Chronic clinical manifestations

Assuming no treatment of asymptomatic hyperuricemia, pharma-coeconomic considerations apply only to the management of the acute and chronic clinical manifestations of gout. 

Beri-beri or clinically manifest thiamin deficiency exists in several subforms infantile beri-beri and adult beri-beri. Infantile beri-beri occurs in exclusively breastfed infants of thiamin-deficient mothers. Adults can develop different forms of the disease, depending on their constitution, environmental conditions, the relative contribution of other nutrients to the diet as well as the duration and severity of deficiency. First of all, there is a so called dry or atrophic (paralytic or nervous) form, including peripheral degenerative polyneuropathy, muscle weakness and paralysis. Second, a wet or exudative (cardiac) form exists. In this form, typical symptoms are lung and peripheral oedema as well as ascites. Finally, there is a cerebral form, that can occur as Wernicke encephalopathy or Korsakoff psychosis. Tli is latter form mostly affects chronic alcoholics with severe thiamin deficiency. 

Diabetes continues to be a major cause of excessive morbidity, severe disability and premature death in Western populations. In developed countries, the cost of diabetes to society may be estimated to be as high as 5% of the total health costs, much of which relates to the chronic vascular complications of this disorder (Williams, 1991). The vascular lesion in diabetes consists of (1) microangiopathy, distinguished by thickening of capillary basement membranes resulting in increased vascular permeability, which is clinically manifested as diabetic retinopathy (Fig. 12.1a) and/or nephropathy (Fig. 12.1b), and (2) macroangiopathy (Fig. 12.2),... 

O Ischemic heart disease results from an imbalance between myocardial oxygen demand and oxygen supply that is most often due to coronary atherosclerosis. Common clinical manifestations of ischemic heart disease include chronic stable angina and the acute coronary syndromes of unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. 

Evaluate patients presenting with the typical clinical manifestations for chronic or acute adrenal insufficiency. 

Pneumonia is the most common infectious cause of death in the United States. It occurs in persons of all ages, although the clinical manifestations are most severe in the very young, the elderly, and the chronically ill. 

The pathophysiology, clinical manifestations, diagnosis, and treatment of acute renal failure and chronic kidney disease (CKD) or end-stage renal disease are discussed in Chaps. 75 and 76, respectively. 

Hyperuricemia-associated medical problems are clinical manifestations of gout by recurrent attacks of inflammatory arthritis, chronic tophaceous gout, uric acid urolithiasis, renal impairment, end stage renal disease and early mortality. These manifestations... 

Table 21.5 Dynamics, in days, of the main clinical manifestations in patients with chronic diseases of digestive system organs...

Since corticosteroids are not usually curative, the pathologic process may progress while clinical manifestations are suppressed. Therefore, chronic therapy with these drugs should be undertaken with great care and only when the seriousness of the disorder warrants their use and when less hazardous measures have been exhausted. 

Clinical manifestations The porphyrias are classified as erythropoietic or hepatic, depending on whether the enzyme deficiency occurs in the erythropoietic cells of the bone marrow or in the liver. Hepatic porphyrias can be further classified as acute or chronic. Individuals with an enzyme defect leading to the accumulation of... 

Genes are segments of deoxyribonucleic acid (DNA) and provide information needed by the cells for protein production. The absence or overproduction of a specific protein in the body can lead to a variety of clinical manifestations depending on the structural or functional role that the protein normally plays in the body. Many severe and debilitating diseases (e.g. diabetes, hemophilia, cystic fibrosis) and several chronic... 

It is important to note that an elevated and/or altered plasma lipid level is only one of a wide range of risk factors that contribute to the clinical manifestations of cardiovascular disease in humans (Lusis, 2000). Consequently, in some studies, the reduced incidence of atherosclerosis in animals fed CLA was not accompanied by an improvement in the plasma lipid profile during the CLA feeding phase (Wilson et al, 2000). Reasons for these effects are not understood fully. However, atherosclerosis can also be considered as a chronic inflammatory disease (Libby, 2002) and several important anti-inflammatory effects have been associated with the use of RA these include a reduction in the expression of COX-2, PGE2, reduced release of nitric oxide, a decreased production of pro-inflammatory cytokines, and PPARy activation (Urquhart et al, 2002 Yu et al, 2002 Toomey et al, 2003). 

It is important to keep in mind, however, that not all patients with chronic pancreatitis develop clinical pancreatic exocrine insufficiency approximately 25% of patients still have sufficient exocrine function after 25 years of disease. On the other hand, it is also important to note that 10%-15% of patients with chronic pancreatitis have primary painless disease in these patients, pancreatic exocrine insufficiency may be the first (and possibly only) clinical manifestation. Thus, the absence of pain or a history of pancreatitis does not exclude the diagnosis (DiMagno et al., 1993). 

Slow, relatively low exposure accumulation of Al over a period of years can lead to a number of clinical manifestations, some of which seem to be bypassed in acute Al encephalopathy due to extremely high exposure to Al. Al encephalopathy is a clinical syndrome and, as can be seen in Table 5, there are similarities and differences in the neurological symptoms of acute and chronic Al encephalopathy. In chronic Al encephalopathy microcytic anemia [41, 93, 95—98] and EEG changes [99-104] can precede clinical symptoms [105]. It is unknown if these symptoms can also precede the clinical symptoms of acute encephalopathy. In contrast to acute Al encephalopathy, where speech disturbances are absent, speech disorders are an important presenting clinical sign of neurotoxicity in chronic Al encephalopathy. The neurological basis of the speech apraxia is obscure but it appears to have elements of dysarthria and dysphasia [33, 73], The initial... 

In the context of reahzation of the conventional programs for chemical weapon (CW) destruction, chronic effects of subsymptomatic concentrations of RVX are of particular interest, since risk of exposure of personnel of the CW destruction facihties to chemical agents cannot be completely ruled out. In addition, members of the rescue service engaged in the decontamination process are regarded as a group at high risk of exposure. The difficulty of diagnosis of delayed effects and chronic intoxication with RVX relates to polymorphism of the clinical manifestations... 

Taking into consideration these clinical manifestations of delayed and chronic effects of RVX, an experimental search was undertaken to seek new possible mechanisms of the pathogenesis and novel functional signs of intoxication (Goncharov et al, 2001, 2002, 2003 Mindukshev et al. 

Beck, H.G. (1927). The clinical manifestations of chronic carbon monoxide poisoning. Ann. Clin. Med. 5 1088-96. 

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