined with pelvic floor biofeedback training seems to be successful for intractable anismus. PMID:25253964

  16. Multifocal epilepsy: the role of palliative resection - intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acute lymphoblastic leukaemia.

    PubMed

    Radhakrishnan, Ashalatha; Sithinamsuwan, Pasiri; Harvey, A Simon; Flanagan, Danny; Fitt, Gregory; Berlangieri, Sam; Jackson, Graeme D; Berkovic, Samuel F; Scheffer, Ingrid E

    2008-12-01

    Patients with multifocal epilepsy are often considered unsuitable for epilepsy surgery. We report an adolescent with intractable frontal and occipital lobe seizures, secondary to complications of treatment for acute lymphoblastic leukaemia as a young child. Chemotherapy and radiotherapy were complicated by bilateral, posterior leukoencephalopathy and later an acquired frontal cerebral cavernous malformation (CCM). Detailed electro-clinical and imaging studies showed multiple, frontal lobe seizures per day with less frequent and non-debilitating, simple, occipital lobe seizures. Focal resection of the frontal CCM abolished the socially-disabling seizures with resultant marked improvement in the patient's quality of life at 12 months. Careful analysis of the type and impact of focal seizures in the setting of multifocal epilepsy may demonstrate that one seizure type is more deleterious to quality of life and may be amenable to surgery. In this situation, the patient may benefit significantly from surgery to resect the more active epileptic focus.

  17. A climate-based model predicts the spatial distribution of the Lyme disease vector Ixodes scapularis in the United States.

    PubMed Central

    Brownstein, John S; Holford, Theodore R; Fish, Durland

    2003-01-01

    An understanding of the spatial distribution of the black-legged tick, Ixodes scapularis, is a fundamental component in assessing human risk for Lyme disease in much of the United States. Although a county-level vector distribution map exists for the United States, its accuracy is limited by arbitrary categories of its reported presence. It is unknown whether reported positive areas can support established populations and whether negative areas are suitable for established populations. The steadily increasing range of I. scapularis in the United States suggests that all suitable habitats are not currently occupied. Therefore, we developed a spatially predictive logistic model for I. scapularis in the 48 conterminous states to improve the previous vector distribution map. We used ground-observed environmental data to predict the probability of established I. scapularis populations. The autologistic analysis showed that maximum, minimum, and mean temperatures as well as vapor pressure significantly contribute to population maintenance with an accuracy of 95% (p < 0.0001). A cutoff probability for habitat suitability was assessed by sensitivity analysis and was used to reclassify the previous distribution map. The spatially modeled relationship between I. scapularis presence and large-scale environmental data provides a robust suitability model that reveals essential environmental determinants of habitat suitability, predicts emerging areas of Lyme disease risk, and generates the future pattern of I. scapularis across the United States. PMID:12842766

  18. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States

    PubMed Central

    Jamieson, Denise J.; Kpaduwa, Julius; Schrier, Sarah; Kim, Moon; Green, Nicole M.; Ströher, Ute; Muehlenbachs, Atis; Bell, Michael; Rollin, Pierre E.; Mascola, Laurene

    2016-01-01

    Many of the survivors of the 2014–2015 epidemic of Ebola virus disease (EVD) in West Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women’s pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors. PMID:27191253

  19. Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States.

    PubMed

    Kamali, Amanda; Jamieson, Denise J; Kpaduwa, Julius; Schrier, Sarah; Kim, Moon; Green, Nicole M; Ströher, Ute; Muehlenbachs, Atis; Bell, Michael; Rollin, Pierre E; Mascola, Laurene

    2016-07-01

    Many of the survivors of the 2014-2015 epidemic of Ebola virus disease (EVD) in western Africa were women of childbearing age. Limited clinical and laboratory data exist that describe these women's pregnancies and outcomes. We report the case of an EVD survivor who became pregnant and delivered her child in the United States, and we discuss implications of this case for infection control practices in obstetric services. Hospitals in the United States must be prepared to care for EVD survivors. PMID:27191253

