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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Postmaturity symptoms vary. The most common are dry skin, overgrown nails, creases on the baby's palms and soles of their feet, minimal fat, abundant hair on their head, and either a brown, green, or yellow discoloration of their skin. Doctors diagnose post-mature birth based on the baby's physical appearance and the length of the mother's pregnancy. However, some postmature babies may show no or few signs of postmaturity.
Postterm pregnancy is the condition of a baby that has not yet been born after 42 weeks of gestation, two weeks beyond the normal 40. Post-mature births can carry risks for both the mother and the infant, including fetal malnutrition. After the 42nd week of gestation, the placenta, which supplies the baby with nutrients and oxygen from the mother, starts aging and will eventually fail. If the fetus passes its fecal matter, which is not typical until after birth, and breathes it in, it could become sick with meconium aspiration syndrome. Postterm pregnancy may be a reason to induce labor.
Post-maturity syndrome develops in about 20% of human pregnancies continuing past the expected dates. Features of post-maturity syndrome include oligohydramnios, meconium aspiration, macrosomia and fetal problems such as dry peeling skin, overgrown nails, abundant scalp hair, visible creases on palms and soles, minimal fat deposition and skin colour become green or yellow due to meconeum staining.
If there are no maternal or fetal complications, labour can be induced after assessing the favourability of the cervix and excluding cephalo-pelvic disproportions. Otherwise emergency lower segment Caesarean section (LSCS) should be made.
The syndrome was first described by Stewart H. Clifford in 1954.
Maternal consequences include the following:
- Itching, which can become intense and debilitating
- Premature labor
- Deranged clotting, which requires Vitamin K
Fetal consequences include:
- Fetal distress
- Meconium ingestion
- Meconium aspiration syndrome
- Stillbirth
Delivery has been recommended in the 38th week when lung maturity has been established.
Most women with this condition present in third trimester with itching without a rash. Typically, the itching is localized to the palms of the hands and soles of the feet but can be anywhere on the body.
Hallmarks of ICP include the following symptoms:
Most common:
- Itching, in particular but not limited to that of the palms of the hands and soles of the feet, without presence of a rash
- Itching that increases in the evening
- Itching that does not respond favorably to anti-histamines or other anti-itch remedies
- Often, elevated LFT results as well as serum bile acid counts
Less common:
- Darker urine
- Lighter stools
- Increased clotting time (due to possibly associated vitamin K deficiency)
- Fatigue
- Increased nausea
- Decrease in appetite
- Jaundice
- Upper right quadrant pain
It is important to note that not all ICP sufferers have all of the above symptoms. For example, Jaundice only occurs in relatively small subset of cases, and in some cases abnormal lab results were not seen until 15 weeks or more after the onset of symptoms.
Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis (blood clots). Pregnancy itself is a factor of hypercoagulability (pregnancy-induced hypercoagulability), as a physiologically adaptive mechanism to prevent "post partum" bleeding. However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.
Pregnancy-induced hypercoagulability is probably a physiologically adaptive mechanism to prevent "post partum" hemorrhage. Pregnancy changes the plasma levels of many clotting factors, such as fibrinogen, which can rise up to three times its normal value. Thrombin levels increase. Protein S, an anticoagulant, decreases. However, the other major anticoagulants, protein C and antithrombin III, remain constant. Fibrinolysis is impaired by an increase in plasminogen activator inhibitor-1 (PAI-1 or PAI) and plasminogen activator inhibitor-2 (PAI-2), the latter synthesized from the placenta. Venous stasis may occur at the end of the first trimester, due to enhanced compliance of the vessel walls by a hormonal effect.
Also, pregnancy can cause hypercoagulability by other factors, e.g. the prolonged bed rest that often occurs "post partum" that occurs in case of delivery by forceps, vacuum extractor or Caesarean section.
A study of more than 200,000 women came to the result that admission to inpatient care during pregnancy was associated with an 18-fold increase in the risk of venous thromboembolism (VTE) during the stay, and a 6-fold increase in risk in the four weeks after discharge, compared with pregnant women who did not require hospitalization. The study included women admitted to hospital for one or more days for reasons other than delivery or venous thromboembolism.
