Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Interleukin-6 (IL-6), among other cytokines, is thought to be involved in the regulation of sickness behavior (e.g., anorexia, cachexia, fever, and lethargy) induced by infections bacterial and viral origin) and sterile tissue necrosis (burns and surgical traumas). Mice deficient in IL-6 (IL-6 KO) were generated by gene targeting. Homozygous IL-6 KO male and female mice and their appropriate controls were implanted with biotelemeters to monitor body temperature (Tb) and motor activity (Act). Normal circadian rhythms in Tb and Act as well as rates of food intake and weight gain did not differ significantly between sex-matched IL-6 KO and control groups at 30 degrees C in a 12:12-h light-dark cycle. Sterile tissue damage was induced in mice by subcutaneous injection of turpentine (0.1 ml, left hindlimb). Influenza pneumonitis was induced by intranasal inoculation of mouse-adapted influenza A virus (17.5 plaque-forming units). Lack of IL-6 completely prevented fever, anorexia, and cachexia because of turpentine abscess in both sexes. It did not prevent lethargy, although IL-6 KO mice recovered to normal Act significantly sooner than wild-type mice. Symptoms of sickness were only slightly modified during influenza virus infection in IL-6 KO mice. Attenuation of sickness behavior was more pronounced in IL-6 KO female than in male mice. We conclude that, although IL-6 is induced during both turpentine abscess and influenza infection, this cytokine appears to be more critical in induction of the symptoms of sickness behavior during sterile tissue abscess than during influenza infection.
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PMID:Sickness behavior in mice deficient in interleukin-6 during turpentine abscess and influenza pneumonitis. 912 87

To minimize the symptoms of antidepressant discontinuation, gradual tapering is necessary for all serotonin reuptake inhibitors (SRIs) except fluoxetine, which has an extended half-life. Agents with shorter half-lives such as venlafaxine, fluvoxamine, and paroxetine should be tapered gradually. Discontinuation symptoms, which frequently emerge after abrupt discontinuation or intermittent non-compliance and, less frequently, during dose reduction, are generally mild, short-lived, and self-limiting but can be distressing and may lead to missed work days and decreased productivity. The symptoms may be somatic (e.g., dizziness and light-headedness; nausea and vomiting; fatigue, lethargy, myalgia, chills, and other flu-like symptoms; sensory and sleep disturbances) or psychological (anxiety and/or agitation, crying spells, irritability). Mild symptoms can often be treated by simply reassuring the patient that they are usually transient, but for more severe symptoms, it may be necessary to reinstitute the dosage of the original antidepressant and slow the rate of taper. Symptoms of discontinuation may be mistaken for physical illness or relapse into depression; misdiagnosing the symptoms may lead to unnecessary, costly tests and treatment. Thus, health care professionals need to be educated about the potential adverse effects of SRI discontinuation.
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PMID:Clinical management of antidepressant discontinuation. 981 35

Influenza viruses rarely cause acute encephalopathy. Post-influenzal encephalitis, which occurs a few weeks after recovery from influenza is thought to be an autoimmune process associated with demyelination and vasculopathy. It has been suggested that Economo lethargic encephalitis followed by postencephalitic Parkinsonism was associated with the influenza A epidemic of 1918 (Spanish flu). The incidence of Reye's syndrome has markedly decreased due to the avoidance of salicylates in the treatment of influenza or varicella. One inactivated flu vaccine is thought to have caused Guillain Barre syndrome due to molecular mimicry between viral protein and myelin, which triggered autoimmune responses. The persistence of influenza virus genes in neural cells as one of the causes of chronic degenerative diseases of the central nervous system by inducing apoptosis of the host cells is yet to be proven.
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PMID:Influenza virus and neurological diseases. 931 61

