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Sample records for patients clinically diagnosed

  1. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric; Gustafsson, F; Ross, Heather; Butany, Jagdish

    2009-01-01

    BACKGROUND: Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac amyloidosis. OBJECTIVE: To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses ...

  2. A clinical approach to diagnose patients with localized telangiectasia.

    Science.gov (United States)

    Gupta, Ruchi; Gautam, Ram Krishan; Bhardwaj, Minakshi; Chauhan, Amrita

    2015-08-01

    Telangiectasia, or dilated blood vessels, may represent a benign condition or a marker of a much more serious internal or cutaneous malignancy (e.g., mycosis fungoides). They can be generalized or localized in distribution. 'Localized telangiectasia? can be macular or papular. Macular ones can be further divided into two major categories: primary and secondary. They can occur on their own (primary), after skin injury (e.g., sun damage, post-radiation therapy, after prolonged topical steroid application), or may arise due to an underlying condition (secondary). While telangiectases can spring from a multitude of possible causes, the location of the lesions, in combination with a careful history and exmination, often helps in elucidating the correct diagnosis. A patient with localized telangiectasia as a manifestation of malignancy may be difficult to diagnose, however the diagnosis is one of exclusion, and a thorough evaluation should be performed before diagnosing this condition. This article reviews possible conditions to consider in these patients and suggests an approach to their evaluation. PMID:25951904

  3. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    OpenAIRE

    Wolfe Rory; de Campo John F; Chan Thomas; Harris Anthony H; Goergen Stacy K; Gospodarevskaya Elena V; Gan Eng T; Wheeler Michael B; McKay John

    2006-01-01

    Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with sus...

  4. New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

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    Pulzi Fernanda BU

    2011-02-01

    Full Text Available Abstract Background Nonalcoholic fatty liver disease (NAFLD is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH, cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery. Methods The medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value Results 83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC?200 mg/dL, alanine aminotransferase (ALT ?30, AST/ALT ratio (AAR? 1, gammaglutaril-transferase (?GT?30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, ?GT and US and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%. Conclusion Alterations in TC, ALT, AAR, ?GT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH. Additionally, negative final scores exclude the presence of an advanced illness. Using this score, the severity of fatty liver infiltration would be predicted without the risks associated with hepatic biopsy.

  5. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Science.gov (United States)

    2011-01-01

    Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high but similar to that reported among self-reported diabetic patients in Kumasi, Ghana and vary according to the condition and age. The determinants of SD from this study are income level, exercise, obesity, higher perception of "desirable" and "too short" IELT. PMID:21612653

  6. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

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    Sarpong Charity

    2011-05-01

    Full Text Available Abstract Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%, non-sensuality (74.5%, dissatisfaction with sexual acts (71.9%, non-communication (70.8% and impotence (67.9%. Other areas of sexual function, including premature ejaculation (56.6% and avoidance (42.7% were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c, FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high but similar to that reported among self-reported diabetic patients in Kumasi, Ghana and vary according to the condition and age. The determinants of SD from this study are income level, exercise, obesity, higher perception of "desirable" and "too short" IELT.

  7. Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES). METHODS: We conducted a retrospective review of patients diagnosed with PNES in a 5-year period. RESULTS: Fifty patients with PNES were identified, giving an estimated incidence of 0.91\\/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments. CONCLUSIONS: PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

  8. New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

    OpenAIRE

    Pulzi Fernanda BU; Cisternas Raul; Melo Murilo R; Ribeiro Cristiane MF; Malheiros Carlos A; Salles João E

    2011-01-01

    Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH), cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify in...

  9. Diagnoses of patients referring to a child and adolescent psychiatry outpatient clinic

    Directory of Open Access Journals (Sweden)

    Koray Karabekiro?lu

    2011-01-01

    Full Text Available Objective: The aim of the present study is to identify the diagnoses of patients who referred to a child and adolescent psychiatry outpatient clinic. Method: Medical records of 538 patients referred to the Children and Adolescent Psychiatry outpatient clinic at Gulhane Military Medical School, between January 2009 and June 2009 were studied retrospectively. Results: It was found that the patients were mostly male and within 7 to 18 years of age. It was also determined that three quarters of patients had at least one diagnosis and the diagnosis rate in children between the ages of 0-6 was 50 percent. Comorbid diagnoses were found in 13.7 percent of all cases and they were mainly in the attention deficit hyperactivity disorder (ADHD group. The most common diagnoses were ADHD, generalized anxiety disorder, mental retardation, depression and enuresis, respectively. The most common diagnosis in all age subgroups was ADHD. While the most common diagnoses in boys are ADHD, mental retardation, generalized anxiety disorder, enuresis and depression respectively, they were ADHD, generalized anxiety disorder, depression, mental retardation and enuresis in girls. Conclusion: To know the most common diagnoses, diagnosis differences within genders and possible diagnoses for certain age groups will be useful for improving child and adolescent psychiatry services.

  10. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

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    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  11. The Evaluation Clinical and Demographic Characteristics of 115 Patients Diagnosed with Herpes Zoster in Eeastern Turkey

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    Hatice Uce Özkol

    2013-12-01

    Full Text Available Objective: The aim of this study was to investigate the clinical and demographic characteristics of patients diagnosed with herpes zoster and to explore the similarities and differences with other epidemiological studies from Turkey and the world. Methods: We retrospectively reviewed the records of 115 patients diagnosed with herpes zoster in the Yuzuncu Y?l University Medical Faculty Dermatology Department between January 2007 and December 2010. Results: The mean age of the patients was 42.21±23.88 years. 115 patients, -47 female (40.9%, 68 male (59.1%- aged between 2 and 93 years were assessed. Pediatric age group, 20 (17.4%, adult age group, 95 (82.6% patients, respectively. The incidence of HZ was found to be 0.43%. HZ was observed winter rarely (13.04%. Is mostly seen in the months of March (17.39% The affected dermatome were thorasic (49 patient, 42.6%, servical (21 patient, 18.3%, ophtalmic (22 patient, 19.1%, lomber (16 patient, 13.9%, sacral (7 patient, 6.1% respectively. Complications developed in 13% of patients. Conclusion: We observed that our findings were more or less similar to the findings of the literature data. Cases of HZ in our study was very rare during the winter season. Multi-center studies are needed to the emergence of clinical and epidemiological characteristics of HZ in Turkey.

  12. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel.

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    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiñones-Hinojosa, Alfredo; Ye, Xiaobu; Brem, Henry

    2015-12-01

    We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70years with MGMT methylation had a significantly longer median OS of 13.5months, compared to 7.6months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS. PMID:26249244

  13. Congenital amegakaryocytic thrombocytopenia: three case reports from patients with different clinical diagnoses and somatic abnormalities.

    Science.gov (United States)

    Yldrm, Ay?en Türedi; Güne?, Burçak Tatl; Oymak, Ye?im; Yaman, Yöntem; Özek, Gülcihan; Cart, Özgür; Ye?ilipek, Akif; Vergin, Canan

    2015-04-01

    The congenital amegakaryocytic thrombocytopenia (CAMT) is a syndrome characterized by preservation of granulocytic and erythroid cells during genesis, with a gradual or progressive decrease in the number of megakaryocytic series of cells in the bone marrow. At later times, most patients develop aplastic anemia. It is important to rule out specific causes of thrombocytopenia that develop in the early stages of CAMT. Typically, there are no specific somatic abnormalities that accompany this deadly disease. Here we present three CAMT cases that presented with different clinical diagnoses, with various physical anomalies in two of those cases. The first patient was examined because of a cytomegalovirus infection. The second patient had been referred with a suspected neonatal alloimmune thrombocytopenia, whereas the third patient presented with chronic immune thrombocytopenic purpura. Subsequently, all three patients were diagnosed with CAMT. Two of the patients had physical anomalies. In particular, the first patient had a duplex urinary system. To our knowledge, this is the first patient with CAMT to have a duplicated collecting sysem. The second patient had a secundum atrial septal defect, an atypical facial appearance, and growth retardation. Since CAMT could also be observed outside the neonatal period, the differential diagnosis for thrombocytopenia should be considered for all age groups. Moreover, it should be considered that CAMT may also be accompanied with somatic abnormalities. PMID:25185677

  14. A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients

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    Jin-You Wang

    2014-05-01

    Full Text Available Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of all included patients, 220 (81.8% were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5% patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.

  15. Clinical study of hepatic dysfunction and its correlative factors in newly diagnosed patients with Graves hyperthyroidism

    International Nuclear Information System (INIS)

    Objective: To investigate the incidence,clinical features and the possible risk factors of hepatic dysfunction in the newly diagnosed patients with Graves hyperthyroidism. Methods: A retrospective analysis about total 204 newly diagnosed patients with Graves hyperthyroidism was studied. All the patients were divided into two groups by liver function:the hepatic dysfunction group (146 cases)and the normal group (58 cases). The gender composition, age, thyroid weight, 24 h-131I intake rate,free triiodothyronine (FT3), free thyronine (FT4), thyroid-stimulating hormone receptor antibody (TRAb), thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibody (TGAb)were compared between the two groups. A correlation analysis was progressed between the indicators of liver function and thyroid hormone. Results: (1) The incidence of hepatic dysfunction (at least one abnormal parameter) in the newly diagnosed patients with Graves hyperthyroidism was 71.6% and the most familiar abnormal parameter was alanine transaminase (ALT) (37.7 %). Altogether 61 patients (41.8 %) had only one abnormal parameter in the hepatic dysfunction group and the most common abnormal parameter was alkaline phosphatase (ALP) (50.8%). (2) Compared with the normal group, hepatic dysfunction group had longer disease duration, higher serum FT3, FT4 and TRAb levels,but there were no significant differences in gender composition, age, thyroid weight, 24 h-131I intake rate, TPOAb, TGAb between the two groups. (3) A significantly positive correlation was found between the aspartate aminotransferase and FT3, the ALP and FT3, FT4, the total bilirubin and FT4, the direct bilirubin and FT3, FT4, respectively. Conclusions: Hepatic dysfunction in newly diagnosed patients with Graves hyperthyroidism is very common and the most common abnormal parameters include ALT and ALP. The hepatic dysfunction is closely correlated with patients' disease duration, thyroid hormone and TRAb levels. (authors)

  16. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

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    Yu Zhang

    2013-06-01

    Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  17. Isolation and Antibiogram of Clostridium tetani from Clinically Diagnosed Tetanus Patients.

    Science.gov (United States)

    Hanif, Hajra; Anjum, Awais; Ali, Naeem; Jamal, Asif; Imran, Muhammad; Ahmad, Bashir; Ali, Muhammad Ishtiaq

    2015-10-01

    Clostridium tetani, the etiologic agent of tetanus, produces a toxin that causes spastic paralysis in humans and other vertebrates. This study was aimed for isolation, identification, and determination of antimicrobial susceptibility of C. tetani from clinically diagnosed tetanus patients. Isolation was done from deep-punctured tissues of the foot and arm injuries of 80 clinically diagnosed tetanus patients from the Pakistan Institute of Medical Sciences hospital. We successfully screened out five C. tetani isolates out of 80 samples based on the strain-specific characteristics confirmed through biochemical testing and toxin production. A disc diffusion method was used for antimicrobial susceptibilities and C. tetani isolates showed susceptibility to cefoperazone, chloramphenicol, metronidazole, penicillin G, and tetracycline, but were found to be resistant to erythromycin and ofloxacin. During animal testing, all the infected mice developed symptoms of tetanus. The results showed that identification of C. tetani is possible using biochemical and molecular tools and that the strains of C. tetani isolated had not developed resistance against the antibiotics most often used for the treatment of tetanus. PMID:26175031

  18. Cryptococcal infection in patients with clinically diagnosed meningitis in a tertiary care center

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    Prasad K

    2003-07-01

    Full Text Available A retrospective analysis of 326 clinically diagnosed cases with meningitis over a period of five-and-a-half years was carried out to determine the prevalence of cryptococcal infection, its associated risk factors and therapeutic outcome. Fifty-four (16.6% patients with cryptococcal meningitis were identified by smear examination, culture and/or cryptococcal antigen latex agglutination test. Records of 45 cryptococcal meningitis patients were available; 18 (40% of them were apparently healthy immunocompetent individuals, 13 (28.9% had human immunodeficiency virus (HIV infection, 9 (20% were renal transplant recipients, 4 (8.9% were diabetic and 1 (2.2% had systemic lupus erythematosus. Ten (22.2% patients died and 11 (24.4% patients (all HIV-positive left against medical advice. The present study indicates that cryptococcal infection is associated with high mortality. Presenting symptoms being indistinguishable from other causes of central nervous system infection, all patients with a clinical diagnosis of meningitis, irrespective of their immune status should be investigated for cryptococcal infection.

  19. Incidence and clinical characteristics of lower urinary tract symptoms as a presenting symptom for patients with newly diagnosed bladder cancer

    Scientific Electronic Library Online (English)

    Ryan W., Dobbs; Lee A., Hugar; Louis M., Revenig; Usama, Al-Qassab; John A., Petros; Chad W., Ritenour; Muta M., Issa; Daniel J., Canter.

    2014-04-01

    Full Text Available PurposeThe incidence of lower urinary tract symptoms (LUTS) as the sole presenting symptom for bladder cancer has traditionally been reported to be low. The objective of this study was to evaluate the prevalence and clinical characteristics of newly diagnosed bladder cancer patients who presented wi [...] th LUTS in the absence of gross or microscopic hematuria.Materials and MethodsWe queried our database of bladder cancer patients at the Atlanta Veteran’s Affairs Medical Center (AVAMC) to identify patients who presented solely with LUTS and were subsequently diagnosed with bladder cancer. Demographic, clinical, and pathologic variables were examined.Results4.1% (14/340) of bladder cancer patients in our series presented solely with LUTS. Mean age and Charlson Co-morbidity Index of these patients was 66.4 years (range = 52-83) and 3 (range = 0-7), respectively. Of the 14 patients in our cohort presenting with LUTS, 9 (64.3%), 4 (28.6%), and 1 (7.1%) patients presented with clinical stage Ta, carcinoma in Situ (CIS), and T2 disease. At a median follow-up of 3.79 years, recurrence occurred in 7 (50.0%) patients with progression occurring in 1 (7.1%) patient. 11 (78.6%) patients were alive and currently disease free, and 3 (21.4%) patients had died, with only one (7.1%) death attributable to bladder cancer.ConclusionsOur database shows a 4.1% incidence of LUTS as the sole presenting symptom in patients with newly diagnosed bladder cancer. This study suggests that urologists should have a low threshold for evaluating patients with unexplained LUTS for underlying bladder cancer.

  20. Concordance between Patient Self-Reports and Claims Data on Clinical Diagnoses, Medication Use, and Health System Utilization in Taiwan

    Science.gov (United States)

    Wu, Chi-Shin; Lai, Mei-Shu; Gau, Susan Shur-Fen; Wang, Sheng-Chang; Tsai, Hui-Ju

    2014-01-01

    Purpose The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization. Methods In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports. Results Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions. Conclusion We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization. PMID:25464005

  1. Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Leber’s Hereditary Optic Neuropathy

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    Haluk Esgin

    2012-09-01

    Full Text Available Objective: To investigate possible mitochondrial DNA (mtDNA mutations in patients with Leber’s hereditary optic neuropathy (LHON in order to provide a precise diagnosis and genetic counseling.Material and Methods: Between 1982 and 2007, ten patients were clinically diagnosed with LHON and six of these patients agreed to be involved in this study. Six healthy individuals were also included as a control group. mtDNA was isolated from peripheral blood samples and polymerase chain reaction and mtDNA sequence analysis were performed. Results: In one of the six patients, a homoplasmic mutant m.11778G>A mutation was detected. All of the clinically diagnosed LHON patients and the control groups had the m.14212C>T and m.14580G>A single nucleotide polymorphisms (SNPs. The m.11719A>G SNP was detected in three of six patients and four of the controls. Two of the six patients had the m.3197T>C SNP and, in addition, the m.14258G>A SNP was found in one of these two patients, while neither of these mutations were present in the control group.Conclusion: The clinical diagnosis of LHON could be supported by molecular genetics only in one patient by the detection of one mutation. The m.3197T>C and m.14258G>A SNPs should be considered as potential mtDNA mutations due to the fact that they were detected in the patient group. These mutations should be investigated further in large case groups for suspected gene loci that could lead to optic neuropathy.

  2. Evaluation of the social, clinical and laboratorial profile of patients diagnosed with leprosy in a reference center in São Paulo

    Scientific Electronic Library Online (English)

    Ana Carolina Souza, Porto; Renata Borges Fortes Costa, Figueira; Jaison Antônio, Barreto; José Roberto Pereira, Lauris.

    2015-04-01

    Full Text Available BACKGROUND: Leprosy is the main infectious cause of disability. It is said to be eradicated in São Paulo since 2005, but diagnosis is still late. OBJECTIVES: To investigate the social, clinical and laboratorial profile of leprosy patients diagnosed between 01/2007 and 12/2011, in a reference center [...] in São Paulo. METHODS: Retrospective descriptive study. Data of all new leprosy cases diagnosed between 01/2007 and 12/2011 were raised in São Paulo. RESULTS: 103 men and 71 women were diagnosed, most of them were multibacillary. Mean age at diagnosis was 49 yrs; 2,2% were children; 70% had incomplete primary education; 50% were referred without diagnostic suspicion of leprosy. Mean time since first symptoms/signs and diagnosis was 2 years; 64% of patients had some degree of disability, and 26% had grade 2. 23 cases were diagnosed only after being summoned, and 80% of these had no disability. Agreement between the Ridley and Jopling and the WHO classification was 75% (kappa index = 0.44). Serology for IgM anti-PGL1 (87 patients) showed a mean value of 0.25, and an association between MB classification and test positivity (p

  3. Clinical characteristics of patients diagnosed as high cardiac event probability by 'heart risk view'

    International Nuclear Information System (INIS)

    'Heart Risk View' is the software to evaluate the cardiac event probability, and it is based on the results of the prospective cohort study (J-ACCESS). We examined the usefulness of this software. Study population consisted of 83 patients, who were diagnosed that cardiac event probability was over 20% by 'Heart Risk View.' During the follow-up period (596±356 days), cardiac event occurred in 23 patients (27.7%), including 7 patients death. No significant differences were observed in the ejection fraction by Quantitative Gated single emission computed tomography (SPECT), total defect score calculated from SPECT, and the percentage of stress perfusion abnormality detected by SPECT between event and non-event groups. However, the percentage of cardiac revascularization therapy based on the SPECT was significantly lower in the event group (9 vs. 38%, p=0.03). In conclusion, cardiac event probability calculated by 'Heart Risk View' was reliable in our study cohort. Cardiac event strongly depended on the cardiac ischemia, for which the therapy was difficult because of lesion complexity or combined diseases. (author)

  4. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

    OpenAIRE

    Raza Syed A; Lewis Jeremy S; Pilcher James; Heron Christine; Poloniecki Jan D

    2009-01-01

    Abstract Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diag...

  5. Evaluation of efficacy and clinical impact of FDG-PET 27 patients with surgery of newly diagnosed colorectal cancer

    International Nuclear Information System (INIS)

    The aim of this study was to assess the potential clinical benefit of positron emission tomography (PET) with Fluorine-18-fluorodeoxyglucose (FDG) in patients with colorectal cancer. A total of 27 patients with surgery of newly diagnosed colorectal cancer who were examined preoperatively by FDG-PET between July 2002 and December 2004 were retrospectively analyzed in this study. FDG-PET detected 89% of primary tumors. FDG-PET depicted lymph node metastases in 4 of 9 patients (sensitivity, 44%) and true-negative in 17 of 18 patients (specificity, 94%). FDG-PET depicted liver metastases in 3 of 3 patients (sensitivity, 100%) and true-negative in 22 of 24 patients (specificity, 91%). A comparison of the FDG uptake and the clinicopathologic findings showed that there was no significant association between FDG uptake and the macro finding type, the depth of invasion and histological type. Five of 8 cases with a preoperative diagnosis as lymph-node negative were diagnosed histologically as lymph-node positive, in which the tumor was less than 10 mm in maximum horizontal size, so its size can be a significant factor. FDG-PET can serve as a valuable tool for detecting primary lesions with preoperative colorectal cancer. (author)

  6. Clinical and demographic profile of HIV/AIDS patients diagnosed at a tertiary care centre in Kashmir

    International Nuclear Information System (INIS)

    Objectives: To study the clinical and demographic profile of HIV/AIDS patients diagnosed at a tertiary care centre. Methods: The study was conducted on a group of 1141 patients suspected of having HIV/AIDS on clinical grounds. Screening was done using different Elisa's as advised by NACO and those confirmed as HIV positive were studied for their clinical spectrum and different demographic parameters. Results: Out of 1141 patients tested, 26 proved to have HIV 1 infection with no case of HIV 2 detected. Mean age of presentation was 40.04 +- 7 years, main age group affected 31-40 years and a male: female ratio of 4.2:1 was observed. More than 42% were non Kashmiris with armed forces outnumbering all other occupational classes. Heterosexual transmission was the commonest with married out numbering unmarried. Fever, asthenia and weight loss were the predominant symptoms and pulmonary tuberculosis and oropharyngeal candidiasis commonest opportunistic infections. Conclusion: The clinical and demographic profile of HIV/AIDS patients in Kashmir is largely similar to the rest of India. Kashmir no longer stands immune to the menace of HIV/AIDS. With increasing globalization, frequent travel and change in social values the state is likely to witness an alarming rise in new cases unless a multi pronged approach is undertaken to control the spread. (author)

  7. The Validity and Clinical Utility of Structured Diagnoses of Antisocial Personality Disorder With Forensic Patients

    OpenAIRE

    Marin-Avellan, L. E.; McGauley, G. A.; Campbell, C. D.; Fonagy, P

    2014-01-01

    Current DSM-based instruments for personality disorders (PDs) limit the investigation of the course and outcome of treatment of these disorders. This study examined the validity of the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) in a sample of forensic PD patients. Results based on 66 participants indicated that the SWAP-200 Q-factors reduced the frequency of diagnostic comorbidity of PD categories by half compared w...

  8. The validity and clinical utility of structured diagnoses of antisocial personality disorder with forensic patients.

    Science.gov (United States)

    Marin-Avellan, Luisa E; McGauley, Gillian A; Campbell, Colin D; Fonagy, Peter

    2014-08-01

    Current DSM-based instruments for personality disorders (PDs) limit the investigation of the course and outcome of treatment of these disorders. This study examined the validity of the Shedler-Westen Assessment Procedure-200 (SWAP-200) and the Structured Clinical Interview for DSM-IV Axis II PD (SCID-II) in a sample of forensic PD patients. Results based on 66 participants indicated that the SWAP-200 Q-factors reduced the frequency of diagnostic comorbidity of PD categories by half compared with the SCID-II. Only the SWAP-200's Antisocial PD category showed good convergent and discriminant validity with respect to other instruments describing aspects of PD. The validity of the cutoff score for severe antisocial PD was confirmed, and this category predicted severe incidents in the hospital at 1 year of follow-up. A violence risk scale was constructed, which differentiated violent and nonviolent offenders. The results support the validity of the SWAP-200 and its potential clinical utility with forensic PD patients. PMID:24511901

  9. Diagnosing Type 2 diabetes before patients complain of diabetic symptoms—clinical opportunistic screening in a single general practice

    OpenAIRE

    Evans, Philip; Langley, Peter; Gray, Denis Pereira

    2008-01-01

    In the UK, patients normally see their general practitioner first and 86% of the health needs of the population are managed in general practice, with 14% being referred to specialist/hospital care. Early diagnosis is the privilege of general practice since general practitioners make most medical diagnoses in the NHS. Their historic aim has been to diagnose as early as possible and if possible before patients are aware of symptoms. Over time, diagnoses are being made earlier in the trajectory ...

  10. The validity of clinical findings for diagnosing temporomandibular disorders in patients from different age and gender groups

    International Nuclear Information System (INIS)

    This study was to clarify the diagnostic accuracy of clinical findings for internal derangement of the temporomandibular joint (TMJ) compared with that of magnetic resonance imaging. A series of 4559 patients (879 male and 3680 female, mean age 32.7 years; range 8-85 years;) with temporomandibular disorders were clinically examined by un unspecified number of dentists. All patients underwent magnetic resonance imaging (MRI). The clinical findings that characterize disc displacement, anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) are pain, clicking sound and limitation of maximum mouth opening. These clinical findings were compared to the MRI interpretation, which was used as the gold standard for diagnosis of temporomandibular disorders to define the diagnostic accuracy, specificity, sensitivity, positive predictive value and negative predictive value of clinical findings. The prevalence of clinical finding was 3990 joints (43%) with pain, 2775 joints (30%) with clicking sound and 1731 patients (38%) with limitation of opening. Three thousands forty seven joints were diagnosed as having a normal disc position, 510 joints with sideways disc displacement, 2312 joints with ADDwR, 3239 joints with ADDwoR on MR image. The sensitivity of clinical findings was considerably low: sensitivity was 0.48 for pain versus internal derangement, 0.51 for clicking sound versus ADDwR, 0.62 for limitation of opening versus ADDwoR. The sensitivity was higher in the younger group for clicking sound versus ADDwR, but sensitivity was higher in the older group for limitation of opening versus ADDwoR. The diagnostic accuracy based on clinical findings of internal derangement of TMJ was found to be correlated with age. This study has been that the overall diagnostic accuracy of the clinical findings to determine the status of the joint is about 50-60%. The status of the joint could not be accurately determined by clinical findings. MR image should be performed when an accurate differential diagnosis is needed to determine the treatment methods. (author)

  11. Prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study

    OpenAIRE

    Li Lian-Xi; Zhao Cui-Chun; Ren Ying; Tu Yin-Fang; Lu Jun-Xi; Wu Xing; Zhang Wei-Xing; Zhu Jia-An; Li Mei-Fang; Yu Li-Bo; Bao Yu-Qian; Jia Wei-Ping

    2013-01-01

    Abstract Background The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies. Methods In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and ...

  12. Evaluation of the MEFV gene mutations and clinical symptoms in186 patients diagnosed as familial Mediterranean fever

    Directory of Open Access Journals (Sweden)

    Mahmut Abuhandan

    2015-03-01

    Full Text Available Objective: This retrospective study aimed to evaluate the clinical symptoms and the MEFV mutation ratios of the 186 patients diagnosed as Familial Mediterranean Fever. Methods: Age, sex, admission symptoms, family history, and the MEFV mutation test cases of the 186 patients followed as Familial Mediterranean Fever were evaluated retrospectively. MEFV gene was analyzed with DNA sequence analysis after amplifying the exons 1.-10. using PCR method. Results: There were 84 male and 102 female in the study, and the mean age was 9.45 ± 4.40 years. 26.9% of the patients had close relationship between the parents, and 25.8% had a family history of AAA. The most common symptoms were abdominal pain (92.5%, fever (89.2%, and arthralgia (24.2% respectively. The most common mutations were R202Q (33.3%, M694V (22.6%, E148Q (22%, V726A (7.5%, R761H (4.3%, M680I (3.8%, and the others (6.5% respectively. 21.5% homozygous, 67.7% heterozygous, and 10.8% compound heterozygous mutations of AAA were detected. Conclusion: FMF is a common disease in our country and has difficulties in the differential diagnosis. In recent years molecular genetically methods are considered more commonly for the diagnosis. The results of this study showed that our AAA patients have a wide range of mutations, and supported the heterogeneity of MEFV gene mutations in AAA.

  13. Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All

    OpenAIRE

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents so...

  14. Comorbodity in Patients Diagnosed with Adult-Attention Deficit Hyperactivity Disorder in Psychiatry Outpatient Clinics

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    Erinç SEV?NÇ

    2010-06-01

    Full Text Available Objective: Although attention-deficit hyperactivity disorder (ADHD was perceived as a disorder of childhood, it is now recognized as a chronic condition persisting into adulthood. The aim of this study was to explore the frequency of comorbidity in adults with ADHD.Methods: 80 ADHD patients between 16 and 60 years of age and 80 controls were recruited to the study. The groups were compared in terms of socio-demographic characteristics and diagnosis based on SCID-I and SCID-II. Results: The groups were identical regarding socio-demographic characteristics such as age, gender, education and marital status. The frequency of generalized anxiety disorder, major depression, dysthymia, somatoform disorder, antisocial and borderline personality disorders was significantly higher in ADHD group compared to the control group. Conclusion: We found that adult ADHD was an important risk factor for psychiatric comorbidity throughout lifetime. It is clear that misdiagnosis of comorbid disorders in ADHD patients may cause worsening of the symptoms and treatment resistance. Further studies on this topic may help us to better understand the course of adult ADHD and its treatment. (Archives of Neuropsychiatry 2010; 47: 139-43

  15. Diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT: A clinical follow up study

    Directory of Open Access Journals (Sweden)

    Manuel Menéndez-González

    2014-04-01

    Full Text Available The [123I]ioflupane - a dopamine transporter radioligand - SPECT (DaT-SPECT has proven to be useful in the differential diagnosis of tremor. Here, we investigate the diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT. Therefore, 30 patients with tremor and normal DaT-SPECT were followed up for 2 years. In 18 cases we were able to make a diagnosis. The residual 12 patients underwent a second DaT-SPECT, were then followed for additional 12 months and thereafter the diagnosis was reconsidered again. The final diagnoses included cases of essential tremor, dystonic tremor, multisystem atrophy, vascular parkinsonism, progressive supranuclear palsy, corticobasal degeneration, fragile X–associated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinson’s disease. However, for 6 patients the diagnosis remained uncertain. Larger series are needed to better establish the relative frequency of the different conditions behind these cases.

  16. Broad-range PCR as a supplement to culture for detection of bacterial pathogens in patients with a clinically diagnosed spinal infection

    DEFF Research Database (Denmark)

    Fuursted, Kurt; Arpi, Magnus; Lindblad, Bent Erling; Pedersen, Lisbeth Nørum

    2008-01-01

    We aimed to evaluate broad-range PCR and subsequent sequencing compared to conventional culture in the diagnosis of spinal infection. The method was a prospective study of all patients admitted to Aarhus University Hospital for surgery during a 12-months period with a clinically diagnosed infection of the spine. Samples from patients undergoing surgery for non-infectious causes (malignancy etc.) were included as control group. Specimens were submitted to conventional culture and molecular invest...

  17. Clinical problems of the patients with subarachnoid hemorrhage which had not been diagnosed until they suffered ischemic neurological deficits and/or rebleeding

    International Nuclear Information System (INIS)

    A small part of the patients with subarachnoid hemorrhage (SAH) are not properly diagnosed until they suffer ischemic neurological deficits and/or rebleeding during vasospasm. We therefore investigated the clinical profile of such patients. We retrospectively analyzed 581 patients with aneurysmal SAH experienced in our institute between 2001 and 2009. Patient's characteristics, presence and severity of headache before final diagnosis, imaging investigations they received, their World Federation of Neurological Surgeons (WFNS) grades at admission, the location of aneurysm, treatment, and outcome at discharge were investigated. Five patients were not correctly diagnosed until they presented neurological deficits due to vasospasm or experienced simultaneous rebleeding. Their mean age was 69.4, and all were female. Although all patients had a bad headache, they did not undergo any imaging examinations. Immediate coil embolization was performed for 2 patients, 1 died due to rupturing during embolization procedure. The other 3 were treated by open clipping surgery (2 delayed and 1 immediate). Four patients had some disability as a sequel, and their outcomes were significantly worse compared with 53 patients with SAH in WFNS Grade II. The patients with SAH who had not been properly diagnosed in the acute stage had a poor outcome. We should be very careful when we see patients complaining of severe headache. (author)

  18. Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study

    Directory of Open Access Journals (Sweden)

    Almind Gitte

    2011-02-01

    Full Text Available Abstract Background Many diabetic patients fear visual loss as the worst consequence of diabetes. In most studies the main eye pathology is assigned as the cause of visual impairment. This study analysed a broad range of possible ocular and non-ocular predictors of visual impairment prospectively in patients newly diagnosed with clinical type 2 diabetes. Methods Data were from a population-based cohort of 1,241 persons newly diagnosed with clinical, often symptomatic type 2 diabetes aged ? 40 years. After 6 years, 807 patients were followed up. Standard eye examinations were done by practising ophthalmologists. Results At diabetes diagnosis median age was 65.5 years. Over 6 years, the prevalence of blindness (visual acuity of best seeing eye ? 0.1 rose from 0.9% (11/1,241 to 2.4% (19/807 and the prevalence of moderate visual impairment (> 0.1; Conclusions In a comprehensive assessment of predictors of visual impairment, even in a health care system allowing self-referral to free eye examinations, treatable eye pathologies such as DR and cataract emerge together with age as the most notable predictors of continued visual loss after diabetes diagnosis. Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.

  19. DIAGNOSING DEMENTIA DUE TO ALZEMIER'S DISEASE : CLINICAL PERSPECTIVE

    OpenAIRE

    Kar, Nilamadhab; Sengupta, Somnath; Sharma, P. S. V. N.

    2000-01-01

    The diagnosis of dementia in Alzheimer's disease on clinical grounds is made by exclusion of other etiologies. The differential diagnoses of other subtypes considered along with dementia of Alzheimer's disease and the clinical process involved were studied in a tertiary level health care set up. Out of 39 patients with dementia admitted over 12 years it was found that a differential diagnoses of other subtype were considered along with dementia of Alzheimer's disease in 13 cases, while 15 cas...

  20. Modifiable clinical and lifestyle factors are associated with elevated alanine aminotransferase levels in newly diagnosed type 2 diabetes patients : results from the nationwide DD2 study

    DEFF Research Database (Denmark)

    Mor, Anil; Svensson, Elisabeth

    2014-01-01

    BACKGROUND: Current literature lacks data on markers of non-alcoholic fatty liver disease (NAFLD) in newly diagnosed type 2 diabetes mellitus (T2DM) patients. We therefore, conducted a cross-sectional study to examine modifiable clinical and lifestyle factors associated with elevated alanine aminotransferase (ALT) levels as a marker of NAFLD in new T2DM patients. METHODS: Alanine aminotransferase levels were measured in 1026 incident T2DM patients enrolled in the nationwide Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort. We examined prevalence of elevated ALT (>38 IU/L for women and >50 IU/L for men) and calculated prevalence ratios associated with clinical and lifestyle factors using Poisson regression. We examined the association with other biomarkers by linear regression. RESULTS: The median value of ALT was 24 IU/L (interquartile range: 18-32 IU/L) in women and 30 IU/L (interquartile range: 22-41 IU/L) in men. Elevated ALT was found in 16% of incident T2DM patients. The risk of elevated ALT was increased in patients who were 14/>21 drinks per week for women/men) (aPR: 1.60, 95% CI: 1.03-2.50), and in those with no regular physical activity (aPR: 1.42, 95% CI: 1.04-1.93). Obesity and metabolic syndrome per se showed no association with elevated ALT when adjusted for other markers, whereas we found positive associations of ALT with increased C-peptide (??=?0.14, 95% CI: 0.06-0.21) and fasting blood glucose (??=?0.07, 95% CI: 0.03-0.11). CONCLUSIONS: Among newly diagnosed T2DM patients, several modifiable clinical and lifestyle factors are independent markers of elevated ALT levels. Copyright © 2014 John Wiley & Sons, Ltd.

  1. Clinical-epidemiological features of HIV-infected patients diagnosed at age of 50 years or older

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    V Fink

    2012-11-01

    Full Text Available HIV/AIDS prevention and care efforts are directed to individuals of reproductive age (15–49 yrs. With the extension of sexual life of older people, they became a growing population at risk of HIV infection, usually not included in prevention strategies. In order to evaluate clinical profile of HIV/AIDS pts diagnosed at 50 yrs or older assisted in an HIV outpatient center in Buenos Aires, we retrospectively assessed clinical records of pts initiating care between Jan 1986 and Dec 2011. Age, CD4 cells and viral load (pVL at HIV diagnosis and most recent value, opportunistic infections (OIs, co-morbidities and antiretroviral therapy (ARV were recorded. Of 10,998 pts assisted in the 26-yr period, 495 (4.5% were?50 yrs old at HIV diagnosis; median annual diagnoses: 18.5 (IQR 3.3–30.3 without significant changes in the last 20 yrs. Demographics: median age 54.7 yrs (IQR 51.8–59.2, rank 50–80, 76.6% male. Risk behavior: HTX 61.4%, MSM 34.1%, others 4.4%. 55.4% of HIV diagnoses occurred during hospitalization or simultaneously with acute OIs. One third (n=176 had AIDS at diagnosis, 24% had history of STDs. HCV co-infection 5.7%, past HBV infection 28.1% and chronic HBV infection 5.1%. Median CD4 cells at HIV diagnosis: 223.5 (13.7% (IQR 98.8–420.3, initial pVL 60,000 cp/mL (IQR 9,995.5–208,391. 69.3% of pts started ARV therapy during follow-up (FU, and the median time between diagnosis and treatment initiation was 3.4 mo (IQR 0.7–14; 56.9% of them started a non-nucleoside-based regimen (ZDV/3TC/EFV, 28.3% a PI-based regimen (ZDV/3TC/IDV and 14.6% a nucleoside-based regimen (ZDV/ddI pre-HAART era. After a year (±6 mo, 63.8% pts achieved undetectable pVL and gained 136 CD4 cells from BSL (IQR 83–204. After 40.6 mo of FU (IQR 6.7-89.8, 66.3% are alive, 7.1% died (68.6% of HIV-related diseases and 26.7% are lost to FU. Co-morbidities were present in 125 (25.3%, mainly hypertension, increased lipids, CVD and DBT. Among treated pts, 70.6% achieved pVL<50 cp/mL, with a median increase of CD4 cells up to 410 (22% (IQR 281.5–563.9 from BSL. 51% (176 changed ARV therapy due to toxicity/AE: 54.5%, ARV failure: 29.5% and simplification: 14.8%. Stable HIV epidemic in older people reinforce the need of specific prevention approaches, while growing age of HIV individuals in care highlights to consider risks associated to older age. Late presentation to care needs to be specifically addressed. Response to treatment is remarkable high in this population.

  2. Lymphography and computed tomography of abdominal nodes in newly diagnosed patients with Hodgkin's disease in clinical stage I-III

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, C.H.

    1986-10-01

    Between 1978 and 1983, 80 patients with Hodgkin's disease (HD) in clinical Stage I-III had computed tomography (CT) of the abdomen and pelvis and lymphography (LAG) prior to staging laparatomy with multiple lymph node biopsies at Stanford University Medical Center. There were 224 biopsied nodal sites. The sensitivity and specificity for CT to determine the status of biopsied paraortic and iliac nodes was .61 and .91 vs. .94 and .90 for LAG. CT appeared of even lower sensitivity (.13) in evaluating splenic hilar, celiac axis and portal nodes. Including all biopsy proven subdiaphragmatic nodal sites, CT's sensitivity to diagnose the presence of subdiaphragmatic adenopathy was .38 vs. .52 in LAG. Assessment of the final pathological stage was more successful by LAG (.61) than by CT (.49). Positive and negative predictive values of both tests indicate higher reliability of LAG results as regards individual intraabdominal nodes (LAG .71, .98 vs. CT .58, .86), the entire subdiaphragmatic nodal area (LAG .79, .77 vs. CT .61, .71) and prediction of final pathological stage. LAG appeared to be the more useful test during initial staging of newly diagnosed and untreated patients with HD. None of the test for itself or in combination can replace laparatomy when exact information is necessary for further clinical decisions.

  3. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas; Jansson, Lennart B; Parnas, Josef; Werge, Thomas

    2005-01-01

    Concern has been expressed as to the reliability of clinical ICD-10 diagnosis of schizophrenia. This study was designed to assess the diagnostic reliability of the clinical ICD-10 diagnosis of schizophrenia in a random sample of Danish in- and outpatients with a history of psychosis. A sample of 100 subjects was assessed using the operational criteria OPCRIT checklist for psychotic and affective illness. The most recent principal and clinical ICD-10 diagnosis was compared with diagnoses generate...

  4. Clinical features, neuroimaging and prognosis of adult patients with clinically diagnosed acute-onset encephalitis treated at a teaching neurology center in the Toyama area of Japan

    International Nuclear Information System (INIS)

    Although acute viral encephalitis (AVE) and acute disseminated encephalomyelitis (ADEM) are etiologically and pathologically distinct, a differential diagnosis between these two disorders is often difficult, especially if the patient exhibits a disturbance in consciousness. To identify useful clinical differences enabling a differential diagnosis to be made at an early stage, we retrospectively analyzed patients who had been admitted to our hospital within the past seven years because of acute-onset encephalitis with a disturbance in consciousness. Eleven adult patients were classified as having AVE, and 8 adult patients were classified as having ADEM within this period. The clinical characteristics of the two groups were then compared. Patients with AVE exhibited a disturbance in consciousness as their first neurological sign, whereas patients with ADEM initially showed focal signs like spastic paralysis, urinary disturbance and ataxia, which were followed by a disturbance in consciousness. ADEM is usually preceded by infection or vaccination, but obtaining a medical history from patients with disturbed consciousness is often difficult. Based on the present analysis, the initial manifestation of focal neurological signs may be very useful for distinguishing ADEM from AVE. (author)

  5. Clinical symptoms and chemotherapy completion in elderly patients with newly diagnosed acute leukemia: a retrospective comparison study with a younger cohort

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    Zhang Wenteng

    2011-06-01

    Full Text Available Abstract Background Cancer affects older adults disproportionately. The disease is often difficult to diagnose and treat due to co-morbidities and performance status, and patients tend to discontinue chemotherapy prematurely. There are no systemic studies of the reasons and factors that create a higher withdrawal rate in older acute leukemia patients. This study tried to understand the initial characteristics, blood counts and bone marrow measurements in older acute leukemia patients by comparing them with a younger group to provide information and assistance in early clinical diagnosis, treatment and reasons for treatment withdrawal. Methods Using retrospective medical record reviews, we examined clinical characteristics and chemotherapy completion status in the patients of two groups (age ? 60, n = 183 and age Results There were no statistical differences in initial presenting symptoms of fatigue (67.2% vs. 57.9%, P>0.05 and pallor (53% vs. 59.6%, P>0.05 between the two groups, but older patients demonstrated more underlying diseases including lung infections (25.7%, P = P = 0.007, and hypertension (20.8%, P =2 = 6.202, P = 0.013. The percentage of patients age 60 and older who prematurely discontinued chemotherapy (50.3%, mainly due to the influences of traditional Chinese concept of critical illness, financial difficulties, and intolerance to adverse reactions to chemotherapy, was significantly higher than that of younger patients (37.7% (?2 = 5.866, P = 0.015. Conclusions A comprehensive approach to diagnosis, treatment selection, and toxicity management, and implementing strategies to enhance treatment compliance may improve outcomes in older adults with acute leukemia.

  6. Prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study

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    Li Lian-Xi

    2013-01-01

    Full Text Available Abstract Background The features of carotid atherosclerosis in ketosis-onset diabetes have not been investigated. Our aim was to evaluate the prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed Chinese diabetic patients with ketosis but without islet-associated autoantibodies. Methods In total, 423 newly diagnosed Chinese patients with diabetes including 208 ketosis-onset diabetics without islet-associated autoantibodies, 215 non-ketotic type 2 diabetics and 79 control subjects without diabetes were studied. Carotid atherosclerosis was defined as the presence of atherosclerotic plaques in any of the carotid vessel segments. Carotid intima-media thickness (CIMT, carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on Doppler ultrasound examination. The clinical features of carotid atherosclerotic lesions were analysed, and the risk factors associated with carotid atherosclerosis were evaluated using binary logistic regression in patients with diabetes. Results The prevalence of carotid atherosclerosis was significantly higher in the ketosis-onset diabetic group (30.80% than in the control group (15.2%, p=0.020 after adjusting for age- and sex-related differences, but no significant difference was observed in comparison to the non-ketotic diabetic group (35.8%, p=0.487. The mean CIMT of the ketosis-onset diabetics (0.70±0.20 mm was markedly higher than that of the control subjects (0.57±0.08 mm, p Conclusions The prevalence and risk of carotid atherosclerosis were significantly higher in the ketosis-onset diabetics than in the control subjects but similar to that in the non-ketotic type 2 diabetics. The characteristics of carotid atherosclerotic lesions in the ketosis-onset diabetics resembled those in the non-ketotic type 2 diabetics. Our findings support the classification of ketosis-onset diabetes as a subtype of type 2 diabetes.

  7. Differential diagnoses to MS : experiences from an optic neuritis clinic

    DEFF Research Database (Denmark)

    Horwitz, Henrik; Friis, Tina

    2014-01-01

    Optic neuritis (ON) is closely linked to multiple sclerosis (MS). It may, however, also be associated to a range of autoimmune or infectious diseases. The purpose of this study was to assess the differential diagnoses in patients with suspected ON. In this retrospective study, we reviewed the files of all patients referred to the Clinic of Optic Neuritis, Glostrup Hospital, University of Copenhagen, Denmark, between January 2000 and November 2011. All patients were referred by ophthalmologists with possible ON. Patients diagnosed with MS prior to referral were excluded from the study. A total of 643 patients were included in the study. Apart from ON, the most frequent diagnoses were tumors (n = 15), ischemic or hypertensive neuropathies (n = 13), and retinal or choroid disorders (n = 9). Six patients were diagnosed with neuromyelitis optica. Rarer causes of visual loss were infections (n = 5), giant cell arteritis (n = 4), sarcoidosis (n = 3), thyrotoxicosis (n = 2), and hereditary or toxic neuropathies (n = 2). Nine percent of patients referred to the Clinic of Optic Neuritis had symptoms caused by medical, neurosurgical or ophthalmic disorders, and 0.9 % of our patients had NMO. Though most of these conditions are rare, it is of importance to keep them in mind upon encountering patients with symptoms of ON.

  8. Does COPD have a clinically relevant impact on hearing loss? A retrospective matched cohort study with selection of patients diagnosed with COPD

    Science.gov (United States)

    Kamenski, Gustav; Bendova, Jana; Fink, Waltraud; Sönnichsen, Andreas; Spiegel, Wolfgang; Zehetmayer, Sonja

    2015-01-01

    Objectives Chronic obstructive pulmonary disease (COPD) as a multisystemic disease has a measurable and biologically explainable impact on the auditory function detectable in the laboratory. This study tries to clarify if COPD is also a significant and clinically relevant risk factor for hearing impairment detectable in the general practice setting. Design Retrospective matched cohort study with selection of patients diagnosed with COPD. Setting 12 general practices in Lower Austria. Participants Consecutive patients >35?years with a diagnosis of COPD who consulted 1 of 12 single-handed GPs in 2009 and 2010 were asked to participate. Those who agreed were individually 1:1 matched with controls according to age, sex, hypertension, diabetes, coronary heart disease and chronic heart failure. Main outcome measures Sensorineural hearing impairment as assessed by pure tone audiometry, answers of three questions concerning a self-perceived hearing problem, application of the whispered voice test and the score of the Hearing Inventory for the Elderly, Screening Version (HHIE-S). Results 194 patients (97 pairs of 194 cases and controls) with a mean age of 65.5 (SD 10.2) were tested. Univariate conditional logistic regression resulted in significant differences in the mean bone conduction hearing loss and in the total score of HHIE-S, in the multiple conditional regression model, only smoking (pCOPD and hearing impairment which, if found, would have allowed better management of patients with COPD. PMID:26586319

  9. A Clinical Pilot Study Comparing Sweet Bee Venom parallel treatment with only Acupuncture Treatment in patient diagnosed with lumbar spine sprain

    OpenAIRE

    Shin Yong-jeen

    2011-01-01

    Objectives: This study was carried out to compare the Sweet Bee Venom (referred to as Sweet BV hereafter) acupuncture parallel treatment to treatment with acupuncture only for the patient diagnosed with lumbar spine sprain and find a better treatment. Methods: The subjects were patients diagnosed with lumbar spine sprain and hospitalized at Suncheon oriental medical hospital, which was randomly divided into sweet BV parallel treatment group and acupuncture-only group, and other treatment c...

  10. The Social Negotiation of Illness : Doctors’ Role as Clinical or Political in Diagnosing Patients with Medically Unexplained Symptoms

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2015-01-01

    The present article examines how doctors explain patients’ symptoms that are medically unexplained (MUS). Present analysis departs in a qualitative study that was conducted in Denmark in 2008–2009 and involved eight small group interviews and three individual interviews with 21 doctors. The following themes evolved from the interviews: (i) descriptions of patients with MUS, (ii) the role of the welfare system and (iii) the role of general practitioner (GP)s in their contacts with this particular patient group according to the doctors. The study demonstrates that MUS patients’ symptoms fail as symptoms in the context of medicine; however, the study shows that if doctors apply the politicised context of the current welfare state in Denmark, then they are able to translate the symptoms of MUS patients into social problems. Doctors can subsequently explain the symptoms described by MUS patients. The study finds that GPs assume a politicised role in their contact with MUS patients, which valorises moral reflections on the Danish welfare state and results in descriptions of individuals’ well-being that are in accordance with a political context regarding the rights and obligations of citizens.

  11. Microbiologic characterization and antimicrobial susceptibility of Clostridium tetani isolated from wounds of patients with clinically diagnosed tetanus.

    OpenAIRE

    Campbell, JI; Lam, TM; Huynh, TL; To, SD; Tran, TT; Nguyen, VM; Le, TS; Nguyen, V; Parry, C.; Farrar, JJ; Tran, TH; Baker, S.(Department of Physics and Astronomy, University College London, London, United Kingdom)

    2009-01-01

    Clostridium tetani is the etiologic agent of the muscle-spasming disease tetanus. Despite an effective vaccine, tetanus is an ongoing problem in some developing countries. Diagnosis by bacterial culture is not done because it is generally unnecessary and the entry of route of the bacteria can be inapparent. We attempted to isolate and evaluate C. tetani from the wounds of 84 patients with tetanus. We effectively isolated C. tetani from 45 patients. All strains tested positive by polymerase ch...

  12. Repeated Aspergillus isolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?

    Directory of Open Access Journals (Sweden)

    Barberan Jose

    2012-11-01

    Full Text Available Abstract Background Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation, treatment (administration or not of antifungals and prognosis (mortality in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples. Methods Records of adult patients (29 Spanish hospitals presenting ?2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates. Logistic regression models (step–wise were performed using Aspergillosis (probable?+?proven, antifungal treatment and mortality as dependent variables. Significant (p?2 were considered. Results A total of 245 patients were identified, 139 (56.7% with Aspergillosis. Aspergillosis was associated (R2?=?0.291 with ICU admission (OR?=?2.82, congestive heart failure (OR?=?2.39 and steroids pre-admission (OR?=?2.19 as well as with cavitations in X-ray/CT scan (OR?=?10.68, radiological worsening (OR?=?5.22 and COPD exacerbations/need for O2 interaction (OR?=?3.52. Antifungals were administered to 79.1% patients with Aspergillosis (100% proven, 76.8% probable and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation (OR?=?12.38. In Aspergillosis patients its administration was positively associated (R2?=?0.312 with bronchospasm (OR?=?9.21 and days in ICU (OR?=?1.82 and negatively with Gold III?+?IV (OR?=?0.26, stroke (OR?=?0.024 and quinolone treatment (OR?=?0.29. Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients (R2?=?0.290 with radiological worsening (OR?=?3.04, APACHE-II (OR?=?1.09 and number of antibiotics for treatment (OR?=?1.51 and negatively with species other than A. fumigatus (OR?=?0.14 and aspergillar tracheobronchitis (OR?=?0.27. Conclusions Administration of antifungals was not always closely linked to the diagnostic categorisation (colonisation vs. Aspergillosis, being negatively associated with severe COPD (GOLD III?+?IV and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs/symptoms between this entity and pulmonary bacterial infections.

