Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series ...of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy. Prompt diagnosis and understanding of the underlying mechanisms of disease leading to this complication in essential for a favorable outcome. In recent years, novel diagnostic scores and treatment modalities along with bedside point-of-care tests were developed and may assist the clinician in the diagnosis and management of DIC. Team work and prompt treatment are essential for the successful management of patients with DIC.
Background There is considerable evidence that the thalamus is abnormal in psychotic disorders. Resting-state functional magnetic resonance imaging has revealed an intriguing pattern of thalamic ...dysconnectivity in psychosis characterized by reduced prefrontal cortex (PFC) connectivity and increased somatomotor-thalamic connectivity. However, critical knowledge gaps remain with respect to the onset, anatomical specificity, and clinical correlates of thalamic dysconnectivity in psychosis. Methods Resting-state functional magnetic resonance imaging was collected on 105 healthy subjects and 148 individuals with psychosis, including 53 early-stage psychosis patients. Using all 253 subjects, the thalamus was parceled into functional regions of interest (ROIs) on the basis of connectivity with six a priori defined cortical ROIs covering most of the cortical mantle. Functional connectivity between each cortical ROI and its corresponding thalamic ROI was quantified and compared across groups. Significant differences in the ROI-to-ROI analysis were followed up with voxel-wise seed-based analyses to further localize thalamic dysconnectivity. Results ROI analysis revealed reduced PFC-thalamic connectivity and increased somatomotor-thalamic connectivity in both chronic and early-stage psychosis patients. PFC hypoconnectivity and motor cortex hyperconnectivity correlated in patients suggesting they result from a common pathophysiological mechanism. Seed-based analyses revealed thalamic hypoconnectivity in psychosis localized to dorsolateral PFC, medial PFC, and cerebellar areas of the well-described executive control network. Across all subjects, thalamic connectivity with areas of the fronto-parietal network correlated with cognitive functioning, including verbal learning and memory. Conclusions Thalamocortical dysconnectivity is present in both chronic and early stages of psychosis, includes reduced thalamic connectivity with the executive control network, and is related to cognitive impairment.
Sepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Knowledge of the pathophysiology of organ failure in sepsis is crucial for optimizing the management and ...treatment of patients and for the development of potential new therapies. In clinical practice, six major organ systems - the cardiovascular (including the microcirculation), respiratory, renal, neurological, haematological and hepatic systems - can be assessed and monitored, whereas others, such as the gut, are less accessible. Over the past 2 decades, considerable amounts of new data have helped improve our understanding of sepsis pathophysiology, including the regulation of inflammatory pathways and the role played by immune suppression during sepsis. The effects of impaired cellular function, including mitochondrial dysfunction and altered cell death mechanisms, on the development of organ dysfunction are also being unravelled. Insights have been gained into interactions between key organs (such as the kidneys and the gut) and organ-organ crosstalk during sepsis. The important role of the microcirculation in sepsis is increasingly apparent, and new techniques have been developed that make it possible to visualize the microcirculation at the bedside, although these techniques are only research tools at present.
As medicine continues to advance, many individuals are living longer with injuries previously considered life threatening. These individuals often face numerous long-term physical and psychological ...sequelae associated with their injury that persist through the course of their lives. Recently, other injury populations have begun to think of their condition as “chronic”. Using data collected from the Burn Model System National Database, a framework for the reconsideration of burn injury as a chronic condition is proposed.
The evaluation of facial dysmorphism is a critical step toward reaching a diagnostic. The aim of the present study was to evaluate the ability to interpret facial morphology in African children with ...intellectual disability (ID). First, 10 experienced clinicians (five from Africa and five from Europe) rated gestalt in 127 African non‐Down Syndrome (non‐DS) patients using either the score 2 for ‘clearly dysmorphic’, 0 for ‘clearly non dysmorphic’ or 1 for ‘uncertain’. The inter‐rater agreement was determined using kappa coefficient. There was only fair agreement between African and European raters (kappa‐coefficient = 0.29). Second, we applied the FDNA Face2Gene solution to assess Down Syndrome (DS) faces. Initially, Face2Gene showed a better recognition rate for DS in Caucasian (80%) compared to African (36.8%). We trained the Face2Gene with a set of African DS and non‐DS photographs. Interestingly, the recognition in African increased to 94.7%. Thus, training improved the sensitivity of Face2Gene. Our data suggest that human based evaluation is influenced by ethnic background of the evaluator. In addition, computer based evaluation indicates that the ethnic of the patient also influences the evaluation and that training may increase the detection specificity for a particular ethnic.
