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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Brain abscess following stroke is rare. We present a case of brain abscess which developed after hypertensive thalamic hemorrhage. A 51-year-old man had a left thalamic hemorrhage. Three months later, the patient was admitted to our hospital due to deterioration of right hemiparesis and motor aphasia. On admission, CT scan showed a ring-like high density area with peripheral edema in the left thalamus. T1-weighted magnetic resonance (MR) images revealed a large ring-enhanced lesion with surrounding edema in the same region. Laboratory examination demonstrated no signs of infectious disease. The patient's neurological state rapidly deteriorated 10 days after admission. Yellowish pus was aspirated during the emergent surgery. Bacteriological study of the pus revealed Staphylococcus Aureus. His symptoms improved after surgery followed by antibiotics therapy. The correct diagnosis prior to surgery was difficult in the present case because of lack of any signs of infection. Our case indicates that possibility of brain abscess should be taken into consideration as a rare differential diagnosis following intracerebral hemorrhage.
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PMID:[Brain abscess following thalamic hemorrhage: a case report]. 1072 29

Healthy People 2000, the national strategy for improving the health of individuals in the United States, provides direction for the prevention of chronic illnesses, injuries, and infectious diseases by specifying desired outcomes for specific populations. The authors focus on outcomes for several illnesses and conditions known to significantly affect the health of women who are menopausal or postmenopausal. These include osteoporosis, hypertension, cardiovascular disease, stroke, diabetes mellitus type 2, congestive heart failure, and obesity. Suggestions for advanced nurse practitioner assessment and intervention are provided for the reader.
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PMID:Is anyone listening? Does anyone care? Menopausal and postmenopausal health risks, outcomes, and care. 1077 59

MNA is a simple and accurate way to assess the nutritional status in routine practice, and is suitable for systematic use and large epidemiologic studies. The purpose of this study was to evaluate the difference in the nutritional status of elderly patients hospitalized in different types of care in the same hospital, and to evaluate its relationship with risk factors. Nutritional status was evaluated in 918 elderly patients hospitalized in acute care (AC) (n=299), sub-acute care (SAC) (n=196) or long-term care (LTC) (n=423), using the MNA (Mini-Nutritional Assessment), a nutritional assessment tool including 18 items grouped in 4 domains, within the first 48 h after admission (all subjects) and at the end of hospitalization (AC, SAC). More patients were rated in the "malnourished" class in SAC (32.5%) than in AC (24.5%) and LTC (24. 7%). Retrospective analysis showed that the initial nutritional status was linked to the type of care and the nature of underlying pathology. The nutritional status on arrival was worse in patients in SAC, and better in those in LTC (p = 0.005). This is probably due to a difference in the kind of patients hospitalized. The nutritional status was worse in patients suffering from infectious disease, stroke, dementia and traumatic injuries, and, conversely, better in patients suffering from cardiopathy, metabolic and gastro-intestinal (except cancerous) diseases (p < 0.0001). Prospective analysis showed that duration of hospitalization was the only variable found to be linked to an improvement of nutritional status. The MNA is a rapid, effective and cheap tool for the assessment of nutritional status and moreover for evaluation of the mortality risk of patients admitted into AC and SAC.
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PMID:Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA. 1082 81

The predictive usefulness of clinical scores in patients with acute bacterial meningitis was investigated. Fifty-one consecutive patients with acute bacterial meningitis were scored on days 1, 3, 5, 8, and 14 after admission according to the Sandinavian Stroke Scale (SSS), Glasgow Coma-Scale (GCS) and Hunt & Hess Scale (HH). As an index of their usefulness to predict the outcome, the scales were correlated with short-term outcome on day 21 assessed by the Glasgow Outcome Scale (GOS). The scores of all three scales correlated highly significantly with short-term outcome. Depending on the day of assessment, Spearman correlation coefficients ranged between 0.52 and 0.88 for SSS, between 0.50 and 0.84 for GCS, and between -0.47 and -0.82 for HH. The scales differed in their ability to predict outcome on and after day 1: mortality was best predicted by GCS, and complete recovery was best predicted by SSS. The use of scales in bacterial meningitis provides a rational quantitative basis to predict outcome more graduated than in dead or alive. Because the scales accentuate different aspects of outcome (e.g. mortality, restitution), the selection of a scale to be used in clinical trials should take into consideration the main focus of the study.
Infection 1999
PMID:Usefulness of clinical scores to predict outcome in bacterial meningitis. 1088 33