  13. A Survey on the Attitude of Professors & Residents of Clinical Wards about Disclosing the Results of Diagnoses for Incurable Patients at Urmia University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    SH Miri Ghaffarzadeh

    2012-05-01

    Full Text Available

    Background and Objectives: One of the most important and complicated problems in medical ethics is to disclose the full truth about diagnosis of incurable diseases which leads to death, and each therapist may be encountered with it during the years of medical profession.

    The aim of this study was to survey on attitude of professors and residents of clinical wards to disclose the diagnosis for incurable patients leading to death.

     

    Methods: In this descriptive study, sampling was carried out by a survey. All faculty members and their residents of teaching hospitals of Urmia University of Medical Sciences, Urmia, Iran, were surveyed as sample in 2007. Of 145 subjects, 138 responded to the questionnaire. The collected data were analyzed using Pearson and Spearman correlation tests with a p?0.05 being considered as significant.

     

    Results: In this study, the tendency to disclose the diagnosis among faculty members and residents was 64.63%. Also, there was no significant relation between age, sex, university degree, educational field, years of service of the faculty members and residents of clinical wards with the tendency for telling the truth to incurable patients.

     

    Conclusion: Final analyses revealed that the faculty members and clinical residents of different fields in terms of diagnosis disclosure do not have a definite idea. However, the majority of them agree to disclose the full truth about diagnoses.

     

  14. Is it possible to diagnose the therapeutic adherence of patients with COPD in clinical practice? A cohort study

    Directory of Open Access Journals (Sweden)

    Prados-Torres Daniel

    2011-01-01

    Full Text Available Abstract Background Therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD is poor. It is therefore necessary to determine the magnitude of non-adherence to develop strategies to correct this behaviour. The purpose of this study was to analyse the diagnostic validity of indirect adherence methods. Methods Sample: 195 COPD patients undergoing scheduled inhaled treatment attending 5 Primary Care Centres of Malaga, Spain. Variables: Sociodemographic profile, illness data, spirometry, quality of life (St. George Respiratory Questionnaire: SGRQ, and inhaled medication counting (count of dose/pill or electronic monitoring were collected. The patient's knowledge of COPD (Batalla test:BT,their attitude towards treatment (Morisky-Green test: MGT and their self-reported therapeutic adherence (Haynes-Sackett test: HST were used as methods of evaluating adherence. The follow-up consisted four visits over one year (the recruitment visit: V0; and after 1 month:V1; 6 months:V2; and 1 year:V3. Results The mean age was 69.59 (95% CI, 68.29-70.89 years old and 93.8% were male. Other findings included: 85.4% had a low educational level, 23.6% were smokers, 71.5% mild-moderate COPD stage with a FEV1 = 56.86 (SD = 18.85; exacerbations per year = 1.41(95% CI, 1-1.8. The total SGRQ score was 44.96 (95% CI, 42.46-47.46, showing a mild self-perceived impairment in health. The prevalence of adherence (dose/pill count was 68.1% (95% CI, 60.9-75.3 at V1, 80% (95% CI, 73-87 at V2 and 84% (95% CI, 77.9 at V3. The MGT showed a specificity of 67.34% at V1, 76.19% at V2 and 69.62% at V3. The sensitivity was 53.33% at V1, 66.66% at V2 and 33.33% at V3.The BT showed a specificity of 55.1% at V1, 70.23% at V2 and 67.09% at V3. The sensitivity was 68.88% at V1, 71.43% at V2 and 46.66% at V3. Considering both tests together, the specificity was 86.73% at V1, 94.04% at V2 and 92.49% at V3 and the sensitivity was 37.77% at V1, 47.62% at V2 and 13.3% at V3. Conclusions The prevalence of treatment adherence changes over time. Indirect methods (dose/pill count and self-reported can be useful to detect non-adherence in COPD patients. The combination of MGT and BT is the best approach to test self-reported adherence.

  15. Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: Design of a multicenter randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Valdimarsdottir Heiddis B

    2011-01-01

    Full Text Available Abstract Background It has been estimated that between 5% and 10% of women diagnosed with breast cancer have a hereditary form of the disease, primarily caused by a BRCA1 or BRCA2 gene mutation. Such women have an increased risk of developing a new primary breast and/or ovarian tumor, and may therefore opt for preventive surgery (e.g., bilateral mastectomy, oophorectomy. It is common practice to offer high-risk patients genetic counseling and DNA testing after their primary treatment, with genetic test results being available within 4-6 months. However, some non-commercial laboratories can currently generate test results within 3 to 6 weeks, and thus make it possible to provide rapid genetic counseling and testing (RGCT prior to primary treatment. The aim of this study is to determine the effect of RGCT on treatment decisions and on psychosocial health. Methods/Design In this randomized controlled trial, 255 newly diagnosed breast cancer patients with at least a 10% risk of carrying a BRCA gene mutation are being recruited from 12 hospitals in the Netherlands. Participants are randomized in a 2:1 ratio to either a RGCT intervention group (the offer of RGCT directly following diagnosis with tests results available before surgical treatment or to a usual care control group. The primary behavioral outcome is the uptake of direct bilateral mastectomy or delayed prophylactic contralateral mastectomy. Psychosocial outcomes include cancer risk perception, cancer-related worry and distress, health-related quality of life, decisional satisfaction and the perceived need for and use of additional decisional counseling and psychosocial support. Data are collected via medical chart audits and self-report questionnaires administered prior to randomization, and at 6 month and at 12 month follow-up. Discussion This trial will provide essential information on the impact of RGCT on the choice of primary surgical treatment among women with breast cancer with an increased risk of hereditary cancer. This study will also provide data on the psychosocial consequences of RGCT and of risk-reducing behavior. Trial registration The study is registered at the Netherlands Trial Register (NTR1493 and ClinicalTrials.gov (NCT00783822.

  16. Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: Design of a multicenter randomized clinical trial

    International Nuclear Information System (INIS)

    It has been estimated that between 5% and 10% of women diagnosed with breast cancer have a hereditary form of the disease, primarily caused by a BRCA1 or BRCA2 gene mutation. Such women have an increased risk of developing a new primary breast and/or ovarian tumor, and may therefore opt for preventive surgery (e.g., bilateral mastectomy, oophorectomy). It is common practice to offer high-risk patients genetic counseling and DNA testing after their primary treatment, with genetic test results being available within 4-6 months. However, some non-commercial laboratories can currently generate test results within 3 to 6 weeks, and thus make it possible to provide rapid genetic counseling and testing (RGCT) prior to primary treatment. The aim of this study is to determine the effect of RGCT on treatment decisions and on psychosocial health. In this randomized controlled trial, 255 newly diagnosed breast cancer patients with at least a 10% risk of carrying a BRCA gene mutation are being recruited from 12 hospitals in the Netherlands. Participants are randomized in a 2:1 ratio to either a RGCT intervention group (the offer of RGCT directly following diagnosis with tests results available before surgical treatment) or to a usual care control group. The primary behavioral outcome is the uptake of direct bilateral mastectomy or delayed prophylactic contralateral mastectomy. Psychosocial outcomes include cancer risk perception, cancer-related worry and distress, health-related quality of life, decisional satisfaction and the perceived need for and use of additional decisional counseling and psychosocial support. Data are collected via medical chart audits and self-report questionnaires administered prior to randomization, and at 6 month and at 12 month follow-up. This trial will provide essential information on the impact of RGCT on the choice of primary surgical treatment among women with breast cancer with an increased risk of hereditary cancer. This study will also provide data on the psychosocial consequences of RGCT and of risk-reducing behavior. The study is registered at the Netherlands Trial Register (NTR1493) and ClinicalTrials.gov (NCT00783822)

  17. Using specialized standardized patients to improve differential diagnoses.

    Science.gov (United States)

    Payne, Leslie Karns

    2015-06-11

    A Specialized Standardized Patient (SSP) is a standardized patient who has advanced nursing education. This article describes an experience of introducing advanced practice registered nurses as SSPs into an advanced health assessment course. The article also discusses the simulated clinical experience and the desired course outcome that the student will be able to merge the patient history and physical exam findings to develop differential diagnoses. PMID:25968985

  18. Diagnosing patients with longstanding shoulder joint pain

    OpenAIRE

    Norregaard, J; Krogsgaard, M; Lorenzen, T; Jensen, E

    2002-01-01

    Methods: Eighty six patients with longstanding shoulder joint pain were "blindly" examined by two trained doctors using several clinical tests. In all patients an ultrasonographic examination was performed, and in 42 (49%) an arthroscopy.

  19. Similar clinical features among patients with severe adult growth hormone deficiency diagnosed with insulin tolerance test or arginine or glucagon stimulation tests

    DEFF Research Database (Denmark)

    Toogood, Andrew; Brabant, Georg

    2012-01-01

    To determine whether insulin tolerance tests (ITTs), arginine stimulation tests (ASTs), and glucagon stimulation tests (GST) identify patients who have similar clinical features of growth hormone (GH) deficiency when a diagnostic GH threshold of 3 ?g/L is used.

  20. Manejo clínico de pacientes con diagnóstico dual: tratamiento de los pacientes farmacodependientes con trastornos psiquiátricos mayores Clinical Management of Dually Diagnosed Patients: Treatment for Drug Abusing and Dependent Patients with Major Psychiatric Comorbidities

    Directory of Open Access Journals (Sweden)

    Juan Francisco Gálvez Flórez

    2009-03-01

    Full Text Available Introducción: Los esfuerzos para avanzar en el tratamiento de patologías duales buscan integrar las intervenciones terapéuticas que permitan mejorar sus tasas de remisión y recuperación. A pesar de la contundente evidencia epidemiológica que asocia el consumo de sustancias con las patologías psiquiátricas mayores, las pautas de tratamiento están basadas en combinaciones que carecen sustento clínico. Objetivos: Describir de forma concisa los estudios clínicos más relevantes sobre intervenciones psicofarmacológicas y psicoterapéuticas en estos pacientes, para desarrollar guías clínicas de manejo dinámicas y flexibles que ayuden en las estrategias usadas en el Eje Cafetero, en Colombia. Método: Búsqueda en la literatura biomédica en Medline, OVID, Proquest, Scielo y EMBASE, cruzando la expresión MeSH diagnóstico dual con tratamiento y pronóstico, delimitando los resultados a los estudios clínicos, revisiones sistemáticas y/o metanálisis en español o inglés en los últimos 25 años en la población farmacodependiente adulta. Resultados: De los 246 artículos arrojados por nuestra búsqueda, se seleccionaron 126, considerados de relevancia clínica por calidad metodológica y resultados en términos de seguridad, eficacia y efectividad. Conclusiones: Se describen los resultados de los estudios clínicos sobre los cuales se basan los nueve protocolos de intervención para pacientes con diagnóstico dual que consultan al Instituto Especializado en Salud Mental Clínica El Prado.Introduction: In an effort to treat dually diagnosed patients, multiple therapeutic interventions that have shown efficacy for inpatients with major psychiatric disorders or substance abuse have been used in combination. In spite of the vast evidence of the association between drug abuse and major psychiatric disorders, most guidelines for the treatment of dually diagnosed patients are based on combinations that lack enough evidence, thus limiting their success. To date, no treatment has shown promise of long-term effectiveness. Objective: To describe briefl y the available evidence for relevant psychotherapeutic and psychopharmacological strategies in the treatment of dually diagnosed patients. At the same time, we hope to develop dynamic and fl exible algorithms to be included in the Clinical Guidelines for the Treatment of Dually Diagnosed Patients admitted to El Prado Psychiatric Institute in Armenia, Colombia. Method: We searched the Biomedical Literature on Medline, OVID, Proquest, Scielo, and EMBASE for articles matching the MeSH, dual diagnosis with treatment and prognosis, limiting results to clinical trials, systematic reviews, meta-analysis and clinical guidelines published in the last 25 years in adult population. Results: 246 articles were downloaded, of which 146 were selected after carefully reviewing all abstracts that met our established inclusion criteria in terms of methodology, safety, efficacy and effectiveness of the interventions. Conclusion: The clinical evidence available supports the nine protocols designed for the treatment of dually diagnosed patients in the addiction program of El Prado Psychiatric Institute in Armenia, Colombia.

  1. Risk of disability pension for patients diagnosed with haematological malignancies

    DEFF Research Database (Denmark)

    Horsboel, Trine A; Nielsen, Claus V; Andersen, Niels T; Nielsen, Bendt; de Thurah, Annette

    2014-01-01

    UNLABELLED: Patients with haematological malignancies are at increased risk of experiencing work-related problems. The aims of this study were to compare the risk of disability pension (DP) among patients diagnosed with eight subtypes of haematological malignancies to a reference cohort, and to determine if relative risks differ between these subtypes; to evaluate the influence of socioeconomic factors, demographic factors, and clinical factors on the risk of DP; and to investigate if these asso...

  2. Different Pathophysiological Phenotypes among Newly Diagnosed Type 2 Diabetes Patients

    DEFF Research Database (Denmark)

    Stidsen, Jacob

    Type 2 diabetes (T2D) can be considered a syndrome with several different pathophysiological mechanisms leading to hyperglycemia. Nonetheless, T2D is treated according to algorithms as if it was one disease entity. Methods: We investigated the prevalence of different pathophysiological phenotypes among newly diagnosed T2D patients in Denmark. Based on baseline data from a Danish national cohort study we investigated 1048 incident diagnosed T2D patients. The diagnosis T2D was made by general practitioners based on clinical judgement. Phenotypes were classified in the following groups: latent autoimmune diabetes (LADA) (GAD antibody titer >= 20 IE/ml and not T1D), secondary diabetes (recent history of pancreatitis, pancreatectomy or pancreas amylase > 65U/l, and GAD negativity), steroid-induced diabetes (oral glucocorticoid-treated subjects), insulinopenic (f-P-C-peptide = 568 pmol/l) and a normoinsulinopenic group (333 <=c-peptid <=568 pmol/l). Results: Median age of our new T2D patients was 61 years (range 21-95 years), 57% were men. We found that 3.0% newly diagnosed T2D patients suffered from LADA, 3.9% from secondary diabetes, 6.0% from steroid induced diabetes 5.9% had insulinopenic diabetes, whereas 56.7% presented the classic obesity-associated insulin-resistant phenotype. 24.6% was classified as normoinsulinopenic patients. Conclusion: We conclude that newly diagnosed T2D patients represents several well-characterized pathophysiological phenotypes with various mechanisms of hyperglycemia. This should be taken into consideration when choosing the appropriate treatment for the individual patient diagnosed with T2D. We suggest to measure f-P-C-peptide, GAD antibodies and pancreas amylase in patients with newly diagnosed T2D.

  3. Behavioral and psychosocial effects of rapid genetic counseling and testing in newly diagnosed breast cancer patients: Design of a multicenter randomized clinical trial

    OpenAIRE

    Valdimarsdottir Heiddis B; van der Luijt Rob B; Hogervorst Frans BL; Hahn Daniela EE; Bleiker Eveline MA; Verhoef Senno; Ausems Margreet GEM; Wevers Marijke R; van Hillegersberg Richard; Rutgers Emiel; Aaronson Neil K

    2011-01-01

    Abstract Background It has been estimated that between 5% and 10% of women diagnosed with breast cancer have a hereditary form of the disease, primarily caused by a BRCA1 or BRCA2 gene mutation. Such women have an increased risk of developing a new primary breast and/or ovarian tumor, and may therefore opt for preventive surgery (e.g., bilateral mastectomy, oophorectomy). It is common practice to offer high-risk patients genetic counseling and DNA testing after their primary treatment, with g...

  4. Dasatinib induces fast and deep responses in newly diagnosed chronic myeloid leukaemia patients in chronic phase: clinical results from a randomised phase-2 study (NordCML006)

    Science.gov (United States)

    Hjorth-Hansen, Henrik; Stenke, Leif; Söderlund, Stina; Dreimane, Arta; Ehrencrona, Hans; Gedde-Dahl, Tobias; Gjertsen, Bjørn Tore; Höglund, Martin; Koskenvesa, Perttu; Lotfi, Kourosh; Majeed, Waleed; Markevärn, Berit; Ohm, Lotta; Olsson-Strömberg, Ulla; Remes, Kari; Suominen, Merja; Simonsson, Bengt; Porkka, Kimmo; Mustjoki, Satu; Richter, Johan

    2015-01-01

    We randomised 46 newly diagnosed patients with chronic myeloid leukaemia (median age 56) to receive dasatinib 100 mg QD or imatinib 400 mg QD and report outcome as an intention-to-treat analysis with 36 months follow-up. Early cytogenetic and molecular responses were superior in the dasatinib group, with a tendency that imatinib patients caught up with time. For instance, MR3.0 was reached at 3 months in 36% vs. 8% (P = 0.02), at 12 months in 81% vs. 46% (P = 0.02) and at 18 months in 73% vs. 65% (n.s.) of the patients in the two groups. In contrast, MR4.5 was consistently superior in the dasatinib group at all time points from 6 months onwards, reaching 61% vs. 21% (P < 0.05) at 36 months. Sixty-four vs. 71% of the patients in the dasatinib and imatinib arms, respectively, remained on assigned drug. Dasatinib dose was frequently reduced, but with maintained excellent effect. One imatinib patient progressed to blastic phase, but no CML-related deaths occurred. In conclusion, our data compare favourably with those of the dasatinib registration study, DASISION. The fast and deep molecular responses induced by dasatinib compared with imatinib may be exploited to increase the proportion of patients who can achieve a treatment-free remission after treatment discontinuation. PMID:25082346

  5. A Clinical Pilot Study Comparing Sweet Bee Venom parallel treatment with only Acupuncture Treatment in patient diagnosed with lumbar spine sprain

    Directory of Open Access Journals (Sweden)

    Shin Yong-jeen

    2011-06-01

    Full Text Available Objectives: This study was carried out to compare the Sweet Bee Venom (referred to as Sweet BV hereafter acupuncture parallel treatment to treatment with acupuncture only for the patient diagnosed with lumbar spine sprain and find a better treatment. Methods: The subjects were patients diagnosed with lumbar spine sprain and hospitalized at Suncheon oriental medical hospital, which was randomly divided into sweet BV parallel treatment group and acupuncture-only group, and other treatment conditions were maintained the same. Then,VAS (Visual Analogue Scale was used to compare the difference in the treatment period between the two groups from VAS 10 to VAS 0, from VAS 10 to VAS 5, and from VAS 5 to VAS 0. Result & Conclusion: Sweet BV parallel treatment group and acupuncture-only treatment group were compared regarding the respective treatment period, and as the result, the treatment period from VAS 10 to VAS 5 was significantly reduced in sweet BV parallel treatment group compared to the acupuncture-only treatment group, but the treatment period from VAS 5 to VAS 0 did not show a significant difference. Therefore, it can be said that sweet BV parallel treatment is effective in shortening the treatment period and controlling early pain compared to acupuncture-only treatment.

  6. The clinical value of prostate-specific antigen and bone scintigraphy in the staging of patients with newly diagnosed, pathologically proven prostate cancer

    International Nuclear Information System (INIS)

    Recent reports suggest that radionuclide bone scan (BS) may not be necessary in the standard staging evaluation of patients with prostate cancer when serum prostate-specific antigen (PSA) levels are normal. To evaluate the ability of PSA to predict BS findings, we retrospectively reviewed the case records of 118 consecutive patients (median age 73 years, range 50-90 years) with newly diagnosed, untreated, pathologically proven prostate cancer who underwent BS and serum PSA sampling within a period of no more than 3 months. Fifty-four out of 118 BSs demonstrated metastatic bone disease. A PSA value of less then 10 ng/ml excluded bone metastasis; of 35 patients with a serum PSA level of 20 ng/ml or less, seven had a positive BS (negative predictive value of 80%). These findings provide additional confirmation of the value of low serum PSA concentrations in excluding the need for a staging BS, although the threshold for a high value of negative predictive accuracy is lower than previously reported. (orig.)

  7. Quality of urological cancer diagnoses in the Danish National Registry of Patients

    DEFF Research Database (Denmark)

    Gammelager, Henrik; Christiansen, Christian Fynbo; Johansen, Martin Berg; Borre, Michael; Schoonen, Marieke; Sørensen, Henrik Toft

    2012-01-01

    Valid and up-to-date data on cancer diagnoses are needed for clinical quality monitoring and epidemiological research. The Danish National Registry of Patients (DNRP) is continuously updated, recording all Danish hospital contacts including cancer diagnoses. The Danish Cancer Registry (DCR) is updated once a year and includes quality control of diagnoses. We compared the quality of urological cancer diagnoses in the DNRP with the DCR to assess whether data in an administrative hospital registry ...

  8. Using fuzzy data mining to diagnose patients' degrees of melancholia

    Science.gov (United States)

    Huang, Yo-Ping; Kuo, Wen-Lin

    2011-06-01

    The common treatments of melancholia are psychotherapy and taking medicines. The psychotherapy treatment which this study focuses on is limited by time and location. It is easier for psychiatrists to grasp information from clinical manifestation but it is difficult for psychiatrists to collect information from patients' daily conversations or emotion. To design a system which psychiatrists enable to capture patients' daily symptoms will show great help in the treatment. This study proposes to use fuzzy data mining algorithm to find association rules among keywords segmented from patients' daily voice/text messages to assist psychiatrists extract useful information before outpatient service. Patients of melancholia can use devices such as mobile phones or computers to record their own emotion anytime and anywhere and then uploading the recorded files to the back-end server for further analysis. The analytical results can be used for psychiatrists to diagnose patients' degrees of melancholia. Experimental results will be given to verify the effectiveness of the proposed methodology.

  9. Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem Clinical-pathological discrepancies in critically ill patients with difficult premortem diagnoses

    Directory of Open Access Journals (Sweden)

    Aline Fusco Fares

    2011-12-01

    Full Text Available INTRODUÇÃO: A importância das autópsias é um tema comum de discussão tanto no Brasil como em todo o mundo, já que pode elucidar as causas de óbito e tem um valor social muito amplo. Entretanto, esta prática vem sendo gradualmente considerada desnecessária, tendo ocorrido um declínio no número de exames post-mortem. OBJETIVOS: Comparar o diagnóstico clínico e patológico em pacientes com difícil diagnóstico pre-mortem. MÉTODOS: Foram analisados todos os casos de autópsias (em um total de 98 de pacientes oriundos de três unidades de terapia intensiva médico-cirúrgicas (total de 78 leitos pertencentes a uma faculdade de medicina, realizadas no período de janeiro de 2003 a dezembro de 2006. Analisamos os diagnósticos clínicos e patológicos segundo os critérios de Goldman. RESULTADOS: Em 49 casos (50% foram encontradas discordâncias classes I e II de Goldman. Por outro lado, apenas 30 (30,6% dos casos tiveram uma concordância completa entre os diagnósticos pre-mortem e post-mortem sendo classificados como classe V. As infecções tiveram uma taxa de concordância significantemente maior do que as doenças cardiovasculares. CONCLUSÃO: Encontramos discrepâncias significantes entre os achados clínicos e patológicos, o que reforça o valor dos exames post-mortem.INTRODUCTION: The importance of autopsies is a common theme of discussions both in Brazil and around the world as it elucidates causes of death and has wide ranging social value. However this is a practice that is gradually being considered unnecessary and there have been a decline in the number of postmortems examinations. OBJECTIVES: To compare clinical and pathological diagnosis in critically ill patients with difficult premortem diagnosis. METHODS: All autopsy cases (total of 98 from any of the three general medical/surgical intensive care units (78 beds in total affiliated to the medical school from January 2003 to December 2006 were analyzed. We analyzed the clinical and pathological diagnosis based on the Goldman criteria. RESULTS: In 49 (50% cases, there were class I and II of Goldman. In contrast, only 30 (30.6% had a complete agreement between premortem and postmortem diagnosis and were classified as class V. Infections had a significantly greater rate of concordant diagnosis than cardiovascular diseases. CONCLUSION: We found significant discrepancies between clinical and pathological findings, reinforcing the value of postmortem examination.

  10. Discrepâncias clínico-patológicas em pacientes graves com difícil diagnóstico pre-mortem / Clinical-pathological discrepancies in critically ill patients with difficult premortem diagnoses

    Scientific Electronic Library Online (English)

    Aline Fusco, Fares; Patrícia Maluf, Cury; Suzana Margareth, Lobo.

    2011-12-01

    Full Text Available INTRODUÇÃO: A importância das autópsias é um tema comum de discussão tanto no Brasil como em todo o mundo, já que pode elucidar as causas de óbito e tem um valor social muito amplo. Entretanto, esta prática vem sendo gradualmente considerada desnecessária, tendo ocorrido um declínio no número de exa [...] mes post-mortem. OBJETIVOS: Comparar o diagnóstico clínico e patológico em pacientes com difícil diagnóstico pre-mortem. MÉTODOS: Foram analisados todos os casos de autópsias (em um total de 98) de pacientes oriundos de três unidades de terapia intensiva médico-cirúrgicas (total de 78 leitos) pertencentes a uma faculdade de medicina, realizadas no período de janeiro de 2003 a dezembro de 2006. Analisamos os diagnósticos clínicos e patológicos segundo os critérios de Goldman. RESULTADOS: Em 49 casos (50%) foram encontradas discordâncias classes I e II de Goldman. Por outro lado, apenas 30 (30,6%) dos casos tiveram uma concordância completa entre os diagnósticos pre-mortem e post-mortem sendo classificados como classe V. As infecções tiveram uma taxa de concordância significantemente maior do que as doenças cardiovasculares. CONCLUSÃO: Encontramos discrepâncias significantes entre os achados clínicos e patológicos, o que reforça o valor dos exames post-mortem. Abstract in english INTRODUCTION: The importance of autopsies is a common theme of discussions both in Brazil and around the world as it elucidates causes of death and has wide ranging social value. However this is a practice that is gradually being considered unnecessary and there have been a decline in the number of [...] postmortems examinations. OBJECTIVES: To compare clinical and pathological diagnosis in critically ill patients with difficult premortem diagnosis. METHODS: All autopsy cases (total of 98) from any of the three general medical/surgical intensive care units (78 beds in total) affiliated to the medical school from January 2003 to December 2006 were analyzed. We analyzed the clinical and pathological diagnosis based on the Goldman criteria. RESULTS: In 49 (50%) cases, there were class I and II of Goldman. In contrast, only 30 (30.6%) had a complete agreement between premortem and postmortem diagnosis and were classified as class V. Infections had a significantly greater rate of concordant diagnosis than cardiovascular diseases. CONCLUSION: We found significant discrepancies between clinical and pathological findings, reinforcing the value of postmortem examination.

  11. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations : a nationwide register study

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf

    2015-01-01

    INTRODUCTION: Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. METHODS: All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. RESULTS: A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P?clinically diagnosed ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.

  12. Patient specific modelling in diagnosing depression

    DEFF Research Database (Denmark)

    Ottesen, Johnny T.

    2015-01-01

    Depression is a very common disease. Approximately 10% of people in the Western world experience severe depression during their lifetime and many more experience a mild form of depression. It is commonly believed that depression is caused by malfunctions in the biological system constituted by the hypothalamus-pituitary-adrenal (HPA) axis. We pose a novel model capable of showing both circardian as well as ultradian oscillations of hormone concentrations. We show that these patterns imitate those observed in the corresponding data. We demonstrate that patient-specific modelling shows its ability to make diagnoses more precise and to offer individual treatment plans and drug design. Efficient and reliable methods for parameter estimation are crucial. Presently we are investigating how well the Metropolis-Hastings Algorithm of the Bayesian Markov Chain Monte Carlo (MCMC) method for estimating the parameters is working and we are about to do the same using iteratively refined principal differential analysis (iPDA) or the approximated maximum likelihood estimate (AMLE). Preliminary results for both methods are promising. The next step is to investigate which parameters there are responsible for which pathologies by statistical hypothesis testing.

  13. Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital / Análisis clínico económico de las infecciones nosocomiales en los pacientes diagnosticados de tumoración cerebral en un hospital terciario

    Scientific Electronic Library Online (English)

    J., Undabeitia; B.G., Liu; G., Catalán; G., Bilbao; I., Pomposo; J.M., Garibi.

    2011-12-01

    Full Text Available Objetivos: Analizar la relación entre la presencia de infección nosocomial y el resultado clínico final, la duración de la estancia y el coste del episodio en los pacientes diagnosticados de tumoración cerebral en nuestro servicio. Material y método: Realizamos un estudio retrospectivo incluyendo lo [...] s pacientes ingresados en el Servicio de Neurocirugía del Hospital Universitario de Cruces con diagnostico de tumoración cerebral en el periodo comprendido entre el 1-1-2007 y el 31-12 del 2007. Recogimos variables demográficas, los microorganismos responsables y la localización de las distintas infecciones, el tiempo de ingreso y los costes de los distintos procedimientos médicos y quirúrgicos realizados. Resultados: Recogimos 139 pacientes, que acumularon un total de 210 episodios. Encontramos la presencia de infecciones nosocomiales en 34 episodios (16,25%). La localización mas frecuente fue la respiratoria, seguida del tracto urinario y la infección de herida quirúrgica. Encontramos unas diferencias significativas en la situación funcional al alta (sig Abstract in english Objectives: To analyze the relationship between hospital acquired infections and clinical outcomes, duration of stay, and cost per infectious episode in patients diagnosed with brain tumors in our service. Materials and methods: We conducted a retrospective study on patients diagnosed with brain tum [...] ors and admitted to the department of neurosurgery in the Cruces Hospital of the University of the Basque Country between January 1st, 2007 and December 31st, 2007. We collected demographics, responsible pathogens, infection location, length of hospitalization, and costs of various medical and surgical procedures performed. Results: We reviewed 139 patients that accumulated 210 hospital visits. We found 34 episodes of hospital acquired infections (16.25% of patients). The most frequent infections were that of the lower respiratory tract, urinary tract, and surgical site. We found that patients with HAIs had a significantly lower final KPS score (sig

  14. Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients : a cross-sectional study from the nationwide DD2 cohort

    DEFF Research Database (Denmark)

    Svensson, Elisabeth; Mor, Anil

    2015-01-01

    BACKGROUND: We aimed to examine the prevalence of and modifiable factors associated with elevated C-reactive Protein (CRP), a marker of inflammation, in men and women with newly diagnosed Type 2 Diabetes mellitus (DM) in a population-based setting. METHODS: CRP was measured in 1,037 patients (57% male) with newly diagnosed Type 2 DM included in the prospective nationwide Danish Centre for Strategic Research in Type 2 Diabetes (DD2) project. We assessed the prevalence of elevated CRP and calculated relative risks (RR) examining the association of CRP with lifestyle and clinical factors by Poisson regression, stratified by gender. We used linear regression to examine the association of CRP with other biomarkers. RESULTS: The median CRP value was 2.1 mg/L (interquartile range, 1.0 - 4.8 mg/L). In total, 405 out of the 1,037 Type 2 DM patients (40%) had elevated CRP levels (>3.0 mg/L). More women (46%) than men (34%) had elevated CRP. Among women, a lower risk of elevated CRP was observed in patients receiving statins (adjusted RR (aRR) 0.7 (95% confidence interval (CI) 0.6-0.9)), whereas a higher risk was seen in patients with central obesity (aRR 2.3 (95% CI 1.0-5.3)). For men, CRP was primarily elevated among patients with no regular physical activity (aRR 1.5 (95% CI 1.1-1.9)), previous cardiovascular disease (aRR1.5 (95% CI 1.2-1.9) and other comorbidity. For both genders, elevated CRP was 1.4-fold increased in those with weight gain >30 kg since age 20 years. Sensitivity analyses showed consistent results with the full analysis. The linear regression analysis conveyed an association between high CRP and increased fasting blood glucose. CONCLUSIONS: Among newly diagnosed Type 2 DM patients, 40% had elevated CRP levels. Important modifiable risk factors for elevated CRP may vary by gender, and include low physical activity for men and central obesity and absence of statin use for women.

  15. Occupational Outcome in Adult ADHD: Impact of Symptom Profile, Comorbid Psychiatric Problems, and Treatment--A Cross-Sectional Study of 414 Clinically Diagnosed Adult ADHD Patients

    Science.gov (United States)

    Halmoy, Anne; Fasmer, Ole Bernt; Gillberg, Christopher; Haavik, Jan

    2009-01-01

    Objective: To determine the effects of symptom profile, comorbid psychiatric problems, and treatment on occupational outcome in adult ADHD patients. Method: Adult ADHD patients (N = 414) responded to questionnaires rating past and present symptoms of ADHD, comorbid conditions, treatment history, and work status. Results: Of the patients, 24%…

  16. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan; Eriksson, Jonas K; Forsblad-d'Elia, Helena; Neovius, Martin; Turesson, Carl; Kristensen, Lars Erik; Jacobsson, Lennart T H

    2015-01-01

    INTRODUCTION: Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. METHODS: All individuals diagnosed with ankylosing spondylitis accor...

  17. Evaluation of combined, conservative treatment impact on the clinical course, blood flow parameters and muscle perfusion in the group of patients with newly diagnosed, untreated peripheral arterial disease (PAD)

    International Nuclear Information System (INIS)

    Background: Epidemiological studies determined incidence of obliterative atherosclerosis as ranging between 2.45 -10 %. The course of disease is often asymptomatic and demonstration of symptoms occurs when vascular lesions are significantly advanced. This article discusses conservative treatment of patients with PAD whose key complaint was intermittent claudication. The Authors proposed multi-stage treatment regimen of this disease including lifestyle modification, treatment of comorbid disorders, and pharmacotherapy (aspirin, pentoxifylline, buflomedil, L-arginine). The study evaluated influence of 6-month treatment on clinical course, blood flow parameters as well as muscle perfusion. Material/Methods: The participants included 35 patients (14 women - 40.0 %, and 21 men - 60.0 %) aged from 49 to 80 (mean age 68.37 ± 10.25 years) first time in life diagnosed with PAD. Physical examination, standard vascular tests (ankle-brachial, thigh-ankle and thigh-shin indices, maximum flow velocity, PI and RI in selected arteries), perfusion scintigraphy of lower limbs muscles at rest and on exertion were carried out before and after 6 months of treatment. Results: Statistically significant increase of total walking distance (198.0 meters vs. 330.0 meters, p< 0.01) and improvement in average values of perfusion indices of all studied areas were detected at rest and after exercise. For shin perfusion index at rest (right and left) and for thigh perfusion index after exercise (right) the difference was statistically significant at p< 0.05. Conclusions: Combined medical treatment brought on positive effect on patients suffering from recently diagnosed, thus not yet treated atherosclerotic lower limb ischaemia of IIA and IIB stages according to Fontaines scale. (authors)

  18. Patients Diagnosed With Severe Adult GH Deficiency Using The Insulin Tolerance Test, Arginine Or Glucagon Stimulation Tests Share Similar Clinical Features

    DEFF Research Database (Denmark)

    Toogood, Andy; Brabant, Georg

    2011-01-01

    Objective: To determine whether the ITT, arginine (AST) and glucagon stimulation tests (GST) identify patients who have similar features of GH deficiency using a diagnostic threshold of 3 µg/l.Patients and Methods: 5453 tests were available from 4,867 patients registered in the KIMS database (49.9% females, ITT = 3111, AST = 1390, GST = 952). Comparisons were made for GH peak, BMI, lipids, waist circumference, waist:hip ratio and quality of life (QoL-AGHDA questionnaire).Results. There were significant (p

  19. Estudo clínico e laboratorial de pacientes com artrite reumatoide diagnosticados em serviços de reumatologia em Cascavel, PR, Brasil / Clinical and laboratory features of patients with rheumatoid arthritis diagnosed at rheumatology services in the Brazilian municipality of Cascavel, PR, Brazil

    Scientific Electronic Library Online (English)

    Juliano Maximiano, David; Rodrigo Antonio, Mattei; Juliana Lustoza, Mauad; Lauren Gabrielle de, Almeida; Márcio Augusto, Nogueira; Poliana Vieira da Silva, Menolli; Rafael Andrade, Menolli.

    2013-02-01

    Full Text Available INTRODUÇÃO: Estudos epidemiológicos brasileiros sobre artrite reumatoide são bastante escassos, e os dados existentes hoje são majoritariamente de literatura internacional. OBJETIVOS: Determinar a incidência e algumas características clínicas e laboratoriais de pacientes com artrite reumatoide em Ca [...] scavel, PR, Brasil. PACIENTES E MÉTODOS: Os dados foram coletados entre agosto de 2010 e julho de 2011 em todos os serviços de saúde do município que possuíam atendimento na especialidade de reumatologia: um hospital universitário, o Centro Regional de Especialidades do Consórcio Intermunicipal de Saúde do Oeste do Paraná (CRE-CISOP) e quatro clínicas privadas da cidade. RESULTADOS: Foram identificados 38 pacientes com diagnóstico de artrite reumatoide, resultando em uma incidência estimada de 13,4 casos/100.000 habitantes/ano. Trinta e dois pacientes eram do gênero feminino, com média de idade de 47,6 anos. A faixa etária com maior incidência foi > 40 anos. O tempo médio entre os primeiros sintomas e o diagnóstico foi de 12,4 meses. O fator reumatoide foi positivo em 68,4% dos casos, e 18,4% já apresentavam alterações radiológicas no momento do diagnóstico. O tratamento farmacológico dos pacientes também foi avaliado e mostrou estar de acordo com o encontrado na literatura. CONCLUSÃO: A incidência de artrite reumatoide obtida em Cascavel está abaixo das incidências observadas em estudos internacionais. Abstract in english INTRODUCTION: Brazilian epidemiological studies on rheumatoid arthritis are scarce, thus all data currently available originate from the international literature. OBJECTIVES: To determine the incidence and some clinical and laboratory characteristics of patients with rheumatoid arthritis in the muni [...] cipality of Cascavel, state of Paraná, Brazil. PATIENTS AND METHODS: Data were collected between August 2010 and July 2011 in all health services of the municipality of Cascavel that provided health care in Rheumatology: a university-affiliated hospital, a public outpatient clinic and four private clinics. RESULTS: We identified 38 patients diagnosed with rheumatoid arthritis, resulting in an estimated incidence of 13.4 cases per 100,000 inhabitants/year. Thirty two patients were females, whose mean age was 47.6 years. The age group with the highest incidence was over 40 years. The mean time between first symptoms and diagnosis was 12.4 months. Rheumatoid factor was positive in 68.4% of the patients, and 18.4% already had radiological abnormalities at diagnosis. The pharmacological treatment of patients was also assessed and proved to be in accordance with those found in the literature. CONCLUSION: The incidence of rheumatoid arthritis obtained in the municipality of Cascavel was lower than those reported in international studies.

  20. Immune system markers of neuroinflammation in patients with clinical diagnose of neuromyelitis optica / Marcadores imunológicos em pacientes com diagnóstico de neuromielite óptica

    Scientific Electronic Library Online (English)

    Soniza Vieira, Alves-Leon; Maria Lucia Vellutini, Pimentel; Gabrielle, Sant' Anna; Fabíola Rachid, Malfetano; Cláudio Duque, Estrada; Thereza, Quirico- Santos.

    Full Text Available A neuromielite óptica (NMO) é doença inflamatória do sistema nervoso central, caracterizada por mielite aguda ou subaguda grave e neurite óptica unilateral ou bilateral. Este estudo objetiva analisar parâmetros imunológicos de pacientes com critérios de Wingerchuck et al. (1999) para NMO. O método d [...] e ELISA avaliou a produção de IgG e IgA para antígenos da proteína básica da mielina (MBP), o proteolipídeo (PLP) 95-116, a glicoproteina associada ao oligodendrócito (MOG) 92-106 e as citocinas interleucina-4 (IL-4) e interferon-gama (INF-?). Foram inclu?dos 28 pacientes com NMO pareados com controles saudáveis. Pacientes com NMO apresentaram níveis significativamente elevados de imunoglobulinas reativas dos isotipos IgG para MOG (p Abstract in english Neuromyelitis optica (NMO) is an inflammatory, demyelinating disease of the central nervous system characterized by the association of a serious myelitis and unilateral or bilateral optic neuritis. The present study aimed to analyze the immunological parameters of NMO patients with diagnosis establi [...] shed based on Wingerchuck et al. (1999) criteria. Production of IgG and IgA antibodies to antigens of MBP, PLP 95-116, MOG 92-106, and the cytokines interleukin-4 (IL-4) and interferon-? (INF-?) were assessed by Elisa assay. The cohort was formed by 28 NMO patients and a matched healthy control group. NMO patients had significant high levels of IgG to MOG (p

  1. Immune system markers of neuroinflammation in patients with clinical diagnose of neuromyelitis optica Marcadores imunológicos em pacientes com diagnóstico de neuromielite óptica

    Directory of Open Access Journals (Sweden)

    Soniza Vieira Alves-Leon

    2008-01-01

    Full Text Available Neuromyelitis optica (NMO is an inflammatory, demyelinating disease of the central nervous system characterized by the association of a serious myelitis and unilateral or bilateral optic neuritis. The present study aimed to analyze the immunological parameters of NMO patients with diagnosis established based on Wingerchuck et al. (1999 criteria. Production of IgG and IgA antibodies to antigens of MBP, PLP 95-116, MOG 92-106, and the cytokines interleukin-4 (IL-4 and interferon-? (INF-? were assessed by Elisa assay. The cohort was formed by 28 NMO patients and a matched healthy control group. NMO patients had significant high levels of IgG to MOG (pA neuromielite óptica (NMO é doença inflamatória do sistema nervoso central, caracterizada por mielite aguda ou subaguda grave e neurite óptica unilateral ou bilateral. Este estudo objetiva analisar parâmetros imunológicos de pacientes com critérios de Wingerchuck et al. (1999 para NMO. O método de ELISA avaliou a produção de IgG e IgA para antígenos da proteína básica da mielina (MBP, o proteolipídeo (PLP 95-116, a glicoproteina associada ao oligodendrócito (MOG 92-106 e as citocinas interleucina-4 (IL-4 e interferon-gama (INF-?. Foram inclu?dos 28 pacientes com NMO pareados com controles saudáveis. Pacientes com NMO apresentaram níveis significativamente elevados de imunoglobulinas reativas dos isotipos IgG para MOG (p<0,0001, PLP (p=0,0002 e MBP (p<0,0001 e IgA somente para MBP (p<0,0001. Os níveis de INF-? (p=0,61 foram semelhantes aos controles. A produção elevada de IL-4 (p=0,0084 indica papel importante na ativação de células regulatórias Th2 e linfócitos B produtores de IgA e da ativação da imunidade humoral.

  2. Different Pathophysiological Phenotypes among Newly Diagnosed Type 2 Diabetes Patients

    DEFF Research Database (Denmark)

    Stidsen, Jacob

    2013-01-01

    Type 2 diabetes (T2D) can be considered a syndrome with several different pathophysiological mechanisms leading to hyperglycemia. Nonetheless, T2D is treated according to algorithms as if it was one disease entity. Methods: We investigated the prevalence of different pathophysiological phenotypes among newly diagnosed T2D patients in Denmark. Based on baseline data from a Danish national cohort study we investigated 1048 incident diagnosed T2D patients. The diagnosis T2D was made by general prac...

  3. [Psychological burden of patients diagnosed with obstructive sleep apnea].

    Science.gov (United States)

    Bratis, D; Tselebis, A; Zafeiropoulos, G; Tsaraklis, A; Dumitru, S; Moussas, G; Kosmas, E; Koutsilieris, M

    2014-01-01

    Obstructive sleep apnea syndrome (OSAS) is characterized by repeated episodes of upper airway obstruction during sleep, which leads to the presence of excessive daytime drowsiness. Regarding the psychological comorbidity in patients diagnosed with OSAS, previous studies focused mainly on depressive and secondarily on anxiety symptoms. Due to the lack of research data regarding the prevalence of anxiety and depressive symptoms as well as of alexithymic characteristics in patients with OSAS in Greece, the aim of the study was to record the above symptomatology in a sample of Greek OSAS patients and to investigate its relation to the respiratory parameter (Apnea-Hypopnea Index, AHI) of polysomnography. The study was conducted in a certified sleep laboratory. Thirty five randomly selected patients who attended the laboratory with symptoms of daytime drowsiness, fatigue, disrupted sleep and snoring, were examined for anxiety, depression and alexithymia using the Spielberger Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI) and the Toronto Alexithymia Scale (TAS-20), respectively, 24 hours prior to being submitted to polysomnography. All 35 patients met the inclusion criteria of the study (age?75 years, no other chronic diseases and no history of major psychiatric disorders). Six patients did not meet the diagnostic criteria for OSAS and were thus used as the control group of the study. A high prevalence of anxiety (41.4%) and depressive (55.2%) symptoms and of alexithymic characteristics (41.4%) was observed in OSAS patients. Although the control group showed a higher prevalence of anxiety (66.7%) and depressive (83.3%) symptoms, there were no differences between the two groups (STAI: t=-0.927, p=0.360, BDI: t=-1.537, p=0.134, TAS-20: t=0.196, p=0.846). With regard to severity, no differences were observed between control, mild, moderate and severe OSAS subgroups (STAI: F=0.583, p=0.660, BDI: F=0.829, p=0.488, TAS-20: F=0.987, p=0.412). Females scored higher on the BDI and on the STAI compared to males (STAI: t=-2.38, p=0.039, BDI: t=-3.59, p=0.01). Finally, no correlation was observed between psychometric scores and AHI (Pearson correlation p>0.05). The study confirms the high prevalence of anxiety and depressive symptoms which has been found in previous studies. Furthermore, we found a high prevalence of alexithymic characteristics, a factor that has not been investigated previously and which is positively correlated with anxiety symptoms. The coexistence of alexithymic characteristics may further complicate the clinical manifestations of OSAS due to the fact that patients with alexithymia typically have difficulty in indentifying and describing their underlying psychological symptomatology and, moreover, tend to exhibit more, and often atypical, physical symptoms. In conclusion, the study supports the presence of a high degree of psychological burden in patients diagnosed with OSAS, regardless of the severity of their symptoms, as determined by the AHI. This comorbidity should be taken into consideration during the clinical assessment of OSAS and for the treatment planning. PMID:25035178

  4. Correlation between clinical and histopathologic diagnoses of potentially malignant oral lesions

    Directory of Open Access Journals (Sweden)

    Bokor-Brati? Marija

    2004-01-01

    Full Text Available BACKGROUND: The serious nature of potentially malignant oral lesions (PMOL demands that the final diagnosis be made on both clinical and histopathologic grounds. The aim of the present study was to determine the correlation between clinical and histopathologic diagnoses of PMOL using a discrepancy index (DI. METHODS: Fifty-one patients with PMOL were examined clinically, and a biopsy was taken from each one. The results of histopathologic diagnosis were compared with the clinical diagnosis. We established that the histopathologic diagnosis was incompatible when the clinical diagnosis was not confirmed. On the basis of the incompatible diagnosis, we calculated a discrepancy index between the clinical and histopathologic diagnosis. RESULTS: Clinically, the homogeneous leukoplakia was the most frequent lesion followed by erosive lichen planus and reticular lichen planus. No cases of erythroplakia were observed. Lesions were most frequently seen at the buccal mucosa, followed by the gingiva (alveolar mucosa and tongue. The histopathologic diagnosis showed that the majority of the lesions were benign keratoses followed by lichen planus. Three cases of epithelial dysplasia were mild. The DI between clinical and histopathologic diagnosis was 17.6 %. The higher DI was found in erosive lichen planus. CONCLUSION: The obtained findings show that in 90% of leukoplakias, clinical diagnosis was confirmed by histopathologic examination. The discrepancy between clinical and histopathologic diagnoses in 17.6 % of cases suggests that all PMOLs should be submitted to histological analysis.

  5. Diagnósticos clínicos al ingreso y al egreso de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos Clinical diagnoses in admission and in discharge of patients admitted to Internal Medicine, Geriatrics and Infection wards

    Directory of Open Access Journals (Sweden)

    Alfredo D Espinosa Brito

    2010-06-01

    Full Text Available A partir de asumir que una coincidencia entre el diagnóstico inicial al ingreso y el definitivo al egreso, refleja alta calidad en el cumplimiento de ese paso esencial del método clínico, se revisaron los resultados de dos series de pacientes hospitalizados en Medicina Interna, Geriatría e Infecciosos, para precisar factores asociados con dicha correspondencia. Se constató total coincidencia en más de las dos terceras partes de los casos, con porcentajes elevados en los más jóvenes, los que tuvieron menor estadía y los que ingresaron en el horario de las guardias. Se destacan los altos valores para enfermedades respiratorias e infecciosas y más bajos para diagnósticos menos precisos, como anemias, síntomas y signos mal definidos y para los ingresados en Geriatría. Se hacen consideraciones sobre el error diagnóstico y la trascendencia de estos resultados para los pacientes y la organización de la atención hospitalaria.The assumption that there is a coincidence between the initial diagnosis at admission and the definite at discharge reflects a high quality in fulfillment of this essential step of clinical method. Results from two series of patients admitted in Internal Medicine, Geriatrics and infectiuos diseases departments were reviewed to specify exactly the factors associated with such correspondence. Authors verified the total coincidence in more than the two third of cases with high percentages in younger, which had a minor stage and those admitted in the medical duty times. Emphasized are the higher values for the respiratory and infectious diseases and lower for fewer accurate diagnoses including anemias, ill-defined symptoms and signs and for those admitted in Geriatrics department. We took into account on the diagnostic error and the importance of these results for patients and the organization of hospital care.

  6. Differences between men with screening-detected versus clinically diagnosed prostate cancers in the USA

    Directory of Open Access Journals (Sweden)

    Stone S Noell

    2005-03-01

    Full Text Available Abstract Background The advent of prostate specific antigen (PSA testing in the United States of America (USA has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers. Methods We evaluated 3,173 men with prostate cancer in the USA. Surveys and medical records provided information on demographics, socioeconomic status, comorbidities, symptoms, tumor characteristics, and treatment. We classified men presenting with symptoms of advanced cancer – bone pain, weight loss, or hematuria – as "clinically diagnosed"; asymptomatic men and those with only lower urinary tract symptoms were considered "screening-detected." We used multivariate analyses to determine whether screening predicted receiving aggressive treatment for a clinically localized cancer. Results We classified 11% of cancers as being clinically diagnosed. Men with screening-detected cancers were more often non-Hispanic white (77% vs. 65%, P Conclusion Most cancers were detected by screening in this American cohort. Appropriately, younger, healthier men were more likely to be diagnosed by screening. Minority status and lower socio-economic status appeared to be screening barriers. Screening detected earlier-stage cancers and was associated with receiving aggressive treatment.

  7. Serum zinc levels in children of 0–24 months diagnosed with pneumonia admitted to our clinic

    OpenAIRE

    Ar?ca, Seçil; Ar?ca, Vefik; Dag, Hüseyin; Kaya, Ay?en; Hatipoglu, Sami; Fenercioglu, Aysen; Karatekin, Güner

    2011-01-01

    Aim: We have planned to study the relationship between zinc (Zn) plasma levels, as well as pneumonia criteria, and zinc in healthy children younger than 2 years of age compared to pediatric patients diagnosed with pneumonia and admitted to a hospital. Materials and methods: The study enrolled 25 patients of 0-24 months referring to our hospital's pediatric clinic, who were then diagnosed with bronchopneumonia based on the World Health Organization diagnostic criteria and admitted to suckling ...