...clinicians must be mindful of patients presenting with atypical symptoms since the appearance of pulmonary infiltrates may be delayed and the absence of pulmonary changes on initial imaging does ...not mean that pneumonia will not develop. 17.6% patients presented with leucopenia, while 11.8% patients presented with leukocytosis, on admission. Patients infected with SARS-CoV-2 were more likely to present with lymphopenia, and increase of ESR and IL-6. Since there are patients with atypical symptoms and imaging of chest radiograph, more attention to atypical symptoms during the early stage of COVID-19 and repeated chest imaging examinations are called for.Funding This research received no external funding.CRediT authorship contribution statement Yihui Huang: Conceptualization, Writing - original draft. Covariate Level Number % Age, years 56.24 ± 17.14 younger than or equal to 40 8 23.5 41–57 10 29.5 58–69 8 23.5 older than or equal to 70 8 23.5 Sex Female 20 58.8 Male 14 41.2 Comorbidity None 18 52.9 Yes 16 47.1 Diabetes 4 11.8 Hypertension 8 23.5 Cardiovascular disease 6 17.6 Chronic obstructive 1 2.9 pulmonary disease 2 5.9 Malignancy 3 8.8 Chronic liver disease 1 2.9 Hyperuricemia 1 2.9 Hypothyroidism 2 5.9 HIV infection 2 5.9 Symptoms when admitted to the hospital Fever 32 94.1 Temperature of the admission, °C 37.34 ± 0.92 Highest temperature, °C 38.61 ± 0.81 Cough 17 50.0 Myalgia or fatigue 22 64.7 Sputum production 8 23.5 Headache 2 5.9 Diarrhea 5 14.7 Dyspnea 5 14.7 Bilateral involvement of chest radiographs Bilateral 27 79.4 Unilateral 3 8.8 Nothing abnormal detected 1 2.9 Unknown 3 8.8 White blood cell count Decreased 6 17.6 Increased 4 11.8 Neutrophil count Increased 4 11.8 Lymphocyte count Decreased 17 50.0 Hemoglobin Decreased 13 38.2 Platelet count Decreased 9 26.5 Prothrombin time Decreased 1 2.9 Increased 17 50.0 D-dimer Increased 5 14.7 Albumin Decreased 25 73.5 Alanine aminotransferase Increased 8 23.5 Aspartate aminotransferase Increased 7 20.6 Total bilirubin Increased 3 8.8 Potassium Decreased 4 11.8 Increased 2 5.9 Creatinine Decreased 7 20.6 Increased 6 17.6 Creatine kinase Increased 1/12 8.3 Myoglobin Increased 3/12 25.0 Hypersensitive troponin I Increased 1/15 6.7 Procalcitonin Increased 13/31 41.9 Erythrocyte sedimentation rate (ESR) Increased 13/22 59.1 Interleukin Increased 9/9 100.0 Brain natriuretic peptide (BNP) Increased 1/4 25.0 Hospitalization ICU care 8 23.5 No-ICU care 26 76.5 Treatment Antibiotic therapy 31 91.2 Antiviral therapy (other drugs but not lopinavir/ritonavir) 32 94.1 Antiviral therapy (switch to lopinavir/ritonavir later) 9 26.5 Use of corticosteroid 21 61.8 Oxygen Support Oxygen Therapy 25 73.5 Non-invasive ventilation or high-flow nasal cannula 2 5.9 Invasive mechanical ventilation 3 8.8 Unknown 4 11.8 Change of chest radiographs (before switching to lopinavir/ritonavir) Worse manifestations 14/16 87.5 Improve manifestations 1/16 6.25 No difference 1/16 6.25 Intervals of re-examined, days 4.5 (3.0–6.0) Unknown 18 52.9 Change of chest radiographs (Refer in particular to the 9 patients who switched to lopinavir/ritonavir later) Improve manifestations 1/9 11.1 Intervals of re-examined, days 4 Not re-examined 8 88.9 Change of Procalcitonin Elevated 4/11 36.4 Declined 3/11 27.3 No difference 4/11 36.4 Unknown 23 67.6 Prognosis Hospitalization 33 97.1 Home isolation 1 2.9 Table 1 Demographical and clinical Information, initial outcomes of laboratory tests, management and treatment of 34 patients who were confirmed as being infected with SARS-CoV-2 after admission to Zhongnan Hospital.
Although intermittent increases in inflammation are critical for survival during physical injury and infection, recent research has revealed that certain social, environmental and lifestyle factors ...can promote systemic chronic inflammation (SCI) that can, in turn, lead to several diseases that collectively represent the leading causes of disability and mortality worldwide, such as cardiovascular disease, cancer, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and autoimmune and neurodegenerative disorders. In the present Perspective we describe the multi-level mechanisms underlying SCI and several risk factors that promote this health-damaging phenotype, including infections, physical inactivity, poor diet, environmental and industrial toxicants and psychological stress. Furthermore, we suggest potential strategies for advancing the early diagnosis, prevention and treatment of SCI.