  20. Impact of lifestyle on prevalence of kidney disease in Pima Indians in Mexico and the United States.

    PubMed

    Valencia, Mauro E; Weil, E Jennifer; Nelson, Robert G; Esparza, Julian; Schulz, Leslie O; Ravussin, Eric; Bennett, Peter H

    2005-08-01

    Pima Indians in the United States and Mexico share a common genetic background but have very different lifestyles. Comparisons were made of the frequency of obesity, diabetes, hypertension, and kidney disease in these geographically separated but susceptible populations. Mexican Pimas had higher levels of physical activity, less obesity, and a lower prevalence of diabetes than their US Pima counterparts. Mean blood pressure rose with worsening glucose tolerance, and the prevalence of elevated urinary albumin excretion was higher in patients with diabetes than in those without, regardless of whether they lived in the United States or Mexico. These findings illustrate the importance of lifestyle in the development of diabetes and in the subsequent occurrence of diabetic kidney disease.

  1. Intractable epileptic spasms in a patient with Pontocerebellar hypoplasia: Severe phenotype of type 2 or another subtype?

    PubMed Central

    Samanta, Debopam; Willis, Erin

    2016-01-01

    Introduction: Pontocerebellar hypoplasia (PCH) involves a diverse range of etiologies including a group of single gene disorders. Mutations in the tRNA splicing endonuclease complex (TSEN) 54 gene can be responsible for PCH type 2, 4 and 5. The more common and less severe PCH 2 phenotype is caused by homozygosity for the common missense mutation A307S, while the severe phenotype seen in type 4 and 5 is caused by compound heterozygosity of the A307S mutation along with a nonsense or splice site mutation. Report: We report a 4- month-old girl who presented with epileptic spasms that remained intractable to several antiepileptic medications. Magnetic Resonance Imaging (MRI) brain showed fairly severe hypoplasia with superimposed atrophy of the cerebellum and brainstem with prominent extra-axial fluid spaces. Extensive metabolic testing was negative. Commercial testing for PCH via TSEN54 gene revealed missense mutation of Ala307Ser. A novel sequence variant, designated c.17_40 del, was also found and was predictive of an in-frame deletion of eight amino acids. Follow-up over 2 years revealed intractable epileptic spasms, progressive microcephaly and development of prominent choreoathetosis. Conclusion: This case report describes a rare case of PCH with overlapping features of the less severe PCH2 and the more severe PCH4/5 phenotype. It also adds another new entity in the list of genetic conditions where West syndrome and pontocerebellar hypoplasia can be seen together, emphasizing the need for further investigations of the genotype-phenotype correlation of mutations in order to advance our understanding of the pathophysiologic mechanism in these rare conditions. PMID:27570394

  2. Argon Plasma Coagulation Therapy Versus Topical Formalin for Intractable Rectal Bleeding and Anorectal Dysfunction After Radiation Therapy for Prostate Carcinoma

    SciTech Connect

    Yeoh, Eric; Tam, William; Schoeman, Mark; Moore, James; Thomas, Michelle; Botten, Rochelle; Di Matteo, Addolorata

    2013-12-01

    Purpose: To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis. Methods and Materials: Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues–Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions). Results: The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology. Conclusions: Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.

  3. The combination of morphine and minocycline may be a good treatment for intractable post-herpetic neuralgia.

    PubMed

    Chen, Suchang; Hui, Hui; Zhang, Deren; Xue, Yanzhi

    2010-12-01

    Post-herpetic neuralgia (PHN) is a devastating complication of shingles. The treatment of PHN with traditional pharmaceutical agents has various side effects. Therefore, the treatment of intractable PHN is often very time consuming, mainly because the available treatments often lead to intolerable side effects before the efficient dose can be reached. Opioids such as morphine and oxycodone are the most widely used drugs for the alleviation for severe chronic pain. A number of high quality studies demonstrated that opioids are effective in relieving neuropathic pain including PHN. Yet concerns of misuse, abuse and tolerance of opioids have, however, severely influenced their contribution to neuropathic pain, especially the tolerance that resulted in a loss of drug effect or the necessity for escalating doses to produce pain relief. The glia cells, particularly microglia and astrocytes are thought to play an important role in central sensitization. It is known that activated microglia cells produce NO, cytokines, and cyclooxygenase. All of these chemicals regulate synaptic transmissions in the central nervous system. Additionally, glia modulations showed antiallodynic and antihyperalgesic properties in various experimental pain models. Minocycline, a semisynthetic, second-generation tetracycline can potently inhibit microglial activation and proliferation. Also, the growing body of recent evidence indicates that minocycline attenuates morphine tolerance in neuropathic mice with a mechanism related to microglia. The combination of morphine and minocycline has synergetic effect. This can prevent the development of intractable PHN and attenuate morphine antinociceptive tolerance and further improve the efficacy of morphine and therefore reducing its dosage and side effects. We thereby hypothesize that the combination of morphine and minocycline may produce a duel effect of morphine antinociceptive and minocycline selectively inhibiting the activation of microglia. PMID