  8. Imaging and clinical follow-up of newborns diagnosed with pyelectasia

    International Nuclear Information System (INIS)

    A prospective, retrospective and descriptive study was conducted in 261 newborns diagnosed with pyelectasia, seen in the Neonatology consultation of the 'Juan Manuel Marquez' Children and University Hospital from 1995 to 2007. The statistical methods used were the absolute frequencies and the percentage figures, mean and quartiles. Also, the ratio difference test was applied. Patients were assessed according clinic and by radioimage studies to specify exactly the cause and course of pyelectasia

  9. The clinical applicability of various radionuclide procedures for diagnosing left ventricular aneurysma

    International Nuclear Information System (INIS)

    The clinical applicability of various radionuclide procedures for diagnosing left ventricular aneurysma was studied. 20 patients in whom aneurisms were suspected to be present by clinical evidence after transmural infarction were involved in the comparative trial. The results suggest that left ventricular aneurysms can be detected with a high measure of sensitivity by combining an analysis of the 8-segment volume curves with that of curves constructed from substraction images. In terms of its diagnostic potential, the radionuclide technique is superior to both resting ECG and echography and thus appears to have a firm place in the noninvasive diagnosis of ventricular aneurisms. (Author)

  10. Whipple's disease in Spain: a clinical review of 91 patients diagnosed between 1947 and 2001 Enfermedad de Whipple en España: Revisión clínica de 91 pacientes diagnosticados durante 1947-2001

    Directory of Open Access Journals (Sweden)

    E. Ojeda

    2010-02-01

    Full Text Available Background: to determine the epidemiological, clinical, diagnostic and therapeutic characteristics of Whipple's disease in Spain. Patients and method: cases of Whipple's disease reported in the Spanish literature between 1947 and 2001 which meet histological or PCR criteria are reviewed. Results: 91 cases were included, 87.5% of which were male. The maximum incidence was between 40 and 60 years of age (68%. There was no family clustering or susceptibility by profession or surroundings. The most common symptoms and signs were: weight loss (80%, diarrhoea (63%, adenopathies (35%, skin problems (32%, abdominal pain (27%, fever (23%, joint problems (20% and neurological problems (16%. Arthralgias, diarrhoea and fever were noted prior to diagnosis in 58, 18 and 13% of patients, respectively. Diagnosis was histological in all cases except two, which were diagnosed by PCR. Intestinal biopsy was positive in 94%. Adenopathic biopsies (mesenteric or peripheral were suggestive in 13% of cases, and treatment was effective in 89%. There were nine relapses, four of which were neurological, although all occurred before the introduction of cotrimoxazole. Conclusions: Whipple's disease is not uncommon, although it requires a high degree of suspicion to be diagnosed in the absence of digestive symptoms. The most common and most sensitive diagnostic method is duodenal biopsy. PCR is beginning to be introduced to confirm the diagnosis and as a therapeutic control. Initial antibiotic treatment with drugs that cross the blood-brain barrier, such as cotrimoxazole and ceftriaxone, is key to achieving a cure and avoiding relapses.Fundamento: conocer las características epidemiológicas, clínicas, diagnósticas y terapéuticas de la enfermedad de Whipple en España. Pacientes y método: se revisan los casos de enfermedad de Whipple de la literatura española que cumplen criterios histológicos o de PCR desde 1947 hasta 2001. Resultados: se incluyeron 91 casos. El 87,5% eran hombres. La incidencia máxima fue entre los 40 y 60 años de edad (68%. No hubo agregación familiar ni preferencia por profesión o entorno ambiental. Los síntomas y signos más habituales fueron: adelgazamiento (80%, diarrea (63%, adenopatías (35%, cutáneos (32%, dolor abdominal (27%, fiebre (23%, articulares (20% y neurológicos (16%. Artralgias, diarrea y fiebre se referían previamente al diagnóstico en el 58, 18 y 13% de los enfermos, respectivamente. El diagnóstico fue histológico en todos salvo en dos que se diagnosticaron por PCR. La biopsia intestinal fue positiva en el 94%. Las biopsias de adenopatías (mesentéricas o periféricas fueron orientadoras en un 13%. El tratamiento fue eficaz en el 89%. Hubo 9 recidivas, 4 neurológicas, estas antes de la introducción del cotrimoxazol. Conclusiones: la enfermedad de Whipple no es tan infrecuente. Se precisa un alto índice de sospecha para diagnosticarla en ausencia de síntomas digestivos. El método diagnóstico más empleado y más sensible es la biopsia duodenal. Se empieza a introducir la técnica de PCR para confirmar el diagnóstico y como control terapéutico. El tratamiento antibiótico inicial con antibióticos que pasan la barrera hematoencefálica como cotrimoxazol y ceftriaxona es determinante para la curación de los pacientes y evitar las recidivas.

  11. Whipple's disease in Spain: a clinical review of 91 patients diagnosed between 1947 and 2001 / Enfermedad de Whipple en España: Revisión clínica de 91 pacientes diagnosticados durante 1947-2001

    Scientific Electronic Library Online (English)

    E., Ojeda; A., Cosme; J., Lapaza; J., Torrado; I., Arruabarrena; L., Alzate.

    2010-02-01

    Full Text Available Fundamento: conocer las características epidemiológicas, clínicas, diagnósticas y terapéuticas de la enfermedad de Whipple en España. Pacientes y método: se revisan los casos de enfermedad de Whipple de la literatura española que cumplen criterios histológicos o de PCR desde 1947 hasta 2001. Resulta [...] dos: se incluyeron 91 casos. El 87,5% eran hombres. La incidencia máxima fue entre los 40 y 60 años de edad (68%). No hubo agregación familiar ni preferencia por profesión o entorno ambiental. Los síntomas y signos más habituales fueron: adelgazamiento (80%), diarrea (63%), adenopatías (35%), cutáneos (32%), dolor abdominal (27%), fiebre (23%), articulares (20%) y neurológicos (16%). Artralgias, diarrea y fiebre se referían previamente al diagnóstico en el 58, 18 y 13% de los enfermos, respectivamente. El diagnóstico fue histológico en todos salvo en dos que se diagnosticaron por PCR. La biopsia intestinal fue positiva en el 94%. Las biopsias de adenopatías (mesentéricas o periféricas) fueron orientadoras en un 13%. El tratamiento fue eficaz en el 89%. Hubo 9 recidivas, 4 neurológicas, estas antes de la introducción del cotrimoxazol. Conclusiones: la enfermedad de Whipple no es tan infrecuente. Se precisa un alto índice de sospecha para diagnosticarla en ausencia de síntomas digestivos. El método diagnóstico más empleado y más sensible es la biopsia duodenal. Se empieza a introducir la técnica de PCR para confirmar el diagnóstico y como control terapéutico. El tratamiento antibiótico inicial con antibióticos que pasan la barrera hematoencefálica como cotrimoxazol y ceftriaxona es determinante para la curación de los pacientes y evitar las recidivas. Abstract in english Background: to determine the epidemiological, clinical, diagnostic and therapeutic characteristics of Whipple's disease in Spain. Patients and method: cases of Whipple's disease reported in the Spanish literature between 1947 and 2001 which meet histological or PCR criteria are reviewed. Results: 91 [...] cases were included, 87.5% of which were male. The maximum incidence was between 40 and 60 years of age (68%). There was no family clustering or susceptibility by profession or surroundings. The most common symptoms and signs were: weight loss (80%), diarrhoea (63%), adenopathies (35%), skin problems (32%), abdominal pain (27%), fever (23%), joint problems (20%) and neurological problems (16%). Arthralgias, diarrhoea and fever were noted prior to diagnosis in 58, 18 and 13% of patients, respectively. Diagnosis was histological in all cases except two, which were diagnosed by PCR. Intestinal biopsy was positive in 94%. Adenopathic biopsies (mesenteric or peripheral) were suggestive in 13% of cases, and treatment was effective in 89%. There were nine relapses, four of which were neurological, although all occurred before the introduction of cotrimoxazole. Conclusions: Whipple's disease is not uncommon, although it requires a high degree of suspicion to be diagnosed in the absence of digestive symptoms. The most common and most sensitive diagnostic method is duodenal biopsy. PCR is beginning to be introduced to confirm the diagnosis and as a therapeutic control. Initial antibiotic treatment with drugs that cross the blood-brain barrier, such as cotrimoxazole and ceftriaxone, is key to achieving a cure and avoiding relapses.

  12. Do all patients with newly diagnosed prostate cancer need staging radionuclide bone scan? a retrospective study

    Scientific Electronic Library Online (English)

    Mohammed A., Al-Ghazo; Ibrahim F., Ghalayini; Rami S., Al-Azab; Ibrahim, Bani-Hani; Alaa, Barham; Yazan, Haddad.

    2010-12-01

    Full Text Available PURPOSE: Define a group of patients with newly diagnosed prostate cancer, whose risk of bone metastasis is low enough to omit a bone scan staging study. MATERIALS AND METHODS: From 2003 to 2009, the medical records of patients who were newly diagnosed with prostate cancer were retrospectively review [...] ed. The data collected included: age, digital rectal examination, serum prostate specific antigen (PSA), Gleason score, clinical T stage, and bone isotope scan. Patients were divided into two groups according to the results of bone isotope scan; positive group and negative group. A univariate and multivariate binary logistic regression was used to analyze the results. RESULTS: Of the 106 patients, 98 had a complete data collection and were entered into the study. The median age of the patients was 70.5 years and patients with a positive bone scan was 74 years, significantly higher than for patients with negative scans (69 years) (p = 0.02). Bone metastasis was detected in 39 cases (39.7%). In all patients with clinical T1-2 stage, a Gleason score of 20 ng/mL) and Gleason score (> 7) were independently predictive of positive bone scan, while clinical stage was not. CONCLUSION: Staging bone scans can be omitted in patients with a PSA level of = 20 ng/mL, and Gleason score

  13. Assessing the accuracy of death records and pre-mortem clinical diagnoses in children diagnosed with brain tumors: A retrospective chart review of children in British Columbia, Canada.

    Science.gov (United States)

    Hasan, Haroon; Hendson, Glenda; Howard, A Fuchsia; Hukin, Juliette; Dunham, Christopher; Ahmed, Tareq; Lo, Andrea C; Goddard, Karen

    2015-10-01

    The advantages of autopsy have been demonstrated in pediatric oncology; however, it is unknown to what extent the utility of autopsy is in deceased children diagnosed with a pediatric brain tumor (PBT). The purpose of this study was to describe the frequency of autopsy, prevalence of clinical discrepancies, and accuracy of cancer registry death records for deceased children diagnosed with a PBT in British Columbia, Canada. A retrospective chart review was performed of medical records and autopsy reports of pediatric patients diagnosed with a PBT that died between 1982 and 2012 in British Columbia. Clinical discrepancies between pre- and post-mortem findings were classified based on a modified classification system of the Goldman Criteria. The overall autopsy rate was 15.5% (32 of 206) during 1982-2012, with a significant (P=0.001) decrease of 22.4% observed between decade 1 (32.8%) and decade 2 (10.4%) and a further slight decrease (4.5%) between decade 2 (10.4%) and decade 3 (5.9%) (P=0.379). A third of patients had discrepancies between pre-mortem and post-mortem clinical diagnoses, with slightly over 10% of these cases revealing information that would have altered the probability of survival had it been known prior to death. More than half (59.3%) of cases had discordant cause of death as recorded in the cancer registry when compared to autopsy findings. Autopsy for children diagnosed with a PBT can provide health care professionals with important information about the accuracy of their diagnoses and evaluate the efficacy of therapy. PMID:26342938

  14. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2012-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based on five validation criteria applied on the ten most common crops. Quality of advice was assessed for the four major problems considering efficacy and f...

  15. [Alternative clinical-chemical laboratories: providers of incorrect or non-existant diagnoses].

    Science.gov (United States)

    Renckens, C N M

    2007-12-22

    Until recently, alternative doctors and healers used to employ alternative ways of making their alternative diagnoses such as electro-acupuncture, iridiscopy, plantar reflexology, live blood analysis, aura reading and bioresonance methods. Two recent papers report the emergence of unjustified diagnoses, resulting from clinical chemistry testing in commercial laboratories with an alternative philosophy and character. Dutch law considers medicine to be a profession for which no special knowledge is demanded. Even incorrect diagnostic procedures and the diagnosis of non-existent diseases by these laboratories is not illegal, in spite of the resulting detrimental effects to the health and the purse of patients. Some would consider the Dutch law in this respect too liberal. PMID:18237047

  16. PREVALENCE OF DIABETIC RETINOPATHY IN PATIENTS WITH NEWLY DIAGNOSED TYPE II DIABETES MELLITUS

    Directory of Open Access Journals (Sweden)

    A. Bostak

    2006-11-01

    Full Text Available Diabetic retinopathy is a common complication of type II diabetes mellitus and carries with it the threat of blindness. Accurate information regarding the incidence of diabetic retinopathy and associated risk factors is important in the prevention of its development and of the visual impairment caused by this complication. This study was designed to determine the prevalence of diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus. We have also evaluated the association of diabetic retinopathy with clinical and biochemical variables. In a cross-sectional study, 152 consecutive patients with newly diagnosed type II diabetes mellitus were referred from two outpatient clinics in Tehran for ophthalmologic exam to detect retinopathy. Indirect ophthalmoscopy was performed and data regarding risk factors were extracted from routine medical records. Chi square and Mann Whitney U tests were used to analyze the data. The overall prevalence of diabetic retinopathy was 13.8 %( 21 cases: three cases with microaneurysm only, 10 with mild, 5 with moderate and 2 with severe non proliferative diabetic retinopathy. Only one patient had advanced proliferative retinopathy. The prevalence of diabetic retinopathy was positively associated with age, duration of disease, fasting plasma glucose, HbA1c, and systolic blood pressure. Diabetic retinopathy is common in newly diagnosed type II diabetes mellitus patients. Ophthalmologic consultation is essential at the time of diagnosis for all patients.

  17. Diagnosing Borderline Personality Disorder: Examination of How Clinical Indicators Are Used by Professionals in the Health Setting

    Science.gov (United States)

    Treloar, Amanda Jane Commons; Lewis, Andrew J.

    2009-01-01

    This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…

  18. Effect of Buteyko breathing exercise in newly diagnosed asthmatic patients

    Directory of Open Access Journals (Sweden)

    KB Prasanna

    2015-01-01

    Full Text Available Introduction: Asthma is a chronic inflammatory disease of the airways and is on the increasing trend owing to air pollution and urbanization. The use of alternative ways of treatment that are as efficacious as the standard treatment is the need of the hour. This study was conducted to study the effects of Buteyko breathing exercise on the newly diagnosed asthmatic patients. Materials and Methods: Totally, 100 newly diagnosed asthmatic patients attending Tagore Medical college out-patient department were randomly allocated into the interventional and the control group for a period of 2 months. The former were taught Buteyko breathing exercise while the control group was on standard asthma treatment. The effects were assessed using a pretested close ended Asthma Control Questionnaire and Pulmonary Function Tests. The results were given in mean with a standard deviation. Chi-square test was done to compare the results between the two groups and P < 0.05 is taken as significant. The analysis was done by SPSS software version 13. Results: Among the 100 participants, majority of the participants were in the age group of 31-40 years. It was observed that there was an overall subjective improvement of asthma symptoms among the interventional group at the end of 2 months (which was statistically significant when compared to the control group. Also, there was an improvement in the pulmonary function in terms of peak expiratory flow rate in both the groups. Conclusions: The results of this study support the effectiveness of Buteyko breathing exercise over the standard treatment in the newly diagnosed asthmatic patients.

  19. Clinical value of MRI and acute madopar responsiveness test in diagnosing progressive supranuclear palsy

    Directory of Open Access Journals (Sweden)

    LI Xiao-hong

    2013-07-01

    Full Text Available Objective To investigate the MRI abnormalities and acute madopar responsiveness test in diagnosing progressive supranuclear palsy (PSP and Parkinson's disease (PD. Methods Seventeen patients with PSP and 17 gender and age matched patients with PD were studied with cranial MRI examinations and results of acute madopar responsiveness test, and the clinical manifestations of PSP were summarized. Results The atrophy of the midbrain tegmentum and hummingbird sign was demonstrated in all of the PSP patients in our study, but was not observed in the PD patients. The areas of the midbrain on mid-sagittal MRI in PSP patients [(77.35 ± 15.30 mm2] were significantly smaller than that in those with PD [(142.35 ± 31.49 mm2]. The average ratio of the area of the midbrain to the area of pons in the patients with PSP [(14.31 ± 2.47%] was significantly smaller than that in those with PD [(24.08 ± 4.73%; P = 0.000, for all]. According to the result of acute madopar responsiveness test, the maximum Unified Parkinson's Disease Rating Scale (UPDRS ? improvement rate of 2 patients with PSP and 16 patients with PD was more than 30? (?2 = 23.142, P = 0.000. Conclusion The assessment of the mid-sagittal MRI and acute madopar responsiveness test may be a useful method to differentiate PSP from PD.

  20. Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis

    DEFF Research Database (Denmark)

    Jørgensen, Terese Sara Høj; Torp-Pedersen, Christian; Gislason, Gunnar H.; Andersson, Charlotte; Holm, Ellen

    2015-01-01

    BACKGROUND: Centralization of specialized health care in Denmark has caused increased geographical distance to health-care providers, which may be a barrier for Alzheimer patients to seek health care. We examined the incidence of Alzheimer diagnosis in Denmark between 2000 and 2009 and investigated the association between patients' distance to Alzheimer clinics and Alzheimer diagnoses. METHODS: Data of all individuals aged 65+ years were collected from Danish national registers. Incidences of Al...

  1. Risk of disability pension for patients diagnosed with haematological malignancies : a register-based cohort study

    DEFF Research Database (Denmark)

    Horsboel, Trine A; Nielsen, Claus V

    2014-01-01

    UNLABELLED: Patients with haematological malignancies are at increased risk of experiencing work-related problems. The aims of this study were to compare the risk of disability pension (DP) among patients diagnosed with eight subtypes of haematological malignancies to a reference cohort, and to determine if relative risks differ between these subtypes; to evaluate the influence of socioeconomic factors, demographic factors, and clinical factors on the risk of DP; and to investigate if these associations differ between the reference cohort and the patient cohort. MATERIAL AND METHODS: We combined data from national registers on Danish patients diagnosed with haematological malignancies between 2000 and 2007 and a reference cohort without a history of these diseases. A total of 3194 patients and 28 627 reference individuals were followed until DP, emigration, old age pension or anticipatory pension, death or 26 February 2012, whichever came first. RESULTS: A total of 550 (17%) patients and 1511 (5%) referenceindividuals were granted DP. Age- and gender-adjusted relative risks differed significantly between the subgroups of haematological malignancies and ranged from 2.64 (95% CI 1.84-3.78) for patients with Hodgkin lymphoma to 12.53 (95% CI 10.57-14.85) for patients with multiple myeloma. In the patient cohort we found that gender, age, comorbidity, ethnicity, educational level, household income, history of long-term sick leave, and need of treatment with anxiolytics or antidepressants after diagnosis were associated with receiving DP. However, most of these associations were stronger in the reference cohort. CONCLUSION: All eight subtypes of haematological malignancies were associated with an increased risk of DP compared to the reference cohort. The relative risks differed according to subtype, and patients with multiple myeloma had the highest risk of DP. Furthermore, most socioeconomic, demographic and clinical factors had a stronger impact on the risk of DP in the reference cohort than in the patient cohort.

  2. Diagnósticos de enfermagem em clínica cirúrgica / Nursing diagnoses in surgical clinic

    Scientific Electronic Library Online (English)

    Elisiane Soares, Novaes; Maricy Morbin, Torres; Ana Paula Vilcinski, Oliva.

    2015-02-01

    Full Text Available Objetivo Identificar a frequência dos diagnósticos de enfermagem em pacientes de clínica cirúrgica. Métodos Estudo transversal, descritivo e exploratório, de abordagem quantitativa, com dados referentes a 28 pacientes. O instrumento de coleta de dados foi desenvolvido pelos pesquisadores, com base e [...] m padrões funcionais de saúde. Resultados Foram encontrados 301 diagnósticos de enfermagem, com média de 12 por paciente. Somente quatro diagnósticos apresentaram frequência acima de 50%. Os mais frequentes foram: “risco de infecção”, “integridade da pele/tissular prejudicada”, “disposição para bem-estar espiritual”, “disfunção sexual” e “padrão do sono perturbado”. Diagnósticos que se enquadram no domínio 13 (Crescimento/Desenvolvimento) não foram documentados nesta amostra. Conclusão Os achados demostraram ampla variedade de diagnósticos na população estudada, reflexo da diversidade de cuidados a serem prestados. A identificação das necessidades de cuidados favorece a implantação de intervenções específicas, contribuindo para a qualidade da assistência de enfermagem. Abstract in english Objective To identify the frequency of nursing diagnosis in patients in surgical clinic. Methods A transverse, descriptive and exploratory study of quantitative approach, with data referring to 28 patients. The data collection instrument was developed by the researchers based on health functional pa [...] tterns. Results In total, 301 nursing diagnosis were found, with an average of 12 per patient. Only four diagnoses showed frequency above 50 percent. The most frequent were ‘risk for infection’, ‘impaired skin/tissue integrity’, ‘readiness for enhanced spiritual well-being’, ‘sexual dysfunction’ and ‘disturbed sleep pattern’. The diagnoses that fit in domain 13 (Growth/Development) were not documented in this sample. Conclusion The findings demonstrated a wide variety of diagnoses in the study population, a reflex of the diversity of care provided. Identifying the care needs favors the implantation of specific interventions, contributing to the quality of nursing assistance.

  3. Complex dental anomalies in a belatedly diagnosed cleidocranial dysplasia patient

    International Nuclear Information System (INIS)

    Cleidocranial dysplasia (CCD) is a rare congenital disorder, typically characterized by persistently open skull sutures, aplastic or hypoplastic clavicles, and supernumerary teeth. Mutations in the gene encoding the runt-related transcription factor 2 (RUNX2) protein are responsible for approximately two thirds of CCD patients. We report a 20-year-old CCD patient presenting not only with typical skeletal changes, but also complex dental anomalies. A previously undiagnosed odontoma, 14 supernumerary teeth, a cystic lesion, and previously unreported fused primary teeth were discovered on cone-beam computed tomography (CBCT) scans. Mutation analysis identified the causal c.578G>A (p.R193Q) mutation in the RUNX2 gene. At 20 years of age, the patient had already missed the optimal period for dental intervention. This report describes the complex dental anomalies in a belatedly diagnosed CCD patient, and emphasizes the significance of CBCT assessment for the detection of dental anomalies and the importance of early treatment to achieve good outcomes

  4. [Effects of stepped counseling intervention on quality of life among newly diagnosed HIV-positive patients].

    Science.gov (United States)

    Hsiao, Ching-Fang; Chao, Shu-Ling; Tsai, Tsui-Ching; Chuang, Peing

    2004-04-01

    The purpose of this research was to understand how stepped counseling intervention affects quality of life in newly diagnosed HIV-positive patients. The study made use of quasi-experimental methodology that included a three-step interview process over 45 days. The theoretical framework supporting interviews with 32 newly diagnosed HIV-positive patients in northern Taiwan included a combination of rational-emotive therapy, cognitive-behavior therapy, and health education. Participants were divided into an experimental and control group of equal size. Data collection also included responses to the WHOQOL-HIV instrument at the beginning and end of each interview session. Responses were analyzed with the SPSS software package. The results showed a 25-point difference between pre- and post-test scores in the experimental group (SD = 3.2) and a 6 point difference in the control group (SD = 4.3). The results indicate that stepped counseling techniques are effective in helping this patient population to adjust to the physical, emotional, social, and environmental stresses associated with their newly diagnosis. The researchers suggest that stepped counseling be used with all newly diagnosed HIV-positive Taiwanese patients in all hospitals and clinics to promote adaptive abilities and to control the further spread of HIV. PMID:15137184

  5. Value of polymerase chain reaction in patients with presumptively diagnosed and treated as tuberculous pericardial effusion

    International Nuclear Information System (INIS)

    Objective: To know the sensitivity of polymerase chain reaction (PCR) in pericardial fluid and response to antituberculous treatment (ATT) in PCR positive patients who were presumptively diagnosed and treated as tuberculous pericardial effusion. Methodology: This was a descriptive cross sectional study carried out from June 1, 2009 to 31 May 2010 at Cardiology Department, Lady Reading Hospital, Peshawar. Patients with presumptive diagnosis and receiving treatment for tuberculous pericardial effusion were included. Pericardial fluid sample was aspirated under fluoroscopy for the routine work up. The specimens were subjected to PCR detection of mycobacterium tuberculous DNA. Results: During 12 month study period, a total of 54 patients with large pericardial effusion presented to Cardiology department, Lady Reading Hospital, Peshawar. Of them, 46 patients fulfilled the criteria for presumptive diagnosis of tuberculous pericardial effusion. PCR for mycobacterium tuberculous DNA in pericardial fluid was positive in 45.7%(21). Patients were followed for three months. In PCR positive group, 01 patient while in PCR negative group 3 patients were lost to follow up. Among PCR positive patients 17(85%) while in PCR negative group 11(47.82%) patient responded to ATT both clinically and echo-cardio graphically. We found that patients who were PCR positive responded better to therapy than those who were PCR negative and this finding was statistically significant (p=0.035). Conclusion: PCR, with all its limitations, is potentially a useful diagnostic test in patients with presumptively diagnosed tuberculous pericardial effusion. A PCR positive patient responds better to therapy as compared to PCR negative patient. (author)

  6. Frecuencia y características clínicas de la orbitopatía asociada al tiroides en pacientes hipertiroideos de reciente diagnóstico / Frequency and clinical characteristics of thyroid-associated orbitopathy in recently diagnosed hyperthyroid patients

    Scientific Electronic Library Online (English)

    Marelis, Yanes Quesada; Lisette, Leal Curi; Ileydis, Iglesias Marichal; Lisbet, Rodríguez Fernández; Juana Elvira, Maciques Rodríguez.

    2013-12-01

    Full Text Available Introducción: la orbitopatía asociada al tiroides es una complicación frecuente del hipertiroidismo. Objetivo: describir la frecuencia y características de la orbitopatía asociada a la enfermedad autoinmune del tiroides, en pacientes con diagnóstico reciente de hipertiroidismo. Métodos: estudio desc [...] riptivo transversal. A cada caso se le determinó al diagnóstico hormonas tiroideas, y anticuerpos antiperoxidasa. Se examinaron al diagnóstico para evaluar la presencia de orbitopatía, y se identificaron los síntomas y signos oculares presentes en los que la presentaron. Se compararon los resultados a través de estadística descriptiva, utilizando chi². La significación estadística fue para una p Abstract in english Introduction: thyroid-associated orbitopathy is a frequent complication of hyperthyroidism. Objective: to describe the frequency and the characteristics of orbitopathy related to autoimmune disease of thyroids in patients who were recently diagnosed as hyperthyroidism cases. Methods: cross-sectional [...] descriptive study. Every case was detected thyroid hormones and antiperoxidase antibodies at time of diagnosis. They were examined to evaluate the possible presence of orbitopathy whose ocular symptoms and signs were identified in those who had it. The comparison of results was made through summary statistics by using chi-square test. The statistical significance was p

  7. Consistency between Research and Clinical Diagnoses of Autism among Boys and Girls with Fragile X Syndrome

    Science.gov (United States)

    Klusek, J.; Martin, G. E.; Losh, M.

    2014-01-01

    Background: Prior research suggests that 60-74% of males and 16-45% of females with fragile X syndrome (FXS) meet criteria for autism spectrum disorder (ASD) in research settings. However, relatively little is known about the rates of clinical diagnoses in FXS and whether such diagnoses are consistent with those performed in a research setting…

  8. Indicators of distress in newly diagnosed breast cancer patients.

    Science.gov (United States)

    Chirico, Andrea; Lucidi, Fabio; Mallia, Luca; D'Aiuto, Massimiliano; Merluzzi, Thomas V

    2015-01-01

    Background. The diagnosis, treatment, and long-term management of cancer can present individuals with a multitude of stressors at various points in that trajectory. Psychosocial distress may appear early in the diagnostic process and have negative effects on compliance with treatment and subsequent quality of life. Purpose. The aim of the study was to determine early-phase predictors of distress before any medical treatment. Method. Consistent with the goals of the study, 123 newly diagnosed breast cancer patients (20 to 74 years old) completed multiple indicators of knowledge about breast cancer management and treatment, attitudes toward cancer, social support, coping efficacy, and distress. Results. SEM analysis confirmed the hypothesized model. Age was negatively associated with the patient's knowledge (? = - 0.22), which, in turn, was positively associated with both attitudes toward breast cancer (? = 0.39) and coping self-efficacy (? = 0.36). Self-efficacy was then directly related to psychological distress (? = - 0.68). Conclusions. These findings establish indicators of distress in patients early in the cancer trajectory. From a practical perspective, our results have implications for screening for distress and for the development of early interventions that may be followed by healthcare professionals to reduce psychological distress. PMID:26244115

  9. Depression in patients with HIV is under-diagnosed: a cross-sectional study in Denmark

    DEFF Research Database (Denmark)

    Rodkjaer, L; Laursen, T

    2009-01-01

    Background International studies suggesting that 20-37% of HIV-positive patients have diagnosable depression may underestimate the prevalence of this condition. The aim of this study was to investigate the prevalence of depression among HIV-positive patients in an out-patient clinic in Denmark and to detect factors of importance for the development of depression. Methods In 2005, a population of 205 HIV-positive patients was included in a questionnaire-based study. The Beck Depression Inventory II (BDI-II) was used to assess the prevalence and severity of depressive symptoms. Patients with a BDI score of 20 or above were offered a clinical evaluation by a consultant psychiatrist. Results Symptoms of depression (BDI>14) were observed in 77 (38%) patients and symptoms of major depression (BDI>/=20) in 53 (26%). Eighteen patients subsequently started treatment with anti-depressants. In a reduced logistic regression model, self-reported stress, loneliness, constant thoughts about HIV and being in a difficult financial situation were associated with risk of depression. Patients at risk of major depression were nearly six times more likely to have missed at least one dose of highly active antiretroviral therapy (HAART) in the 4 days prior to assessment (odds ratio 5.7, 95% confidence interval 1.7-18.6). There was a dose-response trend in relation to unsafe sex (P=0.03). Conclusions The study found that depression was under-diagnosed among HIV-positive patients and was associated with stress, loneliness, a difficult financial situation, low adherence and unsafe sex. Screening for depression should be conducted regularly to provide full evaluation and relevant psychiatric treatment. This is particularly important at the time of diagnosis and before initiating HAART.

  10. Quality of venous thromboembolism diagnoses among prostate cancer patients in the Danish National Registry of Patients

    DEFF Research Database (Denmark)

    Drljevic, Aska; Borre, Michael

    2014-01-01

    BACKGROUND AND AIM: It is well established that cancer patients have an increased risk of venous thromboembolism (VTE). However, no previous study has examined the quality of VTE diagnoses related to cancer patients in the Danish National Registry of Patients (DNRP). To support future studies on cancer and risk of VTE, this study aimed to estimate the positive predictive value (PPV) of VTE diagnoses among prostate cancer (PC) patients registered in the DNRP. MATERIALS AND METHODS: We conducted a validation study using data from hospitals within the Central Denmark Region, which covers a population of 1.3 million people. Using the DNRP, we identified a total of 120 PC patients registered with VTE within the period 1995-2012. We also identified a random sample of 120 PC patients with no VTE registration within the same period. Therefore, a total of 240 patients were selected for medical chart review. We compared data from the DNRP to data collected from medical record review (ie, reference standard). We then computed PPV, sensitivity, and specificity with corresponding 95% confidence intervals (CIs) using the Jeffreys method. RESULTS: The final study sample included 232 PC patients, of which 115 were registered with VTE and 117 had no registration of VTE in the DNRP. We found the overall PPV of VTE diagnoses in the DNRP to be 86.1% (95% CI 78.9%-91.5%). Sensitivity was 98.0% (95% CI 93.8%-99.6%), and specificity was 87.8% (95% CI 81.4%-92.6%). We also found the PPV of incident PC diagnoses in the DNRP to be 98.3% (95% CI 96.1%-99.4%). CONCLUSION: For PC patients, the registration of VTE diagnoses in the DNRP is associated with a high PPV. We provide evidence that data from the DNRP are valid for studies on risk of VTE among cancer patients.

  11. Using clinical signs to diagnose anaemia in African children.

    OpenAIRE

    Luby, S. P.; Kazembe, P.N.; Redd, S. C.; Ziba, C.; Nwanyanwu, O. C.; Hightower, A. W.; Franco, C.; Chitsulo, L.; Wirima, J J; Olivar, M. A.

    1995-01-01

    Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of ...

  12. Infecciones parasitarias en el paciente infectado por el virus de la inmunodeficiencia humana: Aspectos etiológicos, clínicos, diagnósticos, terapéuticos y profilaxis / Parasitic infections in the infected patient for the human immunodeficiency virus: Ethiological, clinical, diagnoses, therpeutic and prevention aspects

    Scientific Electronic Library Online (English)

    RE, Andrade Pineda; MJ, Marcano Lozada.

    2003-07-01

    Full Text Available El diagnóstico de las infecciones parasitarias en los pacientes infectados por el virus de la inmunodeficiencia humana (VIH) es de crucial importancia, y debe ser realizado de manera razonada, en lugar de ser un hallazgo de exclusión o sugerido por fracasos terapéuticos contra bacterias y hongos. En [...] este artículo se abordan varias parasitosis desde los puntos de vista epidemiológico, clínico, diagnóstico, terapéutico y de prevención, haciendo énfasis en la microsporidiosis y coccidiosis, además de la toxoplasmosis. Es necesario recordar que la infección VIH/SIDA cambia la presentación clínica de las parasitosis y altera su diagnóstico por la debacle inmunológica general, al igual que sus respuestas terapéuticas, por lo cual es necesario para el médico tener siempre presentes estos agentes en el momento de tratar a un paciente seropositivo para VIH. Abstract in english The diagnosis of parasitic infections in patients infected by human immunodeficiency virus (HIV) it is of main importance, and it should be carried out in a reasoned way, instead of being an exclusion discovery or suggested by therapeutic failures against bacterial and micotic agents. In this articl [...] e, several parasitic infections is approached from different points of viw as epidemic, clinical manifestations, diagnosis criteria, therapeutic and prevention, making emphasis in microsporidiosis and coccidiosis, besides toxoplasmosis. It is necessary to remember that the HIV/AIDS infection changes the clinical presentation of parasitic infections, it alters its diagnosis for the immunologic failure the same as its therapeutic answers, reason why is necessary for the physicians to always have present these agents in the moment to face a seropositive patient for HIV infection.

  13. MRI evaluation of the contralateral breast in patients with recently diagnosed breast cancer

    Directory of Open Access Journals (Sweden)

    Sangeeta Taneja

    2012-01-01

    Full Text Available Introduction: Contralateral breast cancer can be synchronous and/or metachronous in patients with cancer of one breast. Detection of a synchronous breast cancer may affect patient management. Dynamic contrast-enhanced MRI of the breast (DCE-MRI is a sensitive technique for detecting contralateral lesions occult on the other imaging modalities in women already diagnosed with cancer of one breast. Aim: The aim was to assess the incidence of mammographically occult synchronous contralateral breast cancer in patients undergoing MRI mammography for the evaluation of a malignant breast lesion. Materials and Methods: A total of 294 patients with recently diagnosed breast cancer who underwent MRI of the breast were evaluated for lesions in the opposite breast. Results: The incidence of synchronous contralateral malignancy detected by preoperative MRI mammography done for evaluation of extent of disease was 4.1%. Conclusion: Preoperative breast MRI may detect clinically and mammographically occult synchronous contralateral cancer, and can help the patient avoid an additional second surgery or a second course of chemotherapy later; also, as theoretically these lesions are smaller, there may be a survival benefit as well.

  14. POLD1 Germline Mutations in Patients Initially Diagnosed with Werner Syndrome.

    Science.gov (United States)

    Lessel, Davor; Hisama, Fuki M; Szakszon, Katalin; Saha, Bidisha; Sanjuanelo, Alexander Barrios; Salbert, Bonnie A; Steele, Pamela D; Baldwin, Jennifer; Brown, W Ted; Piussan, Charles; Plauchu, Henri; Szilvássy, Judit; Horkay, Edit; Högel, Josef; Martin, George M; Herr, Alan J; Oshima, Junko; Kubisch, Christian

    2015-11-01

    Segmental progeroid syndromes are rare, heterogeneous disorders characterized by signs of premature aging affecting more than one tissue or organ. A prototypic example is the Werner syndrome (WS), caused by biallelic germline mutations in the Werner helicase gene (WRN). While heterozygous lamin A/C (LMNA) mutations are found in a few nonclassical cases of WS, another 10%-15% of patients initially diagnosed with WS do not have mutations in WRN or LMNA. Germline POLD1 mutations were recently reported in five patients with another segmental progeroid disorder: mandibular hypoplasia, deafness, progeroid features syndrome. Here, we describe eight additional patients with heterozygous POLD1 mutations, thereby substantially expanding the characterization of this new example of segmental progeroid disorders. First, we identified POLD1 mutations in patients initially diagnosed with WS. Second, we describe POLD1 mutation carriers without clinically relevant hearing impairment or mandibular underdevelopment, both previously thought to represent obligate diagnostic features. These patients also exhibit a lower incidence of metabolic abnormalities and joint contractures. Third, we document postnatal short stature and premature greying/loss of hair in POLD1 mutation carriers. We conclude that POLD1 germline mutations can result in a variably expressed and probably underdiagnosed segmental progeroid syndrome. PMID:26172944

  15. Acute porphyrias: clinical spectrum of hodpitalized patients

    International Nuclear Information System (INIS)

    To determine characteristics, clinical features and triggers of acute porphyria in hospitalized patients presenting to a tertiary care center in Pakistan. Case records of 26 patients hospitalized with diagnosis were identified through computerized hospital patients data. The diagnosis of acute porphyria was based on pertinent clinical features and laboratory investigations after exclusion of other alternative diagnosis and patients previously diagnosed as porphyric. The data was analyzed through SPSS software version 11.0. Twelve patients (46.2%) were males. Mean age was 21 years. Most common manifestation were gastrointestinal (n=22; 88.5%) followed by neurological symptoms (n=14; 54%). Neurological manifestations included seizures (n=9; 34.6%) and neuropathy (n=6; 23%). One patient presented with depression and insomnia. Family history was positive in (n=8; 30.8%). Eighteen (69%) had history of previous attacks at their presentation to the hospital. Most common precipitating factor was eating outside (n=18; 69%). Porphyrias are uncommon and cryptic group of diseases. This study shows a slightly different gender distribution, earlier onset of symptoms, higher number of neuropsychiatric symptoms (especially seizures), more distal neuropathies and different precipitant in the studied subset of patients than described previously in the western studies. (author)

  16. Aromatic L-amino acid decarboxylase deficiency diagnosed by clinical metabolomic profiling of plasma.

    Science.gov (United States)

    Atwal, Paldeep S; Donti, Taraka R; Cardon, Aaron L; Bacino, C A; Sun, Qin; Emrick, L; Reid Sutton, V; Elsea, Sarah H

    2015-01-01

    Aromatic L-amino acid decarboxylase (AADC) deficiency is an inborn error of metabolism affecting the biosynthesis of serotonin, dopamine, and catecholamines. We report a case of AADC deficiency that was detected using the Global MAPS platform. This is a novel platform that allows for parallel clinical testing of hundreds of metabolites in a single plasma specimen. It uses a state-of-the-art mass spectrometry platform, and the resulting spectra are compared against a library of ~2500 metabolites. Our patient is now a 4 year old boy initially seen at 11 months of age for developmental delay and hypotonia. Multiple tests had not yielded a diagnosis until exome sequencing revealed compound heterozygous variants of uncertain significance (VUS), c.286G>A (p.G96R) and c.260C>T (p.P87L) in the DDC gene, causal for AADC deficiency. CSF neurotransmitter analysis confirmed the diagnosis with elevated 3-methoxytyrosine (3-O-methyldopa). Metabolomic profiling was performed on plasma and revealed marked elevation in 3-methoxytyrosine (Z-score +6.1) consistent with the diagnosis of AADC deficiency. These results demonstrate that the Global MAPS platform is able to diagnose AADC deficiency from plasma. In summary, we report a novel and less invasive approach to diagnose AADC deficiency using plasma metabolomic profiling. PMID:25956449

  17. Clinical Impact of the KL-6 Concentration of Pancreatic Juice for Diagnosing Pancreatic Masses.

    Science.gov (United States)

    Matsumoto, Kazuya; Takeda, Yohei; Harada, Kenichi; Onoyama, Takumi; Kawata, Soichiro; Horie, Yasushi; Sakamoto, Teruhisa; Ueki, Masaru; Miura, Norimasa; Murawaki, Yoshikazu

    2015-01-01

    Background and Aim. Pancreatic juice cytology (PJC) is considered optimal for differentially diagnosing pancreatic masses, but the accuracy of PJC ranges from 46.7% to 93.0%. The aim of this study was to evaluate the clinical impact of measuring the KL-6 concentration of pancreatic juice for diagnosing pancreatic masses. Methods. PJC and the KL-6 concentration measurements of pancreatic juice were performed for 70 consecutive patients with pancreatic masses (39 malignancies and 31 benign). Results. The average KL-6 concentration of pancreatic juice was significantly higher for pancreatic ductal adenocarcinomas (PDACs) (167.7 ± 396.1?U/mL) and intraductal papillary mucinous carcinomas (IPMCs) (86.9 ± 21.1?U/mL) than for pancreatic inflammatory lesions (17.5 ± 15.7?U/mL, P = 0.034) and intraductal papillary mucinous neoplasms (14.4 ± 2.0?U/mL, P = 0.026), respectively. When the cut-off level of the KL-6 concentration of pancreatic juice was 16?U/mL, the sensitivity, specificity, and accuracy of the KL-6 concentration of pancreatic juice alone were 79.5%, 64.5%, and 72.9%, respectively. Adding the KL-6 concentration of pancreatic juice to PJC when making a diagnosis caused the values of sensitivity and accuracy of PJC to increase by 15.3% (P = 0.025) and 8.5% (P = 0.048), respectively. Conclusions. The KL-6 concentration of pancreatic juice may be as useful as PJC for diagnosing PDACs. PMID:26451373

  18. Association among nursing diagnoses, demographic variables, and clinical characteristics of patients with high blood pressure Asociación entre diagnósticos de enfermería y variables sociales/clinicas en pacientes hipertensos Associação entre diagnósticos de enfermagem e variáveis sociais/clínicas em pacientes hipertensos

    Directory of Open Access Journals (Sweden)

    Francisca de Fátima Vasconcelos

    2007-09-01

    Full Text Available OBJECTIVES: To analyze the association among diagnoses, demographic variables, and clinical characteristics of patients with high blood pressure. METHODS: The data were collected in 67 patients from a primary care unit in Fortaleza, Brazil. The NANDA Taxonomy was used to determine the nursing diagnoses. Data analysis consisted of Fisher's exact test, Chi-square test, and likelihood ratio test. RESULTS: Fifty four nursing diagnoses were identified; fifteen were above the 75th percentile. Ineffective individual therapeutic regimen management and number of medication, sleep pattern disturbance and marital status, activity intolerance and education, activity intolerance and time of diagnoses, sexual dysfunction and gender, sexual dysfunction and education, risk for falls and age, marital status and time of diagnoses, chronic pain and marital status all had significant association coefficients. CONCLUSION: Some demographic characteristics were associated with nursing diagnoses.OBJETIVO: Analizar la asociación estadística entre diagnósticos y características sociales / clínicas de pacientes hipertensos. MÉTODOS: Los datos fueron recolectados en una unidad básica de salud de Fortaleza-Ceará con 67 pacientes. La identificación de los diagnósticos se llevó a cabo según la taxonomía de la NANDA. Para el análisis de los datos se utilizó test de Fisher, Chi-Cuadrado de Pearson y Razón de Verosemejanza. RESULTADOS: Se encontró 54 diagnósticos de enfermería y 15 sobre el percentil 75. Se verificó asociación estadística entre: Control eficaz del régimen terapéutico y número de medicamentos; Patrón de sueño perturbado y estado civil; Intolerancia a la actividad y escolaridad y años de diagnóstico; Disfunción sexual y sexo y escolaridad; Riesgo para caídas y edad, estado civil y tiempo de diagnóstico de la enfermedad; Dolor crónico y estado civil. CONCLUSIÓN: Algunas características demográficas están asociadas a la ocurrencia de diagnósticos de enfermería.OBJETIVO: Analisar a associação estatística entre diagnósticos e características sociais / clínicas de pacientes hipertensos. MÉTODOS: Os dados foram coletados numa unidade básica de saúde de Fortaleza-Ce com 67 pacientes. A identificação dos diagnósticos foi procedida segundo a taxonomia da NANDA. Para análise dos dados utilizou-se testes de Fisher, Qui-Quadrado de Pearson e Razão de Verossimilhança. RESULTADOS: Encontrou-se 54 diagnósticos de enfermagem e 15 acima do percentil 75. Verificou-se associação estatística entre: Controle eficaz do regime terapêutico e número de medicamentos; Padrão de sono perturbado e estado civil; Intolerância à atividade e escolaridade e anos de diagnóstico; Disfunção sexual e sexo e escolaridade; Risco para quedas e idade, estado civil e tempo de diagnóstico da doença; Dor crônica e estado civil. CONCLUSÃO: Algumas características demográficas estão associadas à ocorrência de diagnósticos de enfermagem.

  19. Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis

    Scientific Electronic Library Online (English)

    Jun, Wang; Yongmei, Yin; Xuedong, Wang; Hao, Pei; Shougang, Kuai; Lan, Gu; Huiqin, Xing; Yu, Zhang; Qiusheng, Huang; Bin, Guan.

    2015-04-01

    Full Text Available Objective: The ratio of monocytes to lymphocytes in peripheral blood could re?ect an indi- vidual's immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes and clinical status of patients with active tuberculosis [...] . Methods: This was a retrospective review of data collected from the clinical database of The Fifth People's Hospital of Wuxi, Medical College of Jiangnan University. A total of 419 patients who had newly diagnosed active tuberculosis and 108 cases from 419 patients with tuberculosis therapy either near completion or completed were selected. Controls were 327 healthy donors. Results: Median ratio of monocytes to lymphocytes was 0.36 (IQR, 0.22-0.54) in patients before treatment, and 0.16 (IQR, 0.12-0.20) in controls (p 25% was signi?cant predictors for active tuberculosis (OR = 114.73, 95% CI, 39.80-330.71; OR = 89.81, 95% CI, 53.18-151.68, respectively). After treatment, the median ratio of monocytes to lymphocytes recovered to be nearly normal. Compared to other patients, patients with extrapulmonary tuberculosis and of age >60 years were more likely to have extreme ratio of monocytes to lymphocytes (AOR = 2.57, 95% CI, 1.08-6.09; AOR = 4.36, 95% CI, 1.43-13.29, respectively). Conclusions: Ratio of monocytes to lymphocytes 25% is predictive of active tuberculosis.

  20. Clinical or radiological diagnosis of impingement; Klinische oder radiologische Diagnose des Impingements

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, J.K.; Weber, M.A. [Universitaetsklinikum Heidelberg, Klinik fuer diagnostische und interventionelle Radiologie, Heidelberg (Germany); Zeifang, F. [Universitaetsklinikum Heidelberg, Zentrum fuer Orthopaedie, Unfallchirurgie und Paraplegiologie, Heidelberg (Germany)

    2015-03-01

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques. (orig.) [German] Das Impingementsyndrom der Schulter ist ein haeufiges Einklemmungsphaenomen von Sehnen oder Bursen mit typischem klinischem Befund. Wichtige radiologische Verfahren sind Sonographie, MRT und MR-Arthrographie. Projektionsradiographie und CT sind ideal, um knoecherne Veraenderungen aufzuzeigen. Die CT-Arthrographie dient zudem als Ersatzverfahren bei Kontraindikationen fuer die MRT. Diese genannten Modalitaeten koennen in der Primaerdiagnostik die Diagnose eines Impingementsyndroms stuetzen und dessen Ursache aufzeigen. Zudem werden bildgebend Folgen der Einklemmung festgestellt und in Zusammenschau von klinischer Symptomatik und radiologischem Befund Therapieentscheidungen getroffen. Die Sensitivitaet und Spezifitaet der zuvor genannten bildgebenden Verfahren in Bezug auf die diagnostische Aufarbeitung einer klinisch evidenten Impingementsymptomatik werden in der Uebersicht abgehandelt. Der Verdacht auf ein Impingementsyndrom wird vom Orthopaeden und Unfallchirurgen anhand von Anamnese und koerperlicher Untersuchung gestellt, die Bestaetigung struktureller Veraenderungen und Schaedigungen erfolgt durch den Radiologen mittels dezidierter Bildgebung. (orig.)

  1. Profile of Infections in Newly Diagnosed Patients with Acute Leukemia During the Induction Phase of Treatment

    International Nuclear Information System (INIS)

    Acute leukemia is the most common pediatric malignancy. Despite the significant progress in the treatment of infectious complications, infection-related morbidity and mortality continue to be of great importance. Prompt initiation of the appropriate empiric antibiotic treatment has improved infection outcome. The aim of the present study is to assess the type, frequency, and severity of infectious complications in a cohort of pediatric cancer patients treated at a single medical institution. We also aim to identify factors affecting bloodstream infections in newly diagnosed ALL and AML pediatric patients during the induction phase of treatment. Patients and Methods: This study was carried out at the Department of Pediatric Oncology, National Cancer Institute, Cairo University, during the time period from January 1st to June 30th 2007. Inclusion criteria were pediatric age group (from 0-16 years), newly diagnosed acute leukemia, positive blood culture and documented site of infection. Data were analyzed using the SPSS package version 15. A p-value £0.05 was considered significant. Results: This is a retrospective study including 100 newly diagnosed cases of acute leukemia. Fifty-four patients had ALL, and 46 patients had AML. 348 infectious episodes were recorded. Blood stream infections (BSI) occurred once or twice in 32%, 3-4 episodes in 58%, and five or more episodes in 10% of the cases. Gram-positive cocci were the most frequently observed cause of BSI, accounting for 77.9% of the total isolates followed by Gram negative organisms seen in 18.9% and mixed infections in 8%. The majority of the episodes (n= 208, 58.4%) responded to first-line empirical antibiotic therapy. Conclusion: Clinical and laboratory risk factors could be identified and can help prediction of serious BSI.

  2. Frecuencia de la hipertensión arterial y su relación con algunas variables clínicas en pacientes con diabetes mellitus tipo 2 / High blood pressure frequency and its relation to some clinical variables in patients diagnosed with type 2 diabetes mellitus

    Scientific Electronic Library Online (English)

    Eduardo, Valdés Ramos; Niurka, Bencosme Rodríguez.

