All 61 patients with a confirmed diagnosis of systemic sclerosis were analysed and the demography, clinical and laboratoryfeatures were recorded. The clinicalfeatures recorded were that of at the time of referral and cumulative clinical manifestation during the entire follow-up. The duration from first signs and symptoms of systemic sclerosis to the time of first encounter at our clinic ranges from 0 – 13 years. The clinicalfeatures were taken from what was written in the medical records by experienced clinicians in our rheumatology unit.
seizure (SFS), whereas seizures were defined as complex (CFS)if they lasted>15min, had focal features, or occurred more than once in 24 hours, and rarely a third category called Febrile status epilepticus (FSE) is a FS lasting longer than 30 min without neurological recovery.SFS are mostly benign, even though they are concerning to the parents when they first witness them but a prolonged (Complex) FS can have long term consequences and approximately 2-fold long-term increase in mortality, as compared to the general population, probably secondary to coexisting pathology. Most children who have a febrile seizure have normal health and development after the event, but there is recent evidence that suggests a small subset of children that present with seizures and fever may have recurrent seizure or develop epilepsy (2- 7%) later in life. FS arise from a wide array of genetic and developmental factors, Various risk factors are said to play a role in the etiology of FS as gender, development aldelay, sudden high body temperature, family history, bacterial and viral infections, certain vaccinations, discharge from a neonatal unit after 28 days, day care attendance and iron deficiency. Despite its benign nature, the underlying cause of fever must be identified, In these patients, in most cases, fever is the result of respiratory system infection, gastroenteritis and urinary tract infection. Bacterial meningitis which is common differential diagnosis was rarely observed but necessary to be ruled out if clinically indicated.
Because of many religious and social concerns in the Kingdom, HIV had been difficult to tackle or even to discuss. This study is the first to look comprehensively at both epidemiology and clinicalfeatures in a cohort of HIV patients in the Kingdom of Saudi Arabia. The first part of this study was carried out retrospectively using case notes and patient details from their files, which varied in accuracy from case to case depending on case note quality. This was a significant limitation during the data collection period (secondary data limitations), although, I attempted to overcome this by reviewing all available medical notes to pick up missing or deficient data for each case.
The AZFc region is particularly susceptible to NAHR events which are known to cause partial deletions and duplications leading to gene dosage variations.(73,74,83) The most important clinical partial deletion is the ‗gr/gr‘ deletion, named after the fluorescent probes (‗green‘ and ‗red‘), first described. (75) Although it removes half of the AZFc gene content (genes with exclusive or predominant expression in the germ cells), its clinical significance is still a matter of debate, because carriers tend to manifest varying spermatogenic phenotypes which can range from azoo- to normozoospermia. Evidently the effect of this deletion mostly depends on the ethnic and geographic origin of the populations studied. In fact, the frequency and phenotypic effect may vary among different ethnic groups, based on the Y chromosome background. For example, in Japan and certain areas of China, where the most common specific Y haplogroups are D2b, Q3 and Q1, the gr/gr deletion does ot significantly affect spermatogenesis.(84,85)
Because some laboratory values can be affected by age, stage of disease including fever duration, and other fac- tors, we analyzed the KD subgroup with a fever duration of 5 days or 6 days (n = 204), and the data are expressed in Table 3. Also, recent KD patients had shorter hospital stays, a higher proportion of incomplete KD, lower inci- dence of CALs, higher values of hemoglobin, albumin, and ESR, and lower CRP and follow-up platelet values compared to the patients with the same fever duration and age in the past KD patients (Table 3). Also, we ana- lyzed the subgroup with complete KD (n = 387) and that with incomplete KD (n = 228), independently. The results of laboratory and clinical indices were nearly identical to those in the total KD group, although a few clinical pa- rameters, such as CALs in the complete KD group, did not reach statistical significance (Tables 4 and 5). In the incomplete KD subgroup, there were no differences in the Table 1 Clinical and laboratory findings in complete KD and incomplete KD
Patients diagnosed with myelofibrosis show a leukoerythroblastic blood picture along with pancytopenia. The blood film is leukoerythroblastic i.e. both nucleated RBCs and erythroblasts are present along with immature WBC (blasts<20%, promyelocytes, metamyelocytes, myelocytes and band forms) and RBCs shows anisocytosis and poikilocytosis resulting in Teardrop RBCs. The RBCs also show polychromasia. Granulocytes and platelets may show features of dysplasia. In the early stages of the PMF the peripheral blood film may show thrombocytosis and leukocytosis. In the later stages of PMF there is reduction in counts of all three cell lines resulting in pancytopenia, leukoerythroblastic blood picture and tear drop poikilocytes become evident. Often there are some giant platelets and occasional circulating micro megakaryocytes. (13, 14)
