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At least 127 records · Page 7Linked to original sources
PubMed2004

Thyroid storm as precipitating factor in onset of coma in an elderly woman: case report and literature review.

Thyroid storm is an uncommon but life-threatening manifestation of hyperthyroidism which, unless appropriately treated by combined therapy, causes 30-60% of deaths in hospitalized patients. Mental deterioration leading to apathy and eventually coma is a rare clinical presentation of this pathology, frequently observed in the elderly. We present the case of a 77-year-old hypertensive woman who was hospitalized for fast onset of coma, probably due to the unusual combination of a hypernatremic hyperosmolar state and an unexpected thyroid storm (TS). Although not definitely ascertained, the possible etiology was the hyperthyroid phase of chronic autoimmune thyreopathy (Hashitoxicosis). Notably, the significant adjunctive role of thyroid hyperfunction in the pathogenesis of coma was confirmed by the fact that, although metabolic abnormalities were overcome, complete and satisfactory recovery of the patient's mental and physical condition occurred only with normalization of thyroid hormones by antithyroid treatment. Our case highlights the importance of properly evaluating thyroid function in elderly patients who show a sudden progressive impairment in their mental condition, for early detection of potentially fatal conditions such as thyroid storm or myxedematous coma.

Aged↗
PubMed1994

Precipitating factors in migraine: a retrospective review of 494 patients.

The predominance of certain triggers for migraine was assessed in 494 migraine patients. Stress (62%) was the most frequently cited precipitant. Weather changes (43%), missing a meal (40%), and bright sunlight (38%) were also prominent factors. Sexual activity (5%) was the precipitant cited by the least number of patients. Significant differences were found between men and women in their responses to weather changes, perfumes, cigarette smoke, missing a meal, and sexual activity. Spring was cited by 14% of patients as a time for increased migraine attacks, followed by fall (13%), summer (11%), and winter (7%).

Adolescent↗
PubMed1983

Antibody to host factor precipitates poliovirus RNA polymerase from poliovirus-infected HeLa cells.

An antibody to a host cell protein (host factor) which inhibited the host factor-dependent transcription of poliovirion RNA was used to characterize the immunoprecipitated proteins from both uninfected and poliovirus-infected HeLa cells. The antibody specifically precipitated a major protein of approximately 67,000 Da and a 40,000-Da minor protein from uninfected HeLa cells. The immune serum also specifically precipitated poliovirus RNA polymerase (P63, NCVP4) from poliovirus-infected HeLa cells indicating an association of the viral RNA polymerase with the host factor in vivo. A physical interaction between purified host factor and P63 could also be demonstrated in vitro. The antibody was further used to determine the distribution of host factor among different subcellular fractions of HeLa cells. Most of the cellular host factor was present in the cytoplasmic fraction (70%). Approximately 30% of the total host factor was found to be associated with the ribosomes.

Antibodies↗
PubMed1992

Prodromal signs and precipitating factors in attempted suicide.

What characterizes the presuicidal phase of suicide attempters in a military population? And what precipitates their suicidal action? These questions were investigated in a sample of 112 male suicide-attempting conscripts serving in the Norwegian Armed Forces. One-half of the subjects had shown behavioral signs such as isolation or aggression, over 80% displayed psychiatric symptoms. A majority verbally expressed their psychic problems, but few had explicitly stated suicidal ideas. Two major clusters of suicide precipitants were identified. Loss traumas were recorded in one-third of cases, some sort of conflict situation in 40% of cases. Implications for suicide preventive measures are discussed.

Adolescent↗
PubMed1993

Environmental factors precipitating bronchial asthma exacerbations in southern Puerto Rico: a pilot study.