  4. Long-term impact of the ketogenic diet on growth and resting energy expenditure in children with intractable epilepsy

    PubMed Central

    GROLEAU, VERONIQUE; SCHALL, JOAN I; STALLINGS, VIRGINIA A; BERGQVIST, CHRISTINA A

    2014-01-01

    AIM The long-term effects of the ketogenic diet, a high fat diet for treating intractable epilepsy, on resting energy expenditure (REE) are unknown. The aim of this study was to evaluate the impact of 15 months of ketogenic diet treatment on growth and REE in children with intractable epilepsy. METHOD Growth, body composition and REE were assessed at baseline, 3 and 15 months in 24 children (14 males, 10 females; mean age 5y 6mo (SD 26mo), range 7mo–6y 5mo), 10 with cerebral palsy [CP]). Fifteen were identified as ketogenic diet responders at 3 months and continued on the ketogenic diet until 15 months. These were compared to 75 healthy children (43 males, 32 females; mean age 6y 3mo [SD 21mo] age range 2–9y). REE was expressed as percentage predicted, growth as height (HAz) and weight (WAz) z-scores, and body composition as fat and fat free mass (FFM). RESULTS HAz declined −0.2 and −0.6 from baseline to 3 and 15 months, respectively (p=0.001), while WAz was unchanged. In ketogenic diet responders, FFM, age and CP diagnosis predicted REE (overall R2=0.76, p<0.001) and REE did not change. REE adjusted for FFM was lower (p<0.01) in children with CP at baseline (mean [standard error], −143[51] kcals/d) and 15 months (−198[53] kcals/d) compared to the healthy children. INTERPRETATION After 15 months of the ketogenic diet, linear growth status declined while weight status and REE were unchanged. REE remained reduced in children with CP. PMID:24749520

  5. Intractable duodenal ulcer caused by transmural migration of gossypiboma into the duodenum - a case report and literature review

    PubMed Central

    2014-01-01

    Background Gossypiboma is a term used to describe a mass that forms around a cotton sponge or abdominal compress accidentally left in a patient during surgery. Transmural migration of an intra-abdominal gossypiboma has been reported to occur in the digestive tract, bladder, vagina and diaphragm. Open surgery is the most common approach in the treatment of gossypiboma. However, gossypibomas can be extracted by endoscopy while migrating into the digestive tract. We report a case of intractable duodenal ulcer caused by transmural migration of gossypiboma successfully treated by duodenorrhaphy. A systemic literature review is provided and a scheme of the therapeutic approach is proposed. Case presentation A 61-year-old Han Chinese man presented with intermittent epigastric pain for the last 10 months. He had undergone laparoscopic cholecystectomy conversion to open cholecystectomy for acute gangrenous cholecystitis 10 months ago at another hospital. Transmural migration of gossypiboma into the duodenum was found. Endoscopic intervention failed to remove the entire gauze, and duodenal ulcer caused by the gauze persisted. Surgical intervention was performed and the gauze was removed successfully. The penetrated ulcer was repaired with duodenorrhaphy. The postoperative period was uneventful. We systematically reviewed the literature on transmural migration of gossypiboma into duodenum and present an overview of published cases. Our PubMed search yielded seven reports of transmural migration of retained surgical sponge into the duodenum. Surgical interventions were necessary in two patients. Conclusion Transmural migration of gossypiboma into the duodenum is a rare surgical complication. The treatment strategies include endoscopic extraction and surgical intervention. Prompt surgical intervention should be considered for emergent conditions such as active bleeding, gastrointestinal obstruction, or intra-abdominal sepsis. For non-emergent conditions, surgical intervention

