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In the wide phenotypic spectrum of cardiomyopathies, sudden cardiac death (SCD) has always been the most visible and devastating disease complication. The introduction of implantable cardioverter-defibrillators for SCD prevention by the late 1980s has moved the question from how to whom we should protect from SCD, leaving clinicians with a measure of uncertainty regarding the most reliable option to guide identification of the highest-risk patients. In this review, we will go through all the available evidence in the field of arrhythmic expression and arrhythmic risk stratification in the different phenotypes of cardiomyopathies to provide practical suggestions in daily clinical management.

Background We report a case of post-coronavirus disease (COVID) immune hepatitis occurring in a young male with no pre-existing comorbidities. Case summary A previously healthy 21-year-old male patient was admitted to our hospital with mild COVID-19. During the course of in-hospital isolation and monitoring, he developed an alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increase, with the enzymes peaking at day 24 (ALT 15 times the upper normal limit), with preserved liver function. The liver enzyme increase occurred 20 d after the complete clinical remission of COVID-19, and ALT dynamics paralleled the increase in total antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The case was interpreted as post-COVID immune hepatitis, with extensive laboratory investigations excluding other potential causes. The hepatocytolysis remitted 20 d after the peak ALT, without further intervention, with complete recovery, but the total anti-SARS-CoV-2 antibodies continued to increase the next 5 mo following the acute infection. Conclusion Close attention should also be paid to young patients with mild forms of disease, and a high index of suspicion should be maintained for post-COVID complications.

We present a fatal case of end-stage renal disease complication that is calciphylaxis, also known as calcific uremic arteriolopathy, characterized by vascular calcification, necrosis of the skin and adipose tissue and constant severe pain of the affected areas.

With the increasing aging population worldwide, cardiovascular disease (CVD) has become the leading cause of disability and death. Hypertension is one of the most critical factors causing CVD complication. Determining risk factors of hypertension is extremely important for preventing elderly people with hypertension from CVD complication. Accordingly, this study proposes a new measurement so-called objective distance that is influenced by the significant risk factors of hypertension development. The assumption is made that the maximum objective distance is derived from significant risk factors. This study employs the secondary data of 121 elderly people aged 65 and over, derived from hospitals in Chiang Rai, Thailand. The gathered data contains all potential risk factors of hypertension development, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), physical activity, smoking, medication adherence, and body mass index. The decision tree is employed in this study for determining the significant risk factors in order to verify the proposed assumption. The results show that the obtained significant risk factors are TC, LDL-C, HDL-C, physical activity, and smoking. Importantly, the combination of obtained significant risk factors provides the maximum objective distance regarding the proposed assumption.

Background: Recent studies have found that women with obstetric disorders are at increased risk for a variety of long-term complications. However, the underlying pathophysiology of these connections remains undetermined. A network-based view incorporating knowledge of other diseases and genetic associations will aid our understanding of the role of genetics in pregnancy-related disease complications. Methods: We built a disease–disease network (DDN) using UK Biobank (UKBB) summary data from a phenome-wide association study (PheWAS) to elaborate multiple disease associations. We also constructed egocentric DDNs, where each network focuses on a pregnancy-related disorder and its neighboring diseases. We then applied graph-based semi-supervised learning (GSSL) to translate the connections in the egocentric DDNs to pathologic knowledge. Results: A total of 26 egocentric DDNs were constructed for each pregnancy-related phenotype in the UKBB. Applying GSSL to each DDN, we obtained complication risk scores for additional phenotypes given the pregnancy-related disease of interest. Predictions were validated using co-occurrences derived from UKBB electronic health records. Our proposed method achieved an increase in average area under the receiver operating characteristic curve (AUC) by a factor of 1.35 from 55.0% to 74.4% compared to the use of the full DDN. Conclusion: Egocentric DDNs hold promise as a clinical tool for the network-based identification of potential disease complications for a variety of phenotypes.

Acute soft skull syndrome is an uncommon complication of patients with sickle cell anemia. Here, we report a case of an adult patient in Sudan with the acute soft syndrome, with our aim of providing more knowledge on this type of complication. The 20-year old patient, with a known history of sickle cell anemia, presented with a 1-day history of headache and joint pain. The complaint continued after admission, with increasing headache severity and development of rapid skull swelling, which indicated the rare sickle cell disease complication known as an acute soft head syndrome. Conservative management resulted in good response and rapid recovery of this case of acute soft skull syndrome with sickle cell anemia mainly related to skull infraction.