    2009-12-01

    Full Text Available Se realizó un estudio descriptivo transversal con 300 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, en el período comprendido entre octubre de 2007 y mayo de 2008, con el objetivo de conocer la frecuencia de hipertensión arterial y su relación con al [...] gunas variables clínicas en estos casos. Se revisaron las historias clínicas de cada uno de ellos para obtener datos de los aspectos siguientes: edad, sexo, color de la piel, hábitos tóxicos, edad al comienzo de la diabetes, estado nutricional, circunferencia de la cintura, tensión arterial y complicaciones crónicas de la diabetes. Se encontró hipertensión arterial en 210 pacientes (70 %); de ellos, 57 (27,1 %) presentaron hipertensión sistólica aislada, 39 (18,5 %) hipertensión diastólica, y 114 (54,4 %) hipertensión sistodiastólica. La hipertensión arterial se presentó desde el inicio de la diabetes en el 62,9 %. El 76,1 % de los pacientes hipertensos tenían sobrepeso u obesidad (P=0,0557). Resultó significativa la asociación entre la hipertensión arterial y la cardiopatía isquémica (p= 0,0117). En relación con el ictus y la insuficiencia arterial periférica, aunque la mayoría de los casos eran hipertensos, no llegó a ser estadísticamente significativo (p= 0,8261, p= 0,8600). El 71,1 % de los pacientes con retinopatía diabética y el 75 % con nefropatía diabética eran hipertensos (p= 0,8261, p= 0,8600). Se concluye que la hipertensión arterial tiene una elevada incidencia en los pacientes con diabetes mellitas tipo 2, porque está presente en un porcentaje importante desde el diagnóstico de la diabetes y se asocia significativamente a la presencia de cardiopatía isquémica. Abstract in english A cross-sectional and descriptive study was conducted in 300 patients with type 2 diabetes admitted in Diabetes Care Center of Bayamo, Granma province between October, 2007 and May, 2008 to know the high blood pressure frequency and its relation to some clinical variables in these cases. Medical rec [...] ords of each patient were reviewed to obtain data on the following features: age, sex, skin color, toxic habits, arterial pressure, and chronic complications of diabetes. High blood pressure was present in 210 patients (70 %), from them 57 (27.1 %) had isolated systolic hypertension, 39 (18.5 %) diastolic hypertension, and 114 (54.4 %) systolic-diastolic hypertension. Arterial hypertension was present from onset of diabetes in 62.9 %. The 76.1 % of hypertensive patients had overweight or obesity (p= 0.0557). The relationship was significant between arterial hypertension and ischemic heart disease (p = 0.0117). With regard to ictus and peripheral arterial failure, although most of cases were hypertensive, there was not statistic significance (p= 0.8261, p= 0.8600). The 71,1 % of patients presenting with diabetic retinopathy and the 75 % with diabetic nephropathy were hypertensive (p= 0.8261, p= 0.8600). We conclude that arterial hypertension shows a high incidence in patients with type 2 diabetes mellitus due to its presence in a significant percentage from the diabetes diagnosis and it is markedly associated with presence of ischemic heart disease.

  3. The clinical study of diagnosing export obstruction with simulative dejecta

    International Nuclear Information System (INIS)

    Objective: To investigate the diagnostic value of two defecography contrast agents, artificial stool and liquid barium, in diagnosis of functional export obstruction. Methods: Defecography by using artificial stool (Artificial Stool Defecography, ASD) was compared with that by using liquid barium (Liquid Barium Defecography, BD). Both of which were conducted in 50 patients. Results: The average inside diameter of recta under ASD was 1.89cm larger than that under BD. The average recta volume ratio of ASD to BD was 2.1. 39 patients were detected as retention of contrast medium of more than 20% in ASD, whereas no patient was detected as that in BD. The number of inward invagination identified by ASD or BD respectively was 8 and 5, and that of Puborectalis Syndrome was 4 and 1. Average evacuate time was 10 seconds in ASD and 2.5 seconds in BD. Conclusion: Artificial stool defecography (ASD) is more beneficial than traditional barium defecography (BD) in diagnosis of export obstruction. Artificial stool defecography results in a higher diagnostic rate and is thus highly recommendable. (authors)

  4. Comparison of Newly Diagnosed and Relapsed Patients with Acute Promyelocytic Leukemia Treated with Arsenic Trioxide: Insight into Mechanisms of Resistance

    OpenAIRE

    Chendamarai, Ezhilarasi; Ganesan, Saravanan; Alex, Ansu Abu; Kamath, Vandana; Nair, Sukesh C.; Nellickal, Arun Jose; Janet, Nancy Beryl; Srivastava, Vivi; Lakshmi, Kavitha M.; Viswabandya, Auro; Abraham, Aby; Aiyaz, Mohammed; Mullapudi, Nandita; Mugasimangalam, Raja; Padua, Rose Ann

    2015-01-01

    There is limited data on the clinical, cellular and molecular changes in relapsed acute promyeloytic leukemia (RAPL) in comparison with newly diagnosed cases (NAPL). We undertook a prospective study to compare NAPL and RAPL patients treated with arsenic trioxide (ATO) based regimens. 98 NAPL and 28 RAPL were enrolled in this study. RAPL patients had a significantly lower WBC count and higher platelet count at diagnosis. IC bleeds was significantly lower in RAPL cases (P=0.022). The ability of...

  5. Perfil clínico-epidemiológico de pacientes do Ambulatório de Alergia Ocular da Santa Casa de São Paulo / Clinical and epidemiological profile of patients diagnosed and treated at the Ocular Allergy Sector at Santa Casa de São Paulo

    Scientific Electronic Library Online (English)

    Denise Atique, Goulart; Dario Grechi, Goulart; Marcela Colussi, Cypel; Paulo Elias Correa, Dantas; Maria Cristina, Nishiwaki-Dantas.

    2003-10-01

    Full Text Available OBJETIVO: Traçar o perfil do paciente portador de alergia ocular baseado nos seus dados epidemiológicos, na sua resposta ao tratamento e nas complicações de sua doença. MÉTODOS: Foram analisados 172 prontuários dos pacientes com diagnóstico de ceratoconjuntivite alérgica primaveril (CCP), atópica (C [...] CA), sazonal (CAS) e perene (CAP) e que tiveram seguimento mínimo de 6 meses no Ambulatório de Alergia Ocular do Departamento de Oftalmologia da Santa Casa de São Paulo. A análise estatística foi feita pelo método da variância e qui-quadrado. RESULTADOS: A alergia ocular mais freqüente foi a CCP (n=95; 55,2%); com predominância do sexo masculino (n=117; 68,1%). A idade média foi 11,7 anos (± 8,7 anos). Também foi a doença que mais acometeu a visão, sendo que 52,7% tiveram AV = 1,0; dos pacientes com ceratoconjuntivite atópica, 54,4% tinham AV=1,0, daqueles com conjuntivite alérgica sazonal, 75% e daqueles com conjuntivite alér-gica perene, 100% tinham AV=1,0. 96,8% dos portadores de ceratoconjuntivite alérgica primaveril apresentaram maior freqüência das crises no calor, e 91,4% dos portadores de ceratoconjuntivite alérgica atópica no frio. As alterações corneais foram mais freqüentes nos pacientes com ceratoconjuntivite alérgica primaveril, com ceratite presente em 57 pacientes (60,0%). Entre as medicações usadas, 21,6% (n=45) precisaram de corticosteróides, sendo que 36,8% destes pacientes portavam conjuntivite alérgica perene (n=35). O cromoglicato dissódico foi, dentre as demais medicações, a que em mais pacientes pareceu controlar os sintomas, com algum sucesso, em todas as formas de alergia ocular. A ressecção de papilas gigantes com transplante autólogo de conjuntiva foi feita em oito pacientes, sendo sete deles portadores de ceratoconjuntivite alérgica primaveril e um de ceratoconjuntivite alérgica atópica. CONCLUSÕES: Ceratoconjuntivite alérgica primaveril é o tipo de conjuntivite alérgica mais freqüente em nosso serviço. A droga mais eficaz na nossa experiência parece ser o cromoglicato dissódico, sendo que os corticosteróides são potentes agentes antiinflamatórios que, nestes pacientes, muitas vezes são as únicas drogas capazes de fazer cessar as crises. Abstract in english PURPOSE: To establish a profile of the allergic patient based on clinical manifestations, epidemiological data, treatment response and complications of ocular allergy. METHODS: A retrospective and descriptive study, in which we analyzed data of 172 patients suffering from perennial conjunctivitis, s [...] easonal conjunctivitis, atopic keratoconjunctivitis and vernal keratoconjunctivitis, with at least 6 months of follow-up. The study was performed at the Ocular Allergy Sector of the "Santa Casa de São Paulo". Statistical analysis was performed using variance method and qui-square test. RESULTS: The most frequent form of ocular allergy was vernal keratoconjunctivitis (n=95; 55.2%) and the male sex was predominant (n=117; 68.1%). Mean age was 111.7 years (± 8.7). Vernal keratoconjunctivitis was the disease that most impaired vision, also responsible for corneal complications in 60% of the patients (n=57). Among medications, corticosteroids were used by 21.6% (n=45) of patients and 36.8% of them had vernal keratoconjunctivitis. Disodium cromoglycate was not only the most used medication, but able to successfully control symptoms in most cases. Papilla resection with autologous transplantation had to be performed in 8 patients. CONCLUSIONS: Vernal keratoconjunctivitis showed to be the most frequent form of ocular allergy in our service. The most efficient drug in our experience seemed to be disodium cromoglycate. Corticosteroids were shown to be as potent anti-inflammatory drugs and sometimes were the only way to discontinue crises.

  6. Perfil clínico-epidemiológico de pacientes do Ambulatório de Alergia Ocular da Santa Casa de São Paulo Clinical and epidemiological profile of patients diagnosed and treated at the Ocular Allergy Sector at Santa Casa de São Paulo

    Directory of Open Access Journals (Sweden)

    Denise Atique Goulart

    2003-10-01

    Full Text Available OBJETIVO: Traçar o perfil do paciente portador de alergia ocular baseado nos seus dados epidemiológicos, na sua resposta ao tratamento e nas complicações de sua doença. MÉTODOS: Foram analisados 172 prontuários dos pacientes com diagnóstico de ceratoconjuntivite alérgica primaveril (CCP, atópica (CCA, sazonal (CAS e perene (CAP e que tiveram seguimento mínimo de 6 meses no Ambulatório de Alergia Ocular do Departamento de Oftalmologia da Santa Casa de São Paulo. A análise estatística foi feita pelo método da variância e qui-quadrado. RESULTADOS: A alergia ocular mais freqüente foi a CCP (n=95; 55,2%; com predominância do sexo masculino (n=117; 68,1%. A idade média foi 11,7 anos (± 8,7 anos. Também foi a doença que mais acometeu a visão, sendo que 52,7% tiveram AV = 1,0; dos pacientes com ceratoconjuntivite atópica, 54,4% tinham AV=1,0, daqueles com conjuntivite alérgica sazonal, 75% e daqueles com conjuntivite alér-gica perene, 100% tinham AV=1,0. 96,8% dos portadores de ceratoconjuntivite alérgica primaveril apresentaram maior freqüência das crises no calor, e 91,4% dos portadores de ceratoconjuntivite alérgica atópica no frio. As alterações corneais foram mais freqüentes nos pacientes com ceratoconjuntivite alérgica primaveril, com ceratite presente em 57 pacientes (60,0%. Entre as medicações usadas, 21,6% (n=45 precisaram de corticosteróides, sendo que 36,8% destes pacientes portavam conjuntivite alérgica perene (n=35. O cromoglicato dissódico foi, dentre as demais medicações, a que em mais pacientes pareceu controlar os sintomas, com algum sucesso, em todas as formas de alergia ocular. A ressecção de papilas gigantes com transplante autólogo de conjuntiva foi feita em oito pacientes, sendo sete deles portadores de ceratoconjuntivite alérgica primaveril e um de ceratoconjuntivite alérgica atópica. CONCLUSÕES: Ceratoconjuntivite alérgica primaveril é o tipo de conjuntivite alérgica mais freqüente em nosso serviço. A droga mais eficaz na nossa experiência parece ser o cromoglicato dissódico, sendo que os corticosteróides são potentes agentes antiinflamatórios que, nestes pacientes, muitas vezes são as únicas drogas capazes de fazer cessar as crises.PURPOSE: To establish a profile of the allergic patient based on clinical manifestations, epidemiological data, treatment response and complications of ocular allergy. METHODS: A retrospective and descriptive study, in which we analyzed data of 172 patients suffering from perennial conjunctivitis, seasonal conjunctivitis, atopic keratoconjunctivitis and vernal keratoconjunctivitis, with at least 6 months of follow-up. The study was performed at the Ocular Allergy Sector of the "Santa Casa de São Paulo". Statistical analysis was performed using variance method and qui-square test. RESULTS: The most frequent form of ocular allergy was vernal keratoconjunctivitis (n=95; 55.2% and the male sex was predominant (n=117; 68.1%. Mean age was 111.7 years (± 8.7. Vernal keratoconjunctivitis was the disease that most impaired vision, also responsible for corneal complications in 60% of the patients (n=57. Among medications, corticosteroids were used by 21.6% (n=45 of patients and 36.8% of them had vernal keratoconjunctivitis. Disodium cromoglycate was not only the most used medication, but able to successfully control symptoms in most cases. Papilla resection with autologous transplantation had to be performed in 8 patients. CONCLUSIONS: Vernal keratoconjunctivitis showed to be the most frequent form of ocular allergy in our service. The most efficient drug in our experience seemed to be disodium cromoglycate. Corticosteroids were shown to be as potent anti-inflammatory drugs and sometimes were the only way to discontinue crises.

  7. CLIPPERS among patients diagnosed with non-specific CNS neuroinflammatory diseases

    DEFF Research Database (Denmark)

    Kerrn-Jespersen, B M; Lindelof, Mette

    2014-01-01

    Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids (CLIPPERS) is an inflammatory CNS disorder characterized by 1) subacute onset of cerebellar and brainstem symptoms, 2) peripontine contrast-enhancing perivascular lesions with a "salt-and-pepper" appearance on MRI, and 3) angiocentric, predominantly T-lymphocytic infiltration as revealed by brain biopsy. Inflammatory diseases including neuroinfections, CNS lymphoma and neurosarcoidosis must be excluded. Since CLIPPERS was described in 2010, many patients might have been misdiagnosed in the past. We therefore searched medical records from a large tertiary neurological center, the Department of Neurology at Rigshospitalet, Copenhagen University Hospital, for patients discharged between 1999 and 2013 with a diagnosis of "sarcoidosis with other localization", "other acute disseminating demyelination", "other demyelinating disease in the CNS" or "encephalitis, myelitis or encephalomyelitis". Of 206 identified patients, 24 had been examined by brain biopsy and were included for further evaluation. Following clinical, neuroradiological and neuropathological review, 3 patients (12.5%) were reclassified as having CLIPPERS. Median long-term follow-up was 75 months. The present results suggest that clinical re-evaluation of patients previously diagnosed with unspecified inflammatory demyelinating CNS disease or atypical neurosarcoidosis may increase the detection rate of CLIPPERS. Further, potentially severe neurological deficits and progressive parenchymal atrophy on MRI may suggest neurodegenerative features, which emphasizes the need for early immunomodulatory treatment.

  8. Health beliefs and prescription medication compliance among diagnosed hypertension clinic attenders in a rural South African hospital

    OpenAIRE

    Peltzer, K

    2004-01-01

    This study examines the relationship between health beliefs and the use of both prescribed medication and alternative healing agents among at least one year diagnosed hypertensives attending an hypertension out-patient clinic in a rural South African hospital. The sample included 33 men and 67 women, in the age range of 31 to 81 years, (M=60.7 years, SD=9.8 years). Main outcome measures included causative beliefs, health beliefs, and quality of the health care provider patient interaction. Fr...

  9. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

  10. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    International Nuclear Information System (INIS)

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV)

  11. Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis

    DEFF Research Database (Denmark)

    Jorgensen, T. S.; Torp-Pedersen, C.

    2015-01-01

    BACKGROUND: Centralization of specialized health care in Denmark has caused increased geographical distance to health-care providers, which may be a barrier for Alzheimer patients to seek health care. We examined the incidence of Alzheimer diagnosis in Denmark between 2000 and 2009 and investigated the association between patients' distance to Alzheimer clinics and Alzheimer diagnoses. METHODS: Data of all individuals aged 65+ years were collected from Danish national registers. Incidences of Alzheimer diagnoses were analysed with joinpoint regression and hazard ratios (HRs) for Alzheimer diagnoses were analysed with Cox regressions. RESULTS: The annual incidence of Alzheimer diagnoses increased with 32.5% [95% confidence interval (CI): 7.1-63.8] among individuals aged 65-74 years from 2000 to 2002 and with 29.1% (95% CI: 11.0-50.2) among individuals aged 75+ years from 2000 to 2003. For both groups, incidence during subsequent years stagnated (0.4%, 95% CI: -1.7 to 2.6; 2.3%, 95% CI: 1.5-6.). From 2008 to 2009, 8605 individuals got an Alzheimer diagnosis. These individuals had a shorter distance to Alzheimer clinics (16.6 vs. 19.1 km, P <0.001), higher mean age (80.7 vs. 73.7 years, P <0.001) and were more often women (63.1 vs. 55.9%, P <0.001). There were inverse associations between distance to Alzheimer clinics and Alzheimer diagnoses (0-19 km: reference; 20-39 km: HR = 0.80, 95% CI: 0.70-0.92; 40-59 km: HR = 0.65, 95% CI: 0.52-0.81). CONCLUSIONS: The incidence of Alzheimer diagnoses stagnated from 2002/03 to 2009 in Denmark-a period during which distances to health-care providers in general increased. The inverse association between geographical distance to Alzheimer clinics and Alzheimer diagnoses suggests that distance exclude a segment of the elderly population from an appropriate diagnostic workup and treatment.

  12. Trends in clinical diagnoses of Rocky Mountain spotted fever among American Indians, 2001-2008.

    Science.gov (United States)

    Folkema, Arianne M; Holman, Robert C; McQuiston, Jennifer H; Cheek, James E

    2012-01-01

    American Indians are at greater risk for Rocky Mountain spotted fever (RMSF) than the general U.S. population. The epidemiology of RMSF among American Indians was examined by using Indian Health Service inpatient and outpatient records with an RMSF International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis. For 2001-2008, 958 American Indian patients with clinical diagnoses of RMSF were reported. The average annual RMSF incidence was 94.6 per 1,000,000 persons, with a significant increasing incidence trend from 24.2 in 2001 to 139.4 in 2008 (P = 0.006). Most (89%) RMSF hospital visits occurred in the Southern Plains and Southwest regions, where the average annual incidence rates were 277.2 and 49.4, respectively. Only the Southwest region had a significant increasing incidence trend (P = 0.005), likely linked to the emergence of brown dog ticks as an RMSF vector in eastern Arizona. It is important to continue monitoring RMSF infection to inform public health interventions that target RMSF reduction in high-risk populations. PMID:22232466

  13. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

    Directory of Open Access Journals (Sweden)

    Reinaldo Benevides dos Santos

    2011-12-01

    Full Text Available CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%, abdominal pain (78%, diarrhea (78% and weight loss (78% were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

  14. Screening and diagnosing depression in women visiting GPs' drop in clinic in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Johansson Sven-Erik

    2008-06-01

    Full Text Available Abstract Background Only half of all depressions are diagnosed in Primary Health Care (PHC. Depression can remain undetected for a long time and entail high costs for care and low quality of life for the individuals. Drop in clinic is a common form of organizing health care; however the visits are short and focus on solving the most urgent problems. The aim of this study was to investigate the prevalence and severity of depression among women visiting the GPs' drop in clinic and to identify possible clues for depression among women. Methods The two-stage screening method with "high risk feedback" was used. Beck's Depression Inventory (BDI was used to screen 155 women visiting two GPs' drop in clinic. Women who screened positive (BDI score ?10 were invited by the GP to a repeat visit. Major depression (MDD was diagnosed according to DSM-IV criteria and the severity was assessed with Montgomery-Asberg Depression Rating Scale (MADRS. Women with BDI score Results The two-stage method worked well with a low rate of withdrawals in the second step, when the GP invited the women to a repeat visit. The prevalence of depression was 22.4% (95% CI 15.6–29.2. The severity was mild in 43%, moderate in 53% and severe in 3%. The depressed women mentioned mental symptoms significantly more often (69% than the controls (15% and were to a higher extent sick-listed for a longer period than 14 days. Nearly one third of the depressed women did not mention mental symptoms. The majority of the women who screened as false positive for depression had crisis reactions and needed further care from health professionals in PHC. Referrals to a psychiatrist were few and revealed often psychiatric co-morbidity. Conclusion The prevalence of previously undiagnosed depression among women visiting GPs' drop in clinic was high. Clues for depression were identified in the depressed women's symptom presentation; they often mention mental symptoms when they visit the GP for somatic reasons e.g. respiratory infections. We suggest that GPs do selective screening for depression when women mention mental symptoms and offer to schedule a repeat visit for follow-up rather than just recommending that the patient return if the mental symptoms do not disappear.

  15. The impact of bevacizumab treatment on survival and quality of life in newly diagnosed glioblastoma patients

    DEFF Research Database (Denmark)

    Poulsen, Hans Skovgaard; Urup, Thomas

    2014-01-01

    Glioblastoma multiforme (GBM) remains one of the most devastating tumors, and patients have a median survival of 15 months despite aggressive local and systemic therapy, including maximal surgical resection, radiation therapy, and concomitant and adjuvant temozolomide. The purpose of antineoplastic treatment is therefore to prolong life, with a maintenance or improvement of quality of life. GBM is a highly vascular tumor and overexpresses the vascular endothelial growth factor A, which promotes angiogenesis. Preclinical data have suggested that anti-angiogenic treatment efficiently inhibits tumor growth. Bevacizumab is a humanized monoclonal antibody against vascular endothelial growth factor A, and treatment has shown impressive response rates in recurrent GBM. In addition, it has been shown that response is correlated to prolonged survival and improved quality of life. Several investigations in newly diagnosed GBM patients have been performed during recent years to test the hypothesis that newly diagnosed GBM patients should be treated with standard multimodality treatment, in combination with bevacizumab, in order to prolong life and maintain or improve quality of life. The results of these studies along with relevant preclinical data will be described, and pitfalls in clinical and paraclinical endpoints will be discussed.

  16. Diagnostic delay, quality of life and patient satisfaction among women diagnosed with endometrial or ovarian cancer

    DEFF Research Database (Denmark)

    Robinson, Kirstine M; Christensen, Karl Bang; Ottesen, Bent; Krasnik, Allan

    2012-01-01

    This study investigates the association between diagnostic delay (total delay), quality of life (QoL) and patient satisfaction, and the associations between QoL and patient satisfaction scores and survival for women diagnosed with ovarian or endometrial cancer.

  17. Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer.

    OpenAIRE

    Ginsburg, M L; Quirt, C; Ginsburg, A D; MacKillop, W J

    1995-01-01

    OBJECTIVE: To determine the nature and incidence of psychiatric illness, symptoms of potential psychiatric significance, substance abuse and psychosocial concerns among patients with newly diagnosed lung cancer. DESIGN: Case series. SETTING: Kingston Regional Cancer Centre, a tertiary care facility for ambulatory cancer patients. PATIENTS: Seventy-one consecutive English-speaking patients with recently diagnosed lung cancer undergoing radiotherapy or chemotherapy were asked to participate; 52...

  18. Apoptosis-related gene expression in tumor tissue samples obtained from patients diagnosed with glioblastoma multiforme.

    Science.gov (United States)

    Blahovcova, Eva; Richterova, Romana; Kolarovszki, Branislav; Dobrota, Dusan; Racay, Peter; Hatok, Jozef

    2015-12-01

    Tumors of the brain are very diverse in their biological behavior and are therefore considered a major issue in modern medicine. The heterogeneity of gliomas, their clinical presentation and their responses to treatment makes this type of tumor a challenging area of research. Glioblastoma multiforme (GBM) is the most common, and biologically the most aggressive, primary brain tumor in adults. The standard treatment for patients with newly diagnosed GBM consists of surgical resection, radiotherapy and chemotherapy. However, resistance to chemotherapy is a major obstacle to successful treatment. The aim of this study was to examine the changes occurring in the expression levels of apoptosis?associated genes in tumor tissue biopsy samples from 7 patients diagnosed with GBM and compare our results with a human astrocyte cell line (used as a reference) cultured under basic conditions. For molecular analysis, we used a commercial pre-designed microfluidic array to quantify the expression of 93 apoptosis?associated human genes. Significant changes in the expression levels of genes were observed in the tumor tissue samples obtained from patients with GBM. We determined significant changes in gene expression (n=32) in all apoptotic signaling pathways (BCl-2, TNF, Caspases, NF??B, IAP and CARD), while the most pronounced deregulation (>5?fold) were observed in 46.9% events. The results of this study underline the importance of apoptosis in heterogenous tumor tissue. The identification of the apoptotic gene panel in tissue biopsies from patients with GBM may help improve the effectiveness of treatments for GBM in clinical practice and may broaden our understanding of brain tumor cell metabolism. Recognizing the changes in the expression of pro-apoptotic and anti?apoptotic genes may aid in the development of novel treatment strategies founded on a molecular basis. PMID:26459752

  19. Evolution of maple syrup urine disease in patients diagnosed by newborn screening versus late diagnosis.

    Science.gov (United States)

    Couce, M L; Ramos, F; Bueno, M A; Díaz, J; Meavilla, S; Bóveda, M D; Fernández-Marmiesse, A; García-Cazorla, A

    2015-11-01

    Maple syrup urine disease (MSUD) is a rare metabolic disorder for which the newborn screening (NBS) is possible but it has not been yet implemented for most Spanish regions. In the present study, we assess the clinical features and outcome of 14 MSUD Spanish patients with similar treatment protocol diagnosed either by NBS or by clinical symptoms. Eight patients were detected by NBS, four classic and four moderate MSUD. The average age at detection was 4.6 days, the mean plasmatic concentration of leucine at diagnosis was 1807 ?M; the average number of days with leucine >1000 ?M was 0.7 (0-4) and the mean number of total hospitalizations was 1.6 (0-5). Mean follow-up time was 70 months. They had good evolution: all remain asymptomatic, but 2 patients have attention deficit and hyperactivity disorder. Six patients with late diagnosis of classic MSUD were followed during 41 months. All presented with acute encephalopathy during the first month of life, mean leucine levels of 2355 ?M, mean number of days with leucine >1000 ?M of 6.6 (1-13) and mean number of total hospitalizations of 5.3 (4-7). Only two patients have a psychomotor development index in the lower limit (80 and 83). For all patients a good genotype-phenotype correlation was found and four novel mutations were identified: p.A311H, p.T84S, p.T397L, pL398P. Our study support that NBS improves prognosis of MSUD patients. But early diagnosis and an aggressive treatment together with a close monitoring of leucine levels improve neurological evolution in MSUD patients, even for those not detected by NBS. PMID:26232051

  20. Prevalence of Chronic Kidney Disease in newly diagnosed patients with Human immunodeficiency virus in Ilorin, Nigeria

    Directory of Open Access Journals (Sweden)

    Dada Samuel Ayokunle

    2015-06-01

    Full Text Available Abstract Introduction: Human immunodeficiency virus (HIV the causative agent of Acquired immunodeficiency syndrome (AIDS is an important cause of renal diseases in sub-Saharan Africa. There is paucity of studies on the burden of chronic kidney disease (CKD among patients with HIV/AIDS in the North-Central zone of Nigeria. Methods: This is a cross-sectional study of 227 newly-diagnosed, antiretroviral naïve patients with HIV/AIDS seen at the HIV clinic of the Medical Out-patient Department (MOPD of University of Ilorin Teaching Hospital (UITH. They were matched with 108 control group. Laboratory investigations were performed for the participants. CKD was defined as estimated glomerular filtration rate (eGFR 30 mg/g. Results: There were 100 (44% males among the patients and 47 (43.5% among the control group. The mean ages of the patients and controls were 40.3 ± 10.3 years and 41.8 ± 9.5 years respectively. CKD was observed in 108 (47.6% among the patients and 18 (16.7% of the controls (p = 0.01. The median CD4 T-cell count was significantly lower in patients with CKD. Ninety-three (41.0% of the patients had dipstick proteinuria of > 2 +. The median albumin creatinine ratio (ACR was significantly higher among the HIV-positive patients (272.3 mg/g compared with the HIV-negative controls (27.22 mg/g p = 0.01. The CD4 T-cell count correlates positively with eGFR (r = 0.463, p = 0.001 and negatively with ACR (r = -0.806, p = 0.001. Conclusions: CKD is very common among patients with HIV/AIDS in Ilorin. Screening and early intervention for CKD should be part of the protocols in the management of these patients.

  1. TREATMENT ADHERENCE AND SOCIAL FUNCTIONING IN PATIENTS DIAGNOSED WITH SCHIZOPHRENIA AND TREATED WITH ANTIPSYCHOTIC DEPOT MEDICATION

    Directory of Open Access Journals (Sweden)

    Bianca Stephanie Popp

    2014-07-01

    Full Text Available Background and aim. Some of the most significant problems encountered in the treatment of schizophrenia are non-adherence to the treatment with oral neuroleptics and difficult recovery of social functioning, after its impairment by negative psychotic symptoms and the progression of the disease with episodes of remission and relapse. Methods. This study comparatively assesses the parameters ”social functioning” and ”treatment adherence” in 34 outpatients diagnosed with schizophrenia at the Adult Psychiatry Clinic III and the Adult Mental Health Center of Cluj-Napoca, using the ”Medication Adherence Rating Scale” (MARS and the ”Social Adaptation Self- evaluation Scale”.Results. The two scales revealed that patients on depot medication tend to have better social functioning and social integration rates than patients for whom oral medication was prescribed. Despite the fact that most patients participating in the study had intellectual preoccupations and, to some extent, enjoyed working, 82% of them did not have a job. The percentage of those who did was higher in the cohort of patients on depot medication (63% than in the cohort of patients for whom orally administered medication was prescribed (53%.Conclusions. Treatment adherence in patients with schizophrenia is thus significantly improved by depot medication, whereas treatment effectiveness and the frequency of adverse effects are similar for the two treatment options.

  2. Patient Safety in Clinical Trials

    Science.gov (United States)

    Information for patients, their families and friends, and the general public about how the rights and safety of people who take part in clinical trials are protected. Learn about informed consent, institutional review boards (IRB's), and how trials are closely monitored for safety.

  3. Molecular detection of Rifampicin and Isoniazid resistance in culture isolates of newly diagnosed TB patients

    Directory of Open Access Journals (Sweden)

    Vanisree R, Kavitha Latha M, Neelima A, Prasanti

    2014-04-01

    Full Text Available Introduction: Multidrug-resistant tuberculosis (MDR-TB isan emerging public health problem in many regions of the world, particularly in developing nations. Accurate and rapid diagnosisis essential in the management of MDR-TB, not onlyto optimize treatment but also to prevent transmission. Aims: To evaluate drug resistance in culture isolates by conventional and molecular methods and detect drug resistance gene in MDR-TB patients. Material and Method: 100 newly diagnosed pulmonary tuberculosis (TB diagnosed patients attending TB Clinic, Gandhi Hospital, Secunderabad were included in the study. Two sputum samples collected from the patients were subjected to sputum microscopy, culture, Drug Susceptibility Testing (DST. Geno Type Mycobacterium Tuberculosis Drug Resistance (MTBDR plus assay was done on the culture isolates to detect Rifampicin and Isoniazid (INH resistance. Results: Out of 100 samples, 48 % smear positivity by Ziehl Neelsen (ZN method, 51 % culture positivity on LJ medium,11.7% multi drug resistance for Rifampicin and Isoniazid with conventional drug susceptibility – Proportion method,17.6 % drug resistance by molecular method – Geno Type MTBDR plus was observed. Among the 4 Rifampicin (Rif resistant isolates 2isolates showed mutation (mut at D516V and in other 2 isolates only wild type (WT was missing but no mut was seen . In the 1 Isoniazid (INH resistant isolate WT was missing, but no mutation was seen. Among the 4 Rif +INH resistance all showed mut at S531L for RIF and at S315T1. Conclusion: The Genotype MTBDR assay is a rapid and reliable tool for the routine direct detection of MTB strains and of strains resistant to INH and RIF in smear positive, highly infectious patients. The rapid turn around time of the test enables the optimization of the therapy of these patients before confirmatory culture results are available. The test does not require viable organisms and thus reduces the biohazard risk in the laboratory.

  4. Nutritional Approach of Pediatric Patients Diagnosed with Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Tog?nel Rodica

    2013-04-01

    Full Text Available Congenital heart defects are among the most frequent anomalies present at birth, representing a heterogeneous group of malformations, both in terms of pathogenesis and clinical significance of the lesion. Failure to grow is well documented in infants with complex congenital heart defects; the presence of associated chromosomal abnormalities, cyanosis, and cardiac failure adds to the complexity and challenge. Malnutrition etiology can be grouped into the following three categories: inadequate intake, inefficient absorption and utilization, and/or increased energy needs. The consequences of malnutrition are both short and long term, timely nutritional intervention being necessary in order to maintain an adequate nutritional state. Because there are several types of congenital heart defects and multiple mechanisms by which they produce failure to thrive, no single strategy will be adequate to treat all cases. Medical complications such as chylotorax, necrotizing enterocolitis, laryngeal and neurological dysfunction play a major role in the requisite nutrition therapy in infants with congenital heart defect; limited access to human milk and parenteral concerns, as well as stress about feeding are also factors that can contribute to poor outcomes concerning nutrition and growth. Protocols are being considered and designed, and a systematic approach is always needed. The quality of life for patient and family, as well as getting the child back on track for age-appropriate development are always at the fore-front of each care plan.

  5. Sexually transmitted diseases in clinic patients in Lagos.

    OpenAIRE

    Rotimi, V. O.; Somorin, A O

    1980-01-01

    In a study of patients attending an STD referral clinic in Lagos, Nigeria, the age distribution was similar to that seen on other parts of the world and the male-to-female ratio was 1.3:1. Non-specific genital infection was diagnosed in about 59% of patients and gonorrhoea in 19%. Most strains of Neisseria gonorrhoeae were sensitive to penicillin (1 unit) and the six relatively penicillin-resistant strains did not produce penicillinase. Candidosis and trichomoniasis were each diagnosed in abo...

  6. Efficacy and safety of delayed-release dimethyl fumarate in patients newly diagnosed with relapsing–remitting multiple sclerosis (RRMS)

    Science.gov (United States)

    Giovannoni, Gavin; Phillips, J Theodore; Fox, Robert J; Zhang, Annie; Meltzer, Leslie; Kurukulasuriya, Nuwan C

    2015-01-01

    Background: Delayed-release dimethyl fumarate (DMF) demonstrated efficacy and safety in the Phase 3 DEFINE and CONFIRM trials. Objective: To evaluate delayed-release DMF in newly diagnosed relapsing–remitting multiple sclerosis (RRMS) patients, in a post-hoc analysis of integrated data from DEFINE and CONFIRM. Methods: Patients included in the analysis were diagnosed with RRMS within 1 year prior to study entry and naive to MS disease-modifying therapy. Results: The newly diagnosed population comprised 678 patients treated with placebo (n = 223) or delayed-release DMF 240 mg BID (n = 221) or TID (n = 234). At 2 years, delayed-release DMF BID and TID reduced the annualized relapse rate by 56% and 60% (both p < 0.0001), risk of relapse by 54% and 57% (both p < 0.0001), and risk of 12-week confirmed disability progression by 71% (p < 0.0001) and 47% (p = 0.0085) versus placebo. In a subset of patients (MRI cohort), delayed-release DMF BID and TID reduced the mean number of new or enlarging T2-hyperintense lesions by 80% and 81%, gadolinium-enhancing lesion activity by 92% and 92%, and mean number of new non-enhancing T1-hypointense lesions by 68% and 70% (all p < 0.0001 versus placebo). Flushing and gastrointestinal events were associated with delayed-release DMF. Conclusion: Delayed-release DMF improved clinical and neuroradiological outcomes relative to placebo in newly diagnosed RRMS patients. PMID:24990854

  7. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2009-11-01

    Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.

  8. Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

    Directory of Open Access Journals (Sweden)

    Chanda Pascalina

    2009-04-01

    Full Text Available Abstract Background Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT, a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. Methods A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. Results Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5 than either microscopy (US$ 11.9 or clinical diagnosis (US$ 17.1 for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. Conclusion RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.

  9. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography

    Energy Technology Data Exchange (ETDEWEB)

    Braithwaite, Kiery A.; Alazraki, Adina L. [Emory University, Department of Radiology and Imaging Sciences, Children' s Healthcare of Atlanta, Atlanta, GA (United States)

    2014-08-15

    Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The ''star sign'' is a radiological finding of internal fistula that has previously been described in the gastroenterology literature in adult Crohn disease patients undergoing MR enteroclysis. The goal of this paper is to review the clinical and imaging features of penetrating disease in pediatric Crohn disease patients, highlighting the star sign as a useful diagnostic tool for diagnosing internal fistula in children by MR enterography. The recognition of penetrating complications by MR imaging can have important therapeutic and prognostic implications. (orig.)

  10. Clinical characteristics of patients with conjunctivochalasis

    Science.gov (United States)

    Balci, Ozlem

    2014-01-01

    Purpose To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). Methods and materials This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora. PMID:25210435

  11. Clinical characteristics of patients with conjunctivochalasis

    Directory of Open Access Journals (Sweden)

    Balci O

    2014-08-01

    Full Text Available Ozlem Balci Ophthalmology Department, Kolan Hospitalium Group, Istanbul, Turkey Purpose: To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh. Methods and materials: This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. Results: The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60% eyes with grade 1 CCh; 15 (30% eyes with grade 2 CCh; and five (10% eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90% eyes, and in the remaining five (10% CCh was located in the superior bulbar conjunctiva. Ten (33.3% patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6% patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. Conclusion: Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora. Keywords: ocular irritation, epiphora, dryness, eye pain, blurry vision

  12. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma

    DEFF Research Database (Denmark)

    Engelhardt, Monika; Terpos, Evangelos

    2014-01-01

    Multiple myeloma management has undergone profound changes in the past thanks to advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A) and for cytogenetically defined high- versus standard-risk groups (2B). Novel-agent-based induction and up-front autologous stem cell transplantation in medically fit patients remains the standard of care (1A). Induction therapy should include a triple combination of bortezomib, with either adriamycin or thalidomide and dexamethasone (1A), or with cyclophosphamide and dexamethasone (2B). Currently, allogeneic stem cell transplantation may be considered for young patients with high-risk disease and preferably in the context of a clinical trial (2B). Thalidomide (1B) or lenalidomide (1A) maintenance increases progression-free survival and possibly overall survival (2B). Bortezomib-based regimens are a valuable consolidation option, especially for patients who failed excellent response after autologous stem cell transplantation (2A). Bortezomib-melphalan-prednisone or melphalan-prednisone-thalidomide are the standards of care for transplant-ineligible patients (1A). Melphalan-prednisone-lenalidomide with lenalidomide maintenance increases progression-free survival, but overall survival data are needed. New data from the phase III study (MM-020/IFM 07-01) of lenalidomide-low-dose dexamethasone reached its primary end point of a statistically significant improvement in progression-free survival as compared to melphalan-prednisone-thalidomide and provides further evidence for the efficacy of lenalidomide-low-dose dexamethasone in transplant-ineligible patients (2B).

  13. Serum zinc levels in children of 0–24 months diagnosed with pneumonia admitted to our clinic

    Science.gov (United States)

    Ar?ca, Seçil; Ar?ca, Vefik; Dag, Hüseyin; Kaya, Ay?en; Hatipoglu, Sami; Fenercioglu, Aysen; Karatekin, Güner

    2011-01-01

    Aim: We have planned to study the relationship between zinc (Zn) plasma levels, as well as pneumonia criteria, and zinc in healthy children younger than 2 years of age compared to pediatric patients diagnosed with pneumonia and admitted to a hospital. Materials and methods: The study enrolled 25 patients of 0-24 months referring to our hospital's pediatric clinic, who were then diagnosed with bronchopneumonia based on the World Health Organization diagnostic criteria and admitted to suckling children clinic due to inability to receive out-patient treatment, and 10 healthy children of the same age group, whose physical examinations revealed no pathological findings. Results: There was no difference between the groups in terms of age and gender distribution (p> 0.05). The control group included in the study showed a significantly higher mean duration of breast milk intake compared to the patient groups (p<0.001). WBC values obtained from the patient group was significantly higher than that of the control group (p<0.001). Zn and iron (Fe) values as determined in the control group enrolled in the study were significantly higher compared to the patient group (p<0.01). Mean total protein in the control group was found to be significantly higher versus that of the patient groups (p<0.05). With regard to the r values of correlation coefficients of the subjects enrolled in the study, a slightly positive correlation was observed between Zn levels and iron levels (r=0.457). Conclusion: It was concluded that infections, particularly pneumonia, which present a serious issue both in our country and developing countries, may be developed more commonly among children with zinc deficiency. PMID:21977237

  14. Síntomas, hallazgos radiológicos, endoscópicos y estudios funcionales del esófago en pacientes con hernia hiatal mayor a 5 cm / Clinical and functional features of patients with a hiatal hernia diagnosed during endoscopy

    Scientific Electronic Library Online (English)

    Attila, Csendes J; Italo, Braghetto M; Ana María, Burgos L; Ana, Henríquez D.

    2013-09-01

    Full Text Available El hallazgo de una hernia hiatal durante un estudio endoscópico se informa frecuentemente. Sin embargo, no hay referencias específicas acerca de los síntomas y los trastornos funcionales del esófago según el tipo de hernia hiatal. Objetivo: Determinar los síntomas predominantes, los hallazgos radiol [...] ógicos y endoscópicos y de los estudios funcionales en pacientes con los diferentes tipos de hernia hiatal. Método: Se evaluaron 115 pacientes, todos con diagnóstico radiológico de hernia hiatal mayor a 5 cm, realizando estudios endoscópicos, histológicos y manometría esofágica, junto a pHmetría de 24 h. Resultados: La edad fue similar en los 4 tipos de hernia hiatal. Síntomas de reflujo gastroesofágico se presentaron con gran frecuencia en hernias tipo I y III, mientras que síntomas mecánicos se manifestaron en hernias tipo IV. El estudio manométrico mostró un esfínter hipotensivo junto con reflujo ácido patológico en casi 90% de las hernias tipo I y IIII. Conclusión: El estudio más útil para el diagnóstico de hernia hiatal es el radiológico. La endoscopia es necesaria para comprobar el daño de la mucosa esofágica. Los estudios funcionales muestran una alta prevalencia de reflujo ácido patológico en hernias hiatales tipo I y II. Abstract in english Background: The finding of a hiatal hernia is usual during upper gastrointestinal endoscopies. However the correlation of symptoms, manometric and radiological findings with the endoscopy report is far from clear. Aim: To assess radiological findings, 24 pH measurements, esophageal manometry and sym [...] ptoms among patients in whom a hiatal hernia was found during an upper gastrointestinal endoscopy. Material and Methods: One hundred fifteen patients aged 23 to 82 years (77 women), with an endoscopic diagnosis of a hiatal hernia of more than 5 cm were studied. An esophageal manometry and 24 hour pH determination were carried out. Results: Hiatal hernias type I, II, II and IV were found in 50, 12, 38 and 15 patients of similar age, respectively. Gastroesophageal reflux symptoms were more common among patients with hernias type I and III. Mechanical symptoms such as retrosternal pain were more common in type IV hernias. Manometry showed a hypotensive sphincter in 100 and 78% of patients with hernias type I and III, respectively. An abnormal 24 hour pH measurement was found in 95 and 85% of patients with hernias type I and III, respectively. Conclusions: Functional studies show a high frequency of pathological acid reflux among patients with hiatal hernias type I and III.

  15. Buprenorphine treatment outcome in dually diagnosed heroin dependent patients: A retrospective study.

    Science.gov (United States)

    Gerra, Gilberto; Leonardi, Claudio; D'Amore, Antonio; Strepparola, Giovanni; Fagetti, Roberto; Assi, Cinzia; Zaimovic, Amir; Lucchini, Alfio

    2006-03-01

    The present study compared retrospectively in a clinical non-experimental setting the efficacy of buprenorphine (BUP) in different subgroups of dually diagnosed and non-dually diagnosed opioid-dependent patients: all the subjects included in the study showed severe long-lasting heroin addiction and 68.4% were affected by psychiatric comorbidity. Participants (206) (mean age 32.2+/-8.9, 177 males-29 females) were applicants to a long-term buprenorphine treatment program (mean doses 7.9+/-0.42 mg). Aim of the study was to evaluate dual diagnosis variables possibly influencing retention rate and abstinence from illicit drugs. The patients were divided into 5 subgroups on the basis of dual diagnosis: group 1: major depression (MD) 29.61%; group 2: generalized anxiety (GAD) (11.2%); group 3: personality disorders (PD), antisocial-borderline (21.84%); group 4: schizophrenia (SC)(6.3%); group 5: substance use disorder without overt psychiatric comorbidity (SUD) (31.1%). Group 1 patients affected by MD showed the highest retention rate at 12 months (72.1%) in comparison with the other groups of patients: group 2 GAD (39.1%), group 3 PD (17.8%), group 4 SC (7.7%) and group 5 SUD, without comorbidity (45.3%) (p=0.006, p<0.001, p<0.001, p=0.002). Similarly, at 12 months, the patients affected by MD showed less risk of illicit opioid use (16.4%) than those affected by GAD (34.8%), PD (42.2%), SC (53.8%) and SUD without comorbidity (34.4%) (p=0.06, p=0.003, p=0.008, p=0.017). When evaluated on the whole sample, retention rate was not influenced by dose. In contrast, the higher BUP doses were associated with less risk of illicit opioid use, than lower doses (p<0.001). Multivariate analysis and factor analysis showed a greater association of outcome measures (retention rate and negative urines rate) with comorbid diagnosis (depression) (respectively 0.64) than with buprenorphine doses (respectively 0.54). Our data need to be interpreted with caution because of the retrospective methodology applied to a clinical non-experimental setting. BUP seems to be more effective in opioid-dependent patients affected by depression, probably due to the kappa opioid-receptors antagonist action, counteracting dysphoria, negativism and anxiety. High doses of BUP appear to predict a better outcome, in terms of negative urines, but not in terms of retention. PMID:16309810

  16. Outcomes of initial antiretroviral treatment (ART among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

    Directory of Open Access Journals (Sweden)

    Volkan Korten

    2014-11-01

    Full Text Available Introduction: HIV-TR is a recently established (2012 multicentre cohort in Turkey. The aim of this study is to analyze epidemiological, immunologic and virologic data of recently diagnosed HIV patients. Materials and Methods: Epidemiologic, clinical and laboratory data of all patients diagnosed in 2011 and 2012 were recorded by a web-based data collection system, retrospectively. Results: A total of 693 patients (561 male, 132 female at 24 sites were enrolled. The median age at first presentation for HIV care was 36. The proportion of patients presenting with advanced HIV disease (CD4 count500 copies/mL in 18.5% of patients. Of 531 patients receiving ART, initial combinations consist of tenofovir/emtricitabine (TDF/FTC plus efavirenz (EFV in 48.2% and TDF/FTC plus lopinavir/ritonavir (LPV/r in 37.5% and other combinations in 14.3% of the patients. Pre-treatment HIV-RNA was over 100.000 copies/mL in 52.3% of patients. At Weeks 24 and 48, HIV-RNA were<50 copies/mL in 63,4% of 385 patients and 82% of 311 patients reported to be still on ART and had a viral load measurement, respectively. Median pretreatment CD4 count was lower for TDF/FTC+LPV/r recipients than TDF/FTC+EFV recipients (250 vs 316 (p<0.05. The median increase from baseline CD4 cell count was 230 in TDF/FTC+LPV/r group, 193 in TDF/FTC+EFV group and 216 among all treated patients. Of 531 patients receiving ART, 11 had died and 19 were lost to follow-up. Conclusion: Despite 52.4% of recently diagnosed patients were late presenters; a high rate of virologic suppression was achieved in HIV-TR Cohort. A national HIV testing strategy targeting subpopulations with higher risk is urgently needed.

  17. Blood Sample Markers of Reproductive Hormones in Assessing Ovarian Reserve in Younger Patients With Newly Diagnosed Lymphomas | Division of Cancer Prevention

    Science.gov (United States)

    This clinical trial studies blood sample markers of reproductive hormones in assessing ovarian reserve in younger patients with newly diagnosed lymphomas. Studying samples of blood from patients with cancer in the laboratory may help measure the effect of curative therapy for lymphoma on ovarian failure.

  18. Being publicly diagnosed : A grounded theory study of Danish patients with tuberculosis

    DEFF Research Database (Denmark)

    Konradsen, Hanne; Lillebaek, Troels

    2014-01-01

    INTRODUCTION: Tuberculosis (TB) is a disease which affects people worldwide, but there is knowledge lacking about patients' experiences in low-prevalence and high-income countries. AIM: To provide a theoretical framework for the process of being diagnosed with tuberculosis in a Danish setting. METHOD: A grounded theory design with field studies and qualitative interviews, following the recommendations from Glaser and Strauss. RESULT: A process of being publicly diagnosed was identified, which developed during the patient's trajectory from being on the way to becoming a patient, becoming a patient with TB, and finally being in medical treatment. Before being diagnosed with TB, patients were weighing between biding their time and deciding to undergo an examination. Social pressure and feelings of social responsibility tended to affect the decision. Having undergone the examination(s), the patients were publicly diagnosed. Being publicly diagnosed meant changing social interactions and fighting to regain control. CONCLUSION: Findings offer new insight and an empirically derived basis for developing interventions aimed at reducing the burden of being diagnosed with tuberculosis and increasing the wellbeing of the patients.

  19. A Syrian patient diagnosed with meningococcal meningitis serogroup B.

    Science.gov (United States)

    Tezer, Hasan; Ozkaya-Parlakay, Aslinur; Kanik-Yuksek, Saliha; Gülhan, Belgin; Güldemir, Dilek

    2014-01-01

    Meningococcal infection is an important health problem in children, with significant mortality and morbidity. In this infection, early recognition and aggressive treatment can reduce mortality. Herein we report an 11-year-old-Syrian refugee girl living in Turkey for 3 months admitting with fever, headache, and vomiting diagnosed as meningococcal meningitis type B who was cured with intravenous ceftriaxone therapy. Infections in refugee populations constitute major importance for highlighting importance of investigation of endemic diseases in their own country and contagious diseases in their present place. PMID:25424959

  20. Cystoid macular edema diagnosed with optical coherent tomography in patients operated on from cataract

    International Nuclear Information System (INIS)

    Refers frequency of cystoid macular edema diagnosed with optical coherence tomography in patients operated on from senile cataract at 'Ramon Pando Ferrer' Cuban Institute of Ophthalmology in the period from December 2006 to February 2007

  1. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Glintborg, Dorte; Hass Rubin, Katrine

    2015-01-01

    OBJECTIVE: The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS. DESIGN: A National Register-based study. METHODS: Patients with PCOS (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital (OUH)) and one control population. Premenopausal women with PCOS underwent clinical and biochemical examination (PCOS OUH, n=1217). PCOS Denmark (n=19?199) included women with PCOS in the Danish National Patient Register. Three age-matched controls were included per patient (n=57?483). MAIN OUTCOME MEASURES: Diagnosis codes and filled prescriptions. RESULTS: The mean (range) age of the PCOS Denmark group and controls was 30.6 (12-60) years. Patients in PCOS Denmark had higher Charlson index, higher prevalence of diabetes, dyslipidemia, and hypertension than controls. PCOS was associated with a two times increased risk of stroke and thrombosis, whereas the risk of other cardiovascular diseases was not increased. Thyroid disease, asthma, migraine, and depression were more prevalent in PCOS Denmark vs controls, whereas fractures were rarer. Infertility was increased in patients compared with controls, but the mean number of births was higher in PCOS. Medicine prescriptions within all diagnosis areas were significantly higher in PCOS patients than in controls.In PCOS OUH, polycystic ovaries (PCO) and irregular menses were associated with a more adverse metabolic risk profile, but individual Rotterdam criteria were not associated with cardiometabolic diagnoses. CONCLUSION: Cardiometabolic and psychiatric morbidity were significantly increased in a Danish population with PCOS. Medical diseases are frequent also in young patients with PCOS.

