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PubMed1987

Changes of skin potential level and of skin resistance level corresponding to lasting motion discomfort.

The qualitative correspondence between degree of motion discomfort and electrodermal activity was investigated. Skin potential level (SPL) and skin resistance level (SRL) in the arousal sweat area and the thermal sweat area were recorded. In order to induce motion discomfort, Coriolis stimulation and/or horizontal body rotation were provided by using a rotatory chair. The degree of discomfort was evaluated according to reports by the subjects. It was observed that SPL depolarized in the arousal sweat area as well as in the thermal sweat area and SRL lowered in the thermal sweat area coincidentally with lasting motion discomfort. SPL showed better correspondence the recovery period from the motion discomfort.

Adult↗
PubMed2002

A "story" of a woman with cystic fibrosis.

Munchausen syndrome is a pattern of abnormal behavior in which patients repeatedly present with symptoms that have no organic basis and are intentionally simulated or produced in order to assume the sick role and gain admission to the hospital. A 25-year-old white woman presented to our adult cystic fibrosis (CF) program and gave a detailed history consistent with a diagnosis of CF, a complicated disease with multiorgan involvement that is difficult to feign. However, discrepancies in her history were noted and objective measures of disease were inconsistent, including evidence of a fabricated sweat chloride result. We describe the classic characteristics of Munchausen syndrome that our patient exhibited, and report this unusual presentation of Munchausen syndrome to be consistent with the recommendation of reporting such cases to other physicians. Such knowledge is likely to result in less harm to the patient through unnecessary testing and treatment.

Adult↗
PubMed2000

Predisposing factors and prevention of frostbite.

This review focuses on the physiological, behavioural and environmental factors which predispose to frostbite. Also prevention of frostbite is summarised. Predisposing factors may increase heat loss, decrease heat production, decrease the insulation of the clothing, make people especially susceptible to cold or make them to behave inadequately. Marked increase in convective or conductive heat loss is often the immediate reason for frostbite. Wind (as described by wind chill index) increases convective heat loss and touching of metal objects increases conductive cooling. Poor insulation of the clothing is also a common reason of frostbite. The insulation can be insufficient when clothing is wet, tight, permeable to wind or does not cover the cold sensitive body parts. Individual factors predisposing to frostbite are inadequate behaviour, low physical fitness, fatigue, dehydration, earlier cold injuries, sickness or poor circulation in peripheral parts of the body. Frostbite is often associated with the use of alcohol. To prevent frostbite, it is necessary to recognise cold risks, practise tasks in the cold, eat and drink well, have physical exercise, have sufficient clothing (also spare clothing), change into dry clothing if necessary and take care of companions. In the cold it is not advisable to get fatigued until exhaustion, sweat excessively, use tight and/or wet clothing, drink alcohol, smoke and expose oneself unnecessarily to wind, metals or fluids.

Adaptation, Physiological↗
PubMed2006

Science and social justice: the lessons of HIV/AIDS activism in the struggle to eradicate tuberculosis.

The global social, political and health emergency presented by the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) has also once again propelled tuberculosis (TB) into a global public health emergency. The examples I will use to show how activism and social mobilisation can assist in overcoming TB are primarily from my home country, South Africa. Despite significant differences in health systems, culture, politics and history, there are lessons that could be used to advocate for TB prevention, diagnosis, treatment and care globally. Our country experiences globally significant HIV and TB epidemics. I will return to the epidemiology of TB-HIV and the crisis of illness and death. Early in April 2005, one of my closest friends, Ronald Louw, a professor of law at the University of KwaZulu-Natal, a human rights lawyer and activist for more than 25 years, suffered a persistent fever and cough. While on sabbatical, he was taking care of his mother who had been diagnosed with cancer. He assumed his illness was stress-related and went to a doctor who diagnosed bronchitis. After 4 weeks' treatment with antibiotics, his illness was worse-he had a raging fever, night sweats and was becoming disoriented. He requested an HIV test. Within 24 hours Ronald Louw knew that he had been infected with HIV. His mother died on the same day. He also knew within 24 hours that his CD4 count was below 100. They could not diagnose his lung disease and concluded that it was Pneumocystis carinii pneumonia. Four weeks later his doctors diagnosed TB through a lung biopsy. Ronald Louw had been desperately sick under medical care with TB and HIV for more than 8 weeks. He died 3 days after receiving a definitive TB diagnosis, and a week after treatment for presumptive TB had commenced.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Recovery of horses from dysautonomia (grass sickness).