Nowadays, people are living longer than in the past which leads to dramatically increasing numbers of elderly people in the world’s populations. Correspondingly, the elderly are facing critical health concerns , particularly Cardiovascular Disease (CVD). CVD is recognized as the main cause of death worldwide for the aged people. Consequently, prevention of CVD complication is extremely significant for the elderly. The purpose of this research study is to determine a personalized recommendation to the elderly for preventing themselves from the complication of CVDs. Therefore, the personalized recommendation method using integrated objective distance is proposed in this study. The integrated objective distance is a new measurement for computing the distance score for indicating a personal suggestion effectively. Importantly, the proposed personalized recommendation method provides the potential direction for an individual lifestyle adjustment. An experiment of this study is conducted in the context of hypertension, which is one of the most significant risk factors for developing CVD. Input data is collected from 121 elderly people who have a high risk of CVD in Chiang Rai, Thailand. An experimental result shows that the proposed method can provide efficient suggestions to elderly people when compared to those from human experts with 95% accuracy.

Objective The development of depressive symptoms in youth with IBD is a concerning disease complication, as higher levels of depressive symptoms have been associated with poorer quality of life and lower medication adherence. Previous research has examined the association between disease activity and depression, but few studies have examined individual differences in experience of stressful life events in relation to depressive symptoms. The purpose of the current study is to examine the relation between stressful life events and depression within pediatric IBD and to determine whether individual differences in stress response moderates this association. Methods 56 youth ages 8–17 years old diagnosed with IBD completed questionnaires about their depressive symptoms and history of stressful life events. We assessed skin conductance reactivity (SCR) to a stressful task as an index of psychophysiological reactivity. Results Stressful life events (r = 0.36, p = .007) were positively related to depressive symptoms. Youth who demonstrated a greater maximum SC level during the IBD-specific stress trial compared to baseline (n = 32) reported greater depressive symptoms. For these same participants, the relationship between stressful life events and depressive symptoms depended on SCR F(3, 28) = 4.23, p = .01, such that at moderate and high levels of SCR, a positive relationship between stressful life events and depressive symptoms was observed. Conclusions The relationship between stressful life events and depressive symptoms in youth with IBD may depend on individual differences in processing stress, such that risk may increase with greater psychophysiological reactivity.

This case highlights a rare presentation of chronic lymphocytic leukemia (CLL). CNS involvement by CLL is rare, and only 5 cases with pituitary or hypothalamic involvement have previously been reported. Unfamiliarity with this disease complication may lead to a delay in diagnosis and treatment.This case highlights a rare presentation of chronic lymphocytic leukemia (CLL). CNS involvement by CLL is rare, and only 5 cases with pituitary or hypothalamic involvement have previously been reported. Unfamiliarity with this disease complication may lead to a delay in diagnosis and treatment., The differential diagnosis for pituitary stalk lesions is broad and includes anatomical variants/congenital anomalies, benign and malignant neoplasms (primary or metastatic), infiltrative and inflammatory disorders, and infection. CLL pituitary infiltration is exceptional, but favoring a second and very rare diagnosis over an unusual manifestation of an actively progressing disease was statistically unappealing.

Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.

Nowadays, the amount of elderly people in the world population is increasing dramatically, so their health problem is the main concern. Cardiovascular Disease (CVD) is one of the major health problems for elderly people. Especially, hypertension is the main risk factor causing CVD. Consequently, recognizing the ability to control hypertension is very important for providing appropriate treatment recommendations. Therefore, this paper proposes a classification of an elderly group respecting the controllability of hypertension for preventing CVD complications. Decision tree, artificial neuron network, and K-nearest neighbors are employed and compared for classifying elderly group. Moreover, this paper also aims to find the most suitable classifier for the datasets used in this study. Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, body mass index, and smoking are considered in this paper as the significant risk factors of hypertension development. All data of these factors are collected from secondary data related to elderly people having hypertension with the number of 748 datasets. Finally, the elderly people are classified into two groups including potential controllable group and potential uncontrollable group. The results show that the decision tree provides the highest accuracy of classification for this dataset with 99.11%.