  6. An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Federated States of Micronesia, State of Pohnpei: A Systems Perspective

    PubMed Central

    Anson, Robina; Keller, Elizabeth; Lippwe, Kipier; Aitaoto, Nia

    2013-01-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Pohnpei and describes the burden due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. Leading causes of death were due to heart disease, diabetes, cancer, and hypertension. Population survey data show that 32.1% of the adult population had diabetes with a higher rate among women (37.1%) when compared to men (26.4%). The data also showed that 73.1% of the adult population was overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no overall planning document for the prevention and control of NCDs or diabetes. There is evidence of little communication among the medical and health care providers which leads to fragmentation of care and loss of continuity of care. Based on some of the findings, priority issues and problems that need to be addressed for the administrative and clinical systems are identified. PMID:23900565

  7. An assessment of non-communicable diseases, diabetes, and related risk factors in the Federated States of Micronesia, State of Pohnpei: a systems perspective.

    PubMed

    Ichiho, Henry M; Anson, Robina; Keller, Elizabeth; Lippwe, Kipier; Aitaoto, Nia

    2013-05-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Pohnpei and describes the burden due to selected NCD (diabetes, heart disease, hypertension, stroke, chronic kidney disease); and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are significant factors in the morbidity and mortality of the population. Leading causes of death were due to heart disease, diabetes, cancer, and hypertension. Population survey data show that 32.1% of the adult population had diabetes with a higher rate among women (37.1%) when compared to men (26.4%). The data also showed that 73.1% of the adult population was overweight or obese. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is no overall planning document for the prevention and control of NCDs or diabetes. There is evidence of little communication among the medical and health care providers which leads to fragmentation of care and loss of continuity of care. Based on some of the findings, priority issues and problems that need to be addressed for the administrative and clinical systems are identified.

  8. An assessment of non-communicable diseases, diabetes, and related risk factors in the Federated States of Micronesia, State of Yap: a systems perspective.

    PubMed

    Ichiho, Henry M; Yurow, Julie; Lippwe, Kipier; Aitaoto, Nia

    2013-05-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Yap, and describes the burdens due to diabetes and other NCDs (heart disease, hypertension, stroke, chronic renal disease), and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 1.2% increase in the population between 2000 and 2010; however, there was a significant increase in the 45-64 year old age group. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. The leading causes of death include cancer, heart disease, and diabetes. Local household surveys show that 63% to 80% of the adults and 20.5% to 33.8% of the children were overweight or obese. The surveys also showed that 23% of the adult population had diabetes and 35% were hypertensive. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is a policy and procedure manual that guides the NCD staff. There is no functional data system that is able to identify, register, or track patients with diabetes and other NCDs. Priority administrative and clinical issues were identified.

  9. An Assessment of Non-Communicable Diseases, Diabetes, and Related Risk Factors in the Federated States of Micronesia, State of Yap: A Systems Perspective

    PubMed Central

    Yurow, Julie; Lippwe, Kipier; Aitaoto, Nia

    2013-01-01

    Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Federated States of Micronesia, State of Yap, and describes the burdens due to diabetes and other NCDs (heart disease, hypertension, stroke, chronic renal disease), and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifying the issues that need to be addressed. There has been a 1.2% increase in the population between 2000 and 2010; however, there was a significant increase in the 45–64 year old age group. Findings reveal that the risk factors of poor diet, lack of physical activity, and lifestyle behaviors lead to overweight and obesity and subsequent NCD that are a significant factor in the morbidity and mortality of the population. The leading causes of death include cancer, heart disease, and diabetes. Local household surveys show that 63% to 80% of the adults and 20.5% to 33.8% of the children were overweight or obese. The surveys also showed that 23% of the adult population had diabetes and 35% were hypertensive. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCD. There is a policy and procedure manual that guides the NCD staff. There is no functional data system that is able to identify, register, or track patients with diabetes and other NCDs. Priority administrative and clinical issues were identified. PMID:23900490

  10. Surgical closure of the larynx for intractable aspiration pneumonia: cannula-free care and minimizing the risk of developing trachea-innominate artery fistula.