utes of blood sampling, blood lactate and glucose concen- trations were measured using Accusport™ hand held analyser (Bohringer, Manheim, Inc., Germany) and One- touch Analyzer (LifeScan, Inc., USA) . Blood films were defined as negative if there were no asexual forms of P. falciparum in 100 high power fields of a thick film. The schematic process of the inclusion is shown in Figure 1. Febrile children (or those with history of fever in the last 48 hours) were considered for inclusion in the study if they were: aged 0 to 10 years of age (inclusive), had malaria (> 2 asexual forms of P. falciparum seen on blood film) and had one or more of the following features of severity: [9,12,13]: Blantyre coma score (BCS) ≤ 2 defin- ing cerebral malaria, repeated observed seizures (3 or more observed in 24 hours), lactate concentration in whole blood or capillary blood ≥ 5 mmol/L, glucose con- centration in whole blood or capillary blood ≤ 2.2 mmol/ L, severe anaemia (haemoglobin concentration of < 5 g/ dL) and/or haematocrit concentration < 15%). Children were excluded from the study if informed consent was not obtained from a relative or if an alternative diagnosis was made clinically or by investigation (such as cerebrospinal fluid examination, chest radiography or blood culture). Schematic process of the screening of febrile children in the Centre Hospitalier de Libreville, Gabon
Bleeding time remained normal in all subjects throughout the hospital stay. Two subjects with a prolonged clotting time showed normalization within 48 hours. For other subjects, the clotting time remained prolonged for many days. One subject had a prolonged PT and APTT on admission. Pattern of coagulopathy shown in Figure 4. Out of 30 cases, 10 had deranged lab parameters of coagulation at some point of time during hospital stay though none showed any clinical evidence of bleeding. On direct mixing with pooled normal plasma, the deranged coagulation parameters got corrected in all cases. The mean delay in onset of coagulopathy was 20.9±23.3 hours after the bite. The mean duration of coagulopathy was 5.4±2.95 days.
AFB detection, biopsy features suggestive of TB include confluent granulomas, a lymphoid cuff around granulomas, granulomas larger than 400 μm in diameter, 5 or more granulomas in biopsies from 1 segment, granulomas located in the submucosa or in granulation tissue (often as palisaded epithelioid histiocytes), and disproportionate submucosal inflammation. In our study, we collected mucosal biopsies during colonoscopy. However, the usefulness of mucosal biopsies is limited because granulomas, the primary feature that differentiates TB from CD, are found in only 50%–80% of intestinal mucosal biopsies from patients with clinically confirmed TB. 33–35 Furthermore, caseation of granulomas and
Six clinical isolates of the nonpigmented, rapidly growing species Mycobacterium mageritense were recovered from sputum, bronchial wash, blood, sinus drainage, and two surgical wound infections from separate patients in Texas, New York, Louisiana, and Florida. The isolates matched the ATCC type strain by PCR restriction enzyme analysis of the 65-kDa hsp gene sequence of Telenti, high-performance liquid chromatography, bio- chemical reactions, and partial 16S rRNA gene sequencing. These are the first isolates of this species to be described in the United States and the first isolates to be associated with clinical disease. Susceptibility testing of all known isolates of the species revealed all isolates to be susceptible or intermediate to amikacin, cefoxitin, imipenem, and the fluoroquinolones and sulfonamides but resistant to clarithromycin. Because of their phenotypic and clinical similarity to isolates of the Mycobacterium fortuitum third biovariant complex (sorbitol positive), isolates of M. mageritense are likely to go undetected unless selected carbohydrate utilization or molecular identification methods are used.
Susceptibility testing. Drug susceptibility tests using current NCCLS mycobacterial breakpoints (where available) showed the clinical isolates to be susceptible to ciprofloxacin, gatifloxa- cin, levofloxacin, sulfamethoxazole, and linezolid and interme- diate or susceptible to cefoxitin, clarithromycin, imipenem, and amikacin (13). The isolates were intermediate or resistant to doxycycline except for 1 (2.6%) of 39 strains tested which was susceptible. The eight drugs tested against all 39 clinical iso- lates and the two reference isolates are shown in the Group I section of Table 3, while the three drugs tested against only a small number of isolates are shown in the Group II section of Table 3. The M. porcinum type strain, ATCC 33776, gave the same susceptibility pattern (Table 3). Susceptibilities to ami- kacin, ciprofloxacin, imipenem, doxycycline, and sulfamethox- azole for 13 of these isolates (Mf-91, Mf-131, Mf-147, Mf-239, Mf-450, Mf-485, Mf-487, Mf-533, Mf-607, Mf-611, Mf-661, Mf- 771, and Mf-809) (determined in another laboratory) were published previously as part of an earlier taxonomy study (16). These are the first reported susceptibility data for seven anti- microbial agents for M. porcinum (Table 3), including the ATCC type strain, 33776.