The outcome for 35 horses with chronic dysautonomia which were kept in the hospital at the Royal (Dick) School of Veterinary Studies and subsequently returned to their owners is recorded. They constituted 42.7 per cent of the 82 chronic cases seen between 1991 and 1994; the other 47 horses were euthanased while in hospital. Of the 35 animals returned to their owners four died and 27 were available for follow up; of these 27, 12 were working competitively and six were being trained for future competitive work. It takes at least a year before it is clear whether a horse can compete successfully again but all the surviving animals were capable of being ridden. Some of the horses suffered excessive sweating, had difficulty in swallowing some foodstuffs, or had coat changes for long periods after returning to a normal weight.

Animals↗
PubMed2002

Thoracoscopic sympathectomy for palmar hyperhidrosis and Raynaud's phenomenon of the upper limb and excessive facial blushing: a five year experience.

Primary hyperhidrosis of the palms, face, and axillae has a strong negative impact on social and professional life. A retrospective analysis of 40 laparoscopic transaxillary thoracic sympathectomies performed in a district general hospital over a five year period was undertaken in order to determine the effectiveness of this procedure. A postal questionnaire was sent to all patients to assess the benefit from the operation; postoperative pain and time off work were collated. Immediate failure was noted in three patients, of whom two later underwent successful reoperation. Recurrence was noted in three patients (8%). Though immediate complications were minimal, the major long term postoperative morbidity was compensatory hyperhidrosis on the back, chest, and thigh (77%) along with gustatory sweating over the face (22%). Thoracoscopic sympathectomy is a safe, effective, and minimally invasive surgical treatment for hyperhidrosis, Raynaud's phenomenon of the upper limb, and excessive facial blushing; however, the chance of long term compensatory hyperhidrosis is high.

Adolescent↗
PubMed1987

[Correlation of "latent hyperthyroidism" with psychological and somatic changes].

The study reported here was undertaken to establish the degree to which a person in a preclinical state of hyperthyroidism, with (by definition) euthyroid T3 and T4 levels but suppressed TRH on testing, already exhibits psychological changes and clinical symptoms. Two groups of 20 patients each, with clear clinical and preclinical hyperthyroidism (as defined by laboratory parameters), were studied, as well as a group of 20 controls. The subjects' psychological state of mind was investigated using self-rating scales, including the state-trait-anxiety inventory (STAI), "Befindlichkeits"-Skala (Bf-S'), depression scale (D-S'), and a list of adjectives (EWL-K) with 14 different aspects of affective moods. Cognitive achievements were evaluated using the d2 test. Subjects were examined for somatic symptoms in accordance with Crooks' index of hyperthyroidism. The results clearly showed that typical psychological and somatic changes are already present in preclinical hyperthyroidism, these changes being partly identical with those of definite hyperthyroidism. In both patient groups, a significant increase in anxiety, a sense of not feeling well, and emotional irritability were found, as well as a tendency towards depressiveness, and an increased lack of vitality and activity. Attentiveness and concentration in both patient groups were lower than in the control group. Both patient groups showed the same prevalence of symptoms, such as palpitations, preference of cold over heat, excessive sweating, nervousness, fine digital tremor, and increased heart rate. With regard to the results, the diagnosis "preclinical hyperthyroidism" thus gains importance. Further prospective studies are required to answer the question whether antithyroidal treatment will influence the described psychological and somatic state of patients with preclinical hyperthyroidism.

Adult↗
PubMedDate not supplied

Ginger root against seasickness. A controlled trial on the open sea.

In a double-blind randomized placebo trial, the effect of the powdered rhizome of ginger (Zingiber officinale) was tested on seasickness. Eighty naval cadets, unaccustomed to sailing in heavy seas reported during voyages on the high seas, symptoms of seasickness every hour for 4 consecutive hours after ingestion of 1 g of the drug or placebo. Ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo did (p less than 0.05). With regard to vomiting, a modified Protection Index (PI) = 72% was calculated. Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant. For all symptom categories, PI = 38% was calculated.