    PubMed

    Ise, Kazuya; Kano, Makoto; Yamashita, Michitoshi; Ishii, Show; Shimizu, Hirofumi; Nakayama, Kei; Gotoh, Mitsukazu

    2015-10-01

    There is a risk of developing a fatal trachea-innominate artery fistula following laryngotracheal separation for the prevention of intractable aspiration pneumonia. We developed a novel technique of surgical closure of the larynx to avoid this complication and provide long-term cannula-free care.

  11. Host and Potential Vector Susceptibility to an Emerging Orbivirus in the United States: Epizootic Hemorrhagic Disease Virus Serotype 6.

    PubMed

    Ruder, M G; Stallknecht, D E; Allison, A B; Mead, D G; Carter, D L; Howerth, E W

    2016-05-01

    Epizootic hemorrhagic disease viruses (EHDVs) are orbiviruses transmitted by Culicoides biting midges to domestic and wild ruminants. EHDV-1 and EHDV-2 are endemic in the United States, where epizootic hemorrhagic disease is the most significant viral disease of white-tailed deer (WTD;Odocoileus virginianus) and reports of epizootic hemorrhagic disease in cattle are increasing. In 2006, a reassortant EHDV-6 was isolated from dead WTD in Indiana and has been detected each subsequent year over a wide geographic region. Since EHDV-6 is not a historically endemic serotype in the United States, it is important to understand infection outcome in potential hosts. Specifically, we aimed to evaluate the pathogenicity of the virus in 2 primary US ruminant hosts (WTD and cattle) and the susceptibility of a confirmed US vector (Culicoides sonorensis). Five WTD and 4 cattle were inoculated with >10(6)TCID50EHDV-6 by intradermal and subcutaneous injection. All 5 WTD exhibited moderate to severe disease, and 3 died. Viremia was first detected 3 to 5 days postinfection (dpi) with surviving animals seroconverting by 10 dpi. Two of 4 inoculated cattle had detectable viremia, 5 to 10 dpi and 7 to 24 dpi, respectively. No clinical, hematologic, or pathologic abnormalities were observed. Antibodies were detected by 10 dpi in 3 of 4 cows.C. sonorensis were fed on WTD blood spiked with EHDV-6 and held for 4 to 14 days postfeeding at 25°C. From 4 to 14 days postfeeding, 19 of 171 midges were virus isolation positive and 6 of 171 had ≥10(2.7)TCID50EHDV-6. Although outcomes varied, these studies demonstrate the susceptibility of ruminant and vector hosts in the United States for this recently emerged EHDV serotype. PMID:26459518

  12. Thermal conductivity of biological cells at cellular level and correlation with disease state

    NASA Astrophysics Data System (ADS)

    Park, Byoung Kyoo; Woo, Yunho; Jeong, Dayeong; Park, Jaesung; Choi, Tae-Youl; Simmons, Denise Perry; Ha, Jeonghong; Kim, Dongsik

    2016-06-01

    This paper reports the thermal conductivity k of matched pair cell lines: two pairs of a normal and a cancer cell, one pair of a primary and metastatic cell. The 3ω method with a nanoscale thermal sensor was used to measure k at the single-cell level. To observe the difference in k between normal and cancer cells, the measurements were conducted for Hs 578Bst/Hs 578 T (human breast cells) and TE 353.Sk/TE 354.T (human skin cells). Then k of WM-115/WM-266-4, a primary and metastatic pair of human skin cell, was measured to find the effect of disease progression on k. The measured k data for normal and disease cell samples show statistically meaningful differences. In all cases, k decreased as the disease progressed. This work shows that thermal-analysis schemes, such as the 3ω method, have a potential to detect diseases at the cell level.

  13. Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States.