The therapy of metastatic melanoma is limited by poor responses to known chemotherapeutic agents. The report of Mulder et al. (Proc ASCO 1992; 11: 347) raised the possibility of the known interaction between 5-fluorouracil and interferon-alpha2a improving response rates in melanoma. This study was designed to examine the effects of 5-fluorouracil plus interferon-alpha2a alone without the confounding effects of dacarbazine. Doses were chosen based on the earlier study rather than the higher doses used in colon cancer. Therapy for metastatic melanoma with 5-fluorouracil and interferon-alpha2a is manageable in terms of toxicity. The major toxicities were lethargy, nausea/anorexia and flu-like symptoms. These were thought to be primarily attributable to interferon-alpha2a. Only one case of severe diarrhoea occurred. The response rate of 14% is similar to the reported results of interferon-alpha2a treatment alone. On these data, there is no evidence of synergy using this dose and schedule.
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PMID:Recombinant interferon-alpha2a plus 5-fluorouracil for the treatment of metastatic melanoma. 946 25

The purpose of this study was to assess the incidence, pattern and severity of somnolence and fatigue in patients treated with cranial irradiation for primary brain tumours and to identify factors that may influence or mediate symptoms. A detailed prospective study was carried out of 19 patients who received high-dose (45-55 Gy) cranial irradiation as treatment for primary brain tumours. Data were collected for each patient over a 3 month period using a prospective diary utilizing visual analogue scales of common somnolence symptoms and fatigue, and detailed interviews at 2, 6 and 12 weeks following the completion of treatment. Sixteen patients developed somnolence syndrome following treatment. Time series analysis identified a cyclical pattern to the symptoms, with a period of drowsiness and fatigue occurring from day 11 to day 21 and from day 31 to day 35 after radiotherapy. The principal symptoms were those of excessive drowsiness, feeling clumsy, an inability to concentrate, lethargy, being mentally slow and fatigue. Patients treated with accelerated (n = 11) compared with more conventional (n = 8) fractionation experienced more severe drowsiness and fatigue (P < 0.01), although there was no difference in the pattern or the incidence of symptoms. Interview data suggested that patients frequently attributed their symptoms of somnolence to 'flu or other ailments. The unexplained and overwhelming nature of the symptoms was a cause of anxiety. The prospective assessment of symptoms following radiotherapy highlighted a more detailed definition of the symptom complex and pattern of occurrence. Somnolence syndrome is a collection of symptoms consisting of drowsiness, lethargy and fatigue. Forewarning patients and planning supportive management around times of drowsiness and fatigue can help to reduce the anxiety that these symptoms cause.
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PMID:Somnolence syndrome in adults following cranial irradiation for primary brain tumours. 976 78

Pneumonia, including community-acquired, long-term care facility-associated, and nosocomial infections, is a major cause of morbidity and mortality in the elderly. The aged with pneumonia often present with atypical features, including confusion, lethargy, and general deterioration of condition (so-called "silent infection"). Further investigations, such as a chest radiograph, are more frequently required for diagnosis, but even these results may be normal early in the course of infection, particularly in dehydrated patients. The elderly are more frequently hospitalized for pneumonia and have a greater need for intravenous therapy, longer hospital stay, more prolonged course, greater morbidity, and, ultimately, a poorer outcome. Yet in many studies it is not chronological age per se that impacts negatively on the manifestations of pneumonia in the elderly but rather the presence of comorbid illness. Antibiotic therapy remains the mainstay of therapy for pneumonia, and both community and hospital-based studies confirm the important positive impact of early appropriate empiric antibiotic therapy on outcome. Attention to nutrition and hydration, the use of pneumococcal and influenza vaccination, and a number of diverse procedures in the hospital setting may help limit the occurrence and impact of such infections.
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PMID:Pneumonia in the elderly. 1051 4

Influenza A virus initiated worldwide epidemics (pandemics) in 1918, 1957, 1968 and 1977. A revised calculation of the 1918-1919 pandemic estimates that 40 million persons died and 500 million were infected. The mortalities in 1957 and 1968 were nearly 6 million. Biological and genetic characteristics of the causative agents of the more recent pandemics, have been well studied but little is known about the causative agent of the Great Pandemic in 1918. Genetic characterisation of the 1918 virus has been achieved by sourcing virus RNA from formalin fixed lung samples or by exhuming frozen victims of the outbreak from Arctic regions. Initial analysis of the HA gene from two USA sources indicates a virus related to swine and human influenza with no base insertion at the HA1-HA2 cleavage junction which, at least in avian influenza A, characterises high virulence. Important unanswered questions are whether the 1918 virus spread pantropically perhaps to include the brain and hence cause encephalitis including the later lethargic forms, or whether infection was confined to the respiratory tract. Re-examination of reports of respiratory disease in England and France in 1916-1917 may indicate a non-Spanish origin of the pandemic and a period of 2 years for the virus to be seeded worldwide. In contrast the other two pandemic viruses in 1957 and 1968 appeared to originate in Asia. New anti-neuraminidase drugs in conjunction with amantadine and novel developments with influenza vaccines would be expected to ameliorate the disease in a future pandemic.
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PMID:Influenza A pandemics of the 20th century with special reference to 1918: virology, pathology and epidemiology. 1071 98