Adolescent↗
PubMedDate not supplied

Perimenopause: more than hot flushes and night sweats for some Australian women.

OBJECTIVE: To identify the most common perimenopausal symptoms experienced by a group of Australian women and explore the extent to which those symptoms were distressing. DESIGN: A quantitative survey. SETTING: All women's health centers listed with the New South Wales Women's Information and Referral Service. PARTICIPANTS: A convenience sample of 200 healthy women, aged 45 to 55 years, drawn from a statewide population of women residing in Australia. MAIN OUTCOME MEASURE: The Women's Health Assessment Scale. RESULTS: Most frequently occurring perimenopausal symptoms included forgetfulness, lack of energy, irritability, and weight gain. The most distressing perimenopausal symptoms included weight gain, heavy bleeding, poor concentration, leaking of urine, and feeling as though life were not worth living. Current use of hormone replacement therapy contributed to the prediction of both symptom occurrence and symptom distress. CONCLUSION: Perimenopause is marked by more than hot flushes and night sweats; cognitive and affective changes are other distressing symptoms. The relationships between hormone replacement therapy use and both symptom occurrence and symptom distress warrant further investigation. In addition, practitioners should address concerns related to urinary incontinence, weight gain, cognitive and affective dysfunction, and general health status.

Estrogen Replacement Therapy↗
PubMed2000

A foodborne outbreak of gastroenteritis associated with Norwalk-like viruses: first molecular traceback to deli sandwiches contaminated during preparation.

In March 1998, an outbreak of acute gastroenteritis occurred among students at a Texas university. Overall, 125 ill students sought medical care. Case-control studies revealed that illness was significantly associated with eating foods from the university's main cafeteria deli bar on 9 and 10 March. Stool specimens from 9 (50%) of 18 ill students and samples of deli ham showed evidence of Norwalk-like viruses (NLVs) by reverse-transcriptase (RT) polymerase chain reaction (PCR) assay. A food handler who prepared sandwiches for lunch on 9 March reported that her infant had been sick with watery diarrhea since just before the outbreak. A stool sample from the infant was positive for NLV by RT-PCR, and the sequence of the amplified product was identical to that of amplified product from deli ham and students' stool specimens. This is the first time RT-PCR and sequence analysis have successfully confirmed viral contamination of a food item likely to have been contaminated by a food handler.

Adolescent↗
PubMed2006

[Treatment of Pseudomonas aeruginosa in cystic fibrosis in a child].

The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment. Fibrosis is the formation of scar tissue due to injury or long term inflammation. The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR genes. The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Five days before the admission, the girl had a higher bodily temperature, cough and difficult breathing. Due to the deteriorated general condition and the respiratory insufficiency and respiratory acidosis in blood gas analysis, the girl was intubated and put on the complete mechanical ventilation (IPPV). Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics), therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteri Pseudomonas aeruginosa--a typical bacteri for chronically sick C. F. patient. Pseudomonas aeruginosa is typically acquired in early childhood. This bacteria is giving progressive lung disease and often aggravates morbidity and mortality. So the main thing as a respiratory management is prevention of lung infection with this bacteria. A Pseudomonas therapy was prescribed according to the sensitive antibiogram, (Garamycin). Antibiotics are crucial to treating cystic fibrosis lung infections. Therapy with an amynoglicoside in combination with a B-lactam or a quinolone antibiotic is standard. It is a difficult to deliver a high doses at these antibiotics via the iv. route without significant systemic adverse events (otoxicity and nephrotoxicity). A reformulation of the aminoglycoside antibiotic tobramicin or garamycin therapy is solution for inhalation. To be well established infections the suppression of Pseudomonas aeruginosa has been shown to lead to decreasing same bacteria and benefits lung function from antibiotic therapy in a way that can be maintained over extended period. During bronchoscopy was given locally on changes mucous pulmozyme (to destroy a very hard mucous) and garamycin. So, after taking out a lot of mucus, it was later continued spontaneously. Control chest x ray and blood gas analysis are now very improved.

Child↗
PubMed2000

A comparison of persons with early-versus late-onset panic attacks.