    PubMed

    Crews, Deidra C; Plantinga, Laura C; Miller, Edgar R; Saran, Rajiv; Hedgeman, Elizabeth; Saydah, Sharon H; Williams, Desmond E; Powe, Neil R

    2010-05-01

    Hypertension is both a cause and a consequence of chronic kidney disease, but the prevalence of chronic kidney disease throughout the diagnostic spectrum of blood pressure has not been established. We determined the prevalence of chronic kidney disease within blood pressure categories in 17 794 adults surveyed by the National Health and Nutrition Examination Survey during 1999-2006. Diagnosed hypertension was defined as self-reported provider diagnosis (n=5832); undiagnosed hypertension was defined as systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg, without report of provider diagnosis (n=3046); prehypertension was defined as systolic blood pressure > or = 120 and <140 mm Hg or diastolic blood pressure > or = 80 and <90 mm Hg (n=3719); and normal was defined as systolic blood pressure <120 mm Hg and diastolic blood pressure <80 mm Hg (n=5197). Chronic kidney disease was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2) or urinary albumin:creatinine ratio >30 mg/g. Prevalences of chronic kidney disease among those with prehypertension and undiagnosed hypertension were 17.3% and 22.0%, respectively, compared with 27.5% with diagnosed hypertension and 13.4% with normal blood pressure, after adjustment for age, sex, and race in multivariable logistic regression. This pattern persisted with varying definitions of kidney disease; macroalbuminuria (urinary albumin:creatinine ratio >300 mg/g) had the strongest association with increasing blood pressure category (odds ratio: 2.37 [95% CI: 2.00 to 2.81]). Chronic kidney disease is prevalent in undiagnosed and prehypertension. Earlier identification and treatment of both these conditions may prevent or delay morbidity and mortality from chronic kidney disease.

  14. Surveillance for waterborne disease outbreaks associated with drinking water and other nonrecreational water - United States, 2009-2010.

    PubMed

    2013-09-01

    Despite advances in water management and sanitation, waterborne disease outbreaks continue to occur in the United States. CDC collects data on waterborne disease outbreaks submitted from all states and territories through the Waterborne Disease and Outbreak Surveillance System. During 2009-2010, the most recent years for which finalized data are available, 33 drinking water-associated outbreaks were reported, comprising 1,040 cases of illness, 85 hospitalizations, and nine deaths. Legionella accounted for 58% of outbreaks and 7% of illnesses, and Campylobacter accounted for 12% of outbreaks and 78% of illnesses. The most commonly identified outbreak deficiencies in drinking water-associated outbreaks were Legionella in plumbing systems (57.6%), untreated ground water (24.2%), and distribution system deficiencies (12.1%), suggesting that efforts to identify and correct these deficiencies could prevent many outbreaks and illnesses associated with drinking water. In addition to the drinking water outbreaks, 12 outbreaks associated with other nonrecreational water were reported, comprising 234 cases of illness, 51 hospitalizations, and six deaths. Legionella accounted for 58% of these outbreaks, 42% of illnesses, 96% of hospitalizations, and all deaths. Public health, regulatory, and industry professionals can use this information to target prevention efforts against pathogens, infrastructure problems, and water sources associated with waterborne disease outbreaks.

  15. Carotid thrombus formation and extension during anticoagulation: a case report of large vessel disease and hypercoagulable state in systemic sclerosis.

    PubMed

    Renard, Dimitri; Heroum, Chérif

    2007-06-01

    Systemic sclerosis (SSc) is an autoimmune multisystem disorder of connective tissue characterized by widespread vascular lesions and fibrosis. Limited cutaneous systemic sclerosis (lcSSc) and diffuse cutaneous systemic sclerosis (dsSSC) are both subsets of SSc. The vascular component of SSc is an important part of the disease. Especially Raynaud's phenomenon and microcirculatory abnormalities are well recognized. Enhanced coagulation pathways, decreased fibrinolysis, and endothelial dysfunction probably contribute to vascular events in SSc. Macrovascular disease is not recognized as a major feature of SSc. However, several studies report an increase in large vessel disease and mortality rate attributable to cardiovascular causes. We present a patient with lcSSc with an acute embolic stroke due to a large carotid thrombus. A hypercoagulable state was suspected because of thrombus formation during oral anticoagulation and extension during intravenous heparin treatment. This is one of the few reports of large vessel disease in systemic sclerosis. The hypercoagulable state may be related to systemic sclerosis. PMID:17710842

