The aim of this study was to investigate the prognostic value of plasma d-dimer levels in patients with community-acquired pneumonia (CAP).
Prospective observational study.
Hospital Lluis Alcanyis of ...Xativa, Spain.
Consecutive adult patients admitted to the hospital with CAP from January 2000 to October 2002.
A total of 302 patients were included. Plasma d-dimer was measured using an automated latex assay. The relationships between plasma d-dimer and prognostic variables included in the pneumonia severity index (PSI) were examined using univariate and multivariate linear and logistic regression analyses. d-Dimer levels were negative (ie, < 500 ng/mL) in 16.9% of the patients. In nonsurvivors, the d-dimer plasma level mean value was 3,786 ng/mL, while in survivors it was 1,609 ng/mL (p < 0.0001). A significant relationship was found between the presence of elevated d-dimer levels and the PSI and APACHE (acute physiology and chronic health evaluation) II score. Elevated d-dimer levels were associated with radiologic pneumonia extension. The d-dimer predictive value for mechanical ventilation therapy showed an area under the curve of 0.78 (95% confidence interval, 0.71 to 0.81).
d-Dimer plasma levels could be useful for predicting clinical outcome in patients with CAP.
Introduction
Pica is a strange eating disorder that consists of eating non-nutritive substances, inappropriate to the developmental level/ cultural normative of the individual. The prevalence is not ...widely studied, but might occur in the context of other mental disorders, such as schizophrenia, that hinders the management and treatment of these patients.
Objectives
To report a severe pica in a patient with late schizophrenia, and highlight the impact this syndrome might cause on the life of these patients.
Methods
We present a case of a 65 year-old-woman with schizophrenia attended in the emergency area for dysphagia due to the intake of a metal washer. Reviewing the patient medical history, an early and severe schizophrenia was described. Within years, disorganization and residual symptoms have become the main disabilities, developing a pica eating disorder with preference in greater metal objects (images are included).
Results
The management has been hindered due to the consequences of pica eating disorder. The patient describes an unstoppable urge to make the intake when she sights wide metallic objects (batteries, docks, washers…). Different antipsychotic drugs have been used, combined with psychotherapy and family education. Despite this, the patient has required multiple attentions in the emergency area due to esophagueal impaction, intestinal obstruction, perforation and peritonitis, that have led to countless surgeries and hospitalizations.
Conclusions
Pica can become a highly dysfunctional syndrome that may lead to severe organic and life impact. The comorbidity with schizophrenia is understudied, but further investigation might be useful to show up specific management strategies of these patients.
Disclosure
No significant relationships.
Introduction
Repeated haemarthrosis is widely accepted as the triggering cause of synovitis and haemophilic arthropathy. A first‐line treatment of chronic synovitis is radiosynoviorthesis (RS). The ...aim of this study was to evaluate the RS effects on the progression of arthropathy and on a reduction in bleeding in patients with haemophilia.
Methods
An observational‐retrospective study was performed. Bleeding episodes in the 12 months following and in the 12 months preceding RS was compared. The arthropathy was clinically and radiologically analysed by age range, joint and subject, comparing those undergoing RS (Radiosynoviorthesis Group, RSG) against those not undergoing this treatment (Non‐Radiosynoviorthesis Group, Non‐RSG).
Results
One hundred and seventy‐four RS were performed in 71 patients (90Y in Knees and 186Re in elbows/ankles/shoulder). RS resulted in significant reduction in bleeding (582 preintervention and 168 postintervention, P < .001). In general, the level of arthropathy measured clinically and radiologically was greater with age increase in both groups (RSG and Non‐RSG), especially in the 25‐40 age range. A significant increase (P < .05) in the progression of arthropathy was also observed, both globally by patient and specifically for each joint, in non‐RSG and RSG group.
Conclusion
RS is an effective method to reduce the number of haemarthrosis episodes in chronic synovitis. Moreover, RS can positively affect arthropathy by slowing down its progression. However, the results obtained suggest that arthropathy may be conditioned by the subject's age, regardless of whether or not the joint has undergone RS.
In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of ...progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis.
We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3-like protein 1 (CHI3L1) in the CSF and serum.
Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.