The purpose of the study was to correlate environmental factors that may play a role in triggering asthma attacks requiring admissions. A retrospective analysis of 320 asthmatic admissions from January 1987 to December 1989 was conducted in two community hospitals in our area. Information from the U.S. Weather Bureau pertaining to temperature, barometric pressure, wind velocity, and precipitation was analyzed. The readings from the Puerto Rican Environmental Agency for Total Suspended Particles (TSP-10) during that period were also reviewed. Our results indicate that the female patients accounted for the majority of the asthmatic admissions: 74.3% versus 26% in males. Eighty-four percent of the patients had a history of asthma attacks and 67% had previous hospitalizations due to asthma exacerbations. Correlation between asthma family history and age was found in only two age groups, 31-40 and 71-80 years. Rhinitis and asthma exacerbations were strongly linked only in the age group of 31-40 years. Active cigarette smoking was strongly associated with asthma exacerbations only in the age group of 61-70 years. Environmental data indicated that there was not a consistent pattern of monthly admissions; however, there was a significant association between admissions and increased precipitation, high counts of annual TSP-10, and decreased wind velocity. In view of our findings, asthmatics living on islands such as Puerto Rico might be affected by an additive effect of pollutants, by local and mainland emissions that are transported by the air currents, leading to a higher incidence of asthma exacerbations.

Adolescent↗
PubMed1985

Precipitating factors in asthma. Aspirin, sulfites, and other drugs and chemicals.

Several types of reactions to drugs and chemicals may precipitate or perpetuate asthmatic relapse. This review focuses on reactions to aspirin and sulfites. Approximately 40 percent of patients with rhinosinusitis, nasal polyps, and asthma and 5 to 10 percent of all asthmatic patients are sensitive to aspirin and aspirin-like nonsteroidal anti-inflammatory drugs at some time in their course. A prudent recommendation to all asthmatics is to substitute acetaminophen for aspirin. When aspirin/aspirin-like drug is essential for treatment of cardiovascular or musculoskeletal disorder, desensitization by cautious oral challenges with graded doses of aspirin can be accomplished. Treatment of the respiratory disorder per se by desensitization followed by daily therapeutic aspirin remains investigational. Sulfur dioxide and sulfites, commonly used as sanitizers and preservatives of foods and pharmaceuticals, may precipitate acute asthma in 5 percent or more of asthmatic patients. When the history suggests sulfite sensitivity, challenges can be used to confirm sensitivity and the patient counseled in avoidance of these chemicals.

Adult↗
PubMed2006

Reported incidence and precipitating factors of work-related stress and mental ill-health in the United Kingdom (1996-2001).

BACKGROUND: Work-related mental ill-health appears to be increasing. Population-based data on incidence are scarce but in the United Kingdom occupational physicians and psychiatrists report these conditions to voluntary surveillance schemes. AIMS: To estimate the incidence of work-related stress and mental illness reported 1996-2001 by occupational physicians and 1999-2001 by psychiatrists. METHODS: Estimated annual average incidence rates were calculated by sex, occupation and industry against appropriate populations at risk. An in-house coding scheme was used to classify and analyse data on precipitating events. RESULTS: An estimated annual average of 3,624 new cases were reported by psychiatrists, and 2,718 by occupational physicians; the rates were higher for men in reports based on the former and for women on the latter. Most diagnoses were of anxiety/depression or work-related stress, with post-traumatic stress accounting for approximately 10% of cases reported by psychiatrists. High rates of ill-health were seen among professional and associated workers and in those in personal and protective services. Factors (such as work overload) intrinsic to the job and issues with interpersonal relations were the most common causes overall. CONCLUSIONS: The steep increase in new cases of work-related mental ill-health reported by occupational physicians since 1996 may reflect a greater willingness by workers to seek help but may also signify an increasing dissonance between workers' expectations and the work environment. Greater expertise is needed to improve the workplace by adjustment of job demands, improvement of working relations, increasing workers' capacities and management of organizational change.

Confidence Intervals↗
PubMed1980

Laparotomy as a precipitating factor in the rupture of intra-abdominal aneurysms.

