Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0012833 (dizziness)
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We report 43 cases of chlorodifluoromethane (Freon-22) intoxication that occurred on August 5, 2003 when a freezer in a seafood factory exploded. In this accident, 80 workers were exposed to Freon-22 gas and 43 workers developed symptoms and were transferred to six hospitals. Neurological symptoms including dizziness, headache, and nausea were most frequently observed (40 of 43 patients). One patient was comatose but recovered within 1 h with oxygen inhalation. Airway and respiratory symptoms including dysesthesia of the tongue, pharyngitis, and shortness of breath were also frequently observed (26 of 43 patients). These symptoms disappeared within a few days in all patients. There were no fatalities. Although Freon-22 has been considered to be a chlorofluorocarbon of relatively low toxicity, this incident suggests that potentially significant toxic effects may occur following large exposures.
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PMID:Acute inhalational exposure to chlorodifluoromethane (freon-22): a report of 43 cases. 1603 10

At present, no universally-accepted effective treatment for cutaneous gnathostomiasis is available. At the Hospital for Tropical Diseases, Mahidol University, albendazole 400 mg twice a day for 14 days is commonly prescribed for patients diagnosed with cutaneous gnathostomiasis. The efficacy of albendazole to induce outward migration of the parasite was less than or around 20% in 2 studies. Research for alternative, more efficacious treatment, is needed. In this prospective open-labeled study, we assessed the safety of ivermectin in 20 Thai patients diagnosed with cutaneous gnathostomiasis. Ivermectin, one time only, at dosages of 50, 100, 150, or 200 microg/kg bodyweight, was given orally to 4 groups of patients, 5 patients each group. Adverse events were recorded and laboratory tests were obtained before and after treatment. No serious adverse events occurred in this study. Forty adverse events were possibly related to ivermectin. The adverse events were malaise (35%), myalgia (30%), drowsiness (30%), pruritus (20%), nausea/vomiting (20%), dizziness (15%), diarrhea (15%), feeling of shortness of breath (10%), feeling of palpitations (10%), constipation (5%), anorexia (5%), and headache (5%). These adverse events were self-limited and not dose-related. Laboratory abnormalities were found in 3 patients (15%). Transient microscopic hematuria, pyuria, and mildly elevated liver enzymes were found in 1 patient each. Ivermectin single dose, of 50,100, 150, and 200 microg/kg bodyweight, is considered safe in Thai patients. Future trials of ivermectin on human gnathostomiasis may be performed using dosages up to 200 microg/kg bodyweight.
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PMID:Tolerability of ivermectin in gnathostomiasis. 1612 31

Subtyping panic disorder by predominant symptom constellations, such as cognitive or respiratory, has been done for some time, but criteria have varied considerably between studies. We sought to identify statistically symptom dimensions from intensity ratings of 13 DSM-IV panic symptoms in 343 panic patients interviewed with the Anxiety Disorders Interview Schedule for DSM-IV Lifetime Version. We then explored the relation of symptom dimensions to selected illness characteristics. Ratings were submitted to exploratory maximum likelihood factor analysis with a Promax rotation. A three-factor solution was found to account best for the variance. Symptoms loading highest on the first factor were palpitations, shortness of breath, choking, chest pain, and numbness, which define a cardio-respiratory type (with fear of dying). Symptoms loading highest on the second factor were sweating, trembling, nausea, chills/hot flashes, and dizziness, which defines a mixed somatic subtype. Symptoms loading highest on the third factor were feeling of unreality, fear of going crazy, and fear of losing control, which defines a cognitive subtype. Subscales based on these factors showed moderate intercorrelations. In a series of hierarchical multiple regression analyses, the cardio-respiratory subscale was a strong predictor of panic severity, frequency of panic attacks, and agoraphobic avoidance, while the cognitive subscale mostly predicted worry due to panic. In addition, patients with comorbid asthma had higher scores on the cardio-respiratory subscale. We conclude that partly independent panic symptom dimensions can be identified that have different implications for severity and control of panic disorder.
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PMID:Panic attack symptom dimensions and their relationship to illness characteristics in panic disorder. 1629 63