In DRC, malaria is endemic, characterized by a high and perennial transmission. However, there are few reports on severe childhood malaria especially BWF. In the present study, the clinical and biological observations and the risk factors of BWF were evaluated for the first time in Central Africa. This case–control study has matched cases and controls for age, sex and location area. It suggests that haemoglobinuria in severe malaria is frequent in children above five years of age. The mean age of these patients in this series was 8.62 (SD = 3.84) years. These findings are comparable with previous stud- ies, which reported the high incidence of BWF in this age even in endemic stable areas where malaria immun- ity is acquired after six years [3,19,28]. In Nigeria, Jelliffe reported that this syndrome was three times prevalent among children than adults, an observation which shows an evidence of the delay in the acquisition of malarial immunity .
All data were entered into a Microsoft Access database (Microsoft Access 2002, Microsoft Corp., Redmond, WA) and exported to SPSS (version 13.0 for Windows; SPSS Inc., Chicago, IL) for statistical analyses. Descriptive statis- tics were used to describe the frequencies of patients' symptoms and the laboratory investigations. Odds ratios and 95% confidence intervals (CI) were determined for the comparisons of clinical and laboratoryfeatures of travellers with and without dengue infections. As the hae- matological and serological data were not normally dis- tributed, the median values were calculated, and when comparing two independent variables the Mann-Whitney rank sum test was used. A statistically significant differ- ence was determined by a p-value <0.05.
Results: A total of 132 cases, out of which 95 cases of Dengue Fever (DF), 34 cases of dengue hemorrhagic fever and 3 cases of Dengue Shock syndrome, out of which Male: Female ratio was 2.1. and mean age of presentation was 37. Fever and myalgia were the most common finding (100%) followed by arthralgia and headache. Pruritus was found in 21 cases (15.9%) which carried a significant difference between DF and DHF (p value <0.05). Among the laboratoryfeatures, thrombocytopenia and hematocrit were found to be statistically significant in DHF patients (p value <0.05). Mean platelet count was 0.71 lakhs/mm3. Leukopenia in 40(30.3%) cases. Raised Serum Aminotransferase level, AST (>40 IU/L) was seen in 39 cases (29.54%.). Pleural effusion was seen in 4 cases (3%), of which 3 cases of DHF and 1 case of DSS. Ascites in 6 cases (4.8%), all cases belong to DHF. Gall bladder wall thickening was seen in 28 cases (21.21%) of which 20 cases (54.04%) were of DHF. Melena was the most common bleeding manifestation. Skin rash was found to be positive in 40.5% cases. Hess test was positive in 4 cases (10.8% of DHF).
Absence of eschar could be secondary to previous exposure to ricketssial antigen and variation in cutaneous immune response and that could be possible reason for absence of eschar in majority of our study children. In our study, we found that the striking difference in clinical parameters between the two groups was hypotension, lower ANC, low ESR and significantly low platelet values and thus provides the best ability to differentiate between severe dengue fever and scrub typhus. ANC has been statistically high in children with scrub typhus than severe dengue. The predominance of lymphocytes with leucopenia and severe thrombocytopenia might be an additional pointer to the diagnosis of severe dengue. In the guideline of Indian academy of pediatrics on ricketssial diseases, marked leukocytosis with the shift to the left in later stages, raised ESR and thrombocytopenia were laboratoryfeatures suggestive of these infections, as noted in children with ST in the present study. 11 Liver dysfunction
Over the course of a week, the patient ’ s laboratory studies normalized. By 2 weeks, his myocarditis had resolved and heart function returned to normal by echocardiography. Two months after discharge, he was awake, alert, and interactive, but not speaking. He was able to sit independently, crawl, and transfer objects between hands and to his mouth, but needed a gastric tube for feeding support.
CM and TBM are common in human immunodefi- ciency virus (HIV) infected patients, but they are also seen in patients with other forms of immunosuppression and apparently immunocompetent individuals . Some studies have sought to identify clinicalfeatures in order to distinguish TBM from CM in human HIV infected patients [10, 11]. Data on how to identify CM and TBM according to clinical profiles in HIV negative patients are scarce. In this retrospective study, we aimed to com- pare the demographic features, clinical presentations, laboratory data, radiographic findings, therapeutic outcomes and prognostic factors of HIV negative TBM and CM patients who were admitted to a university hospital from 2008 to 2015 in China.
The present study has shown that there are no charac- teristic radiological findings, or routine laboratory tests that would distinguish CAP caused by MP from other CAP. Our results suggest that some clinicalfeatures are indicative for MP pneumonia, such as headache and wheezing and therefore may aid the process differentiat- ing it from pneumonia cases caused by other pathogens. However, detection of IgM antibodies together with RT- PCR allows for precise and reliable diagnosis of MP in- fections in children during the acute phases of disease, indicating a possible use of both techniques as a valid diagnostic approach in early detection of MP infection in children with CAP.