Previously asymptomatic aneurysms in ten patients ruptured within 36 days (mean, ten days) of a prior laparotomy. The laparotomy and associated intra-abdominal disease may have precipitated rupture of the unresected abdominal aneurysms by reduction of the collagen content of the aneurysm wall, thus making the wall weaker. The scar-like collagen fibers of an aneurysm wall provide the strength that permits the wall to resist rupture. There is a dynamic equilibrium between synthesis and lysis of this collagen. Lysis of collagen is enhanced by injury, such as laparotomy, and by nutritional depletion and local inflammation. Collagen lysis is greatest in the area adjacent to the injury, but also occurs at remote sites as well. Lysis is greatest during the first postoperative week, after which, in the absence of sepsis or starvation, synthesis exceeds lysis and the equilibrium is restored. A thin aneurysm wall may be weakened enough during this period of negative collagen balance to allow rupture.

Aged↗
PubMed2001

Emergency hospitalization in the elderly in a French university hospital: medical and social conditions and crisis factors precipitating admissions and outcome at discharge.

Emergency admissions of elderly patients constitute a major management issue due to the complexity of their problems. The aim of this retrospective observational study was to identify medical and social characteristics and crisis factors for emergency department (ED) hospitalization in elderly patients, and to evaluate the influence of these factors on the length of stay and outcome at discharge. During a 4-month period, 396 patients aged 70 years and older were referred to the ED of a University Hospital (Hĵpital Edouard Herriot) in Lyon, France. A questionnaire specifically designed for the study was completed for each patient using the information in the patients' files previously filled in by the "Rapid Geriatric Assessment Team" of the ED. We described civil and marital status, living conditions, reason for admission to ED and other associated pathologies according to the ICM-9, crisis factors, length of stay (LOS) and outcome at discharge. The mean age was 81.9 years (SD 6.5); two thirds (66.7%) of the study subjects were female, and 46.7% were widowed; the majority (68.7%) lived in their own homes. The main reasons for admission were cardiopulmonary diseases in 31.6% of cases, followed by neuropsychiatric disorders in 28.2%, and falls in 8.3%; a final category (31.8%) included subjects admitted for general, non-specific symptoms. Among the crisis factors observed, 49.4% presented an acute episode of a chronic illness, 33.6% lived alone, and 20.9% had been hospitalized during the 6-month period preceding the study. The average LOS was 3.15 days. The multivariate model showed that falls increase LOS by 74%, dementia by 65%, and depression by 21%. Upon discharge, 13% returned to their residence before hospitalization, 55% were transferred to a medical speciality ward, and 4% to other facilities, whereas only 19% were transferred to a geriatric ward, and 9% died during their stay in the ED. The multinomial model showed that outcome at discharge was influenced by functional dependency, dementia, depression, and acute episodes of a chronic illness. For many elderly, the ED remains a critical point of access to more complete managed care. This elderly population is comprised of polypathological, frail persons whose morbid state requires multidisciplinary management in geriatric units. The findings of this study suggest that interventions of multidisciplinary networks, such as home health care programs aimed at detecting crisis factors and establishing early prevention of crisis states, may improve unfavorable medical and social conditions and reduce hospitalization in geriatric patients.

Aged↗
PubMed1991

[Infection as the precipitating factor in Schönlein-Henoch purpura].

Shönlein-Henoch's purpura (SHP) is a form of generalized vasculitis. SHP is characterized by a haemorrhagic eruption, colicky abdominal pain, renal involvement with haematuria and proteinuria, arthralgia and cerebral symptoms in the form of headache and seizures. Retrospective investigations have revealed that infection with microorganisms may precipitate SHP. The authors were able to support this observation by means of a prospective investigation. 2/3 of the 26 children in the investigation had symptoms of infection one to two weeks prior to the onset of symptoms of SHP. Ten children had definite positive signs of prior infection. The course of the sedimentation rate and leukocyte counts also support the assumption of previous infection.

Bacterial Infections↗