Pulmonary involvement may sometimes be the initial presentation of Takayasu's arteritis (TA). Since the signs and symptoms of pulmonary TA may be subtle and may not be easily distinguishable from other pulmonary diseases, one has to maintain a high index of suspicion. Cases of pulmonary TA mimicking chronic thromboembolism have been reported. We describe a patient with TA whose initial presentation mimicked acute pulmonary embolism. The patient presented with a 3-day history of cough and shortness of breath and had multiple bilateral perfusion defects on ventilation-perfusion scan, typical of acute pulmonary embolism. However, the constellation of clinical features, elevated erythrocyte sedimentation rate and the angiographic appearance helped us establish the correct diagnosis of pulmonary Takayasu's arteritis. At a 6-year follow-up, the patient had no worsening of pulmonary symptoms but presented with postural dizziness with angiographic evidence of carotid and innominate artery stenosis; she underwent arterial bypass grafting. In young women presenting with a clinical picture of acute pulmonary embolism without the previous history (or risk factors) of thromboembolism, pulmonary TA must be considered in the differential diagnosis.
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PMID:Pulmonary Takayasu's arteritis masquerading as acute pulmonary embolism. 1703 81

Mass psychogenic illness (epidemic sociogenic attacks/mass hysteria) refers to a rapid spread of well-described signs and symptoms affecting members of a group. It might be difficult to differentiate at first from illnesses due to infections, intoxications or "bio-terrorism." We investigated such an occurrence in a small village in Lebanon chronically under threat of war. A 16-year-old single female, school student, was referred to Saint George Hospital University Medical Center, Beirut, for attacks of shortness of breath, muscle cramps, tremors and dizziness, for several days. She was referred because she was the first of eight cases from the same village to have similar symptoms. In parallel to an inpatient multidisciplinary evaluation and treatment, meetings were held with the crisis group comprising members of the hospital Psychiatry and Psychology Department, a public health representative of the Ministry of Health of Lebanon, physicians who were taking care of the other cases and a psychologist working in the area where these cases were declared. The diagnosis of mass psychogenic illness (epidemic sociogenic attacks) was reached. A common strategy was adopted in an effort to control the epidemic. Several explanations had been put forward initially by the community : bioterrorism, noxious fumes and "bad spirits." At the time of writing this report--nine months later--, the epidemic, which had abated within six weeks, was still inactive.
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PMID:Mass psychogenic illness (epidemic sociogenic attacks) in a village in Lebanon. 1768 27

Roasted lupine seeds have been used as snack food in Mediterranean countries for years. Since the 1990s, lupine flour has been used as a substitute for or additive to other flours in countries of the European Union; usually the amount is so low that no declaration is required. Since 1994, a number of cases of immediate-type allergy to lupine flour-containing products have been published. A 52-year-old woman developed facial and mucosal edema, followed by dizziness and shortness of breath a few minutes after ingestion of a nut croissant containing lupine flour; she required emergency care. Allergy diagnostic tests revealed a total IgE of 116 kU/l, a highly elevated concentration of IgE specific for lupine seed (42.9 kU/l) and birch pollen IgE of 2.57 kU/l. Skin prick test with native lupine flour was strongly positive. Allergy against lupine seeds may develop de novo or via cross-reactivity to legumes, particularly peanuts, the latter being detectable in up to 88% of cases, founded on a strong sequence similarity between lupine and peanut allergens. In our patient, no cross-reactivity could be detected via immunoblotting, indicating a rare monovalent sensitization to lupine flour. Treatment consists of avoidance of lupine flour-containing products. Patients with proven peanut allergy should also avoid lupine flour because of the major risk of cross-reaction.
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PMID:Anaphylactic reaction to lupine flour. 1776 Aug 98