The discovery of non-coding RNAs (ncRNAs) has opened a new paradigm to use ncRNAs as biomarkers to detect disease progression. Long non-coding RNAs (lncRNA) have garnered the most attention due to their specific cell-origin and their existence in biological fluids. Type 2 diabetes patients will develop cardiovascular disease (CVD) complications, and CVD remains the top risk factor for mortality. Understanding the lncRNA roles in T2D and CVD conditions will allow the future use of lncRNAs to detect CVD complications before the symptoms appear. This review aimed to discuss the roles of lncRNAs in T2D and CVD conditions and their diagnostic potential as molecular biomarkers for CVD complications in T2D.

Diabetes could be very challenging to manage due to its high complication that could give negative impacts to patient’s quality of life. Diabetes mellitus is a non-communicable chronic disease that has caused significant morbidity since ten years ago. Diabetes Mellitus treatment is essential to reduce disease complication. Adapting self-care behaviour based on theory can, therefore, be implemented as one of the effective ways of managing diabetes. Social Cognitive Theory has been one of the most common theories that used in many studies as to improve behaviours in-patient with chronic disease such as diabetes mellitus. Furthermore, managing good self-care is very important in order to reduce the morbidity and mortality of diabetes patients, however diabetes self-care became a challenge to many people living with diabetes, as they need to adapt and learn self-care practices in their daily lives. Thus this paper would provide an understanding of the health care professional in delivering their self-care services, also helping oneself to stay healthy and control their disease by good self-care practices.

With increasing numbers of elderly people of the world's populations, Cardiovascular Disease (CVD) has become a critical health concern. It represents the main cause of death worldwide. Accordingly, preventing aged people from CVD has been extremely considered nowadays. The aim of this study is to determine proper recommendations to the elderly who have high risks of CVD complication for preventing themselves. Therefore, this paper applies the concept of an objective distance which is a measurement used as the indicator for recommendations. It defines the distance between the current status of the elderly people and objective level of each attribute for deriving the proper recommendations. Significantly, this distance provides the effective direction for their personal lifestyle adjustment. An experiment is performed in the context of hypertension, which is one of the main risk factors of CVDs. Data is gathered from 60 elderly people who are at the high risk of CVD in Chiang Rai, Thailand. A result of this experiment presents that the proposed objective distance can be efficiently employed for providing the appropriate recommendations to each elderly person. Also, they successfully modified their lifestyle behaviors for protecting themselves from CVDs, accounted for 90 percent accuracy.

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

The research is aimed at the evaluation of the role of SPINK1 gene mutations in the development of different etiologic variants of chronic pacreatitis (CP). The examination of 240 CP patients and 107 healthy people, constituting the control group (CG) was undertaken. All the patients underwent general and biochemical blood analysis, clinical urinalysis, standard coprological examination, immunoenzyme method of fecal elastase-1 determination, esophagogastroduodenoscopy (EGC), ultrasound investigation and/or computer tomography (CT) of abdominal cavity organs and genetic research on mutation N34S (AAT>AGT) identification in SPINK1 gene, using the method of restriction analysis. N34S mutation was determined in 22 (9.2 %) CP patients and in 3 (2.8 %) CG people. The upper frequency of N34S mutation was determined in patients with toxic and idiopathic CP, which has reached 16.7 % in total and 13.3 % for homozygotes. High frequency of N34S mutation was registered in patients with complicated forms of idiopathic CP, which can increase the risk of disease complication. Keywords: chronic pacreatitis; mutations; pancreatic secretory trypsin inhibitor; 1 Kazal- type serine protease inhibitor; SPINK1; N34S. Введение. Хронический панкреатит (ХП) - воспалительное заболевание поджелудочной железы (ПЖ), характеризующееся длительным прогрессирующим течением с развитием необратимых морфологических изменений паренхимы железы (1). ХП можно охарактеризовать как полиэтиологическое и полипатогенетическое заболевание. К этиологическим факторам, вызывающим ХП, относится в первую очередь злоупотребление алкоголем, курение, патология билиарного тракта и наследственные факторы (2). Наследственный панкреатит (НП) в течение многих десятилетий оставался редчайшей патологией ПЖ, и только применение генетических исследований в середине 90-х годов прошлого века позволило выявить тип мутаций и классифицировать НП (3-5). На сегодняшний день НП является достаточно широкой и негомогенной нозологической формой, поскольку помимо предполагаемой ранее и выявленной первой доминантной мутации (ген катионического трипсиногена - PRSS1) было выявлено много рецессивных мутаций, полиморфизмов в различных генах, предрасполагающих к развитию ХП (6, 7). Проведенные в дальнейшем клинические исследования выявили особенности клинического течения и диагностические признаки различных подтипов НП, различающихся

The occurrence of strictures as a complication of Crohn’s disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation.

