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Query: UMLS:C0085593 (chills)
 4,268 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathogenesis of freezing cold injuries (FCI) is not yet entirely understood. Two possible hypothesis emerge: 1) Injury is a direct result of cryogenic insult to the cells. 2) Injury is secondary to vascular stasis which leads to anoxia. In clinical congelatio ice crystallization takes place in the EC-space. When water is transformed into ice, the osmolality in this compartment will increase leading to a passive diffusion of water from the IC-space. Cell dehydration modifies protein structure, alters membrane lipids and cellular pH leading to destructions incompatible with cell survival. Cold induces vasoconstriction of both arterioles and venules, which enhances peripheral filtration and raises plasma viscosity. The stability of red corpuscle aggregates increases and showers of emboli course microvessels. Finally progressive thrombosis will end up in anoxia. The indirect vascular effect has earlier been interpreted similar to that found in non-freezing injuries. Recent studies have, however, shown, that endothelial cells are very sensitive to freezing. The rheologic part of the pathogenesis therefore also seems to depend on a direct injury to cells. The development of FCI does not always depend on ambient temperature and duration of exposure but more to the heat loss subjected to exposed skin. Wind chill, humidity and wetness are all of significance in this matter. From a clinical point of view FCI are best subdivided into superficial and deep injuries. The superficial frostbite is limited to the skin and nearest subcutaneous tissue. A stringing, pinching pain is often the first symptom. The affected area becomes pale or waxy-white and numb.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Freezing cold injury. 181 85

In June 1983, an outbreak of waterborne giardiasis occurred in a group of 93 university students and faculty participating in a geology field course in Colorado. All cases occurred in one subgroup of persons who were heavily exposed to untreated stream water on a field trip, and the risk of illness was strongly related to the amount of untreated stream water consumed. The median incubation period from a brief exposure to the first symptom was 7 days. The authors compared symptoms and stool sample results among 31 Giardia-positive persons in the exposed group and 36 Giardia-negative participants in an unexposed group to assess several case definitions for acute giardiasis. Diarrhea, abdominal cramps, flatulence, foul-smelling stools, nausea, excessive tiredness, bloating, anorexia, and chills were each significantly more common in the first group than in the second. A giardiasis case definition of 5 days or more of diarrhea--the definition used in many epidemiologic studies of giardiasis--had a specificity of 100 percent but a sensitivity of only 32.2 percent compared with a definition based on results of stool examinations. When a case was defined as an illness lasting 7 days or more, with a combination of two or more of six symptoms (diarrhea, flatulence, foul-smelling stools, nausea, abdominal cramps, and excessive tiredness), sensitivity rose to 73 percent, with a specificity of 88 percent. Such a case definition may be an improvement over that of 5 days of diarrhea, especially in outbreaks where there is good laboratory documentation that Giardia is the etiologic agent. The definition should be validated in other outbreaks and in situations where giardiasis must be distinguished from gastrointestinal disease caused by other agents.
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PMID:Acute giardiasis: an improved clinical case definition for epidemiologic studies. 199 3

Eighteen patients with solid tumours were treated with human recombinant interferon-gamma at escalating dose levels starting at 1 X 10(6) units/m2 per infusion and rising through 3 X 10(6), 6 X 10(6), 9 X 10(6) and 22 X 10(6) to a maximum of 110 X 10(6) units/m2 per infusion. The IV infusions were given three times a week over a 4-week period. Side effects were seen in all patients, but were mild except at the highest dose. Acute dose-related effects included pyrexia, tiredness, thirst, chills and rigors. Chronic dose-related effects included anorexia, lethargy, weakness, disorientation, a trace of proteinuria and minimal rises in liver enzymes. In addition, effects were observed which were not related to dose. These included headache, nausea and vomiting, backache, myalgia, flatulence and a mild, transient reduction in neutrophils and erythrocytes. At the highest dose level dose-limiting toxicity was observed, consisting in severe tiredness and anorexia, hypotension, disorientation and changes on the electrocardiograph. Overall, toxicity was similar to that seen with preparations of interferon-alpha, except that no tolerance to the effects of interferon-gamma was noted. We observed less hepatic and haematological toxicity, but also recorded flatulence, handcramps and electrocardiograph changes, which have not been reported with interferon-alpha. When given according to this regimen, doses of 22 X 10(6) units/m2 per infusion of recombinant interferon-gamma were generally well tolerated by the patients.
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PMID:A toxicity study of recombinant interferon-gamma given by intravenous infusion to patients with advanced cancer. 309 8