Pregnancy after the age of 35 augments the risk of VTE, as does multigravidity of more than four pregnancies.
Pregnancy in itself causes approximately a five-fold increased risk of deep venous thrombosis. Several pregnancy complications, such as pre-eclampsia, cause substantial hypercoagulability.
Hypercoagulability states as a pre-existing condition in pregnancy include both acquired ones, such as antiphospholipid antibodies, and congenital ones, including factor V Leiden, prothrombin mutation, proteins C and S deficiencies, and antithrombin III deficiency.
Achard–Thiers syndrome affects mostly postmenopausal women and comprises diabetes mellitus, deep voice, hirsutism or hypertrichosis, clitoral hypertrophy and adrenal cortical hyperplasia or adenoma. Patients often also have amenorrhoea, hypertension and osteoporosis.
Breastfeeding and medications is the description of the medications that can be used by a breastfeeding mother with no or few consequences and those medications which are recommended to be avoided. Some medications are excreted in breastmilk. Almost all medicines pass into breastmilk in small amounts. Some have no effect on the baby and can be used while breastfeeding. The National Institutes of Medicine (US) maintains a database containing information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from reliable sources. Some medications and herbal supplements can be of concern. This can be because the drug can accumulate in breastmilk or have effects on the infant and the mother. Those medications of concern are those medications used to treat substance and alcohol addiction. Other medications of concern are those that are used in smoking cessation. Pain medications and antidepressants need evaluation.
Presenting at birth, features of the disorder include moderately severe IUGR, microcephaly, craniosynostosis, moderately severe post uterine growth retardation, deafness, deep set eyes, cryptorchidism, truncal obesity and acanthosis nigricans, small teeth, prognathism, dislocated radial heads without generalized skeletal dysplasia, however, tall vertebrae, moderate mental retardation, hypothyroidism, insulin resistance, hypoparathyroidism.
Achard–Thiers syndrome combines the features of adrenogenital syndrome and Cushing syndrome. It is also known as diabetic-bearded woman syndrome (diabète des femmes à barbe) and occurs mainly in post-menopausal women.
The disease is named for Emile Achard and Joseph Thiers.
Bangstad syndrome is a severe, inherited congenital disorder associated with abnormalities of the cell membrane.
It was characterized in 1989.
Symptoms in people with Treacher Collins syndrome vary. Some individuals are so mildly affected that they remain undiagnosed, while others have moderate to severe facial involvement and life-threatening airway compromise. Most of the features of TCS are symmetrical and are already recognizable at birth.
The most common symptom of Treacher Collins syndrome is underdevelopment of the lower jaw and underdevelopment of the zygomatic bone. This can be accompanied by the tongue being retracted. The small mandible can result in a poor occlusion of the teeth or in more severe cases, trouble breathing or swallowing. Underdevelopment of the zygomatic bone gives the cheeks a sunken appearance.
The external ear is sometimes small, rotated, malformed, or absent entirely in people with TCS. Symmetric, bilateral narrowing or absence of the external ear canals is also described. In most cases, the bones of the middle ear and the middle ear cavity are misshapen. Inner ear malformations are rarely described. As a result of these abnormalities, a majority of the individuals with TCS have conductive hearing loss.
Most affected people also experience eye problems, including colobomata (notches) in the lower eyelids, partial or complete absence of eyelashes on the lower lid, downward angled eyelids, drooping of upper and lower eyelids, and narrowing of the tear ducts. Vision loss can occur and is associated with strabismus, refractive errors, and anisometropia. It can also be caused by severely dry eyes, a consequence of lower eyelid abnormalities and frequent eye infections.
Although an abnormally shaped skull is not distinctive for Treacher Collins syndrome, brachycephaly with bitemporal narrowing is sometimes observed. Cleft palate is also common.
Dental anomalies are seen in 60% of affected people, including tooth agenesis (33%), discoloration (enamel opacities) (20%), malplacement of the maxillary first molars (13%), and wide spacing of the teeth. In some cases, dental anomalies in combination with mandible hypoplasia result in a malocclusion. This can lead to problems with food intake and the ability to close the mouth.