Pegylation (PEG) is used as both a drug-delivery and a drug-modification technology in ten drugs approved by the US FDA. Benefits of PEG drugs can include increased plasma half-life, longer absorption, improved tumor targeting and less antigenicity and immunogenicity. Clinical benefits of PEG drugs over non-PEG drugs may include reduced administration, improved efficacy, improved tolerability, and decreased severity and incidence of adverse events. This study reviews 37 economic literature publications featuring PEG drugs versus non-PEG versions. PEG drugs showed some reductions in overall costs resulting from various offsets including fewer administrations, lower adverse event treatment costs, reduced disease complication costs or reduced inpatient/outpatient costs. Of the 18 cost-effectiveness studies reviewed, 17 of them found PEG drugs to be cost effective versus the non-PEG drugs. Cost offsets and cost-effectiveness of PEG drugs have been demonstrated in multiple studies across various therapies, indications and country settings, and the results have been found to be stable when key parameters were varied in analyses. Further studies are needed to assess the potential for cost savings and cost-effectiveness for new PEG therapies in development.

Treatment of thalassemia major is complex, expensive and requires a multidisciplinary approach. Optimal clinical care is demanding and expensive, but achievable. To assess the prevalence of survival and disease complications among patients with thalassemia major treated at our center; a retrospective chart review was done of all patients followed and treated at King Abdulaziz University Hospital with a diagnosis of Thalassemia Major from 1990-2004. A total of 360 patients (203 males & 157 females) were transfusion dependant since early childhood and treated with parenteral Deferoxamine. Out of 360 patients, 293 (90.29%) patients were alive, 27 (7.2%) patients had died, 15 (4.2%) patients underwent BMT and 25 (6.9%) patients'follow-up were lost. Twelve (3.3%) patients died from heart disease. 7 (1.9%) patients died from infections, all patients were splenectomized. The serum ferritin levels for patients who died were significantly higher than for those patients who survived (7,500 vs. 3, 200; p < 0.001). Cardiac constitutes the first important cause of death followed by infection. Complications and deaths among thalassemics is iron related organ dysfunction and age related. The majority of complicated patients were on non-optimal chelation therapy and non-compliance.

Esta pesquisa objetivou descrever alguns fatores condicionantes básicos do autocuidado e analisar os diagnósticos de enfermagem da North American Nursing Diagnosis Association identificados em pessoas com diabetes tipo 2, mediante abordagem baseada na teoria de Orem. Participaram do estudo sete pessoas, avaliadas de maio a junho de 2006. Os fatores condicionantes básicos do autocuidado neste grupo foram: idade entre 46 a 71 anos, predominando o sexo feminino, estado civil casado, ensino médio completo, aposentados, todos com antecedentes familiares de diabetes. Os diagnósticos de enfermagem identificados em todos os participantes foram: controle ineficaz do regime terapêutico; comportamento de busca de saúde; risco para perfusão tissular cardíaca, renal, periférica e/ou cerebral ineficaz; percepção sensorial perturbada (visual), conhecimento deficiente sobre alimentação, cuidado com as extremidades, complicações da doença e prática de exercícios físicos; disposição para conhecimento aumentado acerca do diabetes mellitus tipo 2 e do regime terapêutico; risco de infecção; risco de lesão micro e macrovascular; risco para quedas e risco de integridade da pele prejudicada. Outros dezesseis diagnósticos foram identificados, com uma freqüência menor. Este perfil denota a necessidade de estabelecer um sistema de enfermagem de apoio e orientação sistematizado e efetivo, de modo a aumentar a agência de autocuidado dos participantes. Palavras chave: Diabetes mellitus tipo 2; Diagnóstico de enfermagem; Teoria de Enfermagem.

Association Rule Discovery is a significant data mining technique. In this paper, we applied this technique to discover fundamental association among a data set of diabetes mellitus (DM) patients with ophthalmic complication using a classifier based on gender, age and payment method of treatment expense. The result indicated that "diabetes mellitus (DM) patients Type II aging between 60-69 years old with no occupation whose payment for their treatment expense was by Government Official Rights of Continuous Treatment tended to have diabetes mellitus (DM) with ophthalmic complication." This conclusion is useful for healthcare treatment of adulthood patients, welfare improvement of public healthcare, provision of helpful recommendation for diabetes mellitus patients and further development in finding disease complication.

e15129 Background: HCC bone mets are a known disease complication but their frequency, morbidity, and biology are poorly understood. Screening guidelines for HCC bone mets are not established prese...

