scholarly journals Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Ranjini Srinivasan ◽  
Rachel Weller ◽  
Anjali Chelliah ◽  
Andrew J. Einstein
Keyword(s):  
Kawasaki Disease ◽  
Cardiac Disease ◽  
Multimodality Imaging ◽  
Adult Population ◽  
Giant Aneurysm ◽  
The United States ◽  
Ivig Treatment ◽  
Serious Illness ◽  
Integral Role

Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease.

Interventions for Students with Autism and Asperger’s Syndrome

2017 ◽  
Author(s):  
Michelle S. Ballan ◽  
Molly Burke Freyer ◽  
Lauren Powledge
Keyword(s):  
Video Modeling ◽  
The United States ◽  
Autism Spectrum ◽  
Attention Training ◽  
Evidence Based ◽  
Activity Schedules ◽  
Training Video ◽  
Integral Role ◽  
Students With Autism

Evidence-based interventions for students with autism spectrum disorder (ASD) are explored, and trends and changes in the diagnosis of ASD in the United States are examined. Evidence-based interventions in various settings and modalities are discussed, with detailed descriptions of several effective evidence-based interventions including joint attention training, video modeling, story-based interventions, and activity schedules. The integral role of social workers in the lives of children with ASD in multiple settings, particularly the classroom, is emphasized. Social work must be vigilant to keep pace with the ever-changing field of autism, with its frequent improvements in understanding, diagnosis, and treatment.

scholarly journals Effect of Early Intravenous Immunoglobulin Therapy in Kawasaki Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 8 ◽  
Author(s):  
Fan Yan ◽  
Huayong Zhang ◽  
Ruihua Xiong ◽  
Xingfeng Cheng ◽  
Yang Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Meta Analysis ◽  
The United States ◽  
Cochrane Library ◽  
Ivig Treatment ◽  
Intravenous Immunoglobulin Therapy ◽  
Increased Risk ◽  
Significant Difference

Background: In the latest 2017 American Heart Association guidelines for Kawasaki disease (KD), there are no recommendations regarding the early administration of intravenous immunoglobulin (IVIG). Therefore, the purpose of this systematic review and meta-analysis was to investigate the effects of early IVIG therapy on KD.Methods: We searched databases including the PubMed, Medline, the Cochrane Library, and the Clinicaltrials.gov website until July 2019.Results: Fourteen studies involving a total of 70,396 patients were included. Early treatment with IVIG can lead to an increased risk of IVIG unresponsiveness [OR 2.24; 95% CI (1.76, 2.84); P = 0.000]. In contrast to the studies performed in Japan [OR 1.27; 95% CI (0.98, 1.64); P = 0.074] that found no significant difference in coronary artery lesions (CAL) development, studies conducted in China [OR 0.73; 95% CI (0.66, 0.80); P = 0.000] and the United States [OR 0.50; 95% CI (0.38, 0.66); P = 0.000] showed a reduced risk in the occurrence of CAL with early IVIG treatment.Conclusions: At present, the evidence does not support the treatment with IVIG in the early stage of the onset of KD. But, early IVIG treatment could be a protective factor against the development of CAL, which needs to be further clarified.

Abstract 65: T cell Differentiation in Human Kawasaki Disease and a Murine Model of Coronary Arteritis

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
I-Chun Lin ◽  
Hsuan-Chang Kuo ◽  
Ying-Jui Lin ◽  
Shao-Ju Chien ◽  
Chien-Fu Huang ◽  
...  
Keyword(s):  
Cell Differentiation ◽  
T Cell ◽  
Kawasaki Disease ◽  
Murine Model ◽  
Th17 Cells ◽  
T Cell Differentiation ◽  
Ivig Treatment ◽  
Th1 Cells ◽  
Coronary Arteritis