BACKGROUND: Although some evidence suggests a bimodal age at onset of panic attacks, the literature comparing subjects with early versus late onset is limited. Previous work suggests that people with late-onset panic attacks may have fewer panic symptoms and exhibit less avoidance. This study sought to compare late-onset panic attacks and early-onset panic attacks with regard to (I) comorbidity, (2) health care utilization, and (3) illness behaviors and coping. METHOD: This community-based study involved interviewing randomly selected adults for the presence of DSM-III-R panic attacks. If panic attacks were confirmed, subjects were asked questions concerning panic characteristics, psychiatric comorbidity, symptom perceptions, illness attitudes, coping, and family characteristics. Subjects reporting early-onset panic (panic onset < 50 years of age) were compared with those reporting late onset (onset > or = 50 years of age). Significant univariate analyses were controlled for differences in age, panic duration, and socioeconomic status by using analysis of covariance and logistic regression. RESULTS: Subjects with late-onset panic attacks (N = 9) utilized the mental health sector less, but were more likely to present to family physicians for their worst panic. Patients with late-onset panic felt that choking and numbness more strongly disrupted function, but felt less strongly that either depersonalization or sweating disrupted function. Subjects with late-onset had fewer comorbid conditions and lower Symptom Checklist-90 scores. Late-onset subjects also had less hypochondriasis and thanatophobia while coping less through avoidance or wishful thinking. CONCLUSION: Late-onset panic attacks are associated with less mental health utilization, lower levels of comorbidity, less hypochondriasis, and a greater number of positive coping behaviors.

Adaptation, Psychological↗
PubMed1997

Evaluation of an algorithm for the integrated management of childhood illness in an area with seasonal malaria in the Gambia.

Most of the 12.4 million deaths occurring every year among under-5-year-olds in developing countries could be prevented by the application of simple treatment strategies. So that health professionals who have had limited training can identify and classify the common childhood diseases, WHO developed a treatment algorithm (the Integrated Management of Childhood Illness (IMCI) or Sick Child algorithm), a prototype of which was tested in 440 Gambian children aged between 2 months and 5 years. The children were first assessed by a trained field worker using the algorithm, and then by a paediatrician whose clinical diagnosis was supported by laboratory investigations and, when indicated, a chest X-ray. Compared with the paediatrician's diagnosis, the sensitivity and specificity of the draft IMCI algorithm were, respectively, 81% and 89% for the detection of pneumonia, 67% and 96% for dehydration, 87% and 8% for malaria parasitaemia (any level), 100% and 9% for malaria parasitaemia (above 5000 parasites/microliter), 100% and 99% for measles, 31% and 97% for otitis media, and 89% and 90% for malnutrition. Among the children admitted by the physician, 45% had been recommended for admission by the algorithm. Intermittent fever, chills and sweats did not help in discriminating between malaria and non-malarious fevers; shivering or shaking of the body had a sensitivity of only 35%. While the algorithm dealt with the majority of presenting complaints, the most common problems not addressed by the chart were skin rashes (21%), mouth problems (8%), and eye problems (6%). The draft IMCI algorithm proved to be effective in the diagnosis of pneumonia, gastroenteritis, measles and malnutrition, but not malaria where its use without microscopy would result in considerable over-treatment, especially in a low transmission area or during a low transmission season in countries with seasonal malaria. The current algorithm would benefit from expansion to cover management of localized infections as well as skin, mouth and eye problems.

Algorithms↗
PubMed1995

A psychological analysis of menopausal hot flushes.

Hot flushes and night sweats are one of the main symptoms accompanying the menopause, and are a main reason for seeking medical help at this time. This study of 61 women (reporting hot flushes once a week or more) investigates dimensions of subjective reporting using open questions and rating scales. Two separate factors were delineated using a principal component factor analysis - frequency (of hot flushes and night sweats) and problem ratings (of distress, interference and perception of flushes as problematic) - which had high test-retest reliability. The frequency ratings correlated highly with prospective daily monitoring. Depressed mood, anxiety and low self-esteem, but not frequency, discriminated between those who regarded flushes as problematic and those who did not. It is suggested that these two subjective measures should be used in assessment and in evaluation of hormonal and psychological interventions.