Encephalitis lethargica (EL) was a mysterious epidemic. temporally associated with the 1918 Spanish influenza pandemic. Numerous symptoms characterized this disease, including headache, diplopia, fever, fatal coma, delirium, oculogyric crisis, lethargy, catatonia, and psychiatric symptoms. Many patients who initially recovered subsequently developed profound, chronic parkinsonism. The etiologic association of influenza with EL is controversial. Five acute EL autopsies and more than 70 postencephalitic parkinsonian autopsies were available in the Armed Forces Institute of Pathology (AFIP) tissue repository. Two of these 5 acute EL cases had histopathologic changes consistent with that diagnosis. The remaining 3 cases were classified as possible acute EL cases as the autopsy material was insufficient for detailed histopathologic examination. RNA lysates were prepared from 29 CNS autopsy tissue blocks from the 5 acute cases and 9 lysates from blocks containing substantia nigra from 2 postencephalitic cases. RNA recovery was assessed by amplification of beta-2-microglobulin mRNA and 65% of the tissue blocks contained amplifiable RNA. Reverse transcription-polymerase chain reaction (RT-PCR) for influenza matrix and nucleoprotein genes was negative in all cases. Thus, it is unlikely that the 1918 influenza virus was neurotropic and directly responsible for the outbreak of EL.
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PMID:Influenza RNA not detected in archival brain tissues from acute encephalitis lethargica cases or in postencephalitic Parkinson cases. 1170 41

Pneumonia, including community-acquired, LTCF-acquired, and nosocomial infections, is a major cause of morbidity and mortality among the elderly. The aged with pneumonia often present with atypical features, including confusion, lethargy, and general deterioration of condition (silent infection). Further investigations, such as a chest radiograph frequently are required for diagnosis. The chest radiograph may be normal early on in the course of infection, particularly in dehydrated patients. The elderly are hospitalized more frequently for pneumonia, have a greater need for intravenous therapy, have a longer hospital stay, have a more prolonged course, have greater morbidity, and ultimately have a poorer outcome. Nevertheless, it may not be chronologic age per se that has a negative impact on the manifestations and outcome of pneumonia in the elderly, but rather the presence of underlying comorbid illness. The mainstay of therapy for pneumonia is antibiotics, and studies in the community and hospital have confirmed the important positive impact of early appropriate empiric therapy on outcome. Many relatively simple procedures, including attention to nutrition, influenza and pneumococcal vaccination, and avoidance of intubation, may help limit the occurrence of such infections.
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PMID:Pneumonia in the elderly. 1168 Jan 11

There is limited published data concerning carbonyl iron ingestion and no data on overdose. A retrospective chart review of all patients with carbonyl iron ingestion reported to 5 regional poison information centers from January 1998 to April 2000 was done. Thirty-three patients with carbonyl iron ingestion were reported. Twenty-seven patients (82%) were managed without referral to a health care facility. The mean and median age of these patients was 3years and 20 months, respectively. The mean dose ingested was 11.2 mg/kg (range of 2.2 to 34.5 mg/kg) with no effects noted. Six patients evaluated in the emergency ingested a mean of 34 mg/kg (range of 12 to 72 mg/kg). The mean peak serum iron concentrations in 4/6 were 82 microg/dL (range of 36 to 177 microg/dL). One child with a history of flu-like symptoms reported diarrhea, fever and lethargy and had a serum iron concentration of 36 microg/dL; symptoms were believed unrelated to the exposure. In this limited first case series of iron carbonyl ingestion, serious toxicity did not occur.
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PMID:Multi-center retrospective evaluation of carbonyl iron ingestions. 1182 71


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