The role of T cell differentiation in the immunopathogenesis of Kawasaki disease (KD) remains unclear. The aim of this study is to elucidate the role of T cell subsets in coronary artery lesion (CAL) of KD. Peripheral blood was obtained in 10 patients with acute KD before and 1 week after intravenous gamma-immunoglobulin (IVIG) treatment and in 20 patients with past history of KD for more than 5~20 years. Meanwhile, induction of coronary arteritis was performed on wild type BALB/c mice by Lactobacillus casei cell wall extract (LCWE). Human peripheral blood leukocytes were analyzed by using flow cytometric analysis and murine hearts were examined for immunofluorescence study and for RNA expression levels. Results: Compared to the febrile controls, KD patients prior to IVIG treatment had increased percentage of CD3 + /CD4 + /interferon-γ + (T helper 1, Th1) cells and CD3 + /CD4 + /interleukin-17A + (Th17) cells (mean ± SD, 1.36% ± 1.39% and 0.51% ± 0.25%, respectively) among Th cells (CD3 + /CD4 + ). Both increases declined after IVIG treatment (0.71% ± 0.74% and 0.33% ± 0.18%) despite no statistically difference by Mann-Whitney test. None of these 10 acute KD patients developed CAL after IVIG treatment. However, patients with previous KD and definite CALs (n= 11) seemed to have higher percentage of Th17 cells (0.50% ± .025% versus 0.35% ± 0.23%) but similar level of Th1 cells (0.93% ± 0.51% versus 1.05% ± 0.64%) when compared to those without CAL (n= 9). Murine cardiac tissues displayed the presence of Th1 (double-stained with CD3 and T-bet) and Th17 cells (double-stained with CD3 and RORγt) during days 7 and 14 after LCWE treatment but not in PBS-treated mice. Compatible with these, cardiac mRNA levels showed both increased levels of IFN-γ and IL17A mRNA in LCWE-treated mice. Conclusions: Our initial data suggests that specific T cell differentiation into Th1 and Th17 cells occurred in both human KD and mice stimulated with LCWE. IVIG treatment was associated with the recovery of such T cell differentiation. However, the clinical application to predict IVIG responsiveness and future CAL development by such increase in the peripheral Th17 remains unclear. Further studies to elucidate the detailed immune regulation of these T subsets on CAL are warrant by using this LCWE murine model.

scholarly journals Etanercept Suppresses Arteritis in a Murine Model of Kawasaki Disease: A Comparative Study Involving Different Biological Agents

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Ryuji Ohashi ◽  
Ryuji Fukazawa ◽  
Makoto Watanabe ◽  
Hanako Tajima ◽  
Noriko Nagi-Miura ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Alternative Therapy ◽  
Suppressive Effect ◽  
Water Soluble ◽  
Ivig Treatment ◽  
Cytokines And Chemokines ◽  
Plasma Cytokines ◽  
Active Inflammation ◽  
Necrosis Factor

Coronary arteritis, a complication of Kawasaki disease (KD), can be refractory to immunoglobulin (IVIG) treatment. To determine the most effective alternative therapy, we compared the efficacy of different agents in a mouse model of KD. Vasculitis was induced by injection ofCandida albicanswater-soluble fractions (CAWS) into a DBA/2 mouse, followed by administration of IVIG, etanercept, methylprednisolone (MP), and cyclosporine-A (CsA). At 2 and 4 weeks, the mice were sacrificed, and plasma cytokines and chemokines were measured. CAWS injection induced active inflammation in the aortic root and coronary arteries. At 2 weeks, the vasculitis was reduced only by etanercept, and this effect persisted for the subsequent 2 weeks. At 4 weeks, IVIG and CsA also attenuated the inflammation, but the effect of etanercept was more significant. MP exerted no apparent effect at 2 or 4 weeks. The suppressive effect exerted by etanercept on cytokines, such as interleukin- (IL-)6, IL-12, IL-13, and tumor necrosis factor-α(TNF-α), was more evident than that of others. The extent of arteritis correlated with the plasma TNF-αlevels, suggesting a pivotal role of TNF-αin KD. In conclusion, etanercept was most effective in suppressing CAWS-induced vasculitis and can be a new therapeutic intervention for KD.

scholarly journals Nurses with Undiagnosed Hearing Loss: Implications for Practice