CI-979 ((E)-1,2,5,6-tetrahydro-1-methyl-3-pyridinecarboxaldehyde, O-methyloxime monohydrochloride), a novel muscarinic agonist, is being investigated as a potential treatment for Alzheimer's disease (AD). The objective of the present study was to determine the safety and tolerance of multiple, rising, oral doses of CI-979 in patients with AD. Ten male patients aged 59 to 74 years (mean 65 years) who met NINCDS criteria for AD were randomized to receive either CI-979 (eight patients) or placebo (two patients) according to a double-blind, parallel-group, rising-dose design. Doses were 0.5-mg q6h, 1-mg q12h, 1-mg q6h, 2-mg q12h, 2-mg q6h, 2.5-mg q6h, and 3-mg q6h. All doses were to be administered sequentially for 3 days each with the exception of the 2.5-mg q6h dose, which was to be administered for 1.5 days. Five patients receiving CI-979 discontinued study medication because of adverse events; two after receiving 2-mg q6h (10 doses), two after 2.5-mg q6h (5 doses), and one after 3-mg q6h (4 doses). The study was terminated following administration of the fourth 3-mg dose due to the nature and intensity of adverse events. Cholinergic symptoms including diaphoresis, hypersalivation, nausea, diarrhea, hypotension, chills, headache, flatulence, and urinary frequency and signs suggestive of parkinsonism (cogwheeling, tremor, pillrolling, posturing, and shuffling gait) were dose-limiting. The frequency and intensity of adverse events increased with increasing CI-979 dose. No other clinically significant CI-979-related changes occurred in physical examinations, clinical laboratory measurements, electrocardiograms, or ophthalmologic examinations. Steady-state trough plasma CI-979 concentrations increased in proportion to dose. In summary, CI-979 doses of 1-mg q6h were well tolerated by all patients; 2-mg q6h was tolerated by most patients, and 2.5-mg and 3-mg doses were poorly tolerated, Dose titration to a maximum of 2-mg q6h will therefore be used in initial efficacy trials of CI-979 in patients with AD.
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PMID:Safety and tolerability of CI-979 in patients with Alzheimer's disease. 762 16

A 58-year-old man presented with profuse diarrhea, abdominal distention, flatulence, weakness, and a 15-lb weight loss. The initial symptoms of nausea and vomiting had begun a week earlier, within hours of eating chicken that had not been well wrapped when purchased. Two days after symptom onset, he received intravenous rehydration therapy at another hospital. With resolution of the nausea and vomiting, he felt slightly better and went home against medical advice. He had not had fever, chills, hematochezia, melena, hematemesis, or dysuria.
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PMID:Aftereffects of a tainted meal. 986 44

This review focuses on the physiological, behavioural and environmental factors which predispose to frostbite. Also prevention of frostbite is summarised. Predisposing factors may increase heat loss, decrease heat production, decrease the insulation of the clothing, make people especially susceptible to cold or make them to behave inadequately. Marked increase in convective or conductive heat loss is often the immediate reason for frostbite. Wind (as described by wind chill index) increases convective heat loss and touching of metal objects increases conductive cooling. Poor insulation of the clothing is also a common reason of frostbite. The insulation can be insufficient when clothing is wet, tight, permeable to wind or does not cover the cold sensitive body parts. Individual factors predisposing to frostbite are inadequate behaviour, low physical fitness, fatigue, dehydration, earlier cold injuries, sickness or poor circulation in peripheral parts of the body. Frostbite is often associated with the use of alcohol. To prevent frostbite, it is necessary to recognise cold risks, practise tasks in the cold, eat and drink well, have physical exercise, have sufficient clothing (also spare clothing), change into dry clothing if necessary and take care of companions. In the cold it is not advisable to get fatigued until exhaustion, sweat excessively, use tight and/or wet clothing, drink alcohol, smoke and expose oneself unnecessarily to wind, metals or fluids.
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PMID:Predisposing factors and prevention of frostbite. 1099 28