We introduce a simulation framework for the transport of high and low energy electrons in xenon-based optical time projection chambers (OTPCs). The simulation relies on elementary cross sections ...(electron–atom and electron–molecule) and incorporates, in order to compute the gas scintillation, the reaction/quenching rates (atom–atom and atom–molecule) of the first 41 excited states of xenon and the relevant associated excimers, together with their radiative cascade. The results compare positively with observations made in pure xenon and its mixtures with CO2 and CF4 in a range of pressures from 0.1 to 10 bar. This work sheds some light on the elementary processes responsible for the primary and secondary xenon-scintillation mechanisms in the presence of additives, that are of interest to the OTPC technology.
The thoughful construction of molecular switches has led to a gamut of supramolecular systems that can be used in molecular electronics. These include molecules based on thienylethenes, spiropyrans, ...fulgides, dithienylphenanthrolines, and diazafluorenes. This article reviews the recent developments made in the synthesis and characterization of all these systems, thereby allowing a comparative study to validate the viability of these switchable molecules on a nanoscale. Also, the drawbacks of each class are demonstrated and, at the same time, the remedies for further improvisation are prescribed. We have made an honest attempt to present an exhaustive account of all the different photochromic switches developed by us hitherto.
New photochromic bridging ligands with covalently bound 2,2′‐bipyridine or phenanthroline coordinating moieties have been prepared. The bridging ligand, with a dithienylethene switching moiety, shows remarkable energy‐transfer properties from the donor to the acceptor unit (see Figure). The open form induces an efficient energy transfer, while the switching unit in the closed form acts as a trap for the same process.
Introduction
Alterations in the musculoskeletal system, especially in the lower limbs, limit physical activity and affect balance and walking. Postural impairments in haemophilic preteens could ...increase the risk of bleeding events and deteriorate the physical condition, promoting the progression of haemophilic arthropathy.
Aim
This study aims to evaluate static postural balance in haemophilic children, assessed by means of the Wii Balance Board® (WBB).
Methods
Nineteen children with haemophilia and 19 without haemophilia aged 9–10 years, have participated in this study. Postural balance was assessed by performing four tests, each one lasting 15 s: bipodal eyes open (BEO), bipodal eyes closed (BEC), monopodal dominant leg (MD) and monopodal non‐dominant leg (MND). Two balance indices, standard deviation of amplitude (SDA) and standard deviation of velocity (SDV) were calculated in the anterior–posterior (AP) and medial–lateral (ML) directions.
Results
Index values were higher in haemophilic group and the differences were statistically significant (P < 0.05) in only six (SDAAP in BEO, BEC and MD conditions, SDAML in BEO, SDVAP in BEO and SDVML in MND condition) of 16 parameters analysed.
Conclusion
Tests performed indicate a poorer static postural balance in the haemophilic cohort compared to the control group. Accordingly, physiotherapy programmes, physical activity and sports should be designed to improve the postural balance with the aim of preventing joint deterioration and improving quality of life.
A simple hole-type secondary scintillation structure (2 mm-hole, 5 mm-pitch, 5 mm-thickness) is introduced and its operation demonstrated in pure xenon in the pressure range 2-10 bar. The new device, ...characteristically translucent, has been manufactured through a collaboration between IGFAE and the CERN workshop, and relies entirely on radiopure materials (acrylic and copper), being extremely rugged in the presence of sparks, mechanically robust, and easily scalable, yet made through a relatively simple process. With an overall figure (at 10 bar) characterized by an energy resolution of 18.9%(FWHM) for 55Fe x-rays, an optical gain of mγ= 500 ph/e, and a stable operation at reduced fields more than twice those of some of the presently running experiments (EEL= 3 kV/cm/bar), this family of structures seems to show great promise for electroluminescence readouts on large scale detectors. As argued below, further improvements have the potential of bringing the energy resolution close to the Fano factor and increasing the optical gain.
This paper uses a unique data set on over 1,400 world leaders between 1848 and 2004 to investigate differences in educational qualifications between leaders who are selected in democracies and ...autocracies. After including country and year fixed effects, we find that democracies are around 20% more likely to select highly educated leaders. This finding is robust to a wide range of specifications, choices of subsamples, controls, and ways of measuring education and democracy.
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