Adult-onset Stills disease (AOSD) remains a perplexing, difficult to diagnose clinical entity, with clinical characteristics that are often broad and encountered in numerous other clinical entities. This vague clinical presentation is depicted in the commonly used diagnostic criteria, as the ones by Yamaguchi and Fautrel. The authors sought to investigate how diagnostic criteria apply in a series of 22 new cases of AOSD patients presenting with fever of unknown origin (FUO) and diagnosed at the Internal Medicine Department of Hatzikosta General Hospital of Ioannina, Greece. The aims of the study were: (1) to study the incidence of AOSD and (2) to retrospectively apply different classifications to the data of these patients in search of a more efficient way of diagnosing these patients in the future. The annual incidence of AOSD was estimated at two new cases per 10(5). The clinical manifestations of the patients are discussed, with an emphasis on specific manifestations being considered as criteria by Yamaguchi and Fautrel classifications. Four patients exhibited markedly increased serum D: -dimers, a finding of which the potential pathophysiologic implications are discussed. Serum ferritin levels have additive values, both for diagnostic and cost-reduction purposes in cases presenting as FUO; serum ferritin values are not included in any diagnostic set of criteria at present. The finding of high levels of D-dimers in AOSD needs further studies.
The cardiac effects imposed by the novel H1N1 influenza strain have not been elucidated until now. Electrocardiographic (ECG) abnormalities were evaluated in a series of 50 patients with confirmed novel H1N1 influenza infection. Epidemiologic and clinical characteristics, laboratory correlations, and the effect ECG abnormalities may exert on disease outcomes were prospectively studied. Of the 50 patients, 14 (28%) exhibited ECG changes on admission. Nine patients presented with T-wave inversions, while ST-segment depression was observed on the electrocardiograms of 6 patients. The presence of ECG changes did not correlate with age, gender, co-morbidities, the laboratory profiles of the patients, or the coexistence of lower respiratory tract involvement. None of the patients exhibited alterations in cardiac-specific biochemistry or cardiac ultrasonography. All ECG changes were transient and reversed during disease regression. Two patients with ECG changes and 1 with normal ECG findings required intensive care, the former 2 eventually dying. Among the remainder, the duration of hospitalization did not exhibit a significant difference between the 2 groups, although there was a trend toward fewer days of hospitalization in the patients with ECG changes. In conclusion, ECG abnormalities are frequently encountered during novel H1N1 influenza infection, but their presence does not indicate a direct pathogen effect to the myocardium; these alterations may necessitate admission in the first place but are transient and not correlated with preexisting patient characteristics or with outcomes.
To describe the first documented case of subacute (De Quervain) thyroiditis in the course of novel H1N1 influenza infection. This is a case report of a patient diagnosed at the General Hospital "G. Hatzikosta" of Ioannina, Greece. A 55-year-old previously healthy male developed an influenza-like syndrome that was accompanied by severe neck pain, palpitations, weight loss, and disproportionately increased erythrocyte sedimentation rate. Polymerase chain reaction assay of pharyngeal swabs confirmed the diagnosis of novel H1N1 influenza infection. Serum thyroid-stimulating hormone was suppressed to zero and levels of free thyroxine and particularly triiodothyronine were increased. Technetium-99m-pertechnetate scintigraphy showed diffuse and inhomogeneous very low technetium trapping. The patient was treated with non-steroidal anti-inflammatory drugs and thyroid function gradually normalized without evolving to a hypothyroid phase. This is the first case of subacute thyroiditis associated with novel H1N1 influenza infection. Furthermore, this is the first case to definitely demonstrate active influenza infection of any type concurrent with thyroiditis, and one of the very rare similar cases for any active viral disease etiologically implicated in the pathogenesis of subacute thyroiditis.
Existing classifications of potential biological weapons, acknowledge only limited important parameters of biological weapon potential. Certain pathogen factors would further influence the outcome of a potential attack in context with social and political aspects of the time and space of the attack. The importance of these factors was investigated through various attack scenarios that have been developed by the authors, and an individual score for each of these factors was calculated, based on the overall effect their variation had in the scenario outcome. A new classification score for potential biological weapons was subsequently developed, one, which drastically alters the perception of risk for certain pathogens, such as filoviruses and anthrax. This frame further allows for more accurate evaluation of the bioweapon potential of agents such as avian flu. Recognition of intervening factors and proper assessment of the actual risk might augment in proper distribution of interest and funds on relevant medical research.
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