  16. Pulmonary Involvement in Niemann-Pick Disease: A State-of-the-Art Review.

    PubMed

    von Ranke, Felipe Mussi; Pereira Freitas, Heloisa Maria; Mançano, Alexandre Dias; Rodrigues, Rosana Souza; Hochhegger, Bruno; Escuissato, Dante; Araujo Neto, Cesar Augusto; da Silva, Thiago Krieger Bento; Marchiori, Edson

    2016-08-01

    Niemann-Pick disease is a rare autosomal recessive lysosomal storage disease with three subtypes. Types A and B result from a deficiency of acid sphingomyelinase activity, associated with the accumulation of lipid-laden macrophages (so-called Niemann-Pick cells) in various tissues, especially the liver and spleen. Type A is a fatal neurodegenerative disorder of infancy. Type B Niemann-Pick disease is a less severe form with milder neurological involvement, characterized by hepatosplenomegaly, hyperlipidemia, and pulmonary involvement; most patients live into adulthood. Type C Niemann-Pick disease is a complex lipid storage disorder caused by defects in cholesterol trafficking, resulting in a clinical presentation dominated by neurological involvement. Pulmonary involvement occurs in all three types of Niemann-Pick disease, but most frequently in type B. Respiratory manifestations range from a lack of symptoms to respiratory failure. Progression of respiratory disease is slow, but inexorable, due to the accumulation of Niemann-Pick cells in the alveolar septa, bronchial walls, and pleura, potentially leading to a progressively worsening restrictive pattern on pulmonary function testing. Bronchoalveolar lavage has important diagnostic value because it shows the presence of characteristic Niemann-Pick cells. Radiographic findings consist of a reticular or reticulonodular pattern and, eventually, honeycombing, involving mainly the lower lung zones. The most common changes identified by high-resolution computed tomography are ground-glass opacities, mild smooth interlobular septal thickening, and intralobular lines. The aim of this review is to describe the main clinical, imaging, and pathological aspects of Niemann-Pick disease, with a focus on pulmonary involvement. PMID:27164983

  17. Improved prediction of complex diseases by common genetic markers: state of the art and further perspectives.

    PubMed

    Müller, Bent; Wilcke, Arndt; Boulesteix, Anne-Laure; Brauer, Jens; Passarge, Eberhard; Boltze, Johannes; Kirsten, Holger

    2016-03-01

    Reliable risk assessment of frequent, but treatable diseases and disorders has considerable clinical and socio-economic relevance. However, as these conditions usually originate from a complex interplay between genetic and environmental factors, precise prediction remains a considerable challenge. The current progress in genotyping technology has resulted in a substantial increase of knowledge regarding the genetic basis of such diseases and disorders. Consequently, common genetic risk variants are increasingly being included in epidemiological models to improve risk prediction. This work reviews recent high-quality publications targeting the prediction of common complex diseases. To be included in this review, articles had to report both, numerical measures of prediction performance based on traditional (non-genetic) risk factors, as well as measures of prediction performance when adding common genetic variants to the model. Systematic PubMed-based search finally identified 55 eligible studies. These studies were compared with respect to the chosen approach and methodology as well as results and clinical impact. Phenotypes analysed included tumours, diabetes mellitus, and cardiovascular diseases. All studies applied one or more statistical measures reporting on calibration, discrimination, or reclassification to quantify the benefit of including SNPs, but differed substantially regarding the methodological details that were reported. Several examples for improved risk assessments by considering disease-related SNPs were identified. Although the add-on benefit of including SNP genotyping data was mostly moderate, the strategy can be of clinical relevance and may, when being paralleled by an even deeper understanding of disease-related genetics, further explain the development of enhanced predictive and diagnostic strategies for complex diseases.