  2. Safety of thalidomide in newly diagnosed elderly myeloma patients

    DEFF Research Database (Denmark)

    Palumbo, Antonio; Waage, Anders; Hulin, Cyrille; Beksac, Meral; Zweegman, Sonja; Gay, Francesca; Gimsing, Peter; Leleu, Xavier; Wijermans, Pierre; Sucak, Gulan; Pezzatti, Sara; Juliusson, Gunnar; Pégourié, Brigitte; Schaafsma, Martijn; Galli, Monica; Turesson, Ingemar; Kolb, Brigitte; van der Holt, Bronno; Baldi, Ileana; Rolke, Jürgen; Ciccone, Giovannino; Wetterwald, Marc; Lokhorst, Henk; Boccadoro, Mario; Rodon, Philippe; Sonneveld, Pieter

    2013-01-01

    Background. Melphalan-prednisone-thalidomide (MPT) improves outcome in multiple myeloma (MM) patients, and it is now considered a standard of care for patients not eligible for transplantation. However, this treatment is a major source of morbidity. Design and Methods. An individual patient data meta-analysis (N=1680) of all the six randomized trials comparing MPT vs melphalan-prednisone (MP) was performed. The main objective was to estimate the risk of serious adverse events (AEs) and their imp...

  3. Diagnoses of Patients with Severe Subjective Health Complaints in Scandinavia: A Cross Sectional Study

    OpenAIRE

    Silje Maeland; Werner, Erik L; Marianne Rosendal; Jonsdottir, Ingibjorg H.; Magnussen, Liv H.; Holger Ursin; Eriksen, Hege R.

    2012-01-01

    Background. A diagnosis is the basis of medical action, the key to various social privileges and national sick leave statistics. The objectives of this study were to investigate which diagnoses general practitioners in Scandinavia give patients with severe subjective health complaints, and what kind of treatments they suggested.

    Methods. One hundred and twenty-six self-selected general practitioners in Scandinavia diagnosed nine patients, presented as video vignettes, in a c...

  4. Diagnosing FASD in adults: the development and operation of an adult FASD clinic in Ontario, Canada.

    Science.gov (United States)

    Temple, Valerie K; Ives, Jillian; Lindsay, Ann

    2015-01-01

    This paper describes the development and operation of an interdisciplinary Fetal Alcohol Spectrum Disorders (FASD) diagnostic clinic focussing specifically on adults. The clinic is embedded within a community-based interdisciplinary health agency specializing in intellectual and developmental disabilities. A review of the clinic’s assessment process is presented describing the steps from intake to feedback and intervention. To date, the clinic has received 93 referrals and given 41 alcohol-related diagnoses including 10 completed using videoconferencing technology. Issues unique to adult diagnosis are discussed as well as some of the challenges, including high rates of cancellations/no-shows for appointments, obtaining background and historical information, establishing maternal alcohol history, working collaboratively with other support sectors such as children’s protective services and the justice system, and finding appropriate follow-up and intervention services in the community. Recommendations for future work to support adults with FASD and their families are presented. PMID:25739127

  5. Characterizing Patient-Generated Clinical Data and Associated Implications for Electronic Health Records.

    Science.gov (United States)

    Arsoniadis, Elliot G; Tambyraja, Rabindra; Khairat, Saif; Jahansouz, Cyrus; Scheppmann, Daren; Kwaan, Mary R; Hultman, Gretchen; Melton, Genevieve B

    2015-01-01

    Patient-facing technologies are increasingly utilized for direct patient data entry for potential incorporation into the electronic health record. We analyzed patient-entered data during implementation of a patient-facing data entry technology using an online patient portal and clinic-based tablet computers at a University-based tertiary medical center clinic, including entries for past medical history, past surgical history, and social history. Entries were assessed for granularity, clinical accuracy, and the addition of novel information into the record. We found that over half of patient-generated diagnoses were duplicates of lesser or equal granularity compared to previous provider-entered diagnoses. Approximately one fifth of patient-generated diagnoses were found to meet the criteria for new, meaningful additions to the medical record. Our findings demonstrate that while patient-generated data provides important additional information, it may also present challenges including generating inaccurate or less granular information. PMID:26262030

  6. Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study.

    Science.gov (United States)

    Huang, Li-Chung; Tsai, Kuen-Jer; Wang, Hao-Kuang; Sung, Pi-Shan; Wu, Ming-Hsiu; Hung, Kuo-Wei; Lin, Sheng-Hsiang

    2014-12-15

    Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. This study estimated the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria by using National Health Research Institute database. These patients received either outpatient or inpatient care for their condition. Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution. The estimated mean annual incidence was 27.57 per 10(5) inhabitants and the one year prevalence was 65.05 per 10(5) inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 53% of adults (?18 years) and 48% of child and adolescent patients (6-17 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients. We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding. PMID:25169892

  7. How successfully do general practitioners diagnose herpetic gingivo-stomatitis clinically?

    OpenAIRE

    Kiderman, Alexander; Furst, Arthur L; Miller, T.; Schmidt-Afek, N; Morag, Avraham; Zakay-Rones, Zichria

    2002-01-01

    Herpetic gingivo-stomatitis is a common, often painful affliction of young children. Recently, aciclovir treatment has been found to be effective in hospital-referred cases, an approach limited in general practice where laboratory diagnosis is invariably impractical. This study demonstrated that 49 out of 63 clinical diagnoses of herpetic gingivo-stomatitis [PPV = 78%] made by 27 GPs were subsequently validated by laboratory virus culture. This suggests that herpetic gingivo-stomatitis might ...

  8. Computer-assisted interpretation of planar whole-body bone scintigraphy in patients with newly diagnosed prostate cancer

    DEFF Research Database (Denmark)

    Petersen, Lars J; Mortensen, Jesper C; Bertelsen, Henrik; Zacho, Helle D

    2015-01-01

    PURPOSE: The aim of this study was to compare the diagnostic properties of EXINI Bone in newly diagnosed prostate cancer in comparison with expert reading. MATERIALS AND METHODS: Bone scintigraphy was performed in consecutive patients referred for staging at three clinics (342 patients with DICOM file format, 272 with Interfile format). Images were reported by three independent readers on a four-point scale (class 1-4) and by using a dichotomous outcome (M1 or M0). The software analyzed data in ...

  9. Tuberculosis of kidneys diagnosed in a renal transplant patient

    International Nuclear Information System (INIS)

    Not earlier reported case of patient with renal graft and tuberculosis of native kidneys is presented. In diagnosis of renal tuberculosis the bigger diagnostic value has renography than ultrasonography. (author)

  10. Screening and diagnosing depression in women visiting GPs' drop in clinic in Primary Health Care

    OpenAIRE

    Johansson Sven-Erik; Aberg-Wistedt Anna; Furhoff Anna-Karin; Wernering Estera; Stromberg Ranja; Backlund Lars G

    2008-01-01

    Abstract Background Only half of all depressions are diagnosed in Primary Health Care (PHC). Depression can remain undetected for a long time and entail high costs for care and low quality of life for the individuals. Drop in clinic is a common form of organizing health care; however the visits are short and focus on solving the most urgent problems. The aim of this study was to investigate the prevalence and severity of depression among women visiting the GPs' drop in clinic and to identify ...

  11. Diagnosing alcohol abuse in alcohol dependent individuals: diagnostic and clinical implications

    OpenAIRE

    Ray, Lara A; Hutchison, Kent E.; Leventhal, Adam M.; Miranda, Robert; Francione, Caren; Chelminski, Iwona; Young, Diane; ZIMMERMAN, MARK

    2009-01-01

    In DMS-IV, the diagnosis of alcohol abuse is precluded by the diagnosis of alcohol dependence. The goal of this study was to examine the diagnostic and clinical implications of diagnosing alcohol abuse among alcohol dependent individuals. Treatment-seeking psychiatric outpatients with a lifetime history of alcohol dependence (n = 544), some of whom (n = 45) did not meet lifetime criteria for alcohol abuse completed in-depth, face-to-face, semi-structured clinical assessments of DSM-IV axis I ...

  12. Pharmacological therapy in patients diagnosed with Peyronie's disease

    OpenAIRE

    Halal, AA; Geavlete, P; Ceban, E

    2012-01-01

    Peyronie's disease is still a therapeutic dilemma for the urologist. Although medical treatment includes multiple versions, few therapeutic agents had significant effects. The combination between oral therapy and intralesional agents can improve the quality of life of the patients with Peyronie's disease.

  13. Transmission route and reasons for HIV testing among recently diagnosed HIV patients in HIV-TR cohort, 2011–2012

    Directory of Open Access Journals (Sweden)

    Basak Dokuzoguz

    2014-11-01

    Full Text Available Introduction: Routes of transmission and reasons for HIV testing are important epidemiologic data to analyze the epidemic and to tailor the response to AIDS. The aim of this study was to analyze reasons for testing and transmission ways of HIV among recently diagnosed HIV patients registered in the multicenter HIV-TR cohort in Turkey. Methods: Transmission ways and reasons for testing of all patients diagnosed in 2011 and 2012 were recorded on a web-based data collection system and were analyzed retrospectively. Results: The study included 693 patients (561 male, 132 female from 24 sites. Reason for HIV testing was available in 640 patients (92%. The most common reason for HIV testing was diagnostic workout for other conditions or illness followed by patient-initiated testing. The reasons for testing were listed in Table 1. The most common routes of HIV transmission were heterosexual intercourse (62.7% and sex among men who have sex with men (MSM (22.6%. At the time of HIV diagnosis, the mean CD4 lymphocyte cell count was 355/mm3 (3–1433/mm3. Primary HIV infection was determined in 42/693 (6% patients and 9/693 (% 1, 2 cases were considered “probable primary HIV infection.” The majority of the cases presented to a clinic for follow-up right after the diagnosis. On the other hand 32/616 (5.2% patients delayed their presentation for more than 3 months. The longest delay was 11 months. Conclusions: The results of the database suggest that targeted testing is lacking in the country. The shift toward homosexual transmission during the last 2 years emphasizes the need for targeted interventions. Patients present relatively late and HIV infection could only be diagnosed when immunosuppression related findings appeared. Patient-initiated testing,an indicator of awareness, was very low suggesting a need to scale-up awareness raising interventions.

  14. Nursing diagnoses in chronic renal failure patients on hemodialysis / Diagnósticos de enfermagem em pacientes renais crônicos em hemodiálise

    Scientific Electronic Library Online (English)

    Cecília Maria Farias de Queiroz, Frazão; Ana Beatriz de Almeida, Medeiros; Fernanda Beatriz Batista, Lima e Silva; Jéssica Dantas de, Sá; Ana Luisa Brandão de Carvalho, Lira.

    2014-01-01

    Full Text Available OBJETIVO: identificar os diagnósticos de enfermagem mais frequentes em pacientes renais crônicos em hemodiálise. MÉTODOS: Estudo transversal com a inclusão de 178 pacientes, selecionados por amostragem de conveniência do tipo consecutiva. Para a coleta foram utilizados roteiros de entrevista e [...] exame físico. Foi realizado um processo individual de julgamento clínico dos diagnósticos de enfermagem e os resultados obtidos passaram por processo de revisão de forma pareada entre os autores, para maior acurácia. RESULTADOS: Identificaram-se 24 diagnósticos de enfermagem, sendo os mais frequentes: risco de infecção (100%); volume de líquidos excessivo (99,4%); e hipotermia (61,8%). CONCLUSÃO: Os diagnósticos mais frequentes identificados estão inseridos nos domínios segurança/proteção e nutrição. Abstract in english OBJECTIVE: To identify the most frequent nursing diagnoses in chronic renal failure patients on hemodialysis. METHODS: A cross-sectional study including 178 patients, selected by convenience sample, consecutively recruited. For data collection, interview guides and physical examination were us [...] ed. An individual process of clinical judgment for the nursing diagnoses was performed and, for better accuracy, the results obtained underwent a process of paired review among the authors. RESULTS: Twenty-four nursing diagnoses were identified, of which the most frequent were: risk for infection (100%); excessive fluid volume (99.4%); and, hypothermia (61.8%). CONCLUSION: The most frequent diagnoses identified were included in the safety / protection and nutrition domains of NANDA-I.

  15. Using a patient image archive to diagnose retinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Tobin Jr, Kenneth William [ORNL; Abramoff, M.D. [University of Iowa; Chaum, Edward [University of Tennessee, Knoxville (UTK); Giancardo, Luca [ORNL; Govindaswamy, Priya [Oak Ridge National Laboratory (ORNL); Karnowski, Thomas Paul [ORNL; Tennant, M [University of Alberta; Swainson, Stephen [University of Alberta

    2008-01-01

    Diabetes has become an epidemic that is expected to impact 365 million people worldwide by 2025. Consequently, diabetic retinopathy is the leading cause of blindness in the industrialized world today. If detected early, treatments can preserve vision and significantly reduce debilitating blindness. Through this research we are developing and testing a method for automating the diagnosis of retinopathy in a screening environment using a patient archive and digital fundus imagery. We present an overview of our content-based image retrieval (CBIR) approach and provide performance results for a dataset of 98 images from a study in Canada when compared to an archive of 1,355 patients from a study in the Netherlands. An aggregate performance of 89% correct diagnosis is achieved, demonstrating the potential of automated, web-based diagnosis for a broad range of imagery collected under different conditions and with different cameras.

  16. Changes in food choices of recently diagnosed insulin-dependent diabetic patients.

    OpenAIRE

    Niewind, A.C.; Friele, R.D.; Kandou, C.T.; Hautvast, J.G.A.J.; Edema, J.M.P.

    1990-01-01

    Current food use and habitual food use prior to the diagnosis of diabetes were measured using a food frequency questionnaire in a group of recently diagnosed insulin-dependent diabetic patients. Patients (51 m, 29 f) were between the ages of 20 and 40 years and had been diagnosed as insulin-dependent diabetics less than 6 months prior to the study. The results show that patients after the diagnosis of diabetes reduce their consumption of foods and beverages with high sugar content, of snacks ...

  17. Visceral leishmaniasis diagnosed in a patient with MALT lymphoma

    DEFF Research Database (Denmark)

    Kaae, Jeanette; Nørgaard, Peter; Himmelstrup, B

    2007-01-01

    We report a case of visceral leishmaniasis in a 66-year-old female with a history of MALT lymphoma in the gastrointestinal tract. The patient presented with major hemorrhage per rectum and perforation of the small intestine. Due to unexplained decreasing platelets, lymphoma bone marrow involvement was suspected and bone marrow examination was performed. Surprisingly, Leishman-Donovan bodies were detected. The low platelet count, caused by the combination of MALT lymphoma and visceral leishmanias...

  18. How to diagnose neuropathic pain? The contribution from clinical examination, pain questionnaires and diagnostic tests.

    Science.gov (United States)

    La Cesa, S; Tamburin, S; Tugnoli, V; Sandrini, G; Paolucci, S; Lacerenza, M; Marchettini, P; Cruccu, G; Truini, A

    2015-12-01

    Patients with peripheral and central nervous system diseases may suffer from different types of pain, namely nociceptive, neuropathic and mixed pain. Although in some cases, the distinction between these types of pain is clinically evident, yet in some patients an accurate differential diagnosis requires dedicated clinical examination, screening questionnaires and diagnostic techniques some of which are available only in specialized pain centres. This review briefly addresses the currently agreed definitions of the different types of pain and shows how clinical examination, pain questionnaires and diagnostic tests can help the clinicians in identifying neuropathic pain. PMID:26410087

  19. Discrepancias entre diagnósticos clínicos y hallazgos de autopsia / Discrepancies between clinical diagnoses and autopsy findings

    Scientific Electronic Library Online (English)

    María Virginia, Bürgesser; Diego, Camps; Patricia, Calafat; Ana, Diller.

    2011-04-01

    Full Text Available El objetivo principal del presente trabajo fue identificar las discrepancias clínico-patológicas en las autopsias realizadas en la institución. Se revisaron 53 autopsias de casos clínicos en adultos en el período comprendido entre enero de 2005 y junio de 2009, realizadas en el servicio de Anatomía [...] Patológica del Hospital Privado de Córdoba, Argentina. Se excluyeron seis debido a información insuficiente. Se aplicó la clasificación de Goldman y col. para establecer las discrepancias clínico-patológicas entre los diagnósticos pre y post-mortem. Los diagnósticos clínicos más frecuentes fueron las infecciones respiratorias y el tromboembolismo pulmonar agudo. Los hallazgos de autopsia más frecuentes fueron las infecciones respiratorias y el infarto agudo de miocardio. Se detectaron 17 discrepancias mayores y 30 concordancias, no se detectaron discrepancias menores. Las infecciones respiratorias fueron la principal causa de error, seguidas por el infarto agudo de miocardio. Concluimos que en 17/47 (37%) de los casos se realizó un diagnóstico clínico diferente al post-mortem, y que las infecciones respiratorias constituyen el principal tipo de error. Se sugiere adoptar estrategias informativas y educativas, revalorizar la autopsia y las prácticas clínicas tradicionales. Abstract in english The main objective of this study was to identify the clinical-pathological discrepancies in autopsies performed in the institution. We reviewed autopsies of clinical cases in 53 adults in the period between January 2005 and June 2009, carried out in the Pathology Service at the Hospital Privado de C [...] órdoba, Argentina. Six autopsies were excluded due to insufficient information. The Goldman et al. classification was applied to establish clinico-pathologic discrepancies between clinical diagnoses and autopsy findings. Frequently clinical diagnoses were respiratory infections and acute pulmonary embolism. The most frequently reported postmortem diagnoses were respiratory infections and acute myocardial infarction. There were 17 major discrepancies and 30 coincidences. No any minor discrepancy was detected. Respiratory infections were the main cause of error, followed by myocardial infarction. We conclude that in 17/47 (37%) of cases the pre-mortem and postmortem diagnoses were different, and that respiratory infections were the main cause of error. We suggest to adopt educational and informative strategies, to revalue the importance of autopsy, and traditional clinical practices.

  20. Symptoms and diagnoses of patients referring to a child and adolescent psychiatry polyclinic

    Directory of Open Access Journals (Sweden)

    Yonca Sönmez

    2010-01-01

    Full Text Available Objective: The aim of the present study is to identify the complaints and diagnoses of patients who referred to a child and adolescent psychiatry polyclinic. Method: Medical records of 763 patients referred to the Children and Adolescent Psychiatry Polyclinic at Süleyman Demirel University Faculty of Medicine between October 2007 and October 2008 were studied retrospectively. Results: Most of the patients were male and within 7 to 12 years of age. 93.8% of the patients referred to the hospital for chronic conditions persisting for a long time. The most common symptom was nervousness (34.2%. The symptoms of inattentiveness, stuttering, disinterest to school lessons were more frequent among boys and problems in family relations, unhappiness-pessimism-unwillingness, distress-annoyance-discomfort, physical complaints, suicidal attempts, habits, obsessed thoughts and behaviors among girls. The most common diagnosis was depression, followed by anxiety disorders, enuresis, attention deficit hyperactivity disorder, adjustment disorder, relationship problems, stuttering and mental retardation, respectively. Of the cases, 25% were diagnosed with multiple conditions. When the distribution of the diagnoses to sex were assessed, ADHD and stuttering were more frequently diagnosed among boys, on the other hand, depression and relationship problems among girls. Conclusions: In our study, although the internalizing disorders are the most frequent diagnoses, there are differences between genders. The rate of comorbid diagnosis was found to be considerable. In the presence of comorbid diagnoses, the disorder is experienced more heavily and psychosocial functionality gets deteriorated. Diagnostic differences between sex and comorbidity must be assessed carefully in child and adolescent psychiatry polyclinics. It is observed that most of the cases do refer to child psychiatry polyclinic for chronic problems. Prolonged referral period and delay in treatment may cause symptom worsening. When comorbid diagnosis coexistences were evaluated, it is observed that depressive disorder was mostly observed to coexist with relationship problems. It is considered to be important to evaluate family relations and social relations when patients with depressive disorder diagnoses are concerned.

  1. Accuracy of diagnoses predicted from a simple patient questionnaire stratified by the duration of general ambulatory training: an observational study

    Directory of Open Access Journals (Sweden)

    Uehara T

    2013-12-01

    Full Text Available Takanori Uehara,1,2 Masatomi Ikusaka,1 Yoshiyuki Ohira,1 Mitsuyasu Ohta,1,2 Kazutaka Noda,1 Tomoko Tsukamoto,1 Toshihiko Takada,1 Masahito Miyahara11Department of General Medicine, Chiba University Hospital, 2Division of Rotated Collaboration Systems for Local Healthcare, Graduate School of Medicine, Chiba University, Chiba, JapanPurpose: To compare the diagnostic accuracy of diseases predicted from patient responses to a simple questionnaire completed prior to examination by doctors with different levels of ambulatory training in general medicine.Participants and methods: Before patient examination, five trained physicians, four short-term-trained residents, and four untrained residents examined patient responses to a simple questionnaire and then indicated, in rank order according to their subjective confidence level, the diseases they predicted. Final diagnosis was subsequently determined from hospital records by mentor physicians 3 months after the first patient visit. Predicted diseases and final diagnoses were codified using the International Classification of Diseases version 10. A “correct” diagnosis was one where the predicted disease matched the final diagnosis code.Results: A total of 148 patient questionnaires were evaluated. The Herfindahl index was 0.024, indicating a high degree of diversity in final diagnoses. The proportion of correct diagnoses was high in the trained group (96 of 148, 65%; residual analysis, 4.4 and low in the untrained group (56 of 148, 38%; residual analysis, -3.6 (?2=22.27, P<0.001. In cases of correct diagnosis, the cumulative number of correct diagnoses showed almost no improvement, even when doctors in the three groups predicted ?4 diseases.Conclusion: Doctors who completed ambulatory training in general medicine while treating a diverse range of diseases accurately predicted diagnosis in 65% of cases from limited written information provided by a simple patient questionnaire, which proved useful for diagnosis. The study also suggests that up to three differential diagnoses are appropriate for diagnostic prediction, while ?4 differential diagnoses barely improved the diagnostic accuracy, regardless of doctors’ competence in general medicine. If doctors can become able to predict the final diagnosis from limited information, the correct diagnostic outcome may improve and save further consultation hours.Keywords: clinical reasoning, diagnostic accuracy, diagnostic reasoning, general medicine, Herfindahl index, predict disease

  2. Evaluation of Dream Content Among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses Other than Schizophrenia, and Healthy Control

    OpenAIRE

    Leeba Rezaie; Masoud Rezaei; David C Schwebel; Golrokh Younesi; Masoud Tahmasian; Habibolah Khazaie; Mehrak Mohamadi; Arezo Ghanbari

    2012-01-01

    Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content...

  3. Evaluation of thermal, pain, and vibration sensation thresholds in newly diagnosed type 1 diabetic patients.

    OpenAIRE

    Ziegler, D.; Mayer, P.; GRIES, F. A.

    1988-01-01

    Small and large fibre function was studied in 40 non-ketotic, newly diagnosed Type 1 diabetic patients and 48 age-matched controls, using 12 quantitative tests for assessment of cutaneous sensation. Patients were aged 10-39 years and had been treated with insulin for 4-31 days. Thermal discrimination (foot), warm and cold thermal perception (thenar eminence and foot), and heat and cold pain perception thresholds (thenar eminence) were significantly elevated in the patients as compared with th...

  4. European Myeloma Network recommendations on the evaluation and treatment of newly diagnosed patients with multiple myeloma

    DEFF Research Database (Denmark)

    Engelhardt, Monika; Terpos, Evangelos; Kleber, Martina; Gay, Francesca; Wäsch, Ralph; Morgan, Gareth; Cavo, Michele; van de Donk, Niels; Beilhack, Andreas; Bruno, Benedetto; Johnsen, Hans Erik; Hajek, Roman; Driessen, Christoph; Ludwig, Heinz; Beksac, Meral; Boccadoro, Mario; Straka, Christian; Brighen, Sara; Gramatzki, Martin; Larocca, Alessandra; Lokhorst, Henk; Magarotto, Valeria; Morabito, Fortunato; Dimopoulos, Meletios A; Einsele, Hermann; Sonneveld, Pieter; Palumbo, Antonio

    2014-01-01

    Multiple myeloma management has undergone profound changes in the past thanks to advances in our understanding of the disease biology and improvements in treatment and supportive care approaches. This article presents recommendations of the European Myeloma Network for newly diagnosed patients based on the GRADE system for level of evidence. All patients with symptomatic disease should undergo risk stratification to classify patients for International Staging System stage (level of evidence: 1A)...

  5. Analysis of Patient Service Time in Ambulatory Clinics: Patient Tracking

    OpenAIRE

    Zerbe, Tony R.; Zerbe, Shirleen D.

    1990-01-01

    Historically, analysis of patient service time (patient tracking) in ambulatory clinics has been performed manually. A case study of Eye and Ear Clinic in Pittsburgh, PA, revealed that this approach to patient data collection was prone to clerical error and did not satisfy the clinic's information-processing needs. Initial attempts at automation identified the features required of a successful computerized scheduling and patient tracking system.

  6. The Clinical Course of Late Diagnosed Fatal Cases of A (H1N1 Influenza in Poland 

    Directory of Open Access Journals (Sweden)

    Marta Rorat

    2013-06-01

    Full Text Available Introduction: The most frequent complication of A (H1N1 influenza and the leading cause of death was pneumonia with a primary viral or mixed viral and bacterial etiology. 182 patients had died because of a pandemic influenza in Poland by 31st July 2010.Material and Methods: A retrospective study of 6 fatal cases of pandemic influenza, aged 23-41, including 3 women, hospitalised between November 2009 and February 2011 in different Polish medical centres.Results: We present the clinical course of 6 late diagnosed cases of A (H1N1 influenza. All patients presented typical flu-like symptoms in the beginning. 4/6 patients had severe disease risk factors: pregnancy, arthritis, Wegener granulomatosis and obesity. All patients were seen by doctors, no one had received antiviral therapy, 4/5 were treated with antibiotics before they were hospitalized. One patient had nosocomial infection. Patients were admitted to the hospital on the 3rd to 8th day of the disease. They received oseltamivir treatment on the 4th to 9th day. All patients developed pneumonia complicated by acute respiratory distress syndrome. Death appeared between the 4th and 27th day after the onset of symptoms. Autopsies were performed in 5 cases and revealed haemorrhagic pneumonia in 2 patients.Conclusion: Delayed diagnosis and antiviral treatment initiation has a significant impact on mortality in A (H1N1 influenza. During the influenza epidemic, patients presenting typical symptoms should always be suspected of having influenza. Antiviral treatment has to be initiated immediately, especially ifthere are risk factors of severe disease.

  7. A changing trend in the management of patients with newly diagnosed Crohn's disease.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Epidemiologic shift with rising incidence of Crohn\\'s disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.

  8. Assessment of vitamin B6 status in Korean patients with newly diagnosed type 2 diabetes

    OpenAIRE

    Ahn, Hee Jung; Min, Kyung Wan; Cho, Youn-Ok

    2011-01-01

    The purpose of this study was to assess vitamin B6 intake and status in Korean patients with newly diagnosed type 2 diabetes. Sixty-four patients with newly diagnosed type 2 diabetes and 8-11% glycated hemoglobin (A1C), along with 28 age-matched non-diabetic subjects, participated. Dietary vitamin B6 intake was estimated by the 24 hour recall method and plasma pyridoxal 5'-phosphate (PLP) was measured. There was a significant difference in daily total calorie intake between the diabetic and n...

  9. How well do discharge diagnoses identify hospitalised patients with community-acquired infections? - a validation study

    DEFF Research Database (Denmark)

    Henriksen, Daniel Pilsgaard; Nielsen, Stig LØnberg

    2014-01-01

    BACKGROUND: Credible measures of disease incidence, trends and mortality can be obtained through surveillance using manual chart review, but this is both time-consuming and expensive. ICD-10 discharge diagnoses are used as surrogate markers of infection, but knowledge on the validity of infections in general is sparse. The aim of the study was to determine how well ICD-10 discharge diagnoses identify patients with community-acquired infections in a medical emergency department (ED), overall and related to sites of infection and patient characteristics. METHODS: We manually reviewed 5977 patients admitted to a medical ED in a one-year period (September 2010-August 2011), to establish if they were hospitalised with community-acquired infection. Using the manual review as gold standard, we calculated the sensitivity, specificity, predictive values, and likelihood ratios of discharge diagnoses indicating infection. RESULTS: Two thousand five hundred eleven patients were identified with community-acquired infection according to chart review (42.0%, 95% confidence interval [95%CI]: 40.8-43.3%) compared to 2550 patients identified by ICD-10 diagnoses (42.8%, 95%CI: 41.6-44.1%). Sensitivity of the ICD-10 diagnoses was 79.9% (95%CI: 78.1-81.3%), specificity 83.9% (95%CI: 82.6-85.1%), positive likelihood ratio 4.95 (95%CI: 4.58-5.36) and negative likelihood ratio 0.24 (95%CI: 0.22-0.26). The two most common sites of infection, the lower respiratory tract and urinary tract, had positive likelihood ratios of 8.3 (95%CI: 7.5-9.2) and 11.3 (95%CI: 10.2-12.9) respectively. We identified significant variation in diagnostic validity related to age, comorbidity and disease severity. CONCLUSION: ICD-10 discharge diagnoses identify specific sites of infection with a high degree of validity, but only a moderate degree when identifying infections in general.

  10. Long-term mortality in patients diagnosed with Listeria monocytogenes meningitis: A Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess

    2012-01-01

    OBJECTIVES: To determine the long-term mortality, the causes of death and the incidence of cancer in listeria meningitis patients. METHODS: Nationwide, population-based cohort study including all adult patients diagnosed with listeria meningitis from 1977 to 2006 and alive 1 year after diagnosis, and an age-and gender-matched, population control cohort. Kaplan-Meier tables, Cox regression analysis and cumulative incidence function were used as outcome analyses. RESULTS: We identified 114 listeria meningitis patients and 1026 population controls. The adjusted mortality rate ratio (MRR) for listeria meningitis patients the first 5 years of follow-up was 2.35(95% confidence interval (CI) 1.60-3.45) thereafter the MRR was 0.93(95% CI: 0.56-1.55). Listeria meningitis patients had an increased risk of death due to cancer the first 5 years of follow-up, and in the same period patients above 50 years of age had a 2-fold increased risk of being diagnosed with cancer, thereafter the risks declined to that of the background population. CONCLUSIONS: The long-term mortality in adult patients diagnosed with listeria meningitis was increased the first 5 years of follow-up, mainly due to death from cancer, thereafter the mortality did not differ from the background population. To improve survival this patient population should be meticulously screened for predisposing conditions, mainly underlying malignant diseases.

  11. The clinical application studies of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations

    Energy Technology Data Exchange (ETDEWEB)

    Gao Sijia [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China)], E-mail: scarlettgao@126.com; Zhang Mengwei; Liu Xiping; Zh Yushen; Liu Jinghong; Wang Zhonghui [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Zang Peizhuo [Department of Neurosurgery, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Shi Qiang; Wang Qiang [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Liang Chuansheng [Department of Neurosurgery, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China); Xu Ke [Department of Radiology, No. 1 Affiliated Hospital of China Medical University, Shenyang 110001 (China)

    2009-07-15

    Background and purpose: To explore the value of CT spinal angiography with 64-detector row spiral CT in diagnosing spinal vascular malformations. Methods: Seventeen patients with initial MR and clinical findings suggestive of spinal vascular diseases underwent CT spinal angiography. Among these, 14 patients took DSA examination within 1 week after CT scan, 7 patients underwent surgical treatment, and 6 patients underwent vascular intervention embolotheraphy. CT protocol: TOSHIBA Aquilion 64 Slice CT scanner, 0.5 mm thickness, 0.5 s/r, 120 kV and 350 mA, positioned at the aortic arch level, and applied with 'sure start' technique with CT threshold of 180 Hu. Contrast agent Iohexol (370 mg I/ml) was injected at 6 ml/s velocity with total volume of 80 ml. The post-processing procedures included MPR, CPR, MIP, VR, etc. Among the 17 patients, four patients underwent fast dynamic contrast-enhanced 3D MR angiography imaging. CT spinal angiography and three-dimensional contrast-enhanced MR angiography (3D CE-MRA) images were compared and evaluated with DSA and operation results based on disease type, lesion range, feeding arteries, fistulas, draining veins of vascular malformation by three experienced neuroradiologists independently, using double blind method. The data were analyzed using SPSS analytic software with {chi}{sup 2}-test. We compared the results with DSA and operation results. Results: The statistical analysis of the diagnostic results by the three experienced neuroradiologists had no statistical difference (P > 0.05). All of the 17 patients showed clearly the abnormality of spinal cord vessels and the range of lesions by CT spinal angiography. Among them, one patient was diagnosed as arteriovenous fistulas (AVF) by MRI and CT spinal angiography, which was verified by surgical operation. DSA of the same patient, however, did not visualize the lesion. One case was diagnosed as AVM complicated with AVF by DSA, but CT spinal angiography could only show AVM not AVF. The type differentiations of all the other 16 patients were consistent with DSA results. For 13 cases with positive CT spinal angiography results, DSA displayed 20 feeding vessels, among which 16 vessels were displayed correctly by CT spinal angiography, four could not be visualized, and two turned out to be false-positive. Fistulas were not displayed in six cases by CT spinal angiography. Draining veins were displayed clearly in all cases, which agreed with DSA results. Four cases who took CE-MRA obtained the same type diagnosis as that from CT spinal angiography. Feeding arteries were not displayed in CE-MRA of one case, but could be clearly visualized in other three cases, and the results agreed with CTA and DSA results. Fistulas could be seen in two cases. Draining veins and the disease range could be displayed distinctly by 3D CE-MRA. Conclusion: CT spinal angiography is quite valuable for diagnosing vascular malformation of spinal cord. It can be a screening exam before DSA, and has a guiding effect on DSA, reducing the amount of time required for DSA.

  12. Neuroautonomic evaluation of patients with unexplained syncope: incidence of complex neurally mediated diagnoses in the elderly

    Directory of Open Access Journals (Sweden)

    Rafanelli M

    2014-02-01

    Full Text Available Martina Rafanelli, Alessandro Morrione, Annalisa Landi, Emilia Ruffolo, Valentina M Chisciotti, Maria A Brunetti, Niccolò Marchionni, Andrea Ungar Syncope Unit, Cardiology and Geriatric Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy Background: The incidence of syncope increases in individuals over the age of 70 years, but data about this condition in the elderly are limited. Little is known about tilt testing (TT, carotid sinus massage (CSM, or supine and upright blood pressure measurement related to age or about patients with complex diagnoses, for example, those with a double diagnosis, ie, positivity in two of these three tests. Methods: A total of 873 consecutive patients of mean age 66.5±18 years underwent TT, CSM, and blood pressure measurement in the supine and upright positions according to the European Society of Cardiology guidelines on syncope.1 Neuroautonomic evaluation was performed if the first-line evaluation (clinical history, physical examination, electrocardiogram was suggestive of neurally mediated syncope, or if the first-line evaluation was suggestive of cardiac syncope but this diagnosis was excluded after specific diagnostic tests according to European Society of Cardiology guidelines on syncope, or if certain or suspected diagnostic criteria were not present after the first-line evaluation. Results: A diagnosis was reached in 64.3% of cases. TT was diagnostic in 50.4% of cases, CSM was diagnostic in 11.8% of cases, and orthostatic hypotension was present in 19.9% of cases. Predictors of a positive tilt test were prodromal symptoms and typical situational syncope. Increased age and a pathologic electrocardiogram were predictors of carotid sinus syndrome. Varicose veins and alpha-receptor blockers, nitrates, and benzodiazepines were associated with orthostatic hypotension. Twenty-three percent of the patients had a complex diagnosis. The most frequent association was between vasovagal syncope and orthostatic hypotension (15.8%; 42.9% of patients aged 80 years or older had a complex diagnosis, for which age was the strongest predictor. Conclusion: Neuroautonomic evaluation is useful in older patients with unexplained syncope after the initial evaluation. A complex neurally mediated diagnosis is frequent in older people. Our results suggest that complete neuroautonomic evaluation should be done particularly in older patients. Keywords: syncope, elderly, tilt testing, carotid sinus massage, blood pressure, neurally mediated diagnosis

  13. [Real and psychological halitosis--findings, diagnoses and outcomes of a halitosis clinic].

    Science.gov (United States)

    Filippi, Andreas; Müller, Nadja

    2006-01-01

    Halitosis is a common problem among humans. The cause can be oral or non-oral. Psychological causes (psychosomatic halitosis) are to be ranked as exceptional. During a period of 18 months, 144 patients were examined and treated at the Halitosis-Consultation at the University of Basle. All patients were convinced that they suffered from bad oral breath. A specially developed questionnaire was followed by a dental examination and a diagnosis. When halitosis with an oral cause was diagnosed an exclusive cause-related therapy was initiated and regulary controlled. 84% of the patients had halitosis with an oral cause; non-oral causes were rare; 12.5% (n=18) had psychosomatic halitosis. Tongue coating, gingivitis and periodontitis were the most frequent oral causes, tonsillitis the most frequent non-oral cause. No correlations were found between smoking and halitosis, or stress and halitosis. Patients with psychosomatic halitosis had a significantly higher rate of antidepressants intake. These patients generally assessed their bad breath as very strong and omnipresent. Medical examinations and treatments carried out earlier showed that the assumption of doctors, dentists and patients that halitosis was mainly caused by gastroenterological disorders, is still widely spread. The positive results of 91.9% (objective) and 96.9% (subjective) confirmed the therapeutical concept of the "halitosis-consultation" at the University of Basle as highly successful. PMID:16524215

  14. Sociodemographic and clinical characteristics of patients with recurrent aphthous stomatitis

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    An?l Gülsel Bahal?

    2014-12-01

    Full Text Available Background and Design: The purpose of this study was to obtain data that may provide an insight into the etiopathogenesis of recurrent aphtous stomatitis (RAS by the way of analysing the sociodemographic and clinical characteristics of patients who had been diagnosed with RAS. Materials and Metods: The patients, who were diagnosed with RAS in the dermatology outpatient clinic, between May 2007 and May 2010, were evaluated retrospectively. The data including sociodemografic and clinical characteristics, and treatment options were recorded. Results: A hundred patients (68 women, 32 men were included in this study. The average age was 40±13.6 years. RAS was more common in patients with middle-income and low education. The most common type of RAS was minor aphtous ulcers (88%. The lesions were most frequently seen on the lateral side of the tongue (34% and cheek (34%. Sixty percent of patients had a positive family history. Some factors such as biting (12%, tooth brushing (18%, dental disease presence (82%, food (39%, menstruation (10.3%, stress (76%, iron deficiency (16.7%, vitamin B12 deficiency (22.4%, low serum ferritin levels (18%, and seasonal variability (32% showed positive correlation with RAS. A negative correlation was found between RAS and smoking. Forty-nine percent of patients had used alternative therapies in addition to drug therapy. The most frequently used alternative method was consumption of sumac (26.5%. Conlucions: In contrast to the literature, our study found that RAS is started in the third decade of life and, approximately 50% of patients prefered alternative treatment methods, particularly sumac. Nowadays, discussions about the etiopathogenesis of RAS continue. In this study, we found that different sociodemographic and clinical factors may be associated with the etiopathogenesis of the disease. Our study will be followed by further studies using prospective design to identify the the etiopathogenesis of RAS.

  15. CTSH regulates ?-cell function and disease progression in newly diagnosed type 1 diabetes patients.

    Science.gov (United States)

    Fløyel, Tina; Brorsson, Caroline; Nielsen, Lotte B; Miani, Michela; Bang-Berthelsen, Claus Heiner; Friedrichsen, Martin; Overgaard, Anne Julie; Berchtold, Lukas A; Wiberg, Anna; Poulsen, Pernille; Hansen, Lars; Rosinger, Silke; Boehm, Bernhard O; Ram, Ramesh; Nguyen, Quang; Mehta, Munish; Morahan, Grant; Concannon, Patrick; Bergholdt, Regine; Nielsen, Jens H; Reinheckel, Thomas; von Herrath, Matthias; Vaag, Allan; Eizirik, Decio Laks; Mortensen, Henrik B; Størling, Joachim; Pociot, Flemming

    2014-07-15

    Over 40 susceptibility loci have been identified for type 1 diabetes (T1D). Little is known about how these variants modify disease risk and progression. Here, we combined in vitro and in vivo experiments with clinical studies to determine how genetic variation of the candidate gene cathepsin H (CTSH) affects disease mechanisms and progression in T1D. The T allele of rs3825932 was associated with lower CTSH expression in human lymphoblastoid cell lines and pancreatic tissue. Proinflammatory cytokines decreased the expression of CTSH in human islets and primary rat ?-cells, and overexpression of CTSH protected insulin-secreting cells against cytokine-induced apoptosis. Mechanistic studies indicated that CTSH exerts its antiapoptotic effects through decreased JNK and p38 signaling and reduced expression of the proapoptotic factors Bim, DP5, and c-Myc. CTSH overexpression also up-regulated Ins2 expression and increased insulin secretion. Additionally, islets from Ctsh(-/-) mice contained less insulin than islets from WT mice. Importantly, the TT genotype was associated with higher daily insulin dose and faster disease progression in newly diagnosed T1D patients, indicating agreement between the experimental and clinical data. In line with these observations, healthy human subjects carrying the T allele have lower ?-cell function, which was evaluated by glucose tolerance testing. The data provide strong evidence that CTSH is an important regulator of ?-cell function during progression of T1D and reinforce the concept that candidate genes for T1D may affect disease progression by modulating survival and function of pancreatic ?-cells, the target cells of the autoimmune assault. PMID:24982147

  16. CTSH regulates ?-cell function and disease progression in newly diagnosed type 1 diabetes patients

    DEFF Research Database (Denmark)

    FlØyel, Tina; Brorsson, Caroline

    2014-01-01

    Over 40 susceptibility loci have been identified for type 1 diabetes (T1D). Little is known about how these variants modify disease risk and progression. Here, we combined in vitro and in vivo experiments with clinical studies to determine how genetic variation of the candidate gene cathepsin H (CTSH) affects disease mechanisms and progression in T1D. The T allele of rs3825932 was associated with lower CTSH expression in human lymphoblastoid cell lines and pancreatic tissue. Proinflammatory cytokines decreased the expression of CTSH in human islets and primary rat ?-cells, and overexpression of CTSH protected insulin-secreting cells against cytokine-induced apoptosis. Mechanistic studies indicated that CTSH exerts its antiapoptotic effects through decreased JNK and p38 signaling and reduced expression of the proapoptotic factors Bim, DP5, and c-Myc. CTSH overexpression also up-regulated Ins2 expression and increased insulin secretion. Additionally, islets from Ctsh(-/-) mice contained less insulin than isletsfrom WT mice. Importantly, the TT genotype was associated with higher daily insulin dose and faster disease progression in newly diagnosed T1D patients, indicating agreement between the experimental and clinical data. In line with these observations, healthy human subjects carrying the T allele have lower ?-cell function, which was evaluated by glucose tolerance testing. The data provide strong evidence that CTSH is an important regulator of ?-cell function during progression of T1D and reinforce the concept that candidate genes for T1D may affect disease progression by modulating survival and function of pancreatic ?-cells, the target cells of the autoimmune assault.

  17. Clinical and Imaging Findings in 18 Patients with Eosinophilic Pneumonia

    Directory of Open Access Journals (Sweden)

    M. Bakhshayesh Karam

    2007-10-01

    Full Text Available Background/Objective: Eosinophilic pneumonia is a rare cause of lung disease in adulthood. The relatively non-specific clinical presentations of this disease process make the diagnosis a unique challenge. Herein, we reported on clinical and radiological manifestations of this rare clinical entity in 18 patients. "nPatients and Methods: We retrospectively reviewed the medical records of 18 patients with acute eosinophilic pneumonia in Masih Daneshvari Medical Center. Diagnostic criteria were based on clinical, laboratory and imaging findings."nResults: The most clinical manifestations were cough and weight loss 15 (0.83 followed by dyspnea 13 (0.72. The most frequent imaging findings were diffuse opacities (reticulo-nodular or alveolar infiltration in 11 (0.65, consolidation in six (0.33 and ground-glass opacities in four (0.28 patients."nConclusion: Diffuse rather than peripheral air-space opacities in imaging of a patient presented with dyspnea, cough, sputum, constitu-tional symptoms and eosinophilia should make us to think about eosinophilic pneumonia as one of differential diagnoses.

  18. Metastatic calcification in a patient with multiple myeloma diagnosed as SDRA

    International Nuclear Information System (INIS)

    We present the case of a 44 year-old man with multiple myeloma who presented with a fever that is managed initially as pneumonia multilobar and later because of persistence of alveolar infiltrates and severe hypoxaemia as SDRA. The patient in the end passed away and was diagnosed with a metastatic calcification through open lung biopsy

  19. Spreading the clinical window for diagnosing fetal-onset hypogonadism in boys

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    RodolfoRey

    2014-05-01

    Full Text Available In early fetal development, the testis secretes –independently of pituitary gonadotropins– androgens and anti-Müllerian hormone (AMH which are essential for male sex differentiation. In the second half of fetal life, the hypothalamic-pituitary axis gains control of testicular hormone secretion. FSH controls Sertoli cell proliferation, responsible for testis volume increase and AMH and inhibin B secretion, whereas LH regulates Leydig cell androgen and INSL3 secretion, involved in the growth and trophism of male external genitalia and in testis descent. This differential regulation of testicular function between early and late fetal periods underlies the distinct clinical presentations of fetal-onset hypogonadism in the newborn male: primary hypogonadism results in ambiguous or female genitalia when early fetal-onset whereas it becomes clinically undistinguishable from central hypogonadism when established later in fetal life. The assessment of the hypothalamic-pituitary-gonadal axis in the male has classically relied on the measurement of gonadotropin and testosterone levels in serum. These hormone levels normally decline 3-6 months after birth, thus constraining the clinical evaluation window for diagnosing male hypogonadism. The advent of new markers of gonadal function has spread this clinical window beyond the first 6 months of life. In this review, we discuss the advantages and limitations of old and new markers used for the functional assessment of the hypothalamic-pituitary-testicular axis in boys suspected of fetal-onset hypogonadism.

  20. Transmitted antiretroviral drug resistance mutations in newly diagnosed HIV-1 positive patients in Turkey

    Directory of Open Access Journals (Sweden)

    Murat Sayan

    2014-11-01

    Full Text Available Introduction: The objective of this study was to determine the transmitted drug resistance mutations (TDRMs in newly diagnosed HIV-1 positive patients in Turkey. Materials and Methods: The study was carried out between 2009 and 2014 and antiretroviral naïve 774 HIV-1 infected patients from 19 Infectious Diseases and Clinical Microbiology Departments in Turkey were included; gender: 664 (86% male, median age: 37 (range; 1–77, median CD4+T-cell: 360 (range; 1–1320 count/mm3, median HIV-RNA load: 2.10+E6 (range; 4.2+E2–7.41+E8 IU/mL. HIV-1 drug resistance mutations were detected by population based sequencing of the reverse transcriptase (codon 41–238 and protease (codon 1–99 domains of pol gene of HIV-1, and analyzed according to the criteria by the World Health Organization 2009 list of surveillance drug resistance mutations [1]. Results: The patients had TDRMs to NRTIs (K65R, M184V, NNRTIs (K101E, K103N/S, G190A/E/S, Y181I/C, Y188H/L and PIs (M46L, I54V, L76V, V82L/T, N83D, I84V, L90M. The prevalence of overall TDRMs was 6.7% (52/774. Resistance mutations were found to be 0.7% (6/774, 4.1% (32/774 and 2.1% (17/774 to NRTIs, NNRTIs and PIs drug groups, respectively. Three patients had NRTIs+NNRTs resistance mutations (M184V+K103N as multi-class drug resistance. However, thymidine analogue resistance mutations (TAMs determined two distinct genotypic profiles in the HIV-1 reverse transcriptase: TAM1: M41L, L210W and T215Y, and TAM2: D67N, K70R, K219E/Q, and T215F. The prevalence of TAM1 and TAM2 were 7.7% (60/774 and 4.3% (34/774, respectively. Conclusions: The TDRMs prevalence of antiretroviral naïve HIV-1 infected patients may be suggested current situation of Turkey. These long-term and large-scale results show that the resistance testing must be an integral part of the management of HIV infection in Turkey.

  1. The clinical application of C arm CT imaging in diagnosing and treating hypo-vascular primary hepatic carcinomas

    International Nuclear Information System (INIS)

    Objective: To investigate the clinical application of C arm CT imaging technique in diagnosing and treating of hypo-vascular primary hepatic carcinomas. Methods: Forty-three patients with hypo-vascular primary hepatic carcinomas were enrolled in this study. All the patients underwent DSA and C arm CT imaging (Philips dual x-ray flat-panel digital imaging system) before transcatheter arterial chemoembolization (TACE). The imaging findings were retrospectively analyzed. The detection rate of hepatic tumors estimated before TACE were compared among CT/MRI, DSA and C arm CT imaging. Results: After TACE a total of 97 hypo-vascular tumors were found on CT scanning. The detection rates of hepatic tumors on CT/MRI, DSA and C arm CT imaging were 71.1% (69/97), 78.4% (76/97) and 89.7% (87/97), respectively, with P0.05. Conclusion: C arm CT imaging technique is superior to CT/MRI and DSA in detecting the hypo-vascular hepatic tumors. This technique can more precisely and more sensitively demonstrate the hepatic lesions, especially for the tumors with a diameter smaller than 10 mm. Therefore, this technique has great clinical value in treating hepatocellular carcinomas. (authors)

  2. Clinically unsuspected Hodgkin?s lymphoma diagnosed primarily from bone marrow trephine biopsy: Report of six cases

    Directory of Open Access Journals (Sweden)

    Kar Rakhee

    2008-04-01

    Full Text Available Bone marrow may be the initial or rarely the only site of involvement in Hodgkin?s lymphoma. A high index of suspicion is required to pick up the histopathological changes of Hodgkin?s lesions in the bone marrow like necrosis, presence of Reed-Sternberg cell or its variant in a polymorphic background infiltrate, focal fibrosis and myxoid change especially in the absence of classical clinical picture. Bone marrow with immunohistochemistry has a valuable role in the staging and in the diagnosis of primary medullary Hodgkin?s lymphoma. B-symptoms may easily masquerade as an infectious process as in all our cases the patients had fever as a presenting feature, in four of them tuberculosis was suspected clinically and two had received antitubercular therapy elsewhere. We report six human immunodeficiency virus-negative patients diagnosed over a period of 5 years in which the initial diagnosis of Hodgkin?s lymphoma was suggested from bone marrow histology.