The hormone insulin, which is produced in the pancreas, is an important regulator of blood sugar levels. In people with diabetes, the pancreas does not produce sufficient insulin (type 1 diabetes) or the body does not respond appropriately to the insulin (type 2 diabetes). Alcohol consumption by diabetics can worsen blood sugar control in those patients. For example, long-term alcohol use in well-nourished diabetics can result in excessive blood sugar levels. Conversely, long-term alcohol ingestion in diabetics who are not adequately nourished can lead to dangerously low blood sugar levels. Heavy drinking, particularly in diabetics, also can cause the accumulation of certain acids in the blood that may result in severe health consequences. Finally, alcohol consumption can worsen diabetes-related medical complications, such as disturbances in fat metabolism, nerve damage, and eye disease.

Egg-induced lesions in the upper and the lower female reproductive tract are important complications of the infection with Schistosoma mansoni. The understanding of the pathophysiology and pathology of genital lesions is only rudimentary, simple and reliable diagnostic tools are not at hand, epidemiological data do not exist and how to treat best the women affected, is not known. In view of recent advances in the understanding of genital lesions induced by S. haematobium the existing literature is critically analysized and possible consequences of female genital schistosomiasis are outlined. We estimate that 6 to 27 % girls and women with intestinal schistosomiasis, at least temporarily, suffer from pathology induced by eggs sequestered somewhere in their genital organs. This is a mattern of concern and warrants more research into the epidemiology, pathology, diagnosis and therapy of this disease entity.

Measures of association describe the strength of the relationship between an exposure (or intervention) and an outcome in clinical studies (randomised controlled trials [RCTs], cohort studies, and case control studies). There are 2 types of measures: relative (relative risk, relative risk reduction, odds ratios) and absolute (absolute risk reduction, number needed to treat). Confidence intervals (CI) should be given for each measure of association to quantify their uncertainty and are usually reported as 95% CI (ie, the interval has a 95% chance of including the true, but unknown, population value). If the 95% CI overlaps the value of no effect (see below), the result is not statistically significant at the 5% level (p

Introduction Primary intestinal tuberculosis is a rare variant of tuberculosis. The preferred treatment is usually pharmaceutical, but surgery may be required for complicated cases. Case presentation We report two cases of primary intestinal tuberculosis where the initial diagnosis was wrong, with colonic cancer suggested in the first case and a Crohn's disease complication in the second. Both of our patients were Caucasians of Greek nationality. In the first case (a 60-year-old man), a right hemicolectomy was performed. In the second case (a 26-year-old man), excision was impossible due to the local conditions and peritoneal implantations. Histopathology revealed an inflammatory mass of tuberculous origin in the first case. In the second, cell culture and polymerase chain reaction tests revealed Mycobacterium tuberculosis. Both patients were given anti-tuberculosis therapy and their post-operative follow-up was uneventful. Conclusions Gastrointestinal tuberculosis still appears sporadically and should be considered in the differential diagnosis along with other conditions of the bowel. The use of immunosuppressants and new pharmaceutical agents can change the prevalence of tuberculosis.

In a prospective study of 176 patients in whom polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) had been diagnosed between 1968 and 1980 the effect of corticosteroid treatment was studied. In those with PMR alone an initial regimen of 10 mg prednisolone daily and for the majority of those with GCA 20 mg daily were adequate to control symptoms. No patient suffered a serious disease complication after starting treatment. Regular follow-up enabled the minimum effective corticosteroid dose to be used. Complications of treatment were infrequent. Corticosteroid treatment has been withdrawn from 72 patients after a mean of 31 months treatment (range 3-103 months). Thirty subsequently relapsed, all within 21 months of withdrawal. No clinical feature predicted those who were more likely to relapse. No rigid treatment schedule should be used in these diseases.

First and last it is the physician’s task to prevent death. Yet many doctors subscribe to the aphorism, ‘You should not kill nor need you strive officiously to keep alive’. When death is inevitable and expected and when the patient’s position is helpless then heroic, distressing or degrading treatments should not be attempted.