Less common features of TCS may add to an affected person's breathing problems, including sleep apnea. Choanal atresia or stenosis is a narrowing or absence of the choanae, the internal opening of the nasal passages. Underdevelopment of the pharynx, can also narrow the airway.
Features related to TCS that are seen less frequently include nasal deformities, high-arched palate, macrostomia, preauricular hair displacement, cleft palate, hypertelorism, notched upper eyelid, and congenital heart defects.
The general public may associate facial deformity with developmental delay and intellectual disability, but more than 95% of people affected with TCS have normal intelligence. The psychological and social problems associated with facial deformity can affect quality of life in people with TCS.
PVS sufferers often complain of a burning sensation with the tongue and oral mucosa, and atrophy of lingual papillae produces a smooth, shiny, red, dorsum of the tongue. Symptoms include:
Serial contrasted gastrointestinal radiography or upper gastrointestinal endoscopy may reveal the web in the esophagus. Blood tests show a hypochromic microcytic anemia that is consistent with an iron-deficiency anemia. Biopsy of involved mucosa typically reveals epithelial atrophy (shrinking) and varying amounts of submucosal chronic inflammation. Epithelial atypia or dysplasia may be present.It may also present as a post-cricoid malignancy which can be detected by loss of laryngeal crepitus. Laryngeal crepitus is found normally and is produced because the cricoid cartilage rubs against the vertebrae.
PRS symptoms have common characteristics with many other psychiatric disorders. However, none of the present DSM diagnoses can account for the full scope of symptoms seen in PRS, and refusal to eat, weight loss, social withdrawal and school refusal can be considered as the main distinctive features. Any system may be involved, however some more commonly engaged than others.
Gastrointestinal:
- recurring pain
- nausea
- loss of appetite
Neurological:
- headache
- seizure
- motor dysfunction
- sensory dysfunction
- fatigue
- altered consciousness
Musculoskeletal:
- joint pains
- muscle weakness
CHARGE syndrome (formerly known as CHARGE association), is a rare syndrome caused by a genetic disorder. First described in 1979, the acronym "CHARGE" came into use for newborn children with the congenital features of coloboma of the eye, heart defects, atresia of the nasal choanae, retardation of growth and/or development, genital and/or urinary abnormalities, and ear abnormalities and deafness. These features are no longer used in making a diagnosis of CHARGE syndrome, but the name remains. About two thirds of cases are due to a CHD7 mutation. CHARGE syndrome occurs only in 0.1–1.2 per 10,000 live births; as of 2009 it was the leading cause of congenital deafblindness in the US.
Vasoplegic syndrome (VPS) is a postperfusion syndrome characterized by low systemic vascular resistance and a high cardiac output.
Although genetic testing positively identifies nearly two thirds of children with CHARGE syndrome, diagnosis is still largely clinical. The following signs were originally identified in children with this syndrome, but are no longer used in to make the diagnosis alone.
- C - Coloboma of the eye, central nervous system anomalies
- H - Heart defects
- A - Atresia of the choanae
- R - Retardation of growth and/or development
- G - Genital and/or urinary defects (Hypogonadism, undescended testicles, besides hypospadias.)
- E - Ear anomalies and/or deafness and abnormally bowl-shaped and concave ears, known as "lop ears".
Following clinical presentations may be used in the diagnosis of this condition.
1. Dizziness
2. Pallor of the conjuctiva and face
3. Erythematous oral mucosa with burning sensation
4. Breathelessness
5. Atropic and smooth tongue
6. Peripheral rhaggades around the oral cavity
The following tests are helpful in the diagnosis of Plummer–Vinson syndrome.
Vasoplegic syndrome is defined as low systemic vascular resistance (SVR index 2.5 l/min/m2) within the first 4 postoperative hours.
TCS is often first suspected with characteristic symptoms observed during a physical exam. However, the clinical presentation of TCS can resemble other diseases, making diagnosis difficult. The OMENS classification was developed as a comprehensive and stage-based approach to differentiate the diseases. This acronym describes five distinct dysmorphic manifestations, namely orbital asymmetry, mandibular hypoplasia, auricular deformity, nerve development, and soft-tissue disease.