The effects of the thermal state of the body (slightly cool and neutral) and moderate wind speeds on face temperature, blood pressure, respiratory function and pain sensation during cold exposure were studied on eight healthy male subjects. They were dressed in cold-protective clothing and preconditioned at + 20 degrees C (TN) and -5 degrees C (CO) for 60 min, then exposed to -10 degrees C and 0 m x s(-1) (NoW), 1 (W1) and 5 (W5) m x s(-1) wind for 30 min. Thus, each individual was exposed six times. The exposure to wind entailed a combination of strong cooling of the bare face and mild body cooling. The forehead, cheek and nose temperatures decreased during cold exposure, and the decrease was greater at higher air velocities (P < 0.0001). All subjects reported pain sensations at 5 m x s(-1). At the end of exposure only the nose temperature was significantly lower in CO than in TN subjects; it was about 2 degrees C and reached 0 degrees C in two experiments. The systolic and diastolic blood pressure (SBP and DBP, respectively) increased significantly by 7.7 and 5.9 mmHg, respectively, during preconditioning at -5 degrees C, but did not change at + 20 degrees C. SBP and DBP increased during exposure to -10 degrees C in TN by approximately 9 mmHg. However, the total average increase of blood pressure (1-90 min) was similar in TN and CO (SBP 15 mmHg and DBP 13 mmHg). SBP and DBP increased more during exposure to 5 m x s(-1) at -10 degrees C than NoW. Blood pressure responses as observed in this study (SBP and DBP up to 51 and 45 mmHg, respectively) are potential health risks for hypertensive individuals and angina patients. Respiratory functions (FVC, FEV1) were reduced by about 3% by the cold (-5 and -10 degrees C) compared to pre-experiment values. Furthermore, the Wind Chill Index seems to underestimate the cooling power of 5 m x s(-1) at -10 degrees C of bare skin (e.g. face). Therefore it needs to be revised and we suggest that it is expanded to include risk levels for pain sensation.
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PMID:Face temperature and cardiorespiratory responses to wind in thermoneutral and cool subjects exposed to -10 degrees C. 1113 88

Required Clothing Insulation (IREQ) is a new thermal index submitted to the International Organisation for Standardisation (ISO) for discussion. It is designed to prevent general body cooling and is based on an analysis of heat exchanges. The thermal clothing insulation actually worn (lcl) is estimated using a new method, also submitted to ISO. IREQ of 54 workers exposed to artificial cold (air temperature between -30 degrees C and +10 degrees C) was compared with lcl actually worn by these workers. The results of the present study show that, on average, the workers choose accurately lcl they need if their IREQ is below and up to 1.5 clo. Moreover, these workers prefer to wear garments which provide them with thermal comfort. If IREQ of workers is higher than 1.5-2 clo (i e, workers exposed to -20 degrees C), it is difficult for them to increase their thermal insulation with additional garments. Although their lcl is not sufficient, there is no risk of gradual body cooling because of their continuous time exposure (CTE) which is shorter than the calculated Duration Limited Exposure (DLE). On the other hand, Wind Chill Index (WCI), which is proposed to prevent local cooling, is better adapted to prevent cold injuries than physiological thermal strain; for example, impairment of manual dexterity cannot be prevented with this index.
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PMID:Comparison between required clothing insulation and that actually worn by workers exposed to artificial cold. 1567 72

Many persons world wide are exposed to cold environments, either indoors for example in cold stores, or outdoors. Cold is a hazard to health and may affect safety and performance of work. Basis for the creation of safe and optimal working conditions may be obtained by the application of relevant international standards. ISO 11079 presents a method for evaluation of whole body heat balance. On the basis of climate and activity a required clothing insulation (IREQ) for heat balance is determined. For clothing with known insulation value an exposure time limited is calculated. ISO 11079 also includes criteria for assessment of local cooling. Finger temperatures should not be below 24 degrees C during prolonged exposures or 15 degrees C occasionally. Wind chill temperature indicates the risk of bare skin to freeze for combinations of wind and low temperatures. Special protection of airways is recommended at temperatures below -20 degrees C, in particular during heavy work. Additional standards are available describing evaluation strategies, work place observation checklists and checklist for medical screening. Risks associated with contact with cold surfaces can be evaluated with ISO 13732. The strategy and principles for assessment and prevention of cold stress are reviewed in this paper.
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PMID:Evaluation of cold workplaces: an overview of standards for assessment of cold stress. 1953 8

Manual performance during work in cold and windy climates is severely hampered by decreased dexterity, but valid dexterity decrease predictors based on climatic factors are scarce. Therefore, this study investigated the decrease in finger- and hand dexterity and grip force for nine combinations of ambient temperature (-20, -10 and 0 degrees C) and wind speeds (0.2, 4 and 8 m x s(2)), controlled in a climatic chamber. Finger dexterity was determined by the Purdue pegboard test, hand dexterity by the Minnesota manual dexterity test and grip force by a hand dynamometer. Twelve subjects with average to low fat percentage were exposed to cold air for one hour with and without extra insulation by a parka. The subjects were clothed in standard work clothing of the Royal Netherlands Air Force for cold conditions. Extra insulation did affect cold sensation but not manual performance. The deterioration in manual performance appeared to be strongly dependent upon Wind Chill Equivalent Temperature (WCET) and the square root of exposure time (r=0.93 for group average). These simple models may be valuable to assess problems with work in the cold, but more work should be done to determine critical values in dexterity for a wide variety of operational tasks.
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PMID:Manual performance deterioration in the cold estimated using the wind chill equivalent temperature. 1953 12


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