Waterborne and water-washed disease *
Jamie Bartram, Rachel Baum, Peter A. Coclanis, David M. Gute, David Kay, Stéphanie McFadyen, Katherine Pond, William Robertson, Michael J. Rouse in Routledge Handbook of Water and Health, 2015
The severity of disease caused by faecal–oral pathogens differs greatly among the different specific pathogens and it is also influenced by the state of the host (Baron, 1996; Mims et al., 2001: National Institutes of Health). For some pathogens, initial infection and illness may result in later adverse health effects that are different from the initial illness and are referred to as sequelae. These sequelae can range from neurological disease (encephalitis), to neuromuscular disease (paralysis), reactive arthritis, heart disease (myocarditis), diabetes, cancer (e.g. of the stomach) and immunosuppression. The severity of disease is an important consideration not only in terms of the consequences for individual human hosts but also for estimating the disease burdens produced by faecal–oral and other pathogens in populations. Such disease burden estimates are based on disability-adjusted life years (DALYs) that take into consideration both the years of life lost (YLL) and years lived with disability or disease (YLD). DALY = YLL + YLD, which can be quantified for any infectious disease or other disease-causing agent, such as a toxic chemical (World Health Organization, 2011).
The clinical presentation and natural history of acute deep venous thrombosis
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Once formed, the competing processes of recanalization and recurrent venous thrombosis characterize the natural history of acute DVT. The development of chronic sequelae is closely related to the balance between these two processes. The venous lumen is most often re-established after both experimental and clinical thrombosis.62 The mechanisms of thrombus organization and recanalization have been extensively investigated in animal models of DVT. Both the vein wall and thrombus play important roles in these processes. In short, there is rapid regeneration of a fibrinolytically active neoendothelium soon after thrombosis, with an early neutrophilic infiltrate within the thrombus and vein wall, followed by a predominantly monocyte infiltrate.63,64 Monocytes appear to play a particularly important role in thrombus organization and recanalization, functioning as a source of both fibrinolytic and cytokine mediators. Experimental thrombi show complete recanalization by 3 weeks, with the thrombus reduced to an endothelialized subintimal streak.
Clinical Trial Design and Concepts Specific for Biologic Agents in the Treatment of Rheumatic Diseases
Thomas F. Kresina in Monoclonal Antibodies, Cytokines, and Arthritis, 2020
Mild to moderate constitutional symptoms, typical following the administration of biologic proteins, were observed during the treatment days. Fever with and without rigor, associated with nausea, fatigue, and malaise were seen. Symptoms decreased when premedication with acetaminophen, diphenhydramine, and metaclopromide was administered. In some patients, myalgias and muscle weakness were noted after later infusions, although muscle tenderness and creatine phosphokinase (CPK) elevations were rarely seen. These symptoms defined the MTD of 0.33 mg/kg/day for the five-day treatment regimen. Increased extravascular volume, manifested by pedal and/or periorbital edema, occurred after treatment, not associated with abnormalities of renal or hepatic function. All treatment-related symptoms resolved without sequelae.
DRESS syndrome: a detailed insight
Published in Hospital Practice, 2018
Sapan Kumar Behera, Saibal Das, Alphienes Stanley Xavier, Sandhiya Selvarajan
After discontinuation of causative drug, most of the patients take weeks to months to recover completely. The prevalence of sequelae is unknown. Patients are required to be monitored for manifestations of autoimmune diseases [160,161], which might lead to chronic organ failure [162]. Long-term sequelae may lead to renal failure, chronic anemia, autoimmune diseases (autoimmune thyroid disease and autoimmune hemolytic anemia) [162]. Laboratory monitoring, including autoantibodies, and thyroid stimulating hormone, also may be warranted based upon clinical findings. Patients who recover from DRESS syndrome may have an increased risk of reaction to structurally unrelated drugs [18]. The risk appears to be higher in the first few months. Patients should be educated about the need for a strict avoidance of the offending as well as cross-reacting drugs [163]. Although the mortality is low [164], early diagnosis can decrease the mortality due to this syndrome.
Outcome of uncorrected CSF leak and consequent recurrent meningitis in a patient: a case presentation and literature review
Published in British Journal of Neurosurgery, 2020
A. J. Soni, G. Modi
Post-traumatic recurrent bacterial meningitis has primarily been described in case series of paediatric patients. Studies conducted on adult patients with post-traumatic recurrent bacterial meningitis are limited in number. It is an important condition due to its potential for debilitating sequelae. The formidable post-meningitic complications of brain abscess, hydrocephalus, mental retardation, and death serve to heighten awareness of this condition.2 Long-term neurologic sequelae can develop, including hearing loss and other focal neurologic deficits. Cognitive impairment occurs frequently after bacterial meningitis. In one prospective study, cognitive impairment was detected in 27% of adults who had a good recovery from pneumococcal meningitis. Cognitive impairment consisted mainly of cognitive slowness, which was related to lower scores on questionnaires measuring the quality of life.10 Whilst the frequency of death with a single episode of bacterial meningitis is 21%, surprisingly this number decreases with recurrent meningitis. It has been proposed that the reason for this is the earlier recognition of symptoms by patients with recurrent episodes. There is no evidence to support the fact that recurrent infections do lead to cumulative cognitive and neurological deficits and this would be an area to focus on in future studies. Our patient, after careful assessment, did not have any evidence of cumulative negative outcomes, both in terms of focal neurology and cognitive impairment. His seizures resolved spontaneously after 2 years.
Experimental drugs in randomized controlled trials for long-COVID: what’s in the pipeline? A systematic and critical review
Published in Expert Opinion on Investigational Drugs, 2023
Shin Jie Yong, Alice Halim, Michael Halim, Long Chiau Ming, Khang Wen Goh, Mubarak Alfaresi, Bashayer M. AlShehail, Mona A. Al Fares, Mohammed Alissa, Tarek Sulaiman, Zainab Alsalem, Ameen S. S. Alwashmi, Faryal Khamis, Nawal A. Al Kaabi, Hawra Albayat, Ahmed Alsheheri, Mohammed Garout, Jameela Alsalman, Amal H. Alfaraj, Mashael Alhajri, Kuldeep Dhama, Lamees M. Alburaiky, Ahlam H. Alsanad, Abdelmunim T. AlShurbaji, Ali A. Rabaan
Only trials examining the efficacy of at least one drug in treating long-COVID patients compared to controls were included. Inclusion criteria were determined using the PICOS (patient, intervention, comparator, outcome, and study design) framework [22]. The patient group was long-COVID, i.e. COVID-19 survivors with at least one symptom or organ sequelae persisting for ≥12 weeks after COVID-19 symptom onset, diagnosis, or hospital discharge. Patients diagnosed with long-COVID but without specified symptomatic duration were also considered. Patients with symptoms or organ sequela lasting for <12 weeks at follow-up were considered as probable long-COVID. Organ sequelae are defined as organ abnormalities diagnosed via imaging scans or organ function tests. The intervention was the drug or pharmaceutical treatment examined. The comparator was placebo, standard care, or no treatment. The outcome was any change in long-COVID symptoms or organ sequelae. The study design was RCTs. Articles and records were excluded if they (i) were terminated or withdrawn; (ii) did not have the appropriate comparator; (iii) examined non-pharmaceutical drug treatments; (iv) investigated treatments for acute COVID-19 only; or (v) were observational studies, reviews, meta-analyses, or editorials.
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