Cardiovascular disease is the leading cause of death in developed countries. The cause is multifactorial. A substantial proportion of patients with coronary artery disease (CAD) do not have traditional risk factors. Infectious diseases may play a role in these cases, or they may intensify the effect of other risk factors. The association of CAD and Chlamydia pneumoniae infection is firmly established, but causality is yet to be proven. The link with other infectious agents or conditions, such as cytomegalovirus, herpes simplex virus, Helicobacter pylori and periodontitis, is more controversial. Cytomegalovirus infection is more strongly linked than native CAD to coronary artery restenosis after angioplasty and to accelerated CAD after cardiac transplantation. However, new data on this topic are appearing in the literature almost every month. The potential for novel therapeutic management of cardiovascular disease and stroke is great if infection is proven to cause or accelerate CAD or atherosclerosis. However, physicians should not "jump the gun" and start using antibiotic therapy prematurely for CAD. The results of large randomized clinical trials in progress will help establish causality and the benefits of antimicrobial therapy in CAD.
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PMID:Emerging relations between infectious diseases and coronary artery disease and atherosclerosis. 1092 Jul 32

The pattern of acute illness was determined in 102 adolescents and adults with sickle cell anaemia who presented to the emergency unit of a Lagos hospital. The patients had a mean age of 20.5 years (SD 13.1) and a male-female ratio of 1.5. The symptoms included fever (72%), fatigue and weakness (59%), anorexia (59%) and pain (57.5%) while major clinical signs were pallor (100%), jaundice (71%) and hepatomegaly (68%). Sixty-eight per cent of patients had sickle cell crises, including one with hemiplegic stroke, 10% with combined anaemia and pain crises, 33% with anaemia crises only and 23.5% with pain crises only. Sixty-three per cent had infection which was malaria in 24.5%, bacterial in 17% and viral in 6%. Of 16 patients with pyrexia of unknown origin, seven responded to treatment with chloroquine and eight to antibiotics. Infection was detected in 50% of the patients with sickle cell crises. The association between anaemia crises and malaria was significant (P < 0.05). Of the eight deaths, seven (88%) had anaemia crises. In contrast to studies conducted two decades ago in the same hospital, the prevalence of anaemia crises now exceeds that of pain crises and malaria now exceeds that of bacterial infection. Severe symptomatic anaemia (anaemia crisis) was more frequently associated with infection (mostly malaria) than was bone pain crisis. The Girdle pain crisis more frequently resulted in a fatal outcome than the uncomplicated bone pain crisis.
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PMID:Acute sickle cell syndromes in Nigerian adults. 1093 Nov 63

The purpose of screening is to identify asymptomatic disease, or risk factors for disease, so that interventions can occur as early as possible in the disease process. The primary goal is to decrease the morbidity the patient experiences from the disease. For infectious diseases, screening can benefit not only the individual with the disease but also the community, since infectious persons can be identified and treated prior to transmitting the disease to others. Although screening can be very beneficial to the individual and to the community, it can also have adverse outcomes if not used appropriately. In this article we will discuss current recommendations for the use of screening tests and their role in addressing the leading causes of morbidity and mortality in Oklahoma. In general, physicians should consistently screen for the risk factors for cardiovascular disease and stroke (hypertension, high cholesterol, obesity and diabetes) and for early-stage cancers of the colon, breast, and cervix. They should also consider screening Native Americans for diabetes and persons at increased risk for certain infectious diseases, particularly sexually transmitted diseases.
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PMID:Improving the health of Oklahomans through clinical prevention, part II: Screening to identify early-stage disease and risk factors. 1097 17