  18. Spatial and temporal analysis of stem bleeding disease in coconut palm in the state of Sergipe, Brazil.

    PubMed

    Carvalho, Rejane R da Costa e; Souza, Paulo E de; Warwick, Dulce R N; Pozza, Edson A; Filho, José L S de Carvalho

    2013-01-01

    Stem bleeding disease (resinosis) of coconut palm is caused by Thielaviopsis paradoxa and is very important in the state of Sergipe, Brazil. Understanding the epidemiological behavior of the disease is essential for establishing more efficient control strategies. Thus, we characterized the temporal progression and spatial distribution of stem bleeding in a commercial orchard under conditions of natural infection in the area of Neopolis, Sergipe. Three plots with 729 plants each were selected and evaluated every two months for stem bleeding incidence. In the temporal analysis, the monomolecular model gave the best fit to data on disease incidence, as it accurately showed the temporal dynamics of the disease during the experiment period. The spatial pattern of stem bleeding varied over time, with initial infections presenting random pattern and then evolving to aggregate pattern during evaluations. This indicates that the disease may have originated from the pathogen survival structures, followed by auto infections caused by dissemination from plant to plant, either by humans, by contact between roots, or by the vector Rhynchophorus palmarum. PMID:24270840

  19. Racial differences in chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States: a social and economic dilemma.

    PubMed

    Palmer Alves, T; Lewis, J

    2010-11-01

    Chronic kidney disease (CKD), defined as an eGFR < 60 ml/min/1.73 m², affects up to 25% of the United States population. In addition, it is estimated that approximately 6% of the population have early evidence of CKD and will likely progress to end stage renal disease (ESRD) in the near future. Further, ESRD is more common in many ethnic minorities, with African-Americans having the highest rates of treated ESRD, closely followed by Hispanic Americans, when compared to non- Hispanic White persons. Although African-Americans with CKD are more likely to die than non-Hispanic White persons with CKD, these trends reverse once progression to ESRD is established. The reasons for the disparities in the prevalence and incidence of CKD, ESRD, and mortality are unclear, but likely involve a complex interaction of socioeconomic, environmental and genetic factors. This review highlights current data pertaining to the social and economic impact of ethnic differences in the prevalence and incidence of CKD and ESRD in the United Stated. It is hoped that highlighting the current trend of kidney related health disparities will not only lead to an improved understanding of these issues, but also more informed research agendas, that are ultimately aimed at alleviating ethnic differences in kidney health outcomes.

  20. Assessment of 6-sulfatoxymelatonin rhythms and melatonin response to light in disease states: lessons from cirrhosis.

    PubMed

    Montagnese, Sara; Middleton, Benita; Corrias, Michela; Mani, Ali Reza; Skene, Debra J; Morgan, Marsha Y

    2015-03-01

    Circadian rhythmicity and non-visual sensitivity to light can be assessed, in healthy subjects, by measuring the rhythm of the urinary melatonin metabolite 6-sulphatoxymelatonin (aMT6s) and by determining the response of plasma melatonin to nocturnal retinal light exposure, respectively. However, the validity of these techniques has not been assessed in disease states in which disruption of the circadian rhythm is known or suspected to occur. Thus, the aims of this study were as follows: (i) to assess the reliability of circadian aMT6s profile estimates derived from 36 h versus 56 h urine collections and (ii) to test different models for calculating melatonin suppression in response to light in healthy volunteers and patients with cirrhosis. Twenty patients with biopsy-proven cirrhosis and 10 matched healthy volunteers undertook: (i) separate 36 - and 56-h urine collections, under controlled conditions, for cosinor analysis of the urinary aMT6s profile; (ii) a melatonin suppression test, comprising of a baseline night, during which subjects were woken and asked to sit in front of a switched off light sphere, and an experimental night, identically executed, except that the light sphere was switched on and the subjects were exposed to white light (4.1 × 10(14) photons/cm(2)/s) for 30 min. Alternative approaches to the calculation of melatonin suppression were taken, with/without inclusion of the baseline night. Eighteen patients and eight healthy volunteers had matched analysable 36 - and 56-h urinary samples. Cosinor analysis showed a significant fit in 88% of the remaining 56 h collections, and 48% of the remaining 36-h collections. Thus, eight patients and five healthy volunteers had matched analysable samples for cosinor analysis. In the healthy volunteers, aMT6s profile indices obtained using the 36 - and the 56-h collections did not differ significantly. In contrast, considerably more variability was observed in patients [i.e. the difference