Five-point triage assessment scales currently used in many emergency departments (EDs) across the country have been shown to be accurate and reliable. We have found the system to be highly predictive of outcome (hospital admission, intensive care unit/operating room admission, or death) at either extreme of the scale but much less predictive in the middle triage group. This is problematic because the middle triage acuity group is the largest, in our experience comprising almost half of all patients. Patients triaged to the 2 highest acuity categories (A and B) have admission/ED death rates of 76% and 43%, respectively. In contrast, the 2 lowest acuity categories (D and E) have admission/ED death rates of 1% or less. The middle category (C), however, has an overall admission/ED death rate of 10%, too high to be comfortable with prolonged delays in the ED evaluation of these patients. We studied this group to determine if easily obtainable clinical factors could identify higher-risk patients in this heterogeneous category. Data were obtained from a retrospective, cross-sectional study of all patients seen in 2001 at an urban academic hospital ED. The main outcome measure for multivariate logistic regression models was hospital admission among patients triaged as acuity C. Acuity C patients who were 65 years or older, presenting with weakness or dizziness, shortness of breath, abdominal pain, or a final diagnosis related group diagnosis of psychosis, were more likely to be admitted than patients originally triaged in category B. These findings suggest that a few easily obtainable clinical factors may significantly improve the accuracy of triage and resource allocation among patients assigned with a middle-acuity score.
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PMID:Identifying high-risk patients for triage and resource allocation in the ED. 1787 Apr 84

A 40-year-old man was referred to the cardiology outpatient clinic with dizziness, palpitations and shortness of breath. He remembered being bitten by a tick two to three years previously, but had not noticed a characteristic skin rash. The ECG showed a prominent first degree atrioventricular (AV) block and ambulatory electrocardiographic monitoring showed an intermittent complete AV block. A definitive pacemaker was implanted. Antibodies to Borrelia were found. The patient was treated with ceftriaxone. In the weeks and months following implantation, the AV block disappeared completely. The reversibility of the AV block secured the diagnosis 'Lyme carditis with secondary AV block', and the pacemaker was explanted.
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PMID:[Total atrioventricular block following a tick bite]. 1833 48

To assess the associations between job stress and somatic symptoms and to investigate the effect of individual coping on these associations. In July 2006, a cross-sectional study was conducted during a periodic health check-up of 185 Japanese male office workers (21-66 yr old) at a Japanese company. Job stress was measured by job demand, control, and strain (=job demand/control) based on the Job Content Questionnaire (JCQ). Major somatic symptoms studied were headache, dizziness, shoulder stiffness, back pain, shortness of breath, abdominal pain, general fatigue, sleep disturbance, and skin itching. Five kinds of coping were measured using the Job Stress Scale: active coping, escape, support seeking, reconciliation, and emotional suppression. Comorbidities of hypertension, diabetes, obesity, depression, and anxiety were also evaluated. The most frequently cited somatic symptom was general fatigue (66%), followed by shoulder stiffness (63%) and sleep disturbance (53%). Of the five kinds of coping, only "active coping" was significantly and negatively associated with the number of somatic symptoms. The generalized linear models showed that the number of somatic symptoms increased as job strain index (p=0.001) and job demand (p=0.001) became higher, and decreased as active coping (p=0.018) increased, after adjusting for age and comorbidities. There was no statistical interaction among active coping, the number of somatic symptoms, and the three JCQ scales. Reporting somatic symptoms may be a simple indicator of job stress, and active coping could be used to alleviate somatization induced by job stress.
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PMID:The association of the reporting of somatic symptoms with job stress and active coping among Japanese white-collar workers. 1795 68

Enhanced sympathetic activity causes an exaggerated heart rate response to standing in the postural tachycardia syndrome (POTS). All patients describe symptoms of orthostatic intolerance such as dizziness, blurred vision, shortness of breath, palpitations, tremulousness, chest discomfort, headache, lightheadedness and nausea, but only one third suffer loss of consciousness. We report four patients with POTS, who had long ventricular pauses (i.e. asystole) and syncope during head-up tilt test. This suggests that a subset of patients with POTS can have a surge in parasympathetic outflow that precedes vasovagal syncope.
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PMID:Postural tachycardia syndrome with asystole on head-up tilt. 1795 28


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