2014 ◽  
Vol 20 (1) ◽  
Author(s):  
Cara Spencer ◽  
Karen Pennington
Keyword(s):  
Hearing Loss ◽  
Communication Skills ◽  
United States Of America ◽  
Nursing Practice ◽  
Adult Population ◽  
The United States ◽  
Noise Levels ◽  
Practice Review ◽  
The Many

Hearing loss affects 36 million people in the United States of America, including 17% of the adult population. This suggests some nurses will have hearing losses that affect their communication skills and their ability to perform auscultation assessments, potentially compromising patient care and safety. In this article, the authors begin by reviewing the hearing process, describing various types of hearing loss, and discussing noise-induced hearing loss and noise levels in hospitals. Next, they consider the role of hearing in nursing practice, review resources for hearing-impaired nurses, identify the many costs associated with untreated hearing loss, and note nurses’ responsibility for maintaining their hearing health. The authors conclude that nurses need to be aware of their risk for hearing loss and have their hearing screened every five years.

scholarly journals Effect of Hepcidin and Iron Deficiency  Anemia on Clinical Outcome in patients  with Kawasaki Disease

2019 ◽  
Author(s):  
Hyun Jung Kim ◽  
Eun Hye Choi ◽  
Hong Ryang Kil
Keyword(s):  
Iron Deficiency ◽  
Kawasaki Disease ◽  
Iron Deficiency Anemia ◽  
Ivig Therapy ◽  
Acute Stage ◽  
Deficiency Anemia ◽  
Ivig Treatment ◽  
Enzyme Linked Immunosorbent Assay ◽  
Subacute Phase

Abstract Background: The role of iron in children with Kawasaki disease (KD) and the importance of iron deficiency anemia (IDA) in children with KD are not fully known. We aimed to evaluate the effects of IDA on clinical outcomes of KD patients and the role of inflammation-induced hepcidin and leptin in the development of anemia in patients with KD. Methods: A total of 50 children with KD and 47 age-matched children with controls were enrolled. Hepcidin, leptin, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured by an enzyme-linked immunosorbent assay and IDA work-up was performed before and after IVIG therapy, and in the convalescent phase in patients with KD and control patients. Results: (1) Pre-IVIG iron and transferrin saturations in KD children were significantly lower than those in controls ( P =0.001). (2) Pre-IVIG hemoglobin and iron levels were positively correlated with leptin levels ( P =0.018 and P =0.021, respectively). (3) Serum hepcidin levels were significantly elevated after IVIG treatment in patients with KD (1.53 ± 1.36 ng/ml in the acute stage vs 3.09 ± 4.22 ng/mL in the subacute phase, P = 0.001). (4) There was no difference in parameters of IDA, leptin, and hepcidin levels between KD patients with and without coronary artery lesion (CAL). Conclusion: Serum iron and transferrin saturations were lowest in the acute phase, while hepcidin levels were highest in the subacute phase of KD. Although the presence of iron deficiency in the acute stage of KD did not predict CAL, further studies are necessary to clarify the association of hepcidin on the pathogenesis of anemia in KD.

Preoperative Evaluation and Management Before Major Noncardiac Surgery

2014 ◽  
pp. 995-1004
Author(s):  
Adam C. Schaffer ◽  
Sylvia C. W. McKean
Keyword(s):  
Cardiac Disease ◽  
Preoperative Evaluation ◽  
The United States ◽  
Noncardiac Surgery ◽  
Elevated Risk ◽  
Cardiac Events ◽  
Medical Clearance ◽  
Estimated Risk ◽  
Preoperative Risk Stratification

There are more than 10 million major noncardiac surgical procedures performed in the United States per year, and this number is expected to grow as the population ages. The problem of perioperative cardiac events among patients undergoing noncardiac surgery is significant. The estimated risk of myocardial infarction (MI) in patients undergoing noncardiac surgery is 1.1% among unselected patients and 3.1% among patients at elevated risk of cardiac disease. The task of the internist providing preoperative evaluation of patients is not to provide medical “clearance.” Instead, the role of the internist is, in addition to answering any specific questions posed by the requesting physician, to provide a thorough assessment of the patient's cardiovascular and other risks for the procedure. This risk assessment can assist in the balancing of risks and benefits that influences whether the surgeon decides to go forward with the procedure. The consulting internist must also provide specific suggestions regarding further testing that may be indicated for preoperative risk stratification and, most importantly, recommendations for measures that can be taken to mitigate the identified risks.