The overall improvement in the health of Americans over the 20th century is best exemplified by dramatic changes in 2 trends: 1) the age-adjusted death rate declined by about 74%, while 2) life expectancy increased 56%. Leading causes of death shifted from infectious to chronic diseases. In 1900, infectious respiratory diseases accounted for nearly a quarter of all deaths. In 1998, the 10 leading causes of death in the United States were, respectively, heart disease and cancer followed by stroke, chronic obstructive pulmonary disease, accidents (unintentional injuries), pneumonia and influenza, diabetes, suicide, kidney diseases, and chronic liver disease and cirrhosis. Together these leading causes accounted for 84% of all deaths. The size and composition of the American population is fundamentally affected by the fertility rate and the number of births. From the beginning of the century there was a steady decline in the fertility rate to a low point in 1936. The postwar baby boom peaked in 1957, when 123 of every 1000 women aged 15 to 44 years gave birth. Thereafter, fertility rates began a steady decline. Trends in the number of births parallel the trends in the fertility rate. Beginning in 1936 and continuing to 1956, there was precipitous decline in maternal mortality from 582 deaths per 100 000 live births in 1935 to 40 in 1956. Since 1950 the maternal mortality ratio dropped by 90% to 7.1 in 1998. The infant mortality rate has shown an exponential decline during the 20th century. In 1915, approximately 100 white infants per 1000 live births died in the first year of life; the rate for black infants was almost twice as high. In 1998, the infant mortality rate was 7.2 overall, 6.0 for white infants, and 14.3 for black infants. For children older than 1 year of age, the overall decline in mortality during the 20th century has been spectacular. In 1900, >3 in 100 children died between their first and 20th birthday; today, <2 in 1000 die. At the beginning of the 20th century, the leading causes of child mortality were infectious diseases, including diarrheal diseases, diphtheria, measles, pneumonia and influenza, scarlet fever, tuberculosis, typhoid and paratyphoid fevers, and whooping cough. Between 1900 and 1998, the percentage of child deaths attributable to infectious diseases declined from 61.6% to 2%. Accidents accounted for 6.3% of child deaths in 1900, but 43.9% in 1998. Between 1900 and 1998, the death rate from accidents, now usually called unintentional injuries, declined two-thirds, from 47. 5 to 15.9 deaths per 100 000. The child dependency ratio far exceeded the elderly dependency ratio during most of the 20th century, particularly during the first 70 years. The elderly ratio has gained incrementally since then and the large increase expected beginning in 2010 indicates that the difference in the 2 ratios will become considerably less by 2030. The challenge for the 21st century is how to balance the needs of children with the growing demands for a large aging population of elderly persons.
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PMID:Annual summary of vital statistics: trends in the health of Americans during the 20th century. 1109 82

In Africa, a rise in complications of diabetes mellitus has gone in hand with the growing disease prevalence, clearly demonstrating the importance of assessing complications. Diabetes mellitus constitutes a major financial burden in developing countries in Africa with relatively limited resources. Ketoacidosis is observed in 24% of juvenile diabetes and is the inaugural sign in 76% of all cases, progressing to coma in 34%. Even in type 2 diabetes, acidoketosis occurs in 34% of the cases. Infection is particularly frequent and is often fatal in tropical Africa because of the involvement of Staphyococcus and Gram-negative microorganisms. Hyperleukocytosis and anemia are correlated with ineffective antibiotic therapy. Pulmonary tuberculosis is the ninth most frequent complication of diabetes. Overall mortality is 14.9 per 1000 person-years of diabetes. Mean age at death is 51.6 years for women and 57.6 years for men after a mean 12.5 year disease duration. Thirty percent of all deaths result from acute metabolic complications, infections and stroke. More than half of the patients with insulin-dependent-diabetes have retinopathy. Differences observed in patients with different ethnic origins is linked basically to unfavorable social and economic conditions that worsen the risk of poor blood glucose control. Retinopathy accounts for 32% of all ocular complications, similar to other African data and more generally in ophthalmology centers. The rate of neuropathy is high, reaching 70% in patients with microangiopathy. Impotence concerns 48.7% of the diabetic population with a mean age of 41.4+/-15.5 years. Coronary artery disease had a recognized influence on hemoglobin diseases, particularly when the coronarography is normal. Lower limb arteriopathy is observed in 18% of the diabetic patients.
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PMID:[Main complications of diabetes mellitus in Africa]. 1117 5

Medical complications seen in admitted patients in a one-year period in a rehabilitation hospital were evaluated, and patients with neurological diseases were subdivided with age in order to determine trends of complications with occurred in the aged patients. Ninety-five of 117 patients (81.2%) suffered from complications, the most common were respiratory diseases, genitourinary diseases and psychoneurological diseases and events. Infectious diseases were very common throughout all ages. Significantly more cases and occasions of complications occurred in the aged patients (ages 65 or more, n = 59) than in the younger patients (aged under 65, n = 58), which suggests that complications tended to recur in the same patient in the aged group. Genitourinary diseases, especially urinary tract infection, was far more common in the aged group, predominating in women. Recurrences of stroke or poststroke epilepsy were more frequently seen in patients aged under 65. Traumas and fractures related to falls occurred more commonly in the aged group. Elderly patients were more susceptible to complications not directly related to the illness for which they were admitted. Complications occur quite commonly in aged patients admitted to our rehabilitation hospital, and careful attention should be paid to conditions unrelated to the illness causing admission, such as infectious diseases, especially for aged patients.
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PMID:[Comparison of complications in elderly and non-elderly patients with neurological diseases during admission to a rehabilitation hospital]. 1120 Nov 91


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