BACKGROUND As outlined in the 2004 American Heart Association guidelines, the diagnosis of Kawasaki disease (KD) is supported by results of clinical laboratory studies. However, detailed information regarding the evolution of these results during illness has not been previously reported. The goals of this project were to characterize the evolution of clinical laboratory values in KD before and after treatment with intravenous immunoglobulin (IVIG). METHODS Laboratory values from 380 unselected, consecutive KD patients were analyzed at 3 times: acute (illness day 2-10, illness day 1= first day of fever and before IVIG), subacute (illness day 11-21) and convalescent (illness day 22-60). Results were stratified by IVIG response and coronary artery outcome. RESULTS While white blood cell count, percentage bands, erythrocyte sedimentation rate (ESR), and CRP values were highest and age-adjusted hemoglobin was lowest in the acute phase before IVIG, platelet count was highest in the subacute phase and percentage lymphocytes and eosinophils were highest in the convalescent phase after IVIG. KD patients with coronary artery aneurysms had a higher WBC count in the subacute phase and higher ESR in the subacute and convalescent phases compared with those with dilated or normal coronary arteries. CONCLUSIONS A consistent evolution of laboratory values is associated with KD before and after treatment. Understanding the dynamic changes in laboratory values can assist physicians in using laboratory criteria to diagnose KD following the American Heart Association guidelines.
The one-dimensional transonic flow of an inviscid fluid, which at large values of the specific heats exhibits both positive (F > 0) and negative (f; < 0) nonlinearity regions {f; = (l/p) [J(pa)/@],] and which remains in a single phase, is studied. By assuming that i? changes its sign in the small neighborhood of the throat of the nozzle where transonic flow exists and introducing a new scaling of the independent variables, an approximate first-order partial differential equation (PDE) with a nonconvex flux function is derived. It governs both the steady transonic flows and the upstream moving waves near sonic point. The existence of continuous and discontinuous steady transonic flows when the throat area is either a maximum or a minimum is shown. The existence of standing sonic discontinuities and rarefaction shocks in the transonic flow are noted for the first time. Unlike in the classical gas flows, there are two sonic points and continuous transonic flows are possible only through one of them. The numerical evolution of those transonic waves that have both positive and negative nonlinearity in the same pulse is studied and some comments are made on the local stability of the particular steady flows.
The incidence of renal calculi has been evaluated to be 25% in urogenital tuberculosis patients. The stone could be caused due to the host, the pathogenic organism, or possibly by the treatment. Studies were carried out to find out the efficacy of vitamin E supplementation in reducing the risk of stone formation in renal tuberculosis patients. The study constituted four groups, Group I with 30 normal volunteers, the second group comprised of 36 renal tuberculosis patients (GuTb) a day before treatment. Third group comprised of 24 patients with regular anti tuberculosis drug regimen for sixty days. In the fourth group, 12 patients were treated with anti tuberculosis drug regimen along with supplementation of antioxidant vitamin E (200 mg/day) for sixty days. Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs). Renal damage was evident with increased leakage of Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP) and gamma-Glutamyl transferase (gamma-GT) in renal tuberculosis patients. From the results of the above study, it is obvious that increased urinary oxalate levels leads to cellular damage in GuTb patients, which is a prerequisite for crystal retention as revealed by the elevated urinary marker enzymes. Antioxidant therapy prevents membrane injury thereby reducing the risk of stone formation. Hence vitamin E supplementation has a salubrious effect in preventing stone forming tendency with routine anti tuberculosis drug regimen.
Opinion statementPalliative care integrated into standard medical oncologic care will transform the way we approach and practice oncologic care. Integration of appropriate components of palliative care into oncologic treatment using a pathway-based approach will be described in this review. Care pathways build on disease status (early, locally advanced, advanced) as well as patient and family needs. This allows for an individualized approach to care and is the best means for proactive screening, assessment, and intervention, to ensure that all palliative care needs are met throughout the continuum of care. Components of palliative care that will be discussed include assessment of physical symptoms, psychosocial distress, and spiritual distress. Specific components of these should be integrated based on disease trajectory, as well as clinical assessment. Palliative care should also include family and caregiver education, training, and support, from diagnosis through survivorship and end of life. Effective integration of palliative care interventions have the potential to impact quality of life and longevity for patients, as well as improve caregiver outcomes.
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