  3. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B; Olsen, Morten; Ali, Naeem; Angus, Derek C; Sørensen, Henrik Toft

    2014-01-01

    IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patients in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. EXPOSURES: Critical illness defined as intensive care unit admiss...

  4. Long-term mortality in patients diagnosed with Listeria monocytogenes meningitis: A Danish nationwide cohort study

    DEFF Research Database (Denmark)

    Roed, Casper; Engsig, Frederik Neess; Omland, Lars Haukali; Skinhøj, Peter; Obel, Niels

    2012-01-01

    OBJECTIVES: To determine the long-term mortality, the causes of death and the incidence of cancer in listeria meningitis patients. METHODS: Nationwide, population-based cohort study including all adult patients diagnosed with listeria meningitis from 1977 to 2006 and alive 1 year after diagnosis, and an age-and gender-matched, population control cohort. Kaplan-Meier tables, Cox regression analysis and cumulative incidence function were used as outcome analyses. RESULTS: We identified 114 listeri...

  5. Diagnoses and dropout among patients of Danish psychiatrists in private practice

    DEFF Research Database (Denmark)

    Munk-Jørgensen, Povl; Andersen, Bodil B

    2009-01-01

    OBJECTIVE: This study examined diagnoses of patients treated by psychiatrists in private practice in Denmark and identified predictors of dropout. METHODS: Between 1996 and 2006, a total of 37 psychiatrists contributed data about treatment episodes to a quality assurance database. The diagnostic distribution was determined, and univariate and backward stepwise regression analysis was used to identify dropout predictors. RESULTS: Among 41,462 episodes (35,205 patients), 39%-41% were for an ICD-10...

  6. Bortezomib, melphalan, prednisone (VMP) versus melphalan, prednisone, thalidomide (MPT) in elderly newly diagnosed multiple myeloma patients

    DEFF Research Database (Denmark)

    Morabito, Fortunato; Bringhen, Sara; Larocca, Alessandra; Wijermans, Pierre; Victoria Mateos, Maria; Gimsing, Peter; Mazzone, Carla; Gottardi, Daniela; Omedè, Paola; Zweegman, Sonja; José Lahuerta, Juan; Zambello, Renato; Musto, Pellegrino; Magarotto, Valeria; Schaafsma, Martijn; Oriol, Albert; Juliusson, Gunnar; Cerrato, Chiara; Catalano, Lucio; Gentile, Massimo; Isabel Turel, Ana; Marina Liberati, Anna; Cavalli, Maide; Rossi, Davide; Passera, Roberto; Rosso, Stefano; Beksac, Meral; Cavo, Michele; Waage, Anders; San Miguel, Jesus; Boccadoro, Mario; Sonneveld, Pieter; Palumbo, Antonio; Offidani, Massimo

    2014-01-01

    Novel agents in combination with melphalan and prednisone (MP) significantly improved progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM). Randomized trials comparing MP plus bortezomib (VMP) versus MP plus thalidomide (MPT) are lacking. Nine hundred and fifty-six elderly (>65 years) newly diagnosed MM patients from six European randomized trials were retrospectively analyzed and matched for age, albumin, and beta2-microglobulin at diagnosis, 296 patients were sele...

  7. Diabetes education improves depressive state in newly diagnosed patients with type 2 diabetes

    OpenAIRE

    Chen, Bin; Zhang, Xiyao; XU, XIUPING; Lv, Xiaofeng; Yao, Lu; Huang, Xu; Guo, Xueying; Liu, Baozhu; Li, Qiang; CUI, CAN

    2013-01-01

    Objectives: The prevalence of depression is relatively high in individuals with diabetes. However, screening and monitoring of depressive state in patients with diabetes is still neglected in developing countries and the treatment of diabetes-related depression is rarely performed in these countries. In this study, our aim was to study the role of diabetes education in the improvement of depressive state in newly diagnosed patients with type 2 diabetes.

  8. Rituximab and Dexamethasone vs Dexamethasone Monotherapy in Newly Diagnosed Patients with Primary Immune Thrombocytopenia

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre; Frederiksen, Henrik; Jensen, Bjarne Anker; Jensen, Morten Krogh; Kjeldsen, Lars; Klausen, Tobias Wirenfeldt; Larsen, Herdis; Mourits-Andersen, Hans Torben; Nielsen, Claus Henrik; Nielsen, Ove Juul; Plesner, Torben; Pulczynski, Stanislaw; Rasmussen, Inge Helleberg; Rønnov-Jessen, Dorthe; Hasselbalch, Hans Carl

    2013-01-01

    In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts ?25×10(9)/L or ?50×10(9)/L with bleeding symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n = 71) or in combination with rituximab 375 mg/m(2) weekly for 4 weeks (n = 62). Patients were allowe...

  9. High prevalence of the metabolic syndrome among newly diagnosed type 2 diabetes patients in Denmark

    DEFF Research Database (Denmark)

    Nielsen, Jens Steen; Thomsen, Reimar W.

    2013-01-01

    Few population-based data exist on the prevalence of the metabolic syndrome (MS) its components, and its association with subclinical inflammation and insulin resistance among patients newly diagnosed with type 2 diabetes (T2D). We examined the MS according to IDF criteria by linkage primary data (waist circumference, fasting blood glucose, and high-sensitivity C-reactive protein (CRP)) with variables from the Danish Diabetes Database for Adults (blood pressure and lipids) and a nationwide prescription database (antilipidemic, antihypertensive, and hypoglycemic drugs). We included 525 newly diagnosed T2D patients (median age 60 years, 60% men), whereof 89.0% had MS. Age and gender were similar in MS and non-MS patients. Waist circumference was elevated in 98.1% of MS vs. 34.5% of non-MS patients (prevalence ratio 2.84; 95% CI: 2.49-3.20). Most MS patients had elevated blood pressure (systolic >=130, or diastolic >=85, or antihypertensive drug): 94.4% vs. 55.2% in non-MS patients (prevalence ratio 1.71; 95%CI: 1.48-1.94). Fasting blood glucose was increased in nearly all MS and non-MS patients. Triglycerides were elevated in 48.6% of MS and 3.4% of non-MS patients (prevalence ratio 14.10; 95% CI: 12.73-15.46). HDL-cholesterol was reduced in 33.6% of MS and 0.0% of non-MS patients. Increased C-peptide levels >= 300 pmol/L was more common in MS than non-MS patients (96.8% vs. 77.6%, p=0.0005). 23.1% of the MS patients was previous hospital-diagnosed with cardiovascular disease vs. 0% in non-MS. The median CRP was 2.40 mg/L (quartiles 1.00-5.10) in MS patients vs. 1.20 mg/L (quartiles 0.60-3.50) in non-MS patients (p=0.006) 89% of the newly diagnosed T2D patients have the MS, with 90% having elevated waist circumference, blood pressure and blood glucose, and <50% having elevated triglycerides and reduced HDL-cholesterol. Elevated C-peptide levels are common in T2D patients with MS and their CRP level and risk of previous cardiovascular disease is higher than in non-MS patients.

  10. Clinical analysis of 68 patients with pulmonary mycosis in China

    Directory of Open Access Journals (Sweden)

    Luo Bai-ling

    2011-10-01

    Full Text Available Abstract Background Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary mycosis is difficult. This study aimed to investigate the pathogens, clinical manifestations, imaging features, diagnosis and management of pulmonary mycosis. Methods Data on 68 patients diagnosed as pulmonary mycosis in Xiang Ya hospital from January 2001 to December 2010 were collected and their clinical manifestations, radiographic characterization, diagnostic methods and management were analyzed. Results All patients were diagnosed by pathological examination. Of the 68 cases, 38 (55.9% had pulmonary aspergillosis and 19 (27.9% pulmonary cryptococcosis. Open-lung surgery was performed in 38 patients (55.9%, transbronchial biopsy in 15 (22.0%, and computerized tomography (CT guided percutaneous needle biopsy in 11 (16.2%. Main symptoms were as follows: cough in 51 cases (75.0%, expectoration in 38 (55.9%, hemoptysis in 25 (37.8%, fever in 20 (29.4%, while 6 cases (11.1% were asymptomatic. X-ray and chest CT showed masses or nodular lesions in 52 cases (76.5%, patchy lesions in 10 (14.7%, cavity formation in 15 (22.0%, and diffuse miliary nodules in 1 case. In 51 cases (75.0% misdiagnosis before pathological examination occurred. Surgical resection was performed in 38 patients (55.9%. In 25 patients (36.7% systemic antifungal therapy was administered, and 20 patients (29.4% experienced complete responses or partial responses. Conclusion The main pathogens of pulmonary mycosis are Aspergillus, followed by cryptococcosis. Final diagnosis of pulmonary mycosis mainly depends on pathological examination. The clinical manifestations, imaging features, diagnostic methods and management differ depending on the pathogens. Satisfactory therapy can be obtained by both antifungal and surgical treatment.

  11. PET/CT in a Patient Diagnosed With Dandy-Walker Syndrome.

    Science.gov (United States)

    Infante, Jose R; Garcia, Lucia; Rayo, Juan I; Serrano, Justo; Dominguez, Maria L; Moreno, Manuel

    2016-01-01

    The Dandy-Walker syndrome (DWS) is a rare congenital posterior fossa malformation characterized by aplasia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. We present a 52-year-old Caucasian man diagnosed with gastrointestinal stromal tumor and submitted to F-FDG PET/CT as a staging procedure. The patient was previously diagnosed with DWS in brain CT scan. PET/CT images revealed an ametabolic large cyst in the posterior fossa and hypoplasia of cerebellar vermis. The case is presented with the aim to show the appearance of this syndrome on PET/CT study. PMID:26053730

  12. Bolus and continuous infusion mitoxantrone in newly diagnosed adult acute lymphoblastic leukemia: results of two consecutive phase II clinical studies.

    Science.gov (United States)

    Koc, Y; Akpek, G; Kansu, E; Kars, A; Tekuzman, G; Baltali, E; Güler, N; Barista, I; Güllü, I; Ozisik, Y; Firat, D

    1998-01-01

    Two consecutive phase II clinical studies were designed to evaluate the efficacy and safety of bolus and continuous infusion (CI) mitoxantrone (MTZ) in 39 patients with newly diagnosed acute lymphocytic leukemia (ALL). MTZ was used as part of the classical ALL induction regimen. Twenty patients were treated with bolus MTZ (10 mg/m2 for 3 days) combined with vincristine and prednisone. The same regimen was given to a second set of 19 patients, except that MTZ was administered as a 24-hr CI. Both groups received bimonthly intensifications with vincristine and prednisone for 3 years, along with oral maintenance therapy. Patients in the CI-MTZ study arm received additional MTZ on the first day of intensification cycles. Seventeen patients (85%) in the bolus arm and 15 patients (79%) in the CI arm achieved complete remission (CR). Median disease-free survivals (DFS) in the bolus and CI groups were 11 and 15 months after median follow-ups of 16 (3.5-96) and 13 (2.3-32) months, respectively. At 2.5 years, DFS rates were 29.4% and 34.4% in the bolus and CI groups (p > 0.05). There were no significant differences between two groups in rates of early death, degree of organ toxicity, or duration of neutropenia and thrombocytopenia. Significant cardiac toxicity was not observed in either group. Bolus or CI administration of MTZ was equally effective and was well tolerated. Neither the mode of administration nor increasing the dose intensity of MTZ by incorporating intensification cycles reduced relapse rates. Development of new antileukemia agents and novel treatment approaches are still needed to improve the high relapse rates in adult ALL once a complete response is achieved. PMID:9679525

  13. Increased alanine aminotransferase levels and associated characteristics among newly diagnosed type 2 diabetes patients: Results from the DD2 study

    DEFF Research Database (Denmark)

    Mor, Anil; Thomsen, Reimar W.

    Objectives: Elevated levels of serum alanine aminotransferase (ALAT) have been linked with non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), insulin resistance and the metabolic syndrome in type 2 diabetes (T2D) patients. We examined ALAT levels in newly diagnosed T2D patients, and the factors associated with such elevation. Methods: Measurements of ALAT were performed in 1,025 (43% women; 57% men) new T2D patients enrolled from general practitioners and hospital specialist outpatient clinics in the nationwide DD2 project. We calculated the median value of ALAT, and examined the number of T2D patients within gender specific quartiles of ALAT values. We also examined demographic, clinical, and lifestyle characteristics associated with increased ALAT levels. Data on BMI, lipid profile and blood pressure could be ascertained from the Danish Diabetes Database for Adults for a subgroup (n=525) of the study population. Results: The median value of ALAT was 24IU/L (inter-quartile range 18-32IU/L) in women and 30IU/L (inter-quartile range 22-41IU/L) in men. 26% were in the lowest ALAT quartile (32IU/L / >41IU/L for women/men). As compared to people with ALAT values in the lowest quartile, those with high ALAT were younger (median age 57 vs. 64 years, p14/21 weekly drinks in women/men, p<0.0001) as compared to subjects in the lowest quartile. Conclusions: Among newly diagnosed T2D patients, those with a high ALAT level were younger, had more abdominal obesity, dyslipidemia, poorer glucose control, more alcohol overuse, and higher CRP levels as compared with those in the lowest ALAT quartile

  14. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting

    International Nuclear Information System (INIS)

    We evaluated the efficacy of using standard radiologic and histologic criteria to guide the follow-up of patients with lobular carcinoma in situ (LCIS), lobular neoplasia (LN), or atypical lobular hyperplasia (ALH). Patients with high-risk benign lesions diagnosed on biopsy were presented and reviewed in a multidisciplinary clinical management conference from 1 November 2003 through September 2011. Associations between patient characteristics and rates of upgrade were determined by univariate and multivariate logistic models, and times to diagnosis carcinoma were calculated. Of 853 cases reviewed, 124 (14.5%) were lobular neoplasms. In all, 104 patients were clinically and/or radiographically monitored. In 20 patients, who were found to have LN on core biopsy and were recommended to have immediate surgical excision, a more significant lesion was identified in 8 (40%) of the excised specimens. Factors associated with a more significant lesion on excisional biopsy included whether the lobular lesion had been targeted for biopsy and whether the extent of disease involved three or more terminal duct lobular units. Of the 104 patients radiographically and clinically monitored, the median follow-up time was 3.4 years with a range of 0.44–8.6 years. Five patients under surveillance were subsequently diagnosed with breast malignancy (three of the five at a site unrelated to the initial biopsy). Patients with incidental lobular lesions identified on percutaneous core needle biopsy have a small risk of upgrade and may not require an excisional biopsy. Clinical management of low-volume lobular lesions in a multidisciplinary setting is an efficacious alternative to surgical excision when radiologic and histologic characteristics are well-defined

  15. Virtual patients for assessment of clinical reasoning

    OpenAIRE

    Forsberg, Elenita

    2014-01-01

    In healthcare education it is essential for the students to develop and achieve clinical reasoning skills. Clinical reasoning is complex to teach and learn, and effective assessment methods are also lacking. Virtual Patients (VPs) are interactive computer simulations of real-life clinical scenarios for the purpose of healthcare training, education and assessment. Many VP systems are focused on clinical reasoning and have the possibility to track every interaction from the user and therefore h...

  16. Prognostic factors for weight loss over 1-year period in patients recently diagnosed with mild Alzheimer Disease

    DEFF Research Database (Denmark)

    Hansen, M.L.; Waldorff, F.B.

    2011-01-01

    The aim of the study was to identify prognostic factors for weight loss in patients recently diagnosed with mild Alzheimer disease (AD), with special emphasis on the patients' social participation and living arrangements. The data used in this study was part of the Danish Alzheimer Intervention StudY. The patients were home-living patients with a clinical diagnosis, within the past 12 months, of probable AD or mixed AD; age =50 years; mini-mental state examination score =20; informed consent; and data available at 1-year follow-up. In total, 268 patients were included. We used a cut off of 4% in 1 year for defining weight loss. The mean age at inclusion was 76.1 years. Sixty-six patients (24.6%) lost more than 4% of their body weight during the study period. A logistic regression showed that an increase of 1 baseline body mass index point significantly increased the odds of weight loss by 9%. Furthermore, the results suggested a trend that for men, living alone was a risk factor for losing weight, whereas for women living with somebody was associated with a higher risk. However, further studies are pertinent within this area. As weight loss is a predictor of mortality in patients with AD, clinicians should be aware of prognostic social indicators to prevent or halt a potential negative development.

  17. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  18. Diagnosing and following adult patients with acute myeloid leukaemia in the genomic age

    DEFF Research Database (Denmark)

    Roug, Anne S; Hansen, Marcus Celik

    2014-01-01

    The diagnosis and follow-up process of adult patients with acute myeloid leukaemia (AML) is challenging to clinicians and laboratory staff alike. While several sets of recommendations have been published over the years, the development of high throughput screening and characterization for both genetic and epigenetic events have evolved with astonishing speed. Here we attempt to provide a practical guide to diagnose and follow adult AML patients with a focus on how to balance the wealth of information on the one hand, with the restriction put on these processes in terms of time, feasibility and economy when caring for these patients, on the other.

  19. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers : a case study from Uganda

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric

    2012-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based on five validation criteria applied on the ten most common crops. Quality of advice was assessed for the four major problems considering efficacy and feasibility. Findings: The quality of diagnoses varied between crops, from 68% completely validated in maize to 1% in tomato. Complete and partially validated diagnoses were 44% of all queries. The remaining 56% were rejected. Several basic weaknesses were found in data recording and symptom recognition. A greater consistency and precision in naming diseases would increase the number of completely validated diagnoses. The majority of recommendations (82%) were assessed ‘partially effective’. ‘Best practice’ was recommended for 10% and ineffective advice was given in 8% of the cases with considerable variation between diseases. Practical implications: Plant doctors need more training in symptom recognition, pest management and record keeping as well as better technical backstopping to solve unknown problems. Common standards and procedures for clinic data collection and analysis should be established, and roles and responsibilities clearly defined. Originality/value: This is the first time plant clinic registers have been used to systematically assess quality of plant clinic services. Apart from being a valuable tool for quality assessment of extension, the plant clinic registers constitute a novel source of regular information about pests, diseases and farmer demand that can help improve decision-making of extension service providers, researchers, plant health authorities as well as information and technology providers.

  20. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo

    2014-01-01

    IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patients in 2006-2008 with follow-up through 2009, and 2 matched comparison cohorts from hospitalized patients and from the general population. EXPOSURES: Critical illness defined as intensive care unit admission with mechanical ventilation. MAIN OUTCOMES AND MEASURES: Adjusted prevalence ratios (PRs) of psychiatrist-diagnosed psychiatric illnesses and prescriptions for psychoactive medications in the 5 years before critical illness. For patients with no psychiatric history, quarterly cumulative incidence (risk) and adjusted hazard ratios (HRs) for diagnoses and medications in the following year, using Cox regression. RESULTS: Among 24,179 critically ill patients, 6.2% had 1 or more psychiatric diagnoses in the prior 5 years vs 5.4% for hospitalized patients (adjusted PR, 1.31; 95% CI, 1.22-1.42; P<.001) and 2.4% for the general population (adjusted PR, 2.57; 95% CI, 2.41-2.73; P<.001). Five-year preadmission psychoactive prescription rates were similar to hospitalized patients: 48.7% vs 48.8% (adjusted PR, 0.97; 95% CI, 0.95-0.99; P<.001) but were higher than the general population (33.2%; adjusted PR, 1.40; 95% CI, 1.38-1.42; P<.001). Among the 9912 critical illness survivors with no psychiatric history, the absolute risk of new psychiatric diagnoses was low but higher than hospitalized patients: 0.5% vs 0.2% over the first 3 months (adjusted HR, 3.42; 95% CI, 1.96-5.99; P <.001), and the general population cohort (0.02%; adjusted HR, 21.77; 95% CI, 9.23-51.36; P<.001). Risk of new psychoactive medication prescriptions was also increased in the first 3 months: 12.7% vs 5.0% for the hospital cohort (adjusted HR, 2.45; 95% CI, 2.19-2.74; P<.001) and 0.7% for the general population (adjusted HR, 21.09;95% CI, 17.92-24.82; P<.001). These differences had largely resolved by 9 to 12 months after discharge. CONCLUSIONS AND RELEVANCE: Prior psychiatric diagnoses are more common in critically ill patients than in hospital and general population cohorts. Among survivors of critical illness, new psychiatric diagnoses and psychoactive medication use is increased in the months after discharge. Our data suggest both a possible role of psychiatric disease in predisposing patients to critical illness and an increased but transient risk of new psychiatric diagnoses and treatment after critical illness.

  1. Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK : a retrospective study of a clinical cohort

    DEFF Research Database (Denmark)

    Jones, Rupert C M; Price, David

    2014-01-01

    BACKGROUND: Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. METHODS: We did a retrospective analysis of a clinical cohort in the UK with data from Jan 1, 1990 to Dec 31, 2009 (General Practice Research Database and Optimum Patient Care Research Database). We assessed patients aged 40 years or older who had an electronically coded diagnosis of COPD in their primary care records and had a minimum of 3 years of continuous practice data for COPD (2 years before diagnosis up to a maximum of 20 years, and 1 year after diagnosis) and at least two prescriptions for COPD since diagnosis. We identified missed opportunites to diagnose COPD from routinely collected patient data by reviewing patterns of health-care use and comorbidities present before diagnosis. We assessed patterns of health-care use in terms of lower respiratory consultations (infective and non-infective), lower respiratory consultations with a course of antibiotics or oral steroids, and chest radiography. If these events did not lead to a diagnosis of COPD, they were deemed to be missed opportunities. This study is registered with ClinicalTrials.gov, number NCT01655667. FINDINGS: We assessed data for 38,859 patients. Opportunities for diagnosis were missed in 32,900 (85%) of 38,859 patients in the 5 years immediately preceding diagnosis of COPD; in 12,856 (58%) of 22,286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0·05 years of age per year, 95% CI 0·03-0·07) and yearly frequency of lower respiratory prescribing consultations (rate ratio 0·982 opportunities per year, 95% CI 0·979-0·985). Prevalence of all comorbidities present at COPD diagnosis increased except for asthma and bronchiectasis, which decreased between 1990 and 2007, from 281 (33·4%) of 842 patients to 451 of 1465 (30·8%) for asthma, and from 53 of 842 (6·3%) to 53 of 1465 (3·6%) for bronchiectasis. In the 2 years before diagnosis, of 6897 patients who had had a chest radiography, only 2296 (33%) also had spirometry. INTERPRETATION: Opportunities to diagnose COPD at an earlier stage are being missed, and could be improved by case-finding in patients with lower respiratory tract symptoms and concordant long-term comorbidities. FUNDING: UK Department of Health, Research in Real Life.

  2. Intelligent Virtual Patients for Training Clinical Skills

    Directory of Open Access Journals (Sweden)

    Thomas D. Parsons

    2011-09-01

    Full Text Available The article presents the design process of intelligent virtual human patients that are used for the enhancement of clinical skills. The description covers the development from conceptualization and character creation to technical components and the application in clinical research and training. The aim is to create believable social interactions with virtual agents that help the clinician to develop skills in symptom and ability assessment, diagnosis, interview techniques and interpersonal communication. The virtual patient fulfills the requirements of a standardized patient producing consistent, reliable and valid interactions in portraying symptoms and behaviour related to a specific clinical condition.

  3. When to perform positron emission tomography/computed tomography or radionuclide bone scan in patients with recently diagnosed prostate cancer

    Directory of Open Access Journals (Sweden)

    Caldarella C

    2013-06-01

    Full Text Available Carmelo Caldarella,1 Giorgio Treglia,2 Alessandro Giordano,1 Luca Giovanella2 1Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy; 2Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland Abstract: Skeletal metastases are very common in prostate cancer and represent the main metastatic site in about 80% of prostate cancer patients, with a significant impact in patients' prognosis. Early detection of bone metastases is critical in the management of patients with recently diagnosed high-risk prostate cancer: radical treatment is recommended in case of localized disease; systemic therapy should be preferred in patients with distant secondary disease. Bone scintigraphy using radiolabeled bisphosphonates is of great importance in the management of these patients; however, its main drawback is its low overall accuracy, due to the nonspecific uptake in sites of increased bone turnover. Positron-emitting radiopharmaceuticals, such as fluorine-18-fluorodeoxyglucose, choline-derived drugs (fluorine-18-fluorocholine and carbon-11-choline and sodium fluorine-18-fluoride, are increasingly used in clinical practice to detect metastatic spread, and particularly bone involvement, in patients with prostate cancer, to reinforce or substitute information provided by bone scan. Each radiopharmaceutical has a specific mechanism of uptake; therefore, diagnostic performances may differ from one radiopharmaceutical to another on the same lesions, as demonstrated in the literature, with variable sensitivity, specificity, and overall accuracy values in the same patients. Whether bone scintigraphy can be substituted by these new methods is a matter of debate. However, greater radiobiological burden, higher costs, and the necessity of an in-site cyclotron limit the use of these positron emission tomography methods as first-line investigations in patients with prostate cancer: bone scintigraphy remains the mainstay for the detection of bone metastases in current clinical practice. Keywords: bone metastases, prostate cancer, bisphosphonates, positron emission tomography

  4. EEG Abnormalities in Clinically Diagnosed Brain Death Organ Donors in Iranian Tissue Bank

    OpenAIRE

    Seyed Amir Hossein Tavakoli; Abbas Khodadadi; Amir Reza Azimi Saein; Hasan Bahrami-Nasab; Behnam Hashemi; Niloufar Tirgar; Behnaz Nozary Heshmati

    2012-01-01

    Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram (EEG) is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities i...

  5. Pharmacokinetic of Arsenic Trioxide in Newly Diagnosed Acute Promyelocytic Leukemia Patients

    Directory of Open Access Journals (Sweden)

    R. Hosseini

    2008-01-01

    Full Text Available The high complete remission rate with arsenic trioxide (ATO in relapsed Acute Promyelocytic Leukemia (APL patients has been led to its use in newly diagnosed patients. Twenty newly diagnosed APL patients between January 2006 and 2007 received 2 h intravenous infusion of 10 mg day-1 arsenic trioxide for induction therapy until achieving complete remission. Plasma arsenic concentration was analyzed by graphite furnace atomic absorption method by dilution of plasma with a suitable matrix modifier. The concentration of arsenic in 24 h urine of patients was measured by using a valid standard addition method and a suitable matrix modifier. The Limits of Detection (LOD were 1.2 and 1.5 ?g L-1 for arsenic in plasma and urine, respectively. Pharmacokinetic parameters of 20 patients were as following: Cmax: 43.6 ±19.5 ?g L-1, tmax: 2.15±0.7 h, AUC0-24: 683±317 ?g h L-1, AUC0-?: 2027±958 ?g h L-1, t1/2: 41±10 h, kel: 0.02±0.01 h-1, Vd: 5.6±3.6 L kg-1 and Cltotal: 0.1±0.05 L kg-1 h-1. During the first day of induction, 1.4±0.2% of administrated arsenic excreted into urine. Renal clearance was 5.1±4.1 mL kg-1 h-1. However, the results showed that the pharmacokinetic of ATO in newly diagnosed APL patients weren`t dependent to the sex of patients.

  6. Clinical features of depressive disorders in patients with brain tumors

    Directory of Open Access Journals (Sweden)

    Ogorenko V.V.

    2014-03-01

    Full Text Available The aim of the study was to examine the structure of psychopathology and clinical features of depressive disorders in patients with brain oncopathology. Polymorphic mental disorders of various clinical content and severity in most cases not only are comorbid to oncological pathology of the brain, but most often are the first clinical signs of early tumors. The study was conducted using the following methods: clinical psychiatric, questionnaire Simptom Check List- 90 -Revised-SCL- 90 -R, Luscher test and mathematical processing methods. Sample included 175 patients with brain tumors with non-psychotic level of mental disorders. The peculiarities of mental disorders and psychopathological structure of nonpsychotic depressive disorders have been a clinical option of cancer debut in patients with brain tumors. We found that nonpsychotic depression is characterized by polymorphism and syndromal incompletion; this causes ambiguity of diagnoses interpretation on stages of diagnostic period. Features of depressive symptoms depending on the signs of malignancy / nonmalignancy of brain tumor were defined.

  7. Low Prevalence of Transmitted Drug Resistance among Newly Diagnosed HIV 1 Patients in Latvia

    OpenAIRE

    2010-01-01

    Abstract Transmitted drug resistance (TDR) is a concern because it may reduce the efficacy of antiretroviral treatment. Plasma samples of 119 HIV-1 infected patients who were newly diagnosed at the Infectology Center of Latvia in 2005 and 2006 were analyzed by an in-house genotypic resistance assay to determine the prevalence of transmitted drug resistance in Latvia. TDR was identified using the WHO 2009 list of mutations for surveillance of TDR as implemented in the Stanford Calib...

  8. Characterization of a group of patients with cervical intraepithelial neoplasia diagnosed by diathermic loop biopsy

    International Nuclear Information System (INIS)

    A retrospective, longitudinal and descriptive study was conducted in 2 696 medical records corresponding to patients diagnosed with cervical intraepithelial neoplasia (CIN) and invasive cancer of cervix uteri (CCU) seen in the mother hospital of Guanabacoa municipality over above mentioned period. The information processing was from the data retrieval from medical records and biopsy control registry entering in a database in Microsoft Excel and the statistic processing using the SPSS package version 15 and EPIDAT

  9. PREVALENCE OF DIABETIC RETINOPATHY IN PATIENTS WITH NEWLY DIAGNOSED TYPE II DIABETES MELLITUS

    OpenAIRE

    A. Bostak; M. R. Mansoori; M. H. Malekmadani; A. Abdollahi; M. R. Abbaszadeh A. Mirshahi

    2006-01-01

    Diabetic retinopathy is a common complication of type II diabetes mellitus and carries with it the threat of blindness. Accurate information regarding the incidence of diabetic retinopathy and associated risk factors is important in the prevention of its development and of the visual impairment caused by this complication. This study was designed to determine the prevalence of diabetic retinopathy in newly diagnosed patients with type II diabetes mellitus. We have also evaluated the associati...

  10. Risk factors of distant brain failure for patients with newly diagnosed brain metastases treated with stereotactic radiotherapy alone

    Directory of Open Access Journals (Sweden)

    Chen Xiu-jun

    2011-12-01

    Full Text Available Abstract Objective To explore the risk factors of distant brain failure (DBF for patients with brain metastasis (BM who were treated with stereotactic radiotherapy alone and to group the patients on the basis of their risk levels. Methods and Materials We retrospectively analyzed 132 newly diagnosed BM patients who were treated with stereotactic radiotherapy alone from May 2000 to April 2010. Kaplan-Meier and Cox proportional hazards regression analyses were performed for univariate and multivariate analyses. Results The 1-year incidence rate of DBF was 44.7%, and the median DBF time (MDBFT was 18 months. In multivariate analysis, the risk factors of DBF were the number of BMs greater than 1 (p = 0.041, uncontrolled extracranial disease (p = 0.005, interval time (IT of less than 60 months between the diagnosis of primary tumor and BM (p = 0.024, and total volume of BM was greater than 6 cc (p = 0.049. Each risk factor was assigned 1 score. The median survival times for the patients with scores of 0-1, 2-3, and 4 were 31, 12, and 10 months, respectively, and the corresponding MDBFTs were not reached, 13, and 3 months, respectively, (p Conclusions The patients with scores of 0-1 had a lower risk of DBF than the patients with higher scores did, and it may be reasonable to treat these patients with SRS alone and resort to whole-brain radiation therapy only for salvage. The patients with a score of 4 had the highest risk of developing DBF after stereotactic radiotherapy alone, these patients may be candidates for initial whole-brain radiation therapy or clinical trials. The patients with a score of 2-3 had a moderate risk of developing DBF, SRT alone combined with close clinical monitoring would be the optimal treatment regimen for such patients, and for those patients with difficulties in receiving close clinical mornitoring, SRT combined with WBRT will be more suitable.

  11. A study on clinical findings about vertebral disease diagnosed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham-Gyum [Ansan College, Seoul (Korea, Republic of)

    2006-09-15

    In order to analyze clinical characteristics like sex-and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging (MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE (fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics (such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions: 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra (65.5%), which was followed by cervical vertebrae (27.3%) and thoracic vertebrae (7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows: 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%.

  12. Arterial stiffness and endothelial inflammation in prediabetes and newly diagnosed diabetes patients.

    Science.gov (United States)

    Çakar, Mustafa; Balta, ?evket; ?arlak, Hakan; Akhan, Muharrem; Demirkol, Sait; Karaman, Murat; Ay, Seyit Ahmet; Kurt, Ömer; Çayci, Tuncer; ?nal, Sat?lm??; Demirba?, ?eref

    2015-10-01

    ObjectiveThere is a growing body of data supporting the association between diabetes and microcirculatory disfunction. We aimed to study e-selectin levels, and their associations with serum markers of inflammation and arterial stiffness in prediabetes and newly diagnosed diabetes patients in this study.Subjects and methodsSixty patients (25 females) with a newly established elevated fasting serum glucose [20 impaired fasting glucose (IFG), 20 impaired glucose tolerance (IGT), 20 newly diagnosed diabetes (T2DM)] and 17 healthy controls (13 females) were included in the study. Serum e-selectin and hs-CRP levels, and arterial stiffness parameters of the patients were studied.ResultsFasting serum glucose was the most important predictor of serum e-selectin levels. Pulse wave velocity and central aortic pressures were significantly higher in IFG, IGT and T2DM groups, compared to controls (p = 0.001, diagnosis of T2DM. E-selectin is associated with serum glucose levels. Prediabetic and newly diagnosed diabetics have higher arterial stiffness measurements. Serum e-selectin may be a good marker of endothelial inflammation and dysfunction increasing in parallel with serum glucose levels, predicting future cardiovascular events. PMID:26201008

  13. Diagnosing and management of iatrogenic moderate and severe ovarian hyperstymulation syndrome (OHSS in clinical material.

    Directory of Open Access Journals (Sweden)

    Anna Fritz

    2008-04-01

    Full Text Available Severe ovarian hyperstymulation syndrome is a rare but potentially life-threatening complication in patients undergoing assisted reproductive techniques (ART. The pathogenesis of this condition is likely to be multifactorial. The aim of the retrospective study was to present management in moderate and severe iatrogenic ovarian hyperstymulation syndrome (OHSS in clinical material. The study group was 19 women, admitted to the Department of Obstetrics and Gynecology in Central Clinical Hospital of Ministry of Interior and Administration in Warsaw from large outpatient infertility center "Novum" in Warsaw with moderate and severe OHSS between 14.07.2004 and 8.11.2005. Laboratory tests and ultrasound examination of the ovarian size and ascites were performed, abdominal circumference was measured. Patients were treated with rehydration with intravenous crystalloids and colloids, diuretics, antibiotics, anticoagulants and ultrasound-guided paracentesis if symptoms of ascites become severe (ascites causes pain and compromised pulmonary function. Oral intake of water was restricted, monitoring of fluid intake and output, and daily monitoring of body weight was performed. During treatment controlled laboratory tests were done. In one patient occurred intra-abdominal hemorrhage from ovarian rupture and laparotomy with oophorectomy was performed. The ovarian hyperstimulation syndrome is still a difficult diagnostic and therapeutic problem and more studies are required to elucidate pathophysiology of OHSS. Because of still unknown etiology treatment is empirical and in most of cases bases on experience of medical team. Thus, the management in individual patients varies according to the severity of ovarian hyperstymulation syndrome and its complications.

  14. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel

    2015-01-01

    OBJECTIVES: Knowledge of cardiac involvement in idiopathic inflammatory myopathies (IIM) is limited, especially in the early stage of disease. The objective of the present study was to perform a controlled evaluation of cardiac abnormalities in newly diagnosed, untreated patients with idiopathic inflammatory myopathies (IIM) by means of non-invasive techniques. METHODS: Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire, cardiac troponin-I (TnI), electrocardiogram (standard 12-lead and 48-h Holter monitoring), echocardiography with tissue Doppler measures, cardiac magnetic resonance (CMR) imaging with T2 mapping and semi-quantitative 99mtechnetium pyrophosphate (99mTc-PYP) scintigraphy. RESULTS: Dyspnoea was present in 8 (57%) of the patients compared to none of the controls (p<0.01). Median levels of TnI in patients and controls were 20 ng/L and 6 ng/L, respectively (p=0.06). QTc intervals were prolonged in the patient group (p=0.01). Two patients had systolic dysfunction, and one diastolic dysfunction. The myocardial 99mTc-PYP uptake and CMR results differed between patients and controls, albeit not with statistical significance. Overall, cardiac abnormalities were demonstrated in 9 (64%) of the patients versus 2 (14%) of the controls (p=0.02). CONCLUSIONS: Cardiac abnormalities assessed by TnI, ECG or imaging modalities were significantly more common in newly diagnosed, treatment naïve patients with IIM compared to healthy control subjects. These abnormalities, although subclinical, may indicate that myocardial involvement is common in patients and calls for larger controlled studies and further investigations of the prognostic implications of this finding.

  15. Bayesian probability analysis: a prospective demonstration of its clinical utility in diagnosing coronary disease

    International Nuclear Information System (INIS)

    One hundred fifty-four patients referred for coronary arteriography were prospectively studied with stress electrocardiography, stress thallium scintigraphy, cine fluoroscopy (for coronary calcifications), and coronary angiography. Pretest probabilities of coronary disease were determined based on age, sex, and type of chest pain. These and pooled literature values for the conditional probabilities of test results based on disease state were used in Bayes theorem to calculate posttest probabilities of disease. The results of the three noninvasive tests were compared for statistical independence, a necessary condition for their simultaneous use in Bayes theorem. The test results were found to demonstrate pairwise independence in patients with and those without disease. Some dependencies that were observed between the test results and the clinical variables of age and sex were not sufficient to invalidate application of the theorem. Sixty-eight of the study patients had at least one major coronary artery obstruction of greater than 50%. When these patients were divided into low-, intermediate-, and high-probability subgroups according to their pretest probabilities, noninvasive test results analyzed by Bayesian probability analysis appropriately advanced 17 of them by at least one probability subgroup while only seven were moved backward. Of the 76 patients without disease, 34 were appropriately moved into a lower probability subgroup while 10 were incorrectly moved up. We conclude that posttest probabilities calculated from Bayes theorem more accurately classified patients with and without disease than did pretest probabilities, thus demonstrating the utility of the theorem in this application

  16. Chronic complications in newly diagnosed patients with Type 2 diabetes mellitus in India

    Directory of Open Access Journals (Sweden)

    Aravind Sosale

    2014-01-01

    Full Text Available Background: Prevalence of diabetes is on an increase in India, currently there is limited nation-wide data regarding the prevalence of chronic complications in diabetic patients at diagnosis. This information will help health-care professionals approach management more aggressively to prevent complications. Objective: To determine the prevalence of chronic complications in newly-diagnosed Type 2 diabetic (T2D patients in India. Design and Methods: This was a cross-sectional survey of T2D patients, diagnosed within 3 months of their first visit to the centers doing the survey. Each patient was screened for diabetic complications, hypertension, dyslipidemia, and body mass index. Family history was recorded. Standard protocols were used to make the diagnosis of retinopathy, neuropathy and nephropathy. Data analysis was carried out using the standard statistical techniques. Results: Of the total 4,600 (males 67%, females 33% newly diagnosed patients with T2D, majority were from the age group 41-50 years (40%. 13.15% of newly detected India T2D had neuropathy 6.1% had retinopathy and 1.06% had nephropathy. Risk factors of macro vascular complication such as hypertension, obesity, and dyslipidemia were observed in 23.3%, 26%, and 27% of patients respectively. Ischemic heart disease was noticed in 6%. Conclusion: High prevalence of micro vascular complications was present at diagnosis along with association of CV cardiovascular risk factors among Indian T2D. In view of this, screening must be instituted for all diabetics for complications at the time of diagnosis itself.

  17. Vitamin and Mineral Deficiencies Are Highly Prevalent in Newly Diagnosed Celiac Disease Patients

    Directory of Open Access Journals (Sweden)

    Ad A. van Bodegraven

    2013-09-01

    Full Text Available Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD. This study aimed to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B6, B12, and (25-hydroxy D, zinc, haemoglobin (Hb and ferritin were determined (before prescribing gluten free diet. Almost all CD-patients (87% had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B6 14.5%, folic acid 20%, and vitamin B12 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss, 22% of the women were underweight (Body Mass Index (BMI 25. Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B12. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher grade of histological intestinal damage or (impaired nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.

  18. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.

    Science.gov (United States)

    Wierdsma, Nicolette J; van Bokhorst-de van der Schueren, Marian A E; Berkenpas, Marijke; Mulder, Chris J J; van Bodegraven, Ad A

    2013-10-01

    Malabsorption, weight loss and vitamin/mineral-deficiencies characterize classical celiac disease (CD). This study aimed to assess the nutritional and vitamin/mineral status of current "early diagnosed" untreated adult CD-patients in the Netherlands. Newly diagnosed adult CD-patients were included (n = 80, 42.8 ± 15.1 years) and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Nutritional status and serum concentrations of folic acid, vitamin A, B?, B??, and (25-hydroxy) D, zinc, haemoglobin (Hb) and ferritin were determined (before prescribing gluten free diet). Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels, for vitamin B? 14.5%, folic acid 20%, and vitamin B?? 19%. Likewise, zinc deficiency was observed in 67% of the CD-patients, 46% had decreased iron storage, and 32% had anaemia. Overall, 17% were malnourished (>10% undesired weight loss), 22% of the women were underweight (Body Mass Index (BMI) 25). Vitamin deficiencies were barely seen in healthy controls, with the exception of vitamin B??. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. In conclusion, vitamin/mineral deficiencies are still common in newly "early diagnosed" CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment. PMID:24084055

  19. Malnutrition and clinical outcome in urological patients

    OpenAIRE

    Karl A; Staehler M; Bauer R; Tritschler S; Hocaoglu Y; Buchner A; Hoffmann J.; Kuppinger D; Stief C; Rittler P

    2011-01-01

    Abstract Introduction In a previous study we evaluated the risk for malnutrition among urological patients in a German university hospital. There are published different studies in other surgical fields that could show a correlation between malnutrition and clinical outcome. As data on this issue is still rare in the urological field we aimed to correlate the risk of malnutrition with different parameters regarding clinical outcome. Methods In the time from 2007 to 2009 a total of 320 patient...

  20. Phase II study of pegylated liposomal doxorubicin, low-dose dexamethasone, and lenalidomide in patients with newly diagnosed multiple myeloma

    Science.gov (United States)

    Baz, Rachid C.; Shain, Kenneth H.; Hussein, Mohamad A.; Lee, Ji-Hyun; Sullivan, Daniel M.; FinleyOliver, Elizabeth; Nardelli, Lisa A.; Nodzon, Lisa A.; Zhao, Xiuhua; Ochoa-Bayona, Jose Leonel; Nishihori, Taiga; Dalton, William S.; Alsina, Melissa

    2015-01-01

    Our previous phase I/II trial of pegylated liposomal doxorubicin (PLD), low-dose dexamethasone, and lenalidomide in patients with relapsed and refractory myeloma showed an overall response rate of 75%, with 29% achieving ?VGPR. Here, we investigated this combination (PLD 30 or 40 mg/m2 intravenously, day 1; dexamethasone 40 mg orally, days 1-4; lenalidomide 25 mg orally, days 1-21; administered every 28 days) in a phase II study in patients with newly diagnosed symptomatic multiple myeloma to determine its efficacy and tolerability (ClinicalTrials.gov NCT00617591). At best response, patients could proceed with high-dose melphalan or with maintenance lenalidomide and dexamethasone. In 57 patients, we found that the overall response rate and rate of very good partial response and better on intent-to-treat, our primary endpoints, were 77.2% and 42.1%, respectively, with responses per the International Myeloma Working Group. Median progression-free survival was 28 months (95% CI 18.1-34.8), with 1- and 2-year overall survival rates of 98.1 and 79.6%. During induction, grade 3/4 toxicities were neutropenia (49.1%), anemia (15.8%), thrombocytopenia (7%), fatigue (14%), febrile neutropenia (8.8%), and venous thromboembolic events (8.8%). During maintenance, grade 3/4 toxicities were mainly hematologic. We found this combination to be active in patients with newly diagnosed myeloma, with results comparable to other lenalidomide-based induction strategies without proteasome inhibition. In addition, maintenance therapy with lenalidomide was well tolerated. PMID:24030918

  1. Computer-assisted interpretation of planar whole-body bone scintigraphy in patients with newly diagnosed prostate cancer

    DEFF Research Database (Denmark)

    Petersen, Lars J; Mortensen, Jesper C

    2015-01-01

    PURPOSE: The aim of this study was to compare the diagnostic properties of EXINI Bone in newly diagnosed prostate cancer in comparison with expert reading. MATERIALS AND METHODS: Bone scintigraphy was performed in consecutive patients referred for staging at three clinics (342 patients with DICOM file format, 272 with Interfile format). Images were reported by three independent readers on a four-point scale (class 1-4) and by using a dichotomous outcome (M1 or M0). The software analyzed data in balanced mode, as well as using 'patient-specific' settings (based on tumor characteristics), and classified outcome as normal (N), probably normal (pN), probably abnormal (pA), and abnormal (A). RESULTS: Classification of bone metastasis using the software (pA+A) versus experts (class 3+4) showed a sensitivity of 93.3%, specificity of 89.3%, positive predictive value of 57.5%, and negative predictive value of 98.9% with DICOM files. The diagnostic properties of the software were notably different with Interfile format. For example, expert M1 versus software A showed a sensitivity of 90.0%, specificity of 98.9%, positive predictive value of 88.2%, and negative predictive value of 98.3% with DICOM files, versus 69.2, 88.2, 38.3, and 96.4% with Interfile format, respectively. Generally, patient-specific settings did not influence the diagnostic characteristics of the software versus balanced setting with expert reading as reference. CONCLUSION: EXINI Bone showed high sensitivity and specificity for bone metastasis in patients with newly diagnosed prostate cancer. The software ruled out metastasis with confidence, whereas the positive predictive value was modest. The diagnostic properties were different for DICOM and Interfile file formats.

  2. Newly diagnosed incident dizziness of older patients: a follow-up study in primary care

    Directory of Open Access Journals (Sweden)

    Hummers-Pradier Eva

    2011-06-01

    Full Text Available Abstract Background Dizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (?65 with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs' initial diagnoses, referrals and revised diagnoses after six months. Methods An observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrolment and follow-up (after 1 month and 6 months. After six months, chart reviews and face-to-face interviews were also performed with the GPs. Results Mean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8% showed a moderate or severe dizziness handicap, and 43 (62.3% showed a certain disability in terms of quality of life at the time of enrolment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47 than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV. Conclusions New-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as differential diagnosis.

  3. Does delay in diagnosing colorectal cancer in symptomatic patients affect tumor stage and survival? A population-based observational study

    Directory of Open Access Journals (Sweden)

    Visser Otto

    2010-06-01

    Full Text Available Abstract Background Diagnosing colorectal cancer (CRC at an early stage improves survival. To what extent any delay affects outcome once patients are symptomatic is still unclear. Our objectives were to evaluate the association between diagnostic delay and survival in symptomatic patients with early stage CRC and late stage CRC. Methods Prospective population-based observational study evaluating daily clinical practice in Northern Holland. Diagnostic delay was determined through questionnaire-interviews. Dukes' stage was classified into two groups: early stage (Dukes A or B and late stage (Dukes C or D cancer. Patients were followed up for 3.5 years after diagnosis. Results In total, 272 patients were available for analysis. Early stage CRC was present in 136 patients while 136 patients had late stage CRC. The mean total diagnostic delay (SE was 31 (1.5 weeks in all CRC patients. No significant difference was observed in the mean total diagnostic delay in early versus late stage CRC (p = 0.27. In early stage CRC, no difference in survival was observed between patients with total diagnostic delay shorter and longer than the median (Kaplan-Meier, log-rank p = 0.93. In late stage CRC, patients with a diagnostic delay shorter than the median had a shorter survival than patients with a diagnostic delay longer than the median (log-rank p = 0.01. In the multivariate Cox regression model with survival as dependent variable and median delay, age, open access endoscopy, number and type of symptoms as independent variables, the odd's ratio for survival in patients with long delay (>median versus short delay (?median was 1.8 (95% confidence interval (CI 1.1 to 3.0; p = 0.01. Tumor-site was not associated with patient survival. When separating late stage CRC in Dukes C and Dukes D tumors, a shorter delay was associated with a shorter survival in Dukes D tumors only and not in Dukes C tumors. Conclusion In symptomatic CRC patients, a longer diagnostic and therapeutic delay in routine clinical practice was not associated with an adverse effect on survival. The time to CRC diagnosis and initiation of treatment did not differ between early stage and late stage colorectal cancer.

  4. Hypoactivation of reward motivational system in patients with newly diagnosed hypertension grade I-II.

    Science.gov (United States)

    Aftanas, L I; Brak, I V; Gilinskaya, O M; Korenek, V V; Pavlov, S V; Reva, N V

    2014-08-01

    In patients with newly diagnosed untreated grade I-II hypertension, EEG oscillations were recorded under conditions activation of the two basic motivational systems, defensive motivational system and positive reinforcement system, evoked by recall of personally meaningful emotional events. The 64-channel EEG and cardiovascular reactivity (beat-by-beat technology) were simultaneously recorded. At rest, hypertensive patients had significantly reduced platelet serotonin concentrations in comparison with healthy individuals. The patients experiencing emotional activation were characterized by significantly lower intensity of positive emotions associated with more pronounced suppression of EEG activity in the delta (2-4 Hz) and theta (ranges of frequency 4-6 and 6-8 Hz) oscillators in the parieto-occipital cortex (zones P and PO) in both hemispheres of the brain. The findings attest to insufficient function of the brain serotonin system and hypoactivation of the reward/reinforcement system in patients with primary hypertension. PMID:25110077

  5. Time intervals from first symptom to treatment of cancer: a cohort study of 2,212 newly diagnosed cancer patients

    Directory of Open Access Journals (Sweden)

    Sokolowski Ineta

    2011-10-01

    Full Text Available Abstract Background Delay in diagnosis of cancer may worsen prognosis. The aim of this study is to explore patient-, general practitioner (GP- and system-related delay in the interval from first cancer symptom to diagnosis and treatment, and to analyse the extent to which delays differ by cancer type. Methods Population-based cohort study conducted in 2004-05 in the County of Aarhus, Denmark (640,000 inhabitants. Data were collected from administrative registries and questionnaires completed by GPs on 2,212 cancer patients newly diagnosed during a 1-year period. Median delay (in days with interquartile interval (IQI was the main outcome measure. Results Median total delay was 98 days (IQI 57-168. Most of the total delay stemmed from patient (median 21 days (7-56 and system delay (median 55 days (32-93. Median GP delay was 0 (0-2 days. Total delay was shortest among patients with ovarian (median 60 days (45-112 and breast cancer (median 65 days (39-106 and longest among patients with prostate (median 130 days (89-254 and bladder cancer (median 134 days (93-181. Conclusion System delay accounted for a substantial part of the total delay experienced by cancer patients. This points to a need for shortening clinical pathways if possible. A long patient delay calls for research into patient awareness of cancer. For all delay components, special focus should be given to the 4th quartile of patients with the longest time intervals and we need research into the quality of the diagnostic work-up process. We found large variations in delay for different types of cancer. Improvements should therefore target both the population at large and the specific needs associated with individual cancer types and their symptoms.