Orbital symmetry
- O0: normal orbital size, position
- O1: abnormal orbital size
- O2: abnormal orbital position
- O3: abnormal orbital size and position
Mandible
- M0: normal mandible
- M1: small mandible and glenoid fossa with short ramus
- M2: ramus short and abnormally shaped
1. 2A: glenoid fossa in anatomical acceptable position
2. 2B: Temperomandibular joint inferiorly (TMJ), medially, anteriorly displaced, with severely hypoplastic condyle
- M3: Complete absence of ramus, glenoid fossa, and TMJ
Ear
- E0: normal ear
- E1: Minor hypoplasia and cupping with all structures present
- E2: Absence of external auditory canal with variable hypoplasia of the auricle
- E3: Malposition of the lobule with absent auricle, lobular remnant usually inferior anteriorly displaced
Facial nerve
- N0: No facial nerve involvement
- N1: Upper facial nerve involvement (temporal or zygomatic branches)
- N2: Lower facial nerve involvement (buccal, mandibular or cervical)
- N3: All branches affected
Soft tissue
- S0: No soft tissue or muscle deficiency
- S1: Minimal tissue or muscle deficiency
- S2: Moderate tissue or muscle deficiency
- S3: Severe tissue or muscle deficiency
Researchers have been aware of a group of symptoms that frequently followed Ebola virus disease for 20 years, but it became more widely reported with the large number of survivors of the deadly epidemic in 2014.
Post Ebola syndrome may manifest as joint pain, muscle pain, chest pain, fatigue, hearing loss, hair loss, cessation of menstruation, and poor long term health. Some survivors report neurological issues including memory problems and anxiety attacks. Vision loss is also frequently reported, along with eye pain, inflammation, and blurred vision. The New England Journal of Medicine reports that symptoms include lethargy, joint pains, hair loss, and vision loss, frequently to the point of near blindness, and uveitis.
TTN is a diagnosis of exclusion as it is a benign condition that can have symptoms and signs similar to more serious conditions, such as respiratory distress syndrome. A chest X-ray may show a radiopaque line - fluid - in the horizontal fissure of the right lung, fluid infiltrate throughout alveoli or fluid in individual lung lobes. The lungs may also appear hyperinflated.
Pervasive refusal syndrome (PRS), now referred to as pervasive arousal withdrawal syndrome (PAWS), is a rare but serious child psychiatric disorder that was first described by Bryan Lask and colleagues in 1991. As of 2011, it is not included in the standard psychiatric classification systems. PRS is the name allotted to a disorder in which children have abandoned their involvement in all phases of their life. It's characterized by refusal to eat, drink, talk, walk or self-care, and a firm resistance to treatment. PRS is very rare and its cause is unclear, but its severity makes it life-threatening. The disorder usually begins with a 'virus', or the child having a 'pain', that results in the need for consulting a doctor or going to the hospital, even though no substantial cause can be found. PRS starts slowly, but the child then worsens quickly becoming reluctant or not capable to do anything for themselves. They originally refuse to accept others caring for them, or helping them eat, and are very depressed and distraught. It is not guaranteed that recovery will take place, and it is a lengthy and complex process, involving specialist medical care. Nevertheless, once the patient is healthy, relapse is very infrequent.
A family with a psychiatric history or environmental stress factors can also play a role. Hospitalization is almost always necessary and the recovery period is lengthy; typically 12.8 months. During the recovery period symptoms disappear in the opposite order they appear. About 67% of the cases show complete recovery.
PRS may be linked to learned helplessness, and so it can be important for the patient to be able to manage the rate of their recovery. Music therapy may help in this regard as it provides empowerment by giving the patient choice and control, while allowing for improvisation can result in a sense of affirmation and validation; all important for a successful recovery.
Post-Ebola virus syndrome (or post-Ebola syndrome) is a post-viral syndrome affecting those who have recovered from infection with Ebola. Symptoms include joint and muscle pain, eye problems, including blindness, various neurological problems, and other ailments, sometimes so severe that the person is unable to work. Although similar symptoms had been reported following previous outbreaks in the last 20 years, health professionals began using the term in 2014 when referring to a constellation of symptoms seen in people who had recovered from an acute attack of Ebola disease.