GPCR signalling in hypertension: role of GRKs

2008 ◽  
Vol 115 (3) ◽  
pp. 79-89 ◽  
Author(s):  
David M. Harris ◽  
Heather I. Cohn ◽  
Stéphanie Pesant ◽  
Andrea D. Eckhart
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Adult Population ◽  
The United States ◽  
Cardiovascular Complications ◽  
G Protein Coupled Receptors ◽  
Human Hypertension ◽  
Developed World ◽  
G Protein Coupled

Hypertension is a prevalent condition in the developed world and disease severity is directly correlated with additional cardiovascular complications. It is estimated that 30% of the adult population in the United States has hypertension, which is classified as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg. A prolonged increase in afterload ultimately leads to congestive heart failure in the majority of cases. Currently, medication designed to treat hypertension is inadequate, thus new therapies need to be explored. Blood pressure is tightly regulated by blood vessel radius, which is established by hormones and/or peptides binding to GPCRs (G-protein-coupled receptors). Catecholamines and peptide hormones, such as AngII (angiotensin II), are elevated in hypertension and, therefore, signalling by these GPCRs is increased. Their signalling is tightly controlled by a class of proteins, the GRKs (GPCR kinases). Elevated levels of either GRK2 or GRK5 in both the lymphocytes and VSM (vascular smooth muscle) are associated with human hypertension and animal models of the disease. The focus of the present review is on the role GRKs, and their regulation of GPCRs, play in high blood pressure.

Older Workers: Learning from Three International Experiences

2006 ◽  
Vol 5 (4) ◽  
pp. 551-563 ◽  
Author(s):  
Kathleen Riach
Keyword(s):  
Older Workers ◽  
Holistic Approach ◽  
The United States ◽  
Age Discrimination ◽  
Cultural Norms ◽  
Older Worker ◽  
Integral Role ◽  
The Uk ◽  
Worker Experience

The contributions in this issue serve as a timely reminder of the importance of choice and autonomy in later working life. As the UK embarks on legislation prohibiting age discrimination, this paper discusses international lessons which can be drawn from older worker experience and related policy in Japan, Australia and the United States. By exploring the integral role of social and cultural norms in the development of pension, retirement and anti-discrimination reform, it emphasizes the importance of taking a holistic approach to older worker opportunity which ensures that practice reflects the intentions behind policy.

The Role of Gender and Sensation Seeking in Film Choice

2008 ◽  
Vol 20 (3) ◽  
pp. 97-105 ◽  
Author(s):  
Smita C. Banerjee ◽  
Kathryn Greene ◽  
Marina Krcmar ◽  
Zhanna Bagdasarov ◽  
Dovile Ruginyte
Keyword(s):  
United States ◽  
Undergraduate Students ◽  
Sensation Seeking ◽  
Negative Mood ◽  
Positive Mood ◽  
The United States ◽  
High Arousal ◽  
Subject Design ◽  
Happy Mood

This study demonstrates the significance of individual difference factors, particularly gender and sensation seeking, in predicting media choice (examined through hypothetical descriptions of films that participants anticipated they would view). This study used a 2 (Positive mood/negative mood) × 2 (High arousal/low arousal) within-subject design with 544 undergraduate students recruited from a large northeastern university in the United States. Results showed that happy films and high arousal films were preferred over sad films and low-arousal films, respectively. In terms of gender differences, female viewers reported a greater preference than male viewers for happy-mood films. Also, male viewers reported a greater preference for high-arousal films compared to female viewers, and female viewers reported a greater preference for low-arousal films compared to male viewers. Finally, high sensation seekers reported a preference for high-arousal films. Implications for research design and importance of exploring media characteristics are discussed.

Sign in / Sign up

Export Citation Format

Share Document