Adaptation, Psychological↗
PubMed2004

Determinants of the quality of life (QoL) in patients with an implantable cardioverter/defibrillator (ICD).

OBJECTIVES: In high-risk cardiac patients the treatment of life-threatening arrhythmias with an implantable cardioverter/defibrillator (ICD) extends survival. Other important outcome criteria are treatment side effects especially the quality of life (QoL). Knowledge of the variables that influence QoL is important for therapy decisions in ICD patients. METHODS: Ninety-three ICD patients evaluated their QoL by the SF-36 after 1-6 years of ICD implantation. The QoL was studied in relation to cardiac function (severity of heart failure, ejection fraction), treatment course (number of shocks), coping styles and psychiatric syndromes. RESULTS: About 30% of the somatic QoL (physical role function, pain) is determined by the patients' somatization tendency, i.e. the extent to which they suffer from non-specific symptoms (sweating, weakness in the legs, nausea). The severity of heart failure had little influence on the physical QoL. The emotional QoL is primarily determined by phobic anxiety of ICD patients. CONCLUSIONS: Psychiatric symptoms are the most important factors to determine the QoL in ICD patients. Behavioural treatment procedures of phobic anxieties and somatization could improve QoL in ICD patients.

Adaptation, Psychological↗
PubMed2005

Therapeutic flexible bronchoscopy in child with cystic fibrosis.

The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment (2). The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR ( cystic fibrosis transmembrane conductance regulator) genes (3), which result in the production of hyper-viscous mucus and chloride malabsorption in the sweat glands ducts (5,6). Bronchial thickening and plugging and ring shadows suggesting bronchiectasis, segmental or lobar atelectasis are often. Computer tomography of the chest can be used to detect and localize thickening of bronchial airways walls, mucus plugging, hyperinflation and early bronchieactasiae. Pulmonary therapy: the object is to clear secretions from airways and to control infection (7). The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Day before admission in the hospital had a higher bodily temperature, cough and difficult breathing. She already treated conservatively (Ceftazidim, Ceftriakson, Kloksacillin) Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics), therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteria pseudomonas aeruginosa--a typical bacteria for chronically sick C. F. patient. A pseudomonas therapy was prescribed according to the sensitive antibiogram, during which bronchoscopy was given locally on changes mucous pulmozyme and garamycin. Flexible bronchoscopy was performed as therapeutic. Local bronchoscopy findings:by aspiration of tracheo-bronchal truncus it was found hyperemia and a lot of mucous sticky secretion inside of tracheobronchal tree, especially middle lobe right side, lingual and basals part of the lungs. It was performed broncho-alveolar lavage and given steroids on the place of changed inflamed mucous membrane of the bronchi. It was also given pulmozyme to destroid mucous and make better spontaneously expectorations. Control chest x ray was performed and it was better.

Bronchoalveolar Lavage↗
PubMed1991

An unusual case of Munchausen syndrome by proxy.

An 11-year-old boy was presented by his father with a long and plausible history of cystic fibrosis. The diagnostic test for cystic fibrosis, the sweat test, was normal and excluded the diagnosis. The medical history was later found to be false, and the child to be well. By definition, the case met the criteria for Munchausen Syndrome by Proxy with fabrication of symptoms on behalf of another in order to deceive medical personnel. Unusual features included the illness chosen, the father as the parent falsifying illness, his failure to pursue unnecessary investigations and treatment, and the ease with which he relinquished the diagnosis of cystic fibrosis.

Adult↗
PubMed1987

[Causes and treatment of seasickness].

Seasickness is usually induced by conflicting sensory cues. However, very little is known about the neural pathways and processes which play a role in the development of nausea. Since the symptoms, for example, pallor, sweating and vomiting are all of parasympathetic origin, the common antiemetic drugs are anticholinergically efficient. More recently, additional drugs and modified forms of application have been introduced to reduce the soporific side effects. It is pointed out that onboard behaviour and even choice of vessel can be of more importance than use of antivertiginous drugs. Besides attention to the individual adaptation to the atypical seagoing environment, simple behaviour patterns such as fixation on the horizon, avoiding of head movements and reduction of conflicting sensory cues can be very effective in reducing symptoms.

Antiemetics↗