  6. Introducing Optometry Students to Clinical Patient Care.

    Science.gov (United States)

    Gable, Eileen M.

    2001-01-01

    Describes the innovative content and structure of an introductory course on clinical patient care at the Illinois College of Optometry. Critiques its success based on student grades and feedback, concluding that it was successful in imparting skills of data analysis but had minimal impact on students' ability to empathize with patients. (EV)

  7. Clinical study of CT virtual endoscopy in diagnosing polyps of the gallbladder

    International Nuclear Information System (INIS)

    Objective: To evaluate the ability and clinical application of CT virtual endoscopy on polyps of the gallbladder. Methods: CT virtual endoscopy findings of 32 patients with polyps of the gallbladder proved pathologically were presented by using oral iodine contrast, and compared with color Doppler ultrasound. Results: The accuracy rate of color Doppler ultrasound and CTVEGB were 96.9% (93/96) and 93.8% (90/96) respectively (x2 = 0.466, P > 0.05). CTVEGB could more correctly demonstrate the surface details of polyps which were viewed in a 3D fashion in any projection than ultrasound. CTVEGB corresponded well with color Doppler ultrasound and operation and pathology in demonstrating the size, configuration and location of the lesions. Conclusion: CTVEGB is a noninvasive and accurate procedure, which has a important value in clinic applications

  8. Blood vessel ultrastructural picture in a CADASIL patient diagnosed at an advanced age.

    Science.gov (United States)

    Lewandowska, Eliza; Felczak, Paulina; Buczek, Julia; Gramza, Karolina; Rafa?owska, Janina

    2014-01-01

    We report the case of an 84-year-old male patient afflicted by cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) showing minimal symptoms of disease. The patient was diagnosed on the basis of ultrastructural and genetic examinations. Ultrastructurally, a typical vascular pathology was found. However, in abnormal capillary vessel walls no granular osmiophilic material (GOM) was found. In the arteriole there were only a few GOM deposits that revealed various structures, of which only some resembled typical round GOM. The arteriolar walls showed severe damage, including fragmentation, degeneration and loss of vascular smooth muscle cells (VSMCs) with numerous deposits of elastin, mucosubstances, different granular debris, as well as collagen fibres in the basement membrane. Lysosomal inclusions with fingerprint morphology, atypical for CADASIL, were located in some of the VSMCs. Very old age at the onset of the disease may suggest that morphological changes in blood vessels, described in this report, may be due to both the disease and the patient's age. To our best knowledge it is the first description of pathology of blood vessels and GOM morphology in a CADASIL patient diagnosed at an advanced age. PMID:25574750

  9. What diagnoses may make patients more seriously ill than they first appear? Mortality according to the Simple Clinical Score Risk Class at the time of admission compared to the observed mortality of different ICD9 codes identified on death or discharge.

    LENUS (Irish Health Repository)

    Kellett, John

    2009-01-01

    The Simple Clinical Score (SCS) determined at the time of admission places acutely ill general medical patients into one of five risk classes associated with an increasing risk of death within 30 days. The cohort of acute medical patient that the SCS was derived from had, on average, four combinations of 74 groupings of ICD9 codes. This paper reports the ICD9 codes associated with the different SCS risk classes and identifies those ICD9 codes with a greater observed mortality than that of other patients in the same SCS risk class.

  10. Frequency of retinopathy in newly diagnosed patients of type 2 diabetes mellitus (dm)

    International Nuclear Information System (INIS)

    This study was to determine the frequency of retinopathy in newly diagnosed type-II Diabetics. Study Design: Cross sectional descriptive study. Place and Duration of Study: It was conducted at Department of medicine, Military Hospital (MH), Rawalpindi from 1st Jan 2012 to 30 Jun 2012. Material and Methods: We included 200 patients of type-II DM from both genders diagnosed in last 03 months from both outdoor and indoor departments in the age range of 40 to 70 years by consecutive sampling. All patients having co morbidities affecting retina were excluded. Informed written consent was taken before enrollment. Formal approval of the study was taken from hospital ethical committee. Ocular Fundoscopy was performed with WelchAllyn Ophthalmoscope (REF 11470) as per standard protocols and both eyes were examined. The grade of DR (diabetic retinopathy) awarded as per highest changes in any of the two eyes. All tests were carried by a single person to avoid inter-observer variations. Findings of ocular fundoscopy were confirmed by ophthalmologist. All data was analyzed by using SPSS version 11. Results: Out of 200 subjects 63.5% were male and 36.5% were female. Age ranged from 40 to 70 years with mean age of 51.05+ 6.910 years. 29 (14.5%) subjects had Diabetic retinopathy. Out of 29 patients, 24 (82.8%) had preproliferative and 5 (17.2%) had proliferative diabetic retinopathy. Conclusion: A significant proportion of diabetic patients have retinopathy at the time of diagnosis of their disease which is more common in males and with increasing age. It is recommended to thoroughly screen the newly diagnosed diabetics for early detection of diabetic retinopathy and its management involving early referral to eye specialist. (author)

  11. Involvement of patients in Clinical Governance.

    Science.gov (United States)

    Freedman, Danielle B

    2006-01-01

    Clinical Governance is a framework through which the National Health Service (NHS) organisations in the UK are accountable for continuously improving the quality of their services and safeguarding high standards by creating an environment in which excellence in clinical care will flourish. The NHS has moved on from being an organisation that simply delivered services to people, to being a service that is totally patient-led and responds to their needs and wishes. There are numerous national drivers and initiatives for patient involvement, including the NHS Plan 2000, Involving Patients and public in healthcare 2001 and, more recently, Creating a patient-led NHS 2005 and Patient choice 2005. There is also an independent public body funded by the Department of Health, the Commission for Patient and Public Involvement in Health (CPPIH), which supports and enables patient involvement in local decisions about delivery of healthcare. At Luton & Dunstable Hospital NHS Trust, patients and carers are seen as a valuable resource and there are formal mechanisms for recruiting patient representatives to sit on hospital committees and to be involved in service provision, including Clinical Governance arrangements. PMID:16729856

  12. Low-dose unenhanced computed tomography for diagnosing stone disease in obese patients

    Science.gov (United States)

    Abou El-Ghar, Mohamed E.; Shokeir, Ahmed A.; Refaie, Huda F.; El-Nahas, Ahmed R.

    2012-01-01

    Objective To evaluate the detectability, size, location and density of urinary stones with unenhanced computed tomography (CT), using the half-radiation (low) dose (LDCT) technique, compared with the standard-dose CT (SDCT), in obese patients. Patients and methods The study included 50 patients with a body mass index of >30 kg/m2 and bilateral renal stones diagnosed with SDCT, and managed on one side. All the patients had LDCT during the follow-up and SDCT was used as a reference for comparison. Results Of the 50 patients, the right side was affected in 27 and the left side in 23. In all, 35 patients had a single stone while the remaining 15 had multiple stones. With SDCT, 95 stones were detected; there were 45 of ?5 mm, 46 of 6–15 mm and only four of >15 mm. LDCT barely detected three stones of <3 mm, compared with SDCT, while larger stones had the same appearance at both scans. The site of stone in the kidney or the ureter did not affect its detection on LDCT vs. SDCT. The mean stone diameter was identical in both techniques. At LDCT, all stones were detected with no difference in their number, location or density vs. SDCT. However, the tube current and radiation dose were significantly lower with LDCT. Conclusions In obese patients with stone disease, LDCT is as accurate as SDCT, while avoiding exposure of the patient to high-dose radiation. PMID:26558037

  13. “ STUDY OF COAGULATION PROFILE IN CLINICALLY DIAGNOSED CASES OF ACUTE DISSEMINATED INTRAVASCULAR COAGULATION USING ISTH CRITERIA

    Directory of Open Access Journals (Sweden)

    Chopade

    2013-10-01

    Full Text Available Disseminated Intravascular Coagulation (DIC is a pathological activation of coagulation (blood clotting mechanisms that happens in response to a variety of diseases. It involves the generation of intravascular fibrin (small blood c lots and the consumption of pro - coagulants and platelets. It results in the disruption of normal coagulation mechanism and abnormal bleeding occurs from the skin, the gastrointestinal tract, the respiratory tract and surgical wounds. It was the prospecti ve study of 60 patients of acute DIC, in which coagulation profile were studied from December 2010 to October 2012 . 40 controls were studied. Control group include healthy voluntary blood donors. The coagulation profile was studied and DIC scoring was p erformed using the International Society on Thrombosis and Haemostasis [ISTH] criteria. Among the coagulation profile, the sensitivity and specificity of the parameters to diagnose and to assess the severity of DIC, in the decreasing order of frequency wer e of platelet count, D - dimer, PT and APTT. Fibrinogen level was not depleted below the significant level (<1 gm/l in majority cases of DIC. According to the ISTH criteria, DIC scores among cases was ? 5.

  14. Clinical Features and Long Term Outcome of 102 Treated Autoimmune Hepatitis Patients

    OpenAIRE

    Reza Malekzadeh; Siavosh Nasseri-Moghaddam; Masoud Sotoudeh; Shahin Merat; Sadaf G Sepanlou; Homayoon Vahedi; Sepideh Haghazali; Zinab Malekzadeh

    2012-01-01

    Background: Data on the natural history and long term follow up of patients with autoimmune hepatitis who refer for regular medical attention is limited.Objectives: We aimed to evaluate the clinical presentation and the natural history of a large cohort of type I AIH from Iran.Materials and Methods: Between 1997 and 2008, 102 patients were included in the study. Patients were diagnosed using the international autoimmune hepatitis group criteria and were followed up for an average of 60 months...

  15. Bronchial Carcinoid Tumors:Clinical and Radiological Findings in 21 Patients

    OpenAIRE

    F. Tolou MD; K. Kaynama; M.O. Tahbaz; S. Zahirifard; M Bakhshayesh Karam; H. Jabari Darjani

    2005-01-01

    Background/Objectives: Bronchial carcinoid tumors are neoplasms that range from typical carcinoids to the more aggressive atypical ones with similar imaging features. Considering the low prevalence of the tumor, we reviewed 21 patients. Patients and Methods: In this retrospective observational study, we reviewed the clinical, pathological and imaging findings in 21 patients diagnosed with bronchial carcinoid tumors who were admitted to National Research Insti tute of Tuberculosis and Lung Dis...

  16. Clinical features and prognosis in colorectal cancer patients with different ethnicities in Northwest China

    OpenAIRE

    Akram Yusup; Hai-Jiang Wang; Azmat Rahmutula; Parhat Sayim; Ze-Liang Zhao; Guo-Qing Zhang

    2013-01-01

    AIM: To compare the clinical factors and tumor characteristics that predict survival in colorectal cancer (CRC) patients with different ethnicities in Xin Jiang area. METHODS: A total of 1421 histopathologically confirmed sporadic CRC patients who were either Han/Chinese or Uyghur were identified and enrolled from a database of both diagnoses and operative procedures from Xin Jiang Tumor Hospital, which is affiliated to Xin Jiang Medical University between 2000 and 2007. Patients with family ...

  17. Clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Paraná, Brazil

    OpenAIRE

    Andréa Thomaz-Soccol; Marcos Mocellin; Fabiane Mulinari; Edilene Alcântara de Castro; Flávio de Queiroz-Telles; Fernanda de Souza Alcântara; Marcello Tortelli Bavaresco; Luciane Hennig; Anielo Andraus; Ennio Luz; Vanete Thomaz-Soccol

    2011-01-01

    The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL) in patients from the endemic areas of leishmaniasis were assessed. Different methods used in diagnosing the disease and the polymerase chain reaction (PCR) technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14....

  18. Diagnosis-Specific Prognostic Factors, Indexes, and Treatment Outcomes for Patients With Newly Diagnosed Brain Metastases: A Multi-Institutional Analysis of 4,259 Patients

    International Nuclear Information System (INIS)

    Purpose: Controversy endures regarding the optimal treatment of patients with brain metastases (BMs). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of the present study was to identify significant diagnosis-specific prognostic factors and indexes (Diagnosis-Specific Graded Prognostic Assessment [DS-GPA]). Methods and Materials: A retrospective database of 5,067 patients treated for BMs between 1985 and 2007 was generated from 11 institutions. After exclusion of the patients with recurrent BMs or incomplete data, 4,259 patients with newly diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of the prognostic factors and outcomes by primary site and treatment were performed. The significant prognostic factors were determined and used to define the DS-GPA prognostic indexes. The DS-GPA scores were calculated and correlated with the outcomes, stratified by diagnosis and treatment. Results: The significant prognostic factors varied by diagnosis. For non-small-cell lung cancer and small-cell lung cancer, the significant prognostic factors were Karnofsky performance status, age, presence of extracranial metastases, and number of BMs, confirming the original GPA for these diagnoses. For melanoma and renal cell cancer, the significant prognostic factors were Karnofsky performance status and the number of BMs. For breast and gastrointestinal cancer, the only significant prognostic factor was the Karnofsky performance status. Two new DS-GPA indexes were thus designed for breast/gastrointestinal cancer and melanoma/renal cell carcinoma. The median survival by GPA score, diagnosis, and treatment were determined. Conclusion: The prognostic factors for BM patients varied by diagnosis. The original GPA was confirmed for non-small-cell lung cancer and small-cell lung cancer. New DS-GPA indexes were determined for other histologic types and correlated with the outcome, and statistical separation between the groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making.

  19. The Amyand's Hernia: A Rare Clinical Entity Diagnosed by Computed Tomography

    OpenAIRE

    Keskin, Suat; ?im?ek, Cihan; Keskin, Zeynep

    2013-01-01

    Amyand's hernia, named for the first person to describe an inguinal hernia containing the vermiform appendix, is an uncommon variant of an inguinal hernia. Amyand's hernia is an extremely rare condition and is often misdiagnosed. Traditionally, these hernias have been diagnosed at surgery but are increasingly diagnosed by abdominal computed tomography (CT) scans. CT of the abdomen may help in guiding the diagnosis.

  20. Radiotherapy and prognosis of early esophageal carcinoma diagnosed by endoscopy for 17 patients

    International Nuclear Information System (INIS)

    Objective: To study the radiotherapy and prognosis of early esophageal carcinoma diagnosed by endoscopy. Methods: From June 1997 to November 2002, late course accelerated hyperfraction radiotherapy (LCAFR) was used for 17 patients with early esophageal carcinoma diagnosed by endoscopy using Lugol's solution and proved by histopathology. Radiotherapy was: 2.0 Gy/f, 5 times a week, to 30 Gy/ 15f/ 3wk, followed by 1.5 Gy/f bid with an interval > 6 h, to 20-24 Gy/ 14-16f/9-10 days. Kaplan-Meier method and Log-rank method were used in the statistical analysis. Results: The overall 1-, 3- and 5-year survival rates were 100%, 86% and 66%. The 5-year survival rates were 100% and 49% (P=0.111) in patients with tumor length measured by endoscopy ?3 cm and > 5 cm. The 5-year survival rates were 100% and 45% (P=0.102) in patients with lesion thickness by CT?5 mm and >5 mm. Conclusions: Routine radiotherapy combined with late course accelerated hyperfraction radiotherapy is effective and applicable in the treatment of early esophageal carcinoma. The length of irradiation field should be decided by endoscopic diagnosis using Lugol's solution. (authors)

  1. Method and system for the diagnosis of disease using retinal image content and an archive of diagnosed human patient data

    Energy Technology Data Exchange (ETDEWEB)

    Tobin, Kenneth W; Karnowski, Thomas P; Chaum, Edward

    2013-08-06

    A method for diagnosing diseases having retinal manifestations including retinal pathologies includes the steps of providing a CBIR system including an archive of stored digital retinal photography images and diagnosed patient data corresponding to the retinal photography images, the stored images each indexed in a CBIR database using a plurality of feature vectors, the feature vectors corresponding to distinct descriptive characteristics of the stored images. A query image of the retina of a patient is obtained. Using image processing, regions or structures in the query image are identified. The regions or structures are then described using the plurality of feature vectors. At least one relevant stored image from the archive based on similarity to the regions or structures is retrieved, and an eye disease or a disease having retinal manifestations in the patient is diagnosed based on the diagnosed patient data associated with the relevant stored image(s).

  2. Spirometer-controlled cine magnetic resonance imaging to diagnose tracheobronchomalacia in pediatric patients

    DEFF Research Database (Denmark)

    Ciet, Pierluigi; Wielopolski, Piotr

    2014-01-01

    Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard to diagnose TBM, but bronchoscopy has major disadvantages, such as general anaesthesia. Cine-CT is a non-invasive alternative to diagnose TBM, but its use in children is restricted by ionizing radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine-MRI as alternative to cine-CT in a retrospective study.12 children (mean 12 years, range 7-17), suspected to have TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration covering the thorax using a 3D SPGR sequence. 3D-Dynamic-scans were performed covering only the central airways. TBM was defined as a decrease of the trachea or bronchi diameter greater than 50% at end-expiration in the static and dynamic scans.The success rate of the cine-MRI protocol was 92%. Cine-MRI was compared with bronchoscopy or chest-CT in 7 subjects. TBM was diagnosed by cine-MRI in 7 out of 12 children (58%) and was confirmed by bronchoscopy or CT. In 4 patients, cine-MRI demonstrated tracheal narrowing that was not present in the static scans.Spirometer-controlled cine-MRI is a promising technique to assess TBM in children and has the potential to replace bronchoscopy.

  3. A Retrospective Analysis of Patients Admitted to our Clinic with Aortic Dissection

    Directory of Open Access Journals (Sweden)

    Ayhan Sar?ta?

    2011-11-01

    Full Text Available Objective: In this retrospective study, we aimed to manifest some clinical, radiologic and demographical features of patients which were admitted to our emergency department and diagnosed with aortic dissection. Materials and Methods: Records of patients diagnosed with aortic dissection in our Emergency Department during March 2009-March 2011 were scanned retrospectively. Patients’ gender, age, complaints (chest pain, backache, abdominal pain, syncope, dizziness and other, presence of mediastinal widening on tele cardiograph and presence of fleb on echocardiograph were recorded. Results: Total 12 patients (8 males, 4 females were included into the study. Mean age was 63.5±19.0 (minimum 28, maximum 85. Complaints were chest pain (50%, backache (25%, abdominal pain (25%, syncope (25% and dizziness (16.7%, respectively. There was a pulse difference between the two arms in 25% of patients. However, mediastinal widening was present in 50% of patients. Eight patients (67% have a fleb on echocardiograph. Eight patients had Standford Type A and five of patients had De Bakey Type 1 aortic dissection. There were no statistical differences between dissection types and gender (p>0.5. Eleven patients were referred to another hospital, and one of patients died. Conclusion: We thought that in clinical doubt of aortic dissection which is diagnosed with difficulty, bedside echocardiographic evaluation will provide convenience for emergency physicians in emergency departments.

  4. Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses : an explorative study

    OpenAIRE

    Schauer Margarete; Neuner Frank; Rockstroh Brigitte; Bichescu Dana; Saleptsi Evangelia; Studer Karl; Hoffmann Klaus; Elbert Thomas

    2004-01-01

    Abstract Background A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples. Methods A total of 192 patients with diagnoses of alcohol-related disorders (n = 45), schizophrenic disorders (n = 52), affective disorders (n = 54), and personality disorders (n = 41) completed a 42-item self-rating s...

  5. Nerve Conduction Studies, SEP and Blink Reflex Studies in Recently Diagnosed, Untreated Thyroid Disease Patients

    Directory of Open Access Journals (Sweden)

    Gulbun YUKSEL

    2007-03-01

    Full Text Available The purpose of this study was to investigate the electrophysiological changes in the peripheral and central nervous system in recently diagnosed subclinical thyroid disease patients before any treatment. This study included 22 patients with hypothyroidism and 13 patients with hyperthyroidism who had no other disease which could affect peripheral or central nervous system. We performed nerve conduction studies, median nevre somatosensorial evoked potentials and blink reflex studies in 35 patients and 30 age and gender matched controls. Distal latency, compound muscle action potential amplitude, nerve conduction velocity, minumum F-latency were recorded in the motor nerve conduction studies, distal latency, sensorial nerve action potential amplitüde, nerve conduction velocity were recorded in the sensorial nerve conduction studies and cortical N20-P25 potential latencies were recorded during the median somatosensorial evoked potential study. Bilaterally R1, R2 and contralaterally R2 potentials were evaluated during the blink reflex studies. In the subclinical hypothyroid patients median motor and sensorial nerves were the most commonly affected nerves with carpal tunnel syndrom being positive in 54,5 % of these patients. Sensorimotor polyneuropathy was find in 8-9% of subclinical hypothyroid patients while this ratio was 15,38% in subclinical hyperthyroid patients. Sural neuropathy was found in 23,07% of subclinical hyperthyroid patients. A decrease in median, ulnar and sural sensorial nerve action potential amplitüdes and tibial motor nerve conduction velocities were the other findings in this group. During the median nerve SEP studies the most common pathological finding in all patients was an increase in P25 cortical latency. This was found in 45,45%

  6. Intelligent Virtual Patients for Training Clinical Skills

    OpenAIRE

    Thomas D. Parsons; Patrick Kenny; Albert

    2011-01-01

    The article presents the design process of intelligent virtual human patients that are used for the enhancement of clinical skills. The description covers the development from conceptualization and character creation to technical components and the application in clinical research and training. The aim is to create believable social interactions with virtual agents that help the clinician to develop skills in symptom and ability assessment, diagnosis, interview techniques and interpersonal co...

  7. Transcultural study on quality of life in patients diagnosed of schizophrenia from Mexico and Spain

    OpenAIRE

    Maribel Peró Cebollero; Mónica Arroyo Medrano; Joan Guàrdia Olmos; Adolfo Jarne Esparcia; Teresita Villaseñor Cabrera

    2009-01-01

    The aim of this paper was to evaluate the differences between two samples of schizophrenic patients from two different cultural contexts. Matched by age and gender, each 40-subject sample includes patients with differential diagnosis of schizophrenia. One sample was taken from the Barcelona Hospital network (Spain) and the other one from the Hospital Civil Universitario of Guadalajara (Mexico). Several demographic and clinical variables were evaluated and the Health Related Quality of Life Sc...

  8. Bronchial carcinoid tumors: clinical and radiological findings in 21 patients

    International Nuclear Information System (INIS)

    Bronchial carcinoid tumors are neoplasms that range from typical carcinoid s to the more aggressive atypical ones with similar imaging features. Considering the low prevalence of the tumor, we reviewed 21 patients. Patients and methods: in this retrospective observational study, we reviewed the clinical, pathological and imaging findings in 21 patients diagnosed with bronchial carcinoid tumors who were admitted to National Research Institute of Tuberculosis and Lung Disease in a 6 years period. Plain radiography and CT scan of patients were reviewed. Results: 52.4% of the patients were male and 47.6 % female. The mean age of patients was 39.1 years. The most frequent clinical symptoms were cough (n=15; 71.4%), hemoptysis (n.13; 61.9%). dyspnea (n=12; 57.1%). and pleuritic chest pain (n.7; 19%). Most of the lesions (68%) were in the right lung, 24% in the left lung. 8% in the trachea, and 19% were bilateral. Right upper lobe and right intermediate bronchus (24% and 32% respectively) were the most frequent sites of tumor. In radiologic examination, two cases (9.5%) had normal CXRs. Pulmonary collapse (52.4%) and mass (23.8%) were the most frequent findings. Reviewing CT scans showed endobronchial lesion in three (15%) and mass in 11 (55%) patients. The mass was well defined in 8 cases (72%) and ill-defined in 3 (28%). Other findings were: mediastinal invasion (45%), atelectasis (55%). post obstructive pneumonitis (2 0%) and eccentric calcification (15%). Pathological examination revealed typical (n=18: 86% ) and atypical (n.3: 14%) carcinoid tumors. Conclusion: although rare, bronchial carcinoid tumors should be considered a differential diagnosis in adult patients with cough, hemoptysis, dyspnea, and pleuritic chest pain. Chest xray and CT scan can help with diagnosis. Major imaging findings are central, round or ovoid well-defined mass, and obstruction signs like at electasis. Diagnosis and classification should be confirmed by pathological examination on sample taken by bronchos copy or surgery

  9. Clinical service desires of medical cannabis patients

    OpenAIRE

    Janichek Jennifer L; Reiman Amanda

    2012-01-01

    Abstract Background Medical cannabis dispensaries following the social or hybrid model offer supplementary holistic services in addition to dispensing medical cannabis. Historically, alternative physical health services have been the norm for these dispensaries, including services such as yoga, acupuncture, or chiropractor visits. A clinical service dearth remains for medical cannabis patients seeking substance use, misuse, dependence, and mental health services. This study examined patient d...

  10. A subfertile patient diagnosed with testicular carcinoma in situ by immunocytological staining for AP-2gamma in semen samples : case report

    DEFF Research Database (Denmark)

    Hoei-Hansen, C E; Rajpert-De Meyts, E

    2005-01-01

    The incidence of testicular cancer is rising. Despite a high cure rate, efforts should be made to obtain diagnosis at the pre-invasive intratubular carcinoma in situ (CIS) stage, as the disease is potentially lethal and treatment has severe side-effects, especially regarding reproductive function. CIS diagnosis is presently only possible by a surgical biopsy of the testis. Immunocytological staining for transcription factor activator protein (AP-2gamma), previously identified as a marker for neoplastic germ cells, was performed in centrifuged samples of ejaculates obtained from 104 andrological patients, including patients with testicular cancer and subfertility. Cells positive for AP-2gamma were found only in semen samples from patients diagnosed a priori with testicular neoplasms and, surprisingly, in a 23 year old control subject with oligozoospermia and no symptoms of a germ cell tumour. Testicular biopsies performed during the follow-up of this patient revealed widespread CIS in one testicle, thus proving a potential diagnostic value of the new marker. For the first time, a patient without clinical symptoms of testicular neoplasia was diagnosed at the pre-invasive CIS stage using a new, simple method based on immunocytological staining of a semen sample for AP-2gamma, a novel marker for CIS. The value of this method for diagnostic use in the clinic requires further careful validation in a large series of patients and controls, but the preliminary results are promising.

  11. Celiac disease diagnosed after uncomplicated pregnancy in a patient with history of bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Milisavljevi? Nemanja

    2013-01-01

    Full Text Available Introduction. The association between celiac disease and eating disorders has been very rarely reported. This is the first report on celiac disease associated with bulimia in this part of Europe. Case report. An adult female patient with history of bulimia and one uncomplicated pregnancy was admitted to the Gastroenterology Department, due to long lasting dyspeptic symptoms, constipation, major weight loss and fatigue. After positive serological screening, the diagnosis of celiac disease was confirmed with histopathology examination of duodenal biopsy specimen. Conclusion. Complicated interactions between celiac disease and bulimia can make them difficult to diagnose and treat. It is important to consider the presence of celiac disease in patients with bulimia and gastrointestinal symptoms.

  12. Malnutrition and clinical outcome in urological patients

    Directory of Open Access Journals (Sweden)

    Karl A

    2011-10-01

    Full Text Available Abstract Introduction In a previous study we evaluated the risk for malnutrition among urological patients in a German university hospital. There are published different studies in other surgical fields that could show a correlation between malnutrition and clinical outcome. As data on this issue is still rare in the urological field we aimed to correlate the risk of malnutrition with different parameters regarding clinical outcome. Methods In the time from 2007 to 2009 a total of 320 patients were evaluated regarding the risk of malnutrition and occurrence of complications during the time of hospitalization at our Urological department. The Nutritional risk screening 2002 (NRS by Kondrup et al. was used for the estimation of the risk level for malnutrition. Patients of a German university hospital were included independently of intervention, age or gender. Parameters for clinical outcome were: pulmonary complications (infectious/noninfectious, cardiovascular complications (infectious/noninfectious, other infections (urinary tract infection etc., wound healing disorders and time of hospitalization. Results In this evaluation 320 patients were included for analysis. Forty patients (13% presented with a normal nutritional status (NRS score 0 at the time of admission to the hospital and 212 patients (66% were at risk for forming malnutrition problems (NRS score 1-2. sixty eight patients (21% of this urological cohort were detected with a malnutrition according to the applied NRS score (?3. Regarding the occurrence of overall complications in this cohort the rate was rather low compared to other surgical fields. Of 320 patients only 22 patients (7% presented with relevant complications during their hospitalization. However if data were stratified for peri- and postoperative complications in correlation to nutritional status of patients, an evident trend to a higher complication rate of 9% was obvious. Conclusions In our cohort of exclusively urological patients, the risk for post-surgical complications was higher in patients who were malnourished as defined using the Nutritional Risc Screening System (NRS by Kondrup et al. Further studies need to show whether an adequate nutritional supportive therapy could help to optimize the clinical outcome of malnourished urological patients.

  13. The 12 item W.H.O.D.A.S. as primary self report outcome measure in a correctional community treatment center for dually diagnosed patients.

    Science.gov (United States)

    Bastiaens, Leo; Galus, James; Goodlin, Michael

    2015-06-01

    The World Health Organization Disability Assessment Scale (WHODAS) is suggested as a measure of impairment in DSM-5. The measurement of impaired functioning is crucial in the rehabilitation of dually diagnosed, addiction and mental health, patients. This study is the first to look at the use of the 12 item self report WHODAS as the primary outcome in a community correctional treatment facility for dually diagnosed patients.100 (55 male; 73 white, 25 black, 2 hispanic) former inmates, age 36.1 ± 11.1, with psychiatric and addiction diagnoses were treated in an integrated program. The 12 item WHODAS was completed by the patients during the initial evaluation and repeated an average of 11.1 ± 2.7 weeks later. The Clinical Global Impression-Severity Scale (CGI) was completed at the same time by the psychiatrist, independently of the WHODAS. At initial assessment, the CGI showed moderate severity and the WHODAS showed severe disability. CGI and WHODAS were significantly correlated (R 0.48, p WHODAS with 49%. The CGI showed mild severity and the WHODAS moderate disability. The change in CGI was correlated with the change in WHODAS (R 0.57, p WHODAS appears sensitive to clinical improvement related to shortterm treatment of a highly co-morbid dual diagnosis population. PMID:25262006

  14. How Are Pelvic Floor Disorders Diagnosed?

    Science.gov (United States)

    ... Information Clinical Trials Resources and Publications How are pelvic floor disorders diagnosed? Skip sharing on social media links ... fee ). This test is used to evaluate the pelvic floor and rectum while the patient is having a ...

  15. Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre

    2013-01-01

    In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts ?25×10(9)/L or ?50×10(9)/L with bleeding symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n = 71) or in combination with rituximab 375 mg/m(2) weekly for 4 weeks (n = 62). Patients were allowed supplemental dexamethasone every 1 to 4 weeks for up to 6 cycles. Our primary end point, sustained response (ie, platelets ?50×10(9)/L) at 6 months follow-up, was reached in 58% of patients in the rituximab + dexamethasone group vs 37% in the dexamethasone group (P = .02). The median follow-up time was 922 days. We found longer time to relapse (P = .03) and longer time to rescue treatment (P = .007) in the rituximab + dexamethasone group. There was an increased incidence of grade 3 to 4 adverse events in the rituximab + dexamethasone group (P = .04). In conclusion, rituximab + dexamethasone induced higher response rates and longer time to relapse than dexamethasone alone. This study is registered at http://clinicaltrials.gov as NCT00909077.

  16. Rituximab and Dexamethasone vs Dexamethasone Monotherapy in Newly Diagnosed Patients with Primary Immune Thrombocytopenia

    DEFF Research Database (Denmark)

    Gudbrandsdottir, Sif; Birgens, Henrik Sverre

    2013-01-01

    In this study, we report the results from the largest cohort to date of newly diagnosed adult immune thrombocytopenia patients randomized to treatment with dexamethasone alone or in combination with rituximab. Eligible were patients with platelet counts ?25×10(9)/L or ?50×10(9)/L with bleeding symptoms. A total of 133 patients were randomly assigned to either dexamethasone 40 mg/day for 4 days (n = 71) or in combination with rituximab 375 mg/m(2) weekly for 4 weeks (n = 62). Patients were allowed supplemental dexamethasone every 1 to 4 weeks for up to 6 cycles. Our primary end point, sustained response (ie, platelets ?50×10(9)/L) at 6 months follow-up, was reached in 58% of patients in the rituximab + dexamethasone group vs 37% in the dexamethasone group (P = .02). The median follow-up time was 922 days. We found longer time to relapse (P = .03) and longer time to rescue treatment (P = .007) in the rituximab + dexamethasone group. There was an increased incidence of grade 3 to 4 adverse events in the rituximab + dexamethasone group (P = .04). In conclusion, rituximab + dexamethasone induced higher response rates and longer time to relapse than dexamethasone alone. This study is registered at http://clinicaltrials.gov as NCT00909077.

  17. Integrating patient safety into the clinical microsystem

    OpenAIRE

    Mohr, J; Batalden, P; Barach, P

    2004-01-01

    Healthcare institutions continue to face challenges in providing safe patient care in increasingly complex organisational and regulatory environments while striving to maintain financial viability. The clinical microsystem provides a conceptual and practical framework for approaching organisational learning and delivery of care. Tensions exist between the conceptual theory and the daily practical applications of providing safe and effective care within healthcare systems. Healthcare organisat...

  18. Clinical evaluation of 413 Thalassemic patients

    Directory of Open Access Journals (Sweden)

    Korosdari Gh.H

    2000-08-01

    Full Text Available Thalassemia is the most prevalent genetic disorder in Iran and around the world and these patients need regular careful care. The present study reports results of routine examination of patients visited Thalassemia clinic of Tehran. Data about clinical and laboratory examinations of 413 Thalassemic were extracted and analyzed. The prevalence of heart complications, diabetes, growth retardation, delayed puberty and primary and secondary amenorrhea was 9%, 8%, 21.3%, 3.1% and 6.3%, respectively. 44% didn't have secondary sex characteristics. Splenectomy had been done for 67.2% of cases. HBsAg, HBsAb and HBcAb were positive in 1.9%, 57.4% and 43%, respectively. We concluded that blood transfusion standards in this clinic was acceptable, whereas because of poor knowledge, iron chelating is unfavorable.

  19. Periodic paralysis: clinical evaluation in 20 patients

    Directory of Open Access Journals (Sweden)

    Célia Harumi Tengan

    1994-12-01

    Full Text Available Twenty patients with periodic paralysis were evaluated and the aspects studied included epidemiological data, clinical manifestations, ancillary tests, treatment and evolution. Sixteen patients had the hypokalemic form (5 familiar, 5 sporadic, 5 thyrotoxic and 1 secondary. No patient with the normokalemic form was detected. Predominance of men was found (14 patients, especially in the cases with hyperthyroidism (5 patients. No thyrotoxic patient was of oriental origin. Only 4 patients had the hyperkalemic form (3 familiar, 1 sporadic. Attacks of paralysis began during the first decade in the hyperkalemic form and up to the third decade in the hypokalemic. In both forms the attacks occurred preferentially in the morning with rest after exercise being the most important precipitating factor. Seventy five percent of the hyperkalemic patients referred brief attacks (<12 hours. Longer attacks were referred by 43% of the hypokalemic patients. The majority of the attacks manifested with a generalized weakness mainly in legs, and its frequency was variable. Creatinokinase was evaluated in 10 patients and 8 of them had levels that varied from 1,1 to 5 times normal. Electromyography was done in 6 patients and myotonic phenomenon was the only abnormality detected in 2 patients. Carbonic anhydrase inhibitors, especially acetazolamide, were used for prophylactic treatment in 9 pacients with good results in all. Although periodic paralysis may be considered a benign disease we found respiratory distress in 5 patients, permanent myopathy in 1, electrocardiographic abnormalities during crises in 4; death during paralysis occurred in 2. Therefore correct diagnosis and immediate treatment are crucial. This study shows that hyperthyroidism is an important cause of periodic paralysis in our country, even in non oriental patients. Hence endocrine investigation is mandatory since this kind of periodic paralysis will only be abated after return to the euthyroid state.

  20. Evaluation of NANDA nursing diagnoses of healthcare college final year students during the clinical application of the mental health and disease nursing course

    Directory of Open Access Journals (Sweden)

    Gülay Ta?demir

    2013-01-01

    Full Text Available The aim of this descriptive study was to evaluate the NANDA nursing diagnoses of Pamukkale University Denizli Healthcare College final year students for the patients they undertook the care of and to determine the aims and interventions relevant to these diagnoses.The study universe consisted of all Pamukkale University Denizli Healthcare College final year students who were continuing their education during the 2009-2010 educational year and took the Mental Health and Disease Nursing course (84. The universe was studied before selecting a sample. The internal medicine, surgery, cardiovascular surgery, chest disease, orthopedics-urology, and physical treatment and rehabilitation clinics were chosen for the consultation liaison psychiatry (CLP while the AMATEM Center of the Denizli State Hospital and the Pamukkale University Psychiatry clinics were chosen as the student clinical application areas. The data were collected by evaluating the 136 nursing care plans prepared by the students and the data collection forms the students had used for nursing care during the 2009-2010 autumn semester. The nursing care was evaluated according to the symptom, etiology and problem (SEP format, using the diagnostic list containing the NANDA diagnoses that had previously been provided to the students, and the number and percentage distributions were determined.The patients cared for at the CLP clinics by the students included in the study had been admitted for surgical interventions at a rate of 29.8% and cancer at 28.6% while those in the psychiatry clinics had been admitted for psychosis or alcohol-substance abuse at a rate of 16.7%. The students included in the study had determined 36 nursing diagnoses in 136 cases. The 6 most common diagnoses were infection risk at 34.5%, disturbance of sleep pattern at 33.3%, anxiety at 25.0%, activity intolerance at 20.2%, inadequate personal coping at 16.7% and trauma risk at 13.1% at the CLP clinics, and disturbed sleep pattern at 15.5%, inadequate personal coping at 14.3%, anxiety at 14.3%, changes in family processes at 10.7%, self-care deficit at 10.7% and social interaction disturbance at 10.7% at the psychiatry clinics.The students showed low rates of being able to determine nursing diagnoses according to the SEP format and to plan, administer and evaluate result criteria accordingly. We recommend frequent demonstration of the nursing process via case studies starting from the first year of nursing training, providing a similar interpretation of the nursing process in all main nursing lectures by using a common language, informing the student that the nursing process is not just homework or a way of grading but is the essential tool of nursing care based on scientific foundations.

  1. Clinical diagnoses and characteristics of women entering the Reykjavik Emergency Departments during the economic collapse in 2008

    OpenAIRE

    Rebekka Sigrún Lynch 1989

    2013-01-01

    Background: The Prime Minister’s speech to the Icelandic nation on October 6th 2008 dramatically signalled the start of a swift economic collapse in Iceland. An earlier study reported a 40% increase in women attending to the Cardiac Emergency Department (ED) of Landspitali University Hospital in the following week. This spike is now being investigated further to determine underlying clinical characteristics and diagnoses of these women. Methods: Using electronic medical records at Landspi...

  2. Birth Order and Sibling Gender Ratio of a Clinical Sample of Children and Adolescents Diagnosed with Attention Deficit Hyperactivity Disorder

    OpenAIRE

    Ahmad Ghanizadeh; Marzie Abotorabi-Zarchi; Mohammad Reza Mohammadi; Ali Firoozabadi

    2012-01-01

    Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD). This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-I...

  3. Clinical Significances of 99mTc-DMSA Renal Scan in Patients with Acute Pyelonephritis

    International Nuclear Information System (INIS)

    Patients with acute pyleonephritis may present with a spectrum of clinical symptoms and signs. There are few noninvasive diagnostic studies, however to confirm or exclude this diagnosis. To evaluate the clinical utility of 99mTc-DMSA renal scan in diagnosis of acute pyelonephritis, we performed 99mTc-DMSA renal scan in 37 patients suspected with urinary tract infection. Simultaneously kidney ultrasonography was done in 21 patients diagnosed with acute pyelonephritis, clinically. And we performed the followup scan after treatment in two to six weeks. The results were as follows. 1) 99mTc-DMSA renal scan disclosed single of multiple cortical defects and decreased radiouptake ratio of affected kidney in 23 patients among 25 patients diagnosed with acute pyleonephritis. 2) In the 21 patients with acute pyelonephritis, kidney ultrasonography showed abnormal findings in the 7 patients. And 99mTc-DMSA renal scan disclosed abnormal cortical defects in this 7 patients also. 3) Between the patients with acute pyelonephritis and those with lower urinary tract infection, asymptomatic bacteriuria or pyuria, right-to-left radiouptake ratios (R/L ratio ) were significantly different(p99mTc-DMSA renal scan for 5 patients among 25 acute pyelonephritis patients. And we have found the improvement of cortical defects and the right-to-left radiouptake ratio. In conclusion, we thought that 99mTc-DMSA renal scan should be useful in diagnosis of acute pyelonephritis and follow up examination.

  4. Overestimated value of 18F-FDG PET/CT to diagnose pulmonary nodules: Analysis of 298 patients

    International Nuclear Information System (INIS)

    Aim: To investigate the accuracy and efficacy of combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT) in the diagnosis of pulmonary nodules. Material and methods: The present retrospective study included 298 patients with clinically suspected pulmonary malignancy who underwent preoperative PET/CT. The results of PET/CT were compared with the histopathological findings after thoracotomy or thoracoscopic surgery. Results: Of 298 patients, pulmonary malignancy was histopathologically diagnosed in 248 and benign lesions in 50 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT in detecting malignant lesions were 80.2%, 38%, 86.5%, 27.9%, and 73.1%, respectively. The specificity and NPV were very low, and the area under curve (AUC) in the receiver operating characteristic (ROC) curve analysis was 0.694. For 219 patients with non-small cell lung cancer (NSCLC), falsely negative results occurred in 43 patients. The multivariate risk-factor analysis identified high differentiation (p < 0.001), peripheral lung cancer (p = 0.016), non-pleural invasion (p = 0.001), tumour size ?3 cm (p = 0.026), adenocarcinoma (p = 0.062) and non-smoker (p = 0.066) as risk factors for false negatives.. Conclusion: The study suggests that the role of PET/CT in the detection of pulmonary malignancy has been overestimated in the past. It warrants attention that high differentiation, peripheral lung cancer, non-pleural invasion, tumour size ?3 cm, adenocarcinoma, and non-smoker were independent risk factors for negative PET/CT findings of NSCLC.. - Highlights: • The role of PET/CT in the detection of pulmonary malignancy has been overestimated. • There are some independent risk factors for negative PET/CT findings of NSCLC. • Our study can promote the reasonable use of PET/CT in partial

  5. Thirty-Four Patients with Cushing’s Syndrome: Our Clinical Experience in the Past 20 Years

    OpenAIRE

    Mehtap Evran; Murat Sert; Tamer Tetiker

    2009-01-01

    Objective: Cushing’s syndrome is a relatively rare disorder caused by chronic endogenous hypercortisolemia. We aimed to present patients with Cushing’s syndrome who were diagnosed and followed at our endocrinology clinic. Materials and Methods: 34 patients (26 female, 8 male) with Cushing’s syndrome were enrolled in this retrospective study. Results: Of 34 patients, 20 had Cushing’s disease and 14 had Cushing’s syndrome. Regarding the clinical signs of Cushing’s syndrome, purple striae were ...

  6. Profile of sapacitabine: potential for the treatment of newly diagnosed acute myeloid leukemia in elderly patients

    Directory of Open Access Journals (Sweden)

    Lim MY

    2014-05-01

    Full Text Available Ming Y Lim, Katarzyna JamiesonDepartment of Medicine, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USAAbstract: Acute myeloid leukemia (AML is a hematopoietic stem cell disorder that affects approximately 14,000 persons each year in the US. AML occurs at all ages but the incidence increases with age with the median age at diagnosis being 67 years. Advances in the treatment of AML over the past decades have led to improved survival, albeit mostly in younger patients. The prognosis of older patients with this disease over the same time span has not changed much and remains dismal. This review focuses on the epidemiology and characteristics of AML in elderly patients, the rationale for treating elderly AML patients, and the currently available and potential future treatment options such as sapacitabine. Elderly AML patients treated with intensive chemotherapy have a higher mortality rate, and a lower rate of complete remission and overall survival when compared to the younger population. This is due to both the different biology of the disease and the number of patient-specific factors. However, elderly AML patients treated with aggressive chemotherapy can achieve durable remissions, which offer prolonged survival and improved quality of life. Recent data also indicates that elderly AML patients deemed unfit for intensive chemotherapy benefit from leukemia-specific attenuated dose chemotherapy compared to supportive care alone. This has led to renewed interest to look for anti-leukemic therapies designed specifically for older patients. Sapacitabine, a novel oral nucleoside analog, promises good efficacy, favorable toxicity profile, and ease of administration; all of which makes it very appealing. Results from pre-clinical and clinical studies have been very encouraging and sapacitabine is currently being evaluated in a Phase III study, of which the results are eagerly awaited.Keywords: AML, elderly, management, sapacitabine

  7. Poor Clinical Outcomes among Pneumonia Patients with Depressive Disorder

    Science.gov (United States)

    Kao, Li-Ting; Liu, Shih-Ping; Lin, Herng-Ching; Tsai, Ming-Chieh

    2014-01-01

    Background Some studies suggested that psychological stress may be associated with the severity and duration of infectious diseases. In this population-based study, we investigated associations between depressive disorder (DD) and pneumonia outcomes in Taiwan with a large-scale database from the National Health Insurance. Methods Our study defined 112,198 patients who were hospitalized with a principal diagnosis of pneumonia. We defined their admission date for treatment of pneumonia as the index date. Subsequently, we selected 2,394 patients with DD within 3 years prior to their index date and 11,970 matched patients without DD. We carried out separate conditional logistic regressions to explore the association of clinical pneumonia treatment outcome (ICU admission, use of mechanical ventilation, acute respiratory failure and in-hospital death) with previously diagnosed DD. Results Patients with DD had a significantly higher probability of an intensive care unit admission (18.1% vs. 12.9%; p<0.001), need for mechanical ventilation (21.9% vs. 18.1%; p<0.001) and in-hospital death (10.4% vs. 9.0%; p?=?0.025) than patients without DD. The study showed that pneumonia patients with DD were respectively 1.41- (95% CI: 1.25?1.59, p<0.001), 1.28- (95% CI: 1.14?1.43, p<0.001), and 1.17- times (95% CI: 1.01?1.36, p?=?0.039) greater odds of being admitted to the ICU, need for mechanical ventilation, and in-hospital death than patients without DD after adjusting for monthly income, urbanization level, geographic region and Charlson Comorbidity Index score. Conclusions In conclusion, we found that pneumonia patients with DD were associated with poor treatment outcomes compared to patients without DD. PMID:25551389

  8. Evaluation of Dream Content Among Patients with Schizophrenia, their Siblings, Patients with Psychiatric Diagnoses Other than Schizophrenia, and Healthy Control

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    Leeba Rezaie

    2012-04-01

    Full Text Available Objective: Schizophrenia is a chronic psychotic disorder with unknown etiology that causes cognitive impairment, affecting thinking, behavior, social function, sleep and dream content. This study considered the dream content of patients with schizophrenia, siblings of patients with schizophrenia, patients with psychiatric diagnoses other than schizophrenia, and a group of healthy controls. The aim of this study was to compare the dream content of patients with schizophrenia with dream content of individuals with other mental disorders, first degree relatives of patients with schizophrenia, and community controls . Method: Seventy-two patients were selected and placed in 4 groups. The first group consisted of 18 inpatients with schizophrenia whose medications were stable for at least four weeks; the second group consisted of 16 nonpsychotic mentally ill inpatients; the third group consisted of 18 individuals who were siblings of patients with schizophrenia; and the fourth group consisted of 20 healthy individuals in the community with no family history of mental or somatic disorders. The four groups were matched by age and gender. A 14-item dream content questionnaire was administered for all the participants, and the Positive and Negative Symptoms Scale (PANSS was also administered for the two groups of hospitalized patients . Results: Results showed that there were significant differences in dream content among groups included friends acquaintances, females and colorful components. No significant differences were found between the positive and negative subscales of PANSS and any of the dream questionnaire subscales. Conclusion: Our results suggest that there were a few changes in the dream content of the patients with schizophrenia compare to other groups.

  9. Clinical aspects of patients with nasal polyposis

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    Crespo, Cassio Caldini

    2009-09-01

    Full Text Available Introduction: The nasal Polyposis is a non-neoplastic chronic inflammatory process of the nasal mucosa. It causes a large impact to the patients' life quality. Objective: To analyze the characteristics of patients with polyposis in the Brazilian population. Method: 50 records of patients followed up in a tertiary hospital and submitted to surgical treatment of nasal polyposis were reviewed. The following variables were analyzed: age, sex, smoking, presence of asthma, presence of AAS intolerance and also the clinical manifestations: anterior and posterior rhinorrhea, nasal obstruction, hyposmia, sneezing and pruritus. The tomographic evaluation system applied was that of Lund-McKay. For statistical analysis we applied the chi-square test with p<0.05. Results: Out of 50 patients evaluated, 28 were male and 22 were female. The mean age range was of 40.8 years. The main clinical manifestation was nasal obstruction in 100% of the patients. In the tomographic evaluation, according to the Lund-McKay system, the average scoring was of 10.9. Discussion: No statistically significant difference was obtained in the patients' general symptoms compared to the patients with asthma or AAS intolerance. The difference in the Lund-McKay score was statistically significant in the populations studied. The symptoms were similar to the frequency of symptoms of other works. Conclusion: We concluded that the main complaint of the patients with nasal polyposis is nasal obstruction, the most affected age is of about 40 years old, without preference of sex. The severity of tomographic findings is higher in patients with asthma and AAS intolerance.

  10. [Therapy helps -- psychosocial support for patients diagnosed with breast cancer, reducing anxiety and depression].

    Science.gov (United States)

    Kovács, Zsuzsanna; Szabó, Csaba; Fülöp, Emöke

    2013-01-01

    The results of epidemiological researches are alarming. It is anticipated that in the next few decades the number of patients suffering from malignant tumours will double. Caring for patients with cancer sets a serious challenge to the health services - not only to the oncology specialists, but among the others also to the psychiatrists and the psychologists. The diagnosis of cancer commonly pushes the patient into a depressed, hopeless and anxious emotional state that can persist for years after the diagnosis causing serious damage - a decline in the health-related quality of life, it narrows life opportunities, it makes coping and cooperating more difficult, and it predicts the progression of the disease and mortality. Treating these is crucial. Results published in related literature prove the positive effects of psychosocial interventions (a wide range of psychological and psychosocial support of the patients) on emotional distress. The most commonly applied interventions are the supportive-expressive therapies and cognitive methods. Recently a new trend started unfolding where the patients, as their complementary care instead of having single interventions they are offered complex programmes - psychotherapy, exercise, diet, education, etc. are all applied together, amplifying the synergic effects of the components. Our research is aimed to assess the results of a complex programme in decreasing emotional distress in women diagnosed with primer breast cancer (n=173, experimental group n=86, of whom 34 participated the programme, control group n=87) short term (at the end of the 15 week long programme) and longitudinally (15 months after the end of programme). The results are very promising: there were significant improvements in patients, a decrease in depression (Beck), as well as in anxiety (STAI), and some aspects of positive effects showed long-lasting. PMID:24443579

  11. Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke

    Scientific Electronic Library Online (English)

    Gisele, Pinto; Viviane, Zétola; Marcos, Lange; Guilherme, Gomes; Maria Cristina, Nunes; Gisela, Hirata; Hellen Nataly, Lagos-Guimarães.