Objective
Temporal arteritis (TA) is a typical manifestation of giant cell arteritis (GCA). Antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides (AAVs) are rarely revealed by TA ...manifestations, leading to a risk of misdiagnosis of GCA and inappropriate treatments. This study was undertaken to describe the clinical, biologic, and histologic presentations and outcomes in cases of TA revealing AAV (TA‐AAV) compared to controls with classic GCA.
Methods
In this retrospective case–control study, the characteristics of patients with TA‐AAV were compared to those of control subjects with classic GCA. Log‐rank test, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), was used to assess the risk of treatment failure.
Results
Fifty patients with TA‐AAV (median age 70 years) were included. Thirty‐three patients (66%) presented with atypical symptoms of GCA (ear, nose, and throat involvement in 32% of patients, and renal, pulmonary, and neurologic involvement in 26%, 20%, and 16% of patients, respectively). Blood samples were screened for ANCAs at the time of disease onset in 33 patients, and results were positive in 88%, leading to a diagnosis of early TA‐AAV in 20 patients. The diagnosis of AAV was delayed a median interval of 15 months in 30 patients. Compared to controls with GCA, patients with TA‐AAV were younger (median age 70 years versus 74 years), were more frequently men (48% versus 30%), and had high frequencies of atypical manifestations and higher C‐reactive protein levels (median 10.8 mg/dl versus 7.0 mg/dl). In patients with TA‐AAV, temporal artery biopsy (TAB) showed fibrinoid necrosis and small branch vasculitis in 23% of patients each, whereas neither of these characteristics was evident in controls with GCA. Treatment failure–free survival was comparable between early TA‐AAV cases and GCA controls, whereas those with delayed TA‐AAV had a significantly higher risk of treatment failure compared to controls (HR 3.85, 95% CI 1.97–7.51; P < 0.0001).
Conclusion
TA‐AAV should be considered diagnostically in cases of atypical manifestations of GCA, refractoriness to glucocorticoid treatment, or early relapse. Analysis of TAB specimens for the detection of small branch vasculitis and/or fibrinoid necrosis could be useful. Detection of ANCAs should be performed in cases of suspected GCA with atypical clinical features and/or evidence of temporal artery abnormalities on TAB.
To synthesize evidence on the prevalence and incidence of physical health conditions in people with intellectual disability (ID).
We searched Medline, PsycInfo, and Embase for eligible studies and ...extracted the prevalence, incidence, and risk of physical health conditions in people with ID.
Of 131 eligible studies, we synthesized results from 77 moderate- to high-quality studies, which was mainly limited to high-income countries. The highest prevalence estimates were observed for epilepsy, ear and eye disorders, cerebral palsy, obesity, osteoporosis, congenital heart defects, and thyroid disorders. Some conditions were more common in people with a genetic syndrome. Compared with the general population, many health conditions occur more frequently among people with ID, including asthma and diabetes, while some conditions such as non-congenital circulatory diseases and solid cancers occur at the same or lower rate. The latter associations may reflect under-detection.
People with ID have a health profile more complex than previously known. There is a pressing need for targeted, evidence-informed population health initiatives including preventative programs for this population.
•SARS-CoV-2 interfered primarily by angiotensin-converting enzyme 2 (ACE2) receptor.•Depending on the viral load, SARS-COV-2 infections spread to other major organs, mainly based on ACE2 receptor ...expression.•Cytokine storm and organ crosstalk result in systemic inflammation with multi-organ failure syndromes.
Globally, the current medical emergency for novel coronavirus 2019 (COVID-19) leads to respiratory distress syndrome and death.
This review highlighted the effect of COVID-19 on systemic multiple organ failure syndromes. This review is intended to fill a gap in information about human physiological response to COVID-19 infections. This review may shed some light on other potential mechanisms and approaches in COVID -19 infections towards systemic multiorgan failure syndromes.
SARS-CoV-2 intervened mainly in the lung with progression to pneumonia and acute respiratory distress syndrome (ARDS) via the angiotensin-converting enzyme 2(ACE2) receptor. Depending on the viral load, infection spread through the ACE2 receptor further to various organs such as heart, liver, kidney, brain, endothelium, GIT, immune cell, and RBC (thromboembolism). This may be aggravated by cytokine storm with the extensive release of proinflammatory cytokines from the deregulating immune system.
The widespread and vicious combinations of cytokines with organ crosstalk contribute to systemic hyper inflammation and ultimately lead to multiple organ dysfunction (Fig. 1). This comprehensive study comprises various manifestations of different organs in COVID-19 and may assist the clinicians and scientists pertaining to a broad approach to fight COVID 19.
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