    2014-09-01

    Full Text Available Introduction Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective To evaluate the use of software to infer the probability of pneumonia in patients [...] with ischemic stroke. Methods Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke.

  12. Medical Yoga for Patients with Stress-Related Symptoms and Diagnoses in Primary Health Care: A Randomized Controlled Trial

    OpenAIRE

    Monica Köhn; Ulla Persson Lundholm; Ing-Liss Bryngelsson; Agneta Anderzén-Carlsson; Elisabeth Westerdahl

    2013-01-01

    An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, ove...

  13. Changes of ?-cell function after short-term transient intensive insulin treatment in newly diagnosed type 2 diabetes patients

    International Nuclear Information System (INIS)

    To evaluate the effect of short-term intensive insulin treatment on ?-cell function in newly diagnosed type 2 diabetes patients with apparently hyperglycemia, twenty-four newly diagnosed type 2 diabetes patients with FPG more than 12.0 mmol/L were treated by short-term transient intensive insulin in average 9.04-4.8 days. Their ?-cell function was assessed by oral glucose tolerance test. The FPG, HbAlc and HOMA IR of patients were significantly decreased (P<0.01), while the insulin, the Area Under Curve (AUC) of insulin and HOMA ? were significantly increased (P<0.01) after the treatment with insulin. Improvement of ?-cell function can be induced by short-term intensive insulin treatment for newly diagnosed type 2 diabetes patients with apparently hyperglycemia. (authors)

  14. Tobacco use prevalence, knowledge, and attitudes among newly diagnosed tuberculosis patients in Penang State and Wilayah Persekutuan Kuala Lumpur, Malaysia

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    Mohamad Noordin Noorliza

    2010-01-01

    Full Text Available Abstract Background There is sufficient evidence to conclude that tobacco smoking is strongly linked to tuberculosis (TB and a large proportion of TB patients may be active smokers. In addition, a previous analysis has suggested that a considerable proportion of the global burden of TB may be attributable to smoking. However, there is paucity of information on the prevalence of tobacco smoking among TB patients in Malaysia. Moreover, the tobacco-related knowledge, attitudes, and behaviors of TB patients who are smokers have not been previously explored. This study aimed to document the prevalence of smoking among newly diagnosed TB patients and to learn about the tobacco use knowledge and attitudes of those who are smokers among this population. Methods Data were generated on prevalence rates of smoking among newly diagnosed TB patients in the State of Penang from January 2008 to December 2008. The data were obtained based on a review of routinely collated data from the quarterly report on TB case registration. The study setting comprised of five healthcare facilities (TB clinics located within Penang and Wilayah Persekutuan, Kuala Lumpur health districts in Malaysia, which were involved in a larger project, known as SCIDOTS Project. A 58-item questionnaire was used to assess the tobacco use knowledge, attitudes and behaviors of those TB patients who were smokers. Results Smoking status was determinant in 817 of 943 new cases of TB from January to December 2008. Of this, it was estimated that the prevalence rates of current- and ex-smoking among the TB patients were 40.27% (329/817 and 13.95% (114/817, respectively. The prevalence of ever-smoking among patients with TB was estimated to be 54,220 per 100,000 population. Of 120 eligible participants for the SCIDOTS Project, 88 responded to the survey (73.3% response rate and 80 surveys were analyzed (66.7% usable rate. The mean (± SD total score of tobacco use knowledge items was 4.23 ± 2.66 (maximum possible score=11. More than half of the participants (51.3% were moderately dependent to nicotine. A moderately large proportion of the respondents (41.2% reported that they have ever attempted to quit smoking, while more than half (56.3% have not. Less than half (47.5% of the study participants had knowledge about the body system on which cigarette smoking has the greatest negative effect. The majority wrongly believed that smokeless tobacco can increase athletic performance (60% and that it is a safe and harmless product (46.2%. An overwhelming proportion (>80% of the patients believed that: smoking is a waste of money, tobacco use is very dangerous to health, and that smokers are more likely to die from heart disease when compared with non-smokers. The use of smokeless tobacco was moderately prevalent among the participants with 28.8% reporting ever snuffed, but the use of cigar and pipe was uncommon. Conclusion Smoking prevalence rate is high among patients with TB in Malaysia. These patients generally had deficiencies in knowledge of tobacco use and its health dangers, but had positive attitudes against tobacco use. Efforts should be geared towards reducing tobacco use among this population due to its negative impact on TB treatment outcomes.

  15. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea

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    Rajesh Kumar

    2014-01-01

    Full Text Available Obstructive sleep apnea (OSA is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male and 61 control subjects (47.6 ± 8.8 years; 39 male using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume. Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA.

  16. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea.

    Science.gov (United States)

    Kumar, Rajesh; Farahvar, Salar; Ogren, Jennifer A; Macey, Paul M; Thompson, Paul M; Woo, Mary A; Yan-Go, Frisca L; Harper, Ronald M

    2014-01-01

    Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA. PMID:24567910

  17. Risk factors of breast cancer in patients diagnosed at the Julio Trigo hospital

    International Nuclear Information System (INIS)

    A retrospective descriptive study was carried out with the objective of identifying some risk factors of breast cancer in patients diagnosed in the hospital Julio Trigo Lopez from 2007 to 2008. Of a universe of 54 patients, it was selected a sample of 31 patients (57,4%) who were those that gave their consent to be interviewed at the time that lasted the investigation (6 months). The 90,3% of the cases corresponded to infiltrating ductal carcinoma type. The age group more affected was 60-69 years and the white race; 41,9% presented personal antecedents of breast nodule, whereas the familiar antecedent of breast cancer was not significant. The 61,3% presented menarche after 12 years old, and the greater percent appeared to the childbirth before 24 years old. The 40,7% did not only offer maternal lactation; 87,1% had one or more children and 58,6% presented the menopause after the 50 years old. There was not risk exposure at the workplaces. The conjunction of several risk factors can favor the appearance of breast cancer, but the absence of demonstrable risk factors does not exclude the possibility of suffering the disease

  18. Serum Calcium Levels in Newly-diagnosed Patients with Tuberculosis in Hamedan (West of Iran

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    Seyyed Hamid Hashemi

    2005-01-01

    Full Text Available To investigate the incidence of hypercalcemia in TB patients and to assess its relationship with TB, a study was conducted in Infectious Diseases Division of Sina Hospital in Hamedan province (west of Iran. During an 18-month period, 65 patients with newly-diagnosed TB (30 males and 35 females, were prospectively evaluated who aged between 15 and 84 years (mean 53.3 years. Age- and sex-matched subjects (82 with chronic obstructive pulmonary disease (27 males and 55 females, aged between 16 and 85 (mean 53.5 years was selected as a control group. Serum calcium, phosphorus, total protein, albumin and alkaline phosphatase were measured in all subjects. No significant difference was found between the mean albumin-adjusted calcium levels in the TB group (8.79±1.53 mg dL-1 and the control group (8.57±1.12 mg dL-1. Hypercalcemia was found in 11 (16.9 % of TB patients and 6 (7.3 % of controls (?2 = 3.27, p = 0.07, non significant. This study revealed that there is non significant difference association between hypercalcemia and tuberculosis.

  19. Differential diagnoses and management strategies in patients with schizophrenia and bipolar disorder

    OpenAIRE

    A. Carlo Altamura; Goikolea, Jose M

    2008-01-01

    A Carlo Altamura1, Jose M Goikolea21Department of Psychiatry, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy; 2Bipolar Disorder Program, Hospital Clinic i Universitari, Barcelona, SpainAbstract: Successful treatment of psychiatric disorders, including bipolar disorder and schizophrenia, is complicated and is affected by a broad range of factors associated with the diagnosis, choice of treatment and social factors. In these patients...

  20. Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Glintborg, Dorte; Hass Rubin, Katrine; Nybo, Mads; Abrahamsen, Bo; Andersen, Marianne

    2015-01-01

    OBJECTIVE: The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS. DESIGN: A National Register-based study. METHODS: Patients with PCOS (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital (OUH)) and one control population. Premenopausal women with PCOS underwent clinical and biochemical examination (PCOS OUH, n=1217). PCOS Denm...

  1. Understanding the treatment of attention deficit hyperactivity disorder in newly diagnosed adult patients in general practice: a UK database study

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    Bushe C

    2015-01-01

    Full Text Available Christopher Bushe,1 Bernard Wilson,2 Foula Televantou,1 Mark Belger,1 Louise Watson3 1Lilly UK, Erl Wood Manor, Windlesham, Surrey, 2Lilly UK, Lilly House, Basingstoke, Hampshire, 3EpiPharmaCo Ltd, Buxton, Derbyshire, UK Background: Adult attention deficit hyperactivity disorder (ADHD has been largely ignored in psychiatric and general practice guidance until recently. Adult ADHD has a high social and medical burden, but health care is not well described in the UK. The main study objective was to evaluate a primary care adult ADHD population in terms of prescribing and health care contact rates. Methods: This was a retrospective observational study using data from the Clinical Practice Research Database from January 1, 2002 to July 31, 2011. Adult patients with an incident ADHD diagnosis or ADHD medication were identified as having been free of ADHD medication or diagnoses in the previous 2 years. Patients were followed for 12–24 months after diagnosis. Results: Of the 663 patients with ADHD in the cohort, 54.1% were prescribed ADHD medication during the observation period. During the first 6 months, 34.2% of patients initiated methylphenidates and 14.0% atomoxetine. In total, 36.3% patients were referred to secondary care psychiatry during observation, with the remaining population (63.7% never having a referral. Most of the referrals were before diagnosis in primary care. At the end of the observation period, 16.2% of patients were on antipsychotics, 17.3% hypnotics, and 34.8% antidepressants or anxiolytics; however, some patients appeared to be prescribed antipsychotic or antidepressant medications even if they did not have an observable diagnosis in their records. Health care contact rates (general practitioner or hospital increased by 39.2% post-diagnosis (incidence rate ratio: 1.39; 95% confidence interval: 1.32, 1.47, which may be related to the need for medication monitoring and titration. Conclusion: This study has shown in primary care that there is relatively low use of ADHD medication, low referrals into secondary care, high rates of usage of psychiatric non-ADHD medications for different indications, and an increasing burden in terms of health care contacts in adult ADHD patients post-diagnosis. Keywords: adult ADHD, prescribing, health care, health outcomes, epidemiology, CPRD

  2. Children diagnosed with congenital cardiac malformations at the national university departments of pediatric cardiology: positive predictive values of data in the Danish National Patient Registry

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    Peter Agergaard

    2011-02-01

    Full Text Available Peter Agergaard1, Anders Hebert2, Jesper Bjerre3, Karina Meden Sørensen4, Charlotte Olesen3, John Rosendal Østergaard31Department of Pediatrics, Viborg Hospital, Viborg, Denmark; 2Department of Pediatrics, Copenhagen University Hospital, Rigshospitalet, Denmark; 3Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark; 4Department of Clinical Biochemistry and Immunology, Statens Serum Institut, Copenhagen, DenmarkIntroduction: The present study was conducted to establish the positive predictive value of congenital cardiac malformation diagnoses registered in the Danish National Patient Registry (NPR, thereby exploring whether the NPR can serve as a valid tool for epidemiologic studies of congenital cardiac malformations.Materials and methods: The study population comprised every individual born from 2000 to 2008 who was registered in the NPR with a congenital cardiac malformation diagnosis and treated at one of the two national departments of pediatric cardiology. Positive predictive values were established comparing NPR information with the clinical record of each individual.Results: A total of 2952 patients with a total of 3536 diagnoses were eligible for validation. Review of their clinical records unveiled no patient without cardiac malformation. In 98% (98%–99% of the cases, the NPR diagnosis could be found as the discharge diagnosis in the patient's clinical record, and in 90% (89%–91% of the cases the NPR diagnosis was considered a true reflection of the patient's actual malformation.Conclusions: Our study verifies that the present study population retrieved from the NPR is a valid tool for epidemiological research within the topic of congenital cardiac malformations, given that the research question is not dependent on a fully established sensitivity of the NPR. Precautions should be made regarding cardiac malformations characterized by low prevalence or poor predictive values, and the reported validity should not be extrapolated beyond the study period.Keywords: congenital cardiac malformation, registry, validation

  3. Amyloid associated with elastin-staining laminar aggregates in the lungs of patients diagnosed with acute respiratory distress syndrome

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    Fan Kang

    2002-10-01

    Full Text Available Abstract Background The heterogeneity of conditions underlying respiratory distress, whether classified clinically as acute lung injury (ALI or the more severe acute respiratory distress syndrome (ARDS, has hampered efforts to identify and more successfully treat these patients. Examination of postmortem lungs among cases clinically diagnosed as ARDS identified a cohort that showed a consistent morphology at the light and electron microscope levels, and featured pathognomonic structures which we termed elastin-staining laminar structures (ELS. Methods Postmortem tissues were stained using the Verhoeff-Van Gieson procedure for elastic fibers, and with Congo red for examination under a polarizing microscope. Similar samples were examined by transmission EM. Results The pathognomonic ELS presented as ordered molecular aggregates when stained using the Verhoeff-van Gieson technique for elastic fibers. In several postmortem lungs, the ELS also displayed apple-green birefringence after staining with Congo red, suggesting the presence of amyloid. Remarkably, most of the postmortem lungs with ELS exhibited no significant acute inflammatory cellular response such as neutrophilic reaction, and little evidence of widespread edema except for focal intra-alveolar hemorrhage. Conclusions Postmortem lungs that exhibit the ELS constitute a morphologically-identifiable subgroup of ARDS cases. The ordered nature of the ELS, as indicated by both elastin and amyloid stains, together with little morphological evidence of inflammation or edema, suggests that this cohort of ARDS may represent another form of conformational disease. If this hypothesis is confirmed, it will require a new approach in the diagnosis and treatment of patients who exhibit this form of acute lung injury.

  4. Comparison of Newly Diagnosed and Relapsed Patients with Acute Promyelocytic Leukemia Treated with Arsenic Trioxide: Insight into Mechanisms of Resistance

    Science.gov (United States)

    Chendamarai, Ezhilarasi; Ganesan, Saravanan; Alex, Ansu Abu; Kamath, Vandana; Nair, Sukesh C.; Nellickal, Arun Jose; Janet, Nancy Beryl; Srivastava, Vivi; Lakshmi, Kavitha M.; Viswabandya, Auro; Abraham, Aby; Aiyaz, Mohammed; Mullapudi, Nandita; Mugasimangalam, Raja; Padua, Rose Ann; Chomienne, Christine; Chandy, Mammen; Srivastava, Alok; George, Biju; Balasubramanian, Poonkuzhali; Mathews, Vikram

    2015-01-01

    There is limited data on the clinical, cellular and molecular changes in relapsed acute promyeloytic leukemia (RAPL) in comparison with newly diagnosed cases (NAPL). We undertook a prospective study to compare NAPL and RAPL patients treated with arsenic trioxide (ATO) based regimens. 98 NAPL and 28 RAPL were enrolled in this study. RAPL patients had a significantly lower WBC count and higher platelet count at diagnosis. IC bleeds was significantly lower in RAPL cases (P=0.022). The ability of malignant promyelocytes to concentrate ATO intracellularly and their in-vitro IC50 to ATO was not significantly different between the two groups. Targeted NGS revealed PML B2 domain mutations in 4 (15.38%) of the RAPL subset and none were associated with secondary resistance to ATO. A microarray GEP revealed 1744 genes were 2 fold and above differentially expressed between the two groups. The most prominent differentially regulated pathways were cell adhesion (n=92), cell survival (n=50), immune regulation (n=74) and stem cell regulation (n=51). Consistent with the GEP data, immunophenotyping revealed significantly increased CD34 expression (P=0.001) in RAPL cases and there was in-vitro evidence of significant microenvironment mediated innate resistance (EM-DR) to ATO. Resistance and relapse following treatment with ATO is probably multi-factorial, mutations in PML B2 domain while seen only in RAPL may not be the major clinically relevant cause of subsequent relapses. In RAPL additional factors such as expansion of the leukemia initiating compartment along with EM-DR may contribute significantly to relapse following treatment with ATO based regimens. PMID:25822503

  5. Clinical Aspects of Thyrotoxicosis in 592 Patients: A Single Center Experience from Turkey

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    Serap Baydur ?ahin

    2014-12-01

    Full Text Available Purpose: To determine the main causes of thyrotoxicosis and to compare the clinical and biochemical fetaures of the patients according to the underlying cause of thyrotoxicosis. Material and Method: Five hundred ninety-two patients, who were consecutively diagnosed with thyrotoxicosis, were retrospectively analysed. Symptoms of thyrotoxicosis, serum thyroid-stimulating hormone (TSH, free T3 and free T4 levels, anti-thyroglobulin autoantibody (TGAb, anti-thyroid peroxidase autoantibody (TPOAb and ultrasonographic features were recorded. To determine the cause of thyrotoxicosis, Tc-99m pertechnetate thyroid scintigraphy was performed in all patients except for pregnant women. The clinical and biochemical results were compared between the patients with different diagnosis of thyrotoxicosis. Results: 40.9% of patients were diagnosed with toxic multinodular goiter (TMNG. The other main causes of thyrotoxicosis were: Graves’ disease (GD (22%, thyroiditis (14.8%, gestational thyrotoxicosis (12.7%, and toxic adenoma (9.6%. The clinical presentation and severity of thyrotoxicosis varied according to the underlying cause. Weight loss was more frequently observed in patients with GD (p=0.0001, while cardiac arrhythmia dominated in patients with TMNG (p=0.0001. Moderate (27% or severe (23.9% thyrotoxicosis was more common in patients with GD than in patients with other forms of thyrotoxicosis (p=0.0001. Discussion: Toxic multinodular goiter is the most common cause of thyrotoxicosis in our region.

  6. Diagnosing coronary artery disease by sound analysis from coronary stenosis induced turbulent blood flow : diagnostic performance in patients with stable angina pectoris

    DEFF Research Database (Denmark)

    Winther, Simon; Schmidt, Samuel Emil

    2015-01-01

    Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond-Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond-Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond-Forrester score (p < 0.05). Addition of the CAD-score to the Diamond-Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation.

  7. Clinical service desires of medical cannabis patients

    Directory of Open Access Journals (Sweden)

    Janichek Jennifer L

    2012-03-01

    Full Text Available Abstract Background Medical cannabis dispensaries following the social or hybrid model offer supplementary holistic services in addition to dispensing medical cannabis. Historically, alternative physical health services have been the norm for these dispensaries, including services such as yoga, acupuncture, or chiropractor visits. A clinical service dearth remains for medical cannabis patients seeking substance use, misuse, dependence, and mental health services. This study examined patient desires for various clinical services and level of willingness to participate in specific clinical services. Methods Anonymous survey data (N = 303 were collected at Harborside Health Center (HHC, a medical cannabis dispensary in Oakland, CA. The sample was 70% male, 48% Caucasian and 21% African American. The mean male age was 38 years old and female mean age was 30. Sixty two percent of the male participants and 44% of the female participants are single. Sixteen percent of the population reported having a domestic partner. Forty six percent of the participants are employed full time, 41% have completed at least some college, and 49% make less than $40,000 a year. Results A significant portion of the sample, 62%, indicated a desire to participate in free clinical services at HHC, 34% would like more information about substances and use, and 41% want to learn more about reducing harms from substance use. About one quarter of the participants marked "would" or "likely would" participate in individual services such as consultation. Approximately 20% indicated "would" or "likely would" participate in psycho-educational forums, harm reduction information sharing sessions, online support groups, and coping, life, and social skills group. There was little interest in traditional NA/AA 12-step groups or adapted 12-step groups. Conclusions Desired clinical services can be qualified as a combination of harm reduction, educational, skills-based, peer support and therapeutic individual and group services. Results suggest that medical cannabis patients seek more information about various substances, including cannabis. Dispensaries can help to decrease gaps in substance education and clinical services and fulfill unmet clinical desires. More research is necessary in additional medical cannabis dispensaries in different geographic settings with different service delivery models.

  8. A patient presenting with frozen shoulder and diagnosed as breast cancer

    Directory of Open Access Journals (Sweden)

    Feyza ÜNLÜ ÖZKAN

    2014-12-01

    Full Text Available Adhesive capsulitis (frozen shoulder is characterized by limitation of active and passive shoulder motions and severe pain. It is selflimiting and resolves in months when there is no underlying pathology. Adhesive capsulitis may be idiopathic but usually secondary to shoulder lesions. Diabetes, Parkinsonism, cardiac, thyroid, respiratory diseases and malignancy may coexist. We report a patient presenting with adhesive capsulitis and diagnosed as breast cancer. A 54–year-old female admitted with bilateral shoulder pain and limitation of motion. The pain began 8 months ago, and the patient had physical therapy which worsened the symptoms. On physical examination, the shoulder range of motions were limited at all planes. Subacromial injection test was negative. Roentgenograms were normal, shoulder magnetic resonance imaging (MRI revealed bicipital tendinitis on the left. Complete blood count, acute phase reactants and biochemical analyses were normal. Her detailed medical history revealed that she had fibrocystic breast disease and was unable to have the last mammography because of the limitation of the shoulders. Therefore, MRI examination of the breasts was performed and a mass lesion was detected on the right. Biopsy of the lesion revealed invasive ductal carsinoma. Malignancy should always be considered in the differential diagnosis of adhesive capsulitis. Detailed history and systemic evaluation helps to clarif the underlying pathology.

  9. Dementia in patients undergoing long-term dialysis: aetiology, differential diagnoses, epidemiology and management.

    Science.gov (United States)

    Rob, P M; Niederstadt, C; Reusche, E

    2001-01-01

    Dementia in patients undergoing long-term dialysis has not been clearly defined; however, four different entities have been described. Uraemic encephalopathy is a complication of uraemia and responds well to dialysis. Dialysis encephalopathy syndrome, the result of acute intoxication of aluminium caused by the use of an aluminium-containing dialysate, was a common occurrence prior to 1980. However, using modern techniques of water purification, such acute intoxication can now be avoided. Dialysis-associated encephalopathy/dementia (DAE) is always associated with elevated serum aluminium levels. Pathognomonic morphological changes in the brain have been described, but the mechanism for the entry of aluminium into the CNS is incompletely understood. The mechanisms involved in the pathogenesis of the neurotoxicity associated with aluminium are numerous. Although only a very small fraction of ingested aluminium is absorbed, the continuous oral aluminium intake from aluminium-based phosphate binders, and also of dietary or environmental origin, is responsible for aluminium overload in dialysis patients. Age-related dementia, especially vascular dementia, occurs in patients undergoing long-term dialysis as frequently as it does in the general population. The differential diagnoses of dialysis-associated dementias should include investigation for metabolic encephalopathies, heavy metal or trace element intoxications, and distinct structural neurological lesions such as subdural haematoma, normal pressure hydrocephalus, stroke and, particularly, hypertensive encephalopathy and multi-infarct dementia. To prevent DAE, dietary training programmes should aim to achieve the lowest phosphate intake and pharmacological tools should be used to keep serum phosphate levels below 2 mmol/L. To prevent vascular dementia, lifestyle modification should be undertaken, including optimal physical activity and fat intake, nicotine abstinence, and targeting optimal blood glucose, cholesterol and triglyceride levels, and blood pressure, to those outlined in current recommendations. PMID:11580308

  10. Features of Virchow-Robin spaces in newly diagnosed multiple sclerosis patients

    Energy Technology Data Exchange (ETDEWEB)

    Etemadifar, Masoud [Department of Clinical and Biological Sciences, Division of Neurology, San Luigi Gonzaga School of Medicine, Orbassano (Torino), Turin (Italy); Department of Neurology, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Hekmatnia, Ali; Tayari, Nazila [Department of Radiology, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Kazemi, Mojtaba [Department of Neurology, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Ghazavi, Amirhossein [Department of Radiology, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Akbari, Mojtaba [Department of Epidemiology and Statistics, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Maghzi, Amir-Hadi, E-mail: maghzi@edc.mui.ac.ir [Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of); Neuroimmunology Unit, Centre for Neuroscience and Trauma, Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, London (United Kingdom); Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan (Iran, Islamic Republic of)

    2011-11-15

    Background: Virchow-Robin spaces (VRSs) are perivascular pia-lined extensions of the subarachnoid space around the arteries and veins as they enter the brain parenchyma. These spaces are responsible for inflammatory processes within the brain. Objectives: This study was designed to shed more light on the location, size and shape of VRSs on 3 mm slice thickness, 1.5 Tesla MRI scans of newly diagnosed MS patients in Isfahan, Iran and compare the results with healthy age- and sex-matched controls. Methods: We evaluated MRI scans of 73 MS patients obtained within 3 months of MS onset and compared them with MRI scans from 73 age- and sex-matched healthy volunteers. Three mm section proton density, T2W and FLAIR MR images were obtained for all subjects. The location, size and shape of VRSs were compared between the two groups. Results: The total number of VRSs was significantly more in the MS group (p < 0.001). The distribution of VRSs were significantly more located in the high convexity areas in the MS group (p < 0.001), while there was no significant differences in other regions. The round shaped VRSs were significantly more detected on MRI scans of MS patients, and curvilinear shapes were significantly more frequently observed in healthy volunteers, however there were no significant differences for oval shaped VRSs between the two groups. The number of VRSs with the size over than 2 mm were significantly more observed in the MS groups compared to controls. We also observed some differences in the characteristics of VRSs between the genders in the MS group. Conclusion: The results of this study shed more light on the usefulness of VRSs as an MRI marker for the disease. In addition, according to our results VRSs might also have implication to determine the prognosis of the disease. However, larger studies with more advanced MRI techniques are required to confirm our results.

  11. Application of 13C-urea breath test in patients diagnosed as H. pylori-negative by gastroscopy

    International Nuclear Information System (INIS)

    13C-urea breath test(13C-UBT)was used to evaluate infection rate of H. pylori(HP) and effect of HP eradication in patients diagnosed as HP-negative by histology and rapid urease test. Patiens without gastrointestinal disorders were set as control group. Within 640 patients diagnosed as HP-negative by histology and rapid urease test, there were 389 patients showed HP-positive by 13C-UBT. The positive rate of HP was 60.8%. 389 patients diagnosed as HP- positive by 13C-UBT were treated with PPI-based triple therapy, PPI-based double therapy and single PPI therapy, respectively. After treatment, the negative rate of 13C-UBT was 83.8%, 18.4% and 3.3%, respectively. The results showed significant difference between three kinds of therapy (P13C-UBT could improve the diagnostic rate of HP to patients who diagnosed as HP-negative by histology and rapid urease test. (authors)

  12. Phase II trial of hypofractionated intensity-modulated radiation therapy combined with temozolomide and bevacizumab for patients with newly diagnosed glioblastoma.

    Science.gov (United States)

    Ney, Douglas E; Carlson, Julie A; Damek, Denise M; Gaspar, Laurie E; Kavanagh, Brian D; Kleinschmidt-DeMasters, B K; Waziri, Allen E; Lillehei, Kevin O; Reddy, Krishna; Chen, Changhu

    2015-03-01

    Bevacizumab blocks the effects of VEGF and may allow for more aggressive radiotherapy schedules. We evaluated the efficacy and toxicity of hypofractionated intensity-modulated radiation therapy with concurrent and adjuvant temozolomide and bevacizumab in patients with newly diagnosed glioblastoma. Patients with newly diagnosed glioblastoma were treated with hypofractionated intensity modulated radiation therapy to the surgical cavity and residual tumor with a 1 cm margin (PTV1) to 60 Gy and to the T2 abnormality with a 1 cm margin (PTV2) to 30 Gy in 10 daily fractions over 2 weeks. Concurrent temozolomide (75 mg/m(2) daily) and bevacizumab (10 mg/kg) was administered followed by adjuvant temozolomide (200 mg/m(2)) on a standard 5/28 day cycle and bevacizumab (10 mg/kg) every 2 weeks for 6 months. Thirty newly diagnosed patients were treated on study. Median PTV1 volume was 131.1 cm(3) and the median PTV2 volume was 342.6 cm(3). Six-month progression-free survival (PFS) was 90 %, with median follow-up of 15.9 months. The median PFS was 14.3 months, with a median overall survival (OS) of 16.3 months. Grade 4 hematologic toxicity included neutropenia (10 %) and thrombocytopenia (17 %). Grades 3/4 non-hematologic toxicity included fatigue (13 %), wound dehiscence (7 %) and stroke, pulmonary embolism and nausea each in 1 patient. Presumed radiation necrosis with clinical decline was seen in 50 % of patients, two with autopsy documentation. The study was closed early to accrual due to this finding. This study demonstrated 90 % 6-month PFS and OS comparable to historic data in patients receiving standard treatment. Bevacizumab did not prevent radiation necrosis associated with this hypofractionated radiation regimen and large PTV volumes may have contributed to high rates of presumed radiation necrosis. PMID:25524817

  13. Clinical presentation and mutations in Danish patients with Wilson disease

    DEFF Research Database (Denmark)

    MØller, Lisbeth Birk; Horn, Nina

    2011-01-01

    This study describes the clinical presentation and diagnosis in all Danish patients (49, 41 unrelated) with Wilson disease (WND). On the basis of the number of diagnosed patients from 1990-2008, the prevalence was estimated to be 1:49?500. Among routinely used diagnostic tests, none were consistently indicative of WND, with the exception of the 24-h urine-Cu test, which is always outside the normal range. Mutations were identified in 100% of the screened ATP7B alleles (70 unrelated), including five novel mutations: p.1021K; p.G1158V; p.L1304F; IVS20-2A>G; Ex5_6del. In all, 70% of mutations were found in exons 8, 14, 17, 18, and 20. The most frequent mutation, p.H1069Q, comprised 18%. We propose a new and simple model that correlates genotype and age of onset. By assuming that the milder of two mutations is 'functionally dominant' and determines the age of onset, we classified 25/27 mutations as either severe (age of onset 20 years), and correctly predicted the age of onset in 37/39 patients. This method should be tested in other Wilson populations.

  14. Using a computerized patient record to reengineer an outpatient clinic.

    OpenAIRE

    Borowitz, S.M.

    1994-01-01

    By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics.

  15. Clinical presentation in patients with systemic sclerosis

    International Nuclear Information System (INIS)

    Introduction: systemic sclerosis is an autoimmune disease characterized by endothelial damage, and skin, vessel and internal organ fibrosis and inflammation. There are differences in terms of frequency, severity and prognosis for the different ethnic groups, what reinforces the importance of the study in each geographical region with the purpose of enabling early diagnosis of its incipient symptoms.Methods: we conducted a descriptive and retrospective study form March 2006 through March 2008, including patients with a final diagnosis of systemic sclerosis, who are treated at the Systemic Autoimmune Diseases Unit at the Clinicas Hospital. Results: 31 women were included in the study, average follow-up of patients was 39.2 months, and average age at the time of diagnosis was 47.6 years. Eleven patients (35,5) presented diffuse disease and 20 (64.5) of them evidenced limited disease. Thirty patients presented Raynaud's phenomenon. In 92 of cases capilaroscopy showed a sclerodermiform pattern. In terms of the respiratory system, we found interstitial pathology in 25 of cases, pulmonary arterial hypertension in 22.2 and are restrictive pattern in respiratory function studies in 35.5. Also, 67.7 presented digestive manifestations and 9.6 developed sclerodermic renal crisis. We found anti-nuclear antibodies (ANA) in 29 out of 31 patients (93,5) patients; 16 presented anticentromere antibodies and five anti-topoisomerasa-I antibodies. The four patients (12.9)who died during follow-up presented common elements such as diffuse sclerosis, digital ulcers and severe respiratory compromise. Conclusions: the clinical and immune characteristics found in our study were similar to those described in other series. Should there be no specific treatment, it is essential to perform regular assessment of visceral impact in order to control and delay complications which result in high morbimortality rates. (author)

  16. Clinical analysis of 155 patients with Duchenne muscular dystrophy

    Directory of Open Access Journals (Sweden)

    Qi BING

    2015-05-01

    Full Text Available Objective To investigate the clinical manifestations and laboratory examinations of Duchenne muscular dystrophy (DMD patients and evaluate the principle of intermittent intravenous combined with oral glucocorticoid therapy.  Methods The clinical features, laboratory examinations andfollow-up data of 155 DMD patients were collected. These patients were given dexamethasone 5-10 mg/d by intravenous infusion for 10-15 d and oral prednisone acetate 0.50-0.75 mg/(kg·d for one month. After treatment, the motor ability of lower limbs, the level of serum creatine kinase (CK and 99mTc-MIBI gated myocardial perfusion imaging (GMPI findings were compared with those before glucocorticoid therapy by statistical analysis.  Results 1 The motor ability was improved in 70 follow-up cases of DMD patients with long-term oral prednisone (squat and rise: Z = 207.000, P = 0.034; climbing stairs: Z = 237.000, P =0.008. 2 The level of serum CK of 155 first diagnosed patients reached the peak at 3 years old, and declined after the age of 8 (P < 0.05, for all. The serum CK of 70 follow-up cases was significantly decreased after 10-15 d dexamethasone intravenous infusion (P = 0.000, and increased again after one-month oral administration of prednisone acetate (P = 0.000, but was still lower than that before treatment (P = 0.008. 3 The 99mTc-MIBI GMPI of 77 patients showed different degrees of myocardial involvement and significantly uneven left ventricular radionuclide distribution, especially in apex cordis (55 cases, inferior wall (45 cases and anterior wall (30 cases of apex. Conclusions There exists increased level of serum CK in the sub?clinical stage of DMD. The level of serum CK declined year by year after the age of 8. Intermittent intravenous combined with oral glucocorticoid therapy has an important effect on protecting motor and cardiac functions, extending walking time and reducing serum CK level and muscle cell damage. Early glucocorticoid therapy is recommended. DOI: 10.3969/j.issn.1672-6731.2015.05.008

  17. Diagnosing anaemia in pregnancy in rural clinics: assessing the potential of the Haemoglobin Colour Scale.

    OpenAIRE

    van den Broek, N. R.; Ntonya, C.; Mhango, E; White, S. A.

    1999-01-01

    Anaemia in pregnancy is a common and severe problem in many developing countries. Because of lack of resources and staff motivation, screening for anaemia is often solely by clinical examination of the conjunctiva or is not carried out at all. A new colour scale for the estimation of haemoglobin concentration has been developed by WHO. The present study compares the results obtained using the new colour scale on 729 women visiting rural antenatal clinics in Malawi with those obtained by HemoC...

  18. Outcome of infants and young children with newly diagnosed ependymoma treated on the "Head Start" III prospective clinical trial.

    Science.gov (United States)

    Venkatramani, Rajkumar; Ji, Lingyun; Lasky, Joseph; Haley, Kelley; Judkins, Alexander; Zhou, Shengmei; Sposto, Richard; Olshefski, Randal; Garvin, James; Tekautz, Tanya; Kennedy, Gloria; Rassekh, Shahrad Rod; Moore, Theodore; Gardner, Sharon; Allen, Jeffrey; Shore, Richard; Moertel, Christopher; Atlas, Mark; Dhall, Girish; Finlay, Jonathan

    2013-06-01

    This study investigates the outcome of children 2004 and July 2009, 19 children with newly-diagnosed ependymoma were enrolled. All children were to receive five induction chemotherapy cycles followed by one consolidation cycle of myelo-ablative chemotherapy and autologous hematopoietic cell rescue. Children between 6 and 10 years of age or with residual tumor prior to consolidation were to receive irradiation thereafter. Median age of 19 children (8 female) was 20 months at diagnosis. Median follow up was 44 months. The primary site was infratentorial in 11 and supratentorial in 8 patients. Gross total resection was achieved in 10 patients. After induction chemotherapy, all three supratentorial ependymoma patients with residual disease achieved a complete response (CR), while only one of six infratentorial patients with residual disease achieved CR. Three infratentorial patients developed progressive disease during induction chemotherapy. All four infratentorial patients with residual disease who underwent autologous hematopoietic cell transplant, failed to achieve CR. Four patients received focal irradiation following chemotherapy. The 3-year event free survival (EFS) and overall survival (OS) for supratentorial ependymoma were 86 ± 13 % and 100 % respectively. The 3-year EFS and OS for infratentorial ependymoma were 27 ± 13 % and 73 ± 13 % respectively. The role of intensive induction and consolidation chemotherapy in deferring irradiation should be investigated further in children with supratentorial ependymoma with residual disease following surgery. This approach appears ineffective in children with infratentorial ependymoma in the absence of irradiation. PMID:23508296

  19. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Takuro; Kurokawa, Yukinori; Takiguchi, Shuji; Miyazaki, Yasuhiro; Takahashi, Tsuyoshi; Yamasaki, Makoto; Miyata, Hiroshi; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro [Osaka University, Graduate School of Medicine, Department of Gastroenterological Surgery, Suita, Osaka (Japan)

    2014-08-06

    The purpose of this study was to determine the optimal cut-off value of lymph node size for diagnosing metastasis in gastric cancer with multidetector-row computed tomography (MDCT) after categorizing perigastric lymph nodes into three regions. The study included 90 gastric cancer patients who underwent gastrectomy. The long-axis diameter (LAD) and short-axis diameter (SAD) of all visualized lymph nodes were measured with transverse MDCT images. The locations of lymph nodes were categorized into three regions: lesser curvature, greater curvature, and suprapancreatic. The diagnostic value of lymph node metastasis was assessed with receiver operating characteristic (ROC) analysis. The area under the curve was larger for SAD than LAD in all groups. The optimal cut-off values of SAD were determined as follows: overall, 9 mm; differentiated type, 9 mm; undifferentiated type, 8 mm; lesser curvature region, 7 mm; greater curvature region, 6 mm; and suprapancreatic region, 9 mm. The diagnostic accuracies for lymph node metastasis using individual cut-off values were 71.1 % based on histological type and 76.6 % based on region of lymph node location. The diagnostic accuracy of lymph node metastasis in gastric cancer was improved by using individual cut-off values for each lymph node region. (orig.)

  20. AB036. Analysis of human mitochondrial genome mutations of Vietnamese patients tentatively diagnosed with encephalomyopathy

    Science.gov (United States)

    Nghia, Phan Tuan; Thai, Trinh Hong; Hue, Truong Thi; Van Minh, Nguyen; Khanh, Phung Bao; Hiep, Tran Duc; Anh, Tran Kieu; Loan, Nguyen Thi Hong; Van, Nguyen Thi Hong; Anh, Pham Van; Hung, Cao Vu; Anh, Le Ngoc

    2015-01-01

    Human mitochondrial genome consists of 16,569 bp, and replicates independently from the nuclear genome. Mutations in mitochondrial genome are usually causative factors of various metabolic disorders, especially those of encephalomyopathy. DNA analysis is the most reliable method for detection of mitochondrial genome mutations, and accordingly an excellent diagnostic tool for mitochondrial mutation-related diseases. In this study, 19 different mitochondrial genome mutations including A3243G, A3251G, T3271C and T3291C (MELAS); A8344G, T8356C and G8363A (MERRF); G3460A, G11778A and T14484C (LHON); T8993G/C and T9176G (Leigh); A1555G (deafness) and A4225G, G4298A, T10010C, T14727C, T14728C, T14709C (encephalomyopathy in general) were analyzed using PCR-RFLP in combination with DNA sequencing. In addition, a real-time PCR method using locked nucleic acid (LNA) Taqman probe was set up for heteroplasmy determination. Screening of 283 tentatively diagnosed encephalomyopathy patients revealed 7 cases of A3243G, 1 case of G11778A, 1 case of A1555G, 1 case of A4225G, 1 case G4298A, and 1 case of 6 bp (ACTCCT/CTCCTA) deletion. Using the LNA Taqman probe real-time PCR, the heteroplasmy of some point mutations was determined and the results support a potential relationship between heteroplasmy level and severity of the disease.

  1. Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the optimal cut-off value of lymph node size for diagnosing metastasis in gastric cancer with multidetector-row computed tomography (MDCT) after categorizing perigastric lymph nodes into three regions. The study included 90 gastric cancer patients who underwent gastrectomy. The long-axis diameter (LAD) and short-axis diameter (SAD) of all visualized lymph nodes were measured with transverse MDCT images. The locations of lymph nodes were categorized into three regions: lesser curvature, greater curvature, and suprapancreatic. The diagnostic value of lymph node metastasis was assessed with receiver operating characteristic (ROC) analysis. The area under the curve was larger for SAD than LAD in all groups. The optimal cut-off values of SAD were determined as follows: overall, 9 mm; differentiated type, 9 mm; undifferentiated type, 8 mm; lesser curvature region, 7 mm; greater curvature region, 6 mm; and suprapancreatic region, 9 mm. The diagnostic accuracies for lymph node metastasis using individual cut-off values were 71.1 % based on histological type and 76.6 % based on region of lymph node location. The diagnostic accuracy of lymph node metastasis in gastric cancer was improved by using individual cut-off values for each lymph node region. (orig.)

  2. Clinical profile of patients with breast cancer

    International Nuclear Information System (INIS)

    Objective: Based on T. N. M classification, this study was conducted to evaluate the clinical presentation of carcinoma of breast in central part of rural Sindh. Design: This is a 5-year combined study i.e. 3 years retrospective and 2 years prospective. Place and Duration of Study: This study was carried out at People's Medical College Hospital (PMCH) Nawabshah from June 1995 to May, 2000 for a period of five years. Subjects and Methods: Fifty patients having carcinoma breast and admitted to surgical department ware included in study. Results: Eighty four percent of these patients presented in advanced stage of the disease. Well established predisposing factors like early menarche, age at first pregnancy, breast feeding and number of children did not contribute to the risk of developing breast cancer in our patients. Conclusion: Majority of breast cancer patients present in advance stage of the disease, hence can not be benefited from modern methods of treatment. The reasons for this delayed presentation are multi fold and are discussed here. (author)

  3. The efficacy of a brief group CBT program in treating patients diagnosed with bulimia nervosa: a brief report

    DEFF Research Database (Denmark)

    Jones, A.; Clausen, Loa

    2013-01-01

    OBJECTIVE: The aim of the study was to evaluate the efficacy of a brief group cognitive behavior therapy (CBT) program in treating a large cohort of patients diagnosed with bulimia nervosa. METHOD: Treatment outcome defined as reductions in bulimia related behavioral symptoms and bulimia related distress was examined in 205 consecutive new patients enrolled in an eight-session group CBT program. RESULTS: Significant reductions in eating disorder pathology were found on all measures of bulimia re...

  4. How Is Infertility Diagnosed?

    Science.gov (United States)

    ... Information Clinical Trials Resources and Publications How is infertility diagnosed? Skip sharing on social media links Share ... providers evaluate men and women differently to diagnose infertility. Evaluating Female Fertility In evaluating a woman's fertility, ...

  5. Multicenter epidemiological study to describe prevalence of advanced stage disease among newly diagnosed HIV-infected patients in the Russian Federation

    Directory of Open Access Journals (Sweden)

    R Trinh

    2012-11-01

    Full Text Available Purpose of the study: The proportion of HIV-infected persons diagnosed in an advanced stage of HIV disease (ASH varies by country from 15 to 30%. Data are lacking on the proportion of new cases diagnosed in this late stage in Russia. The aim of this study was to estimate the proportion of and further characterize patients with ASH among newly diagnosed HIV-1 infected persons in the Russian Federation. Methods: This was a cross-sectional, multicenter, epidemiologic study. Adult HIV-1 patients that were newly diagnosed within 90 days and naïve to highly active antiretroviral therapy were included at twelve centers/regions (Moscow Region, St Petersburg, Leningrad Region, Ufa, Kazan, Ulyanovsk, Volgograd, Yekaterinburg, Kemerovo, Krasnoyarsk, Irkutsk and Vladivostok of the Russian Federation. ASH was defined as a CD4+ cell count ?200 cells/mm3. Pairwise, two-tailed comparisons were conducted with an unadjusted 5% significance level. For comparison variables between patients with ASH and all other patients, Pearson's chi-square test was used. Summary of results: 4540 patients were included. The overall proportion of ASH was 16.3% (95% CI; 15.3%, 17.4%. The median plasma HIV-1 RNA was 4.48 (Q1, Q3; 3.81, 5.07 log10 copies/mL. The proportion of patients with CD4+ cell count by categories is presented in Figure 1.ASH was associated with male sex (62.3%, 26-40 and >40 years age groups, rural place of residence (18.9%, only primary and/or basic school education (complete or not complete (39.4%, unemployment (40.5%, intravenous drug user as mode of HIV-1 transmission (39.5%, patient with clinical signs of immunodeficiency or condition related to HIV/AIDS as reason for primary HIV-1 testing (35.2%, HBV (5.4%, HCV (44.0% as partly shown in Table 1. Conclusions: The overall prevalence of ASH was 16.3%. At least 9 factors associated with ASH were revealed. Knowledge of these factors is valuable for planning, prevention and post-diagnosis services for HIV-infected patients presenting with advance stage disease.

  6. Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature

    OpenAIRE

    Siragusa, Sergio; Morice, William; Gertz, Morie A.; Kyle, Robert A; Greipp, Philip R.; Lust, John A; Witzig, Thomas E.; Lacy, Martha Q.; Zeldenrust, Steven R; Rajkumar, S. Vincent; Russell, Stephen J; Hayman, Suzanne R.; Buadi, Francis; Kumar, Shaji K.; Dingli, David

    2010-01-01

    Abstract The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-gr...

  7. The Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID): first psychometric evaluation in a Dutch sample of clinically referred youths.

    Science.gov (United States)

    Roelofs, Jeffrey; Muris, Peter; Braet, Caroline; Arntz, Arnoud; Beelen, Imke

    2015-06-01

    The Structured Clinical Interview for DSM-IV Childhood Disorders (Kid-SCID) is a semi-structured interview for the classification of psychiatric disorders in children and adolescents. This study presents a first evaluation of the psychometric properties of the Kid-SCID in a Dutch sample of children and adolescents who had been referred to an outpatient treatment centre for mental health problems. Results indicated that the inter-rater reliability of the Kid-SCID classifications and the internal consistency of various (dimensional) criteria of the diagnoses were moderate to good. Further, for most Kid-SCID diagnoses, reasonable agreement between children and parents was found. Finally, the correspondence between the Kid-SCID and the final clinical diagnosis as established after the full intake procedure, which included the information as provided by the Kid-SCID, ranged from poor to good. Results are discussed in the light of methodological issues pertaining to the assessment of psychiatric disorders in youths. The Kid-SCID can generally be seen as a reliable and useful tool that can assist clinicians in carrying out clinical evaluations of children and adolescents. PMID:24899356

  8. [Ten years of clinical experience with clozapine about 170 patients].

    Science.gov (United States)

    Levoyer, D; Martinet, J-P; Badiche, A; Millet, B

    2004-01-01

    The authors describe a clinical trial of 170 patients who received clozapine over a ten year period between September 1989 and September 1999. It is a retrospective study, describing individual responses. Each patient was his own control before and with treatment. The study also compared individuals within the group of patients whose treatment was stopped and those whose treatment was continuing at the time of the study. Data was collected by analysing all patients' records and by direct enquiry of prescribers. Diagnosis was according to DSM IV criteria. Assessment included: socio-epidemiological data (sex, age, marital status and family situation, education, military and professional status, level of benefits and social support); data related to the illness (age of onset, age at first contact with a psychiatrist, diagnosis, level of hospital contact); data concerning prescriptions of drugs (indications, average dose, duration of treatment, side effects, reason for stopping and other drugs taken at the same time); 170 patients were prescribed clozapine: 96 of them were continuing to take clozapine at the time of the study while 74 patients had stopped. The characteristics of the two groups are described. They show the severity of the illnesses concerned: early onset of illness and early psychiatric care, the absence in many patients of a partner or family, their low level of employment, high dependence on social assistance. Concerning diagnostic criteria, the range of diagnoses included mostly paranoid schizophrenia, then unclassified schizophrenia then schizoaffective disorders. The indication of clozapine prescription was in the majority of the cases (87%) an inefficiency of classical neuroleptic therapy. The average dose was 401 mg per day: 388 mg for the group continuing treatment; 417 for the group which had stopped their treatment. For the patients who continued taking clozapine, the average time of treatment was just over 4 years, with a maximum of 110 months. The tolerance of clozapine was good, with 35% not suffering any side effects. Neutropenia was the commonest side effect (4.1% - a higher incidence than previously reported with one case only of agranulocytosis (0.59%). The other adverse effects were in accordance with known data: sedation affected 22.4% of patients; hypersalivation 13.5%; postural hypotension 7.6%; malocclusion 7.6%; weight gain (>5 kg) 7.1%. Treatment was stopped for side effects in 17.1% of patients; for ineffectiveness in 14.7% and 3% of patients died during treatment (their death attributed to clozapine) from seizures, intestinal obstruction or agranulocytosis. Clozapine significantly reduced the need for other associated psychotropic drugs. 25.3% of all patients were on monotherapy when on clozapine compared with 6.5% before (31.2% compared with 3.1% for those patients continuing treatment). The need for supplementary medication to reduce side effects was much less. However 22% of patients taking clozapine at the time of the study are still on an anticholinergic drug. On the basis of the analysis of 5 successive terms of treatment lasting 12 months, we have shown that for each patient: clozapine significantly reduces the length of hospitalisation compared with standard neuroleptics; it allows for out patient management and continuing integration in the community; the critical length of treatment for the group of patients studied with regard to the need for hospitalisation is 18 months. For patients whose treatment with clozapine was stopped, we noted that with the continued input from the team of carers even after clozapine was stopped, patients who had been seriously ill for long period of time continued to improve. PMID:15235527

  9. Prosthodontic treatment and medical considerations for a patient with Turner syndrome: a clinical report.

    Science.gov (United States)

    Nguyen, Caroline T; Hofstede, Theresa M

    2012-10-01

    This clinical report describes a multidisciplinary approach in the rehabilitation of a 23-year-old Caucasian woman affected with Turner's syndrome and subsequently diagnosed with T4 Giant cell reparative granuloma of the right maxillary sinus. The surgical treatment included a maxillectomy and infratemporal fossa dissection followed by a free fibula palatal reconstruction, fibula bone graft of the orbital floor, dental implant placement, and prosthodontic rehabilitation. Prosthodontic planning and treatment considerations in an adult patient with Turner Syndrome are discussed. PMID:22672559

  10. Clinical Analysis of Cause, Treatment and Prognosis in Acute Kidney Injury Patients

    OpenAIRE

    Yang, Fan; Zhang, Li; Wu, Hao; Zou, Hongbin; Du, Yujun

    2014-01-01

    Acute kidney injury (AKI) is characterized by an abrupt decline in renal function, resulting in an inability to secrete waste products and maintain electrolyte and water balance, and is associated with high risks of morbidity and mortality. This study retrospectively analyzed clinical data, treatment, and prognosis of 271 hospitalized patients (172 males and 99 females) diagnosed with AKI from December, 2008 to December, 2011. In addition, this study explored the association between the cause...

  11. Clinical validity of a population database definition of remission in patients with major depression

    OpenAIRE

    Salvatella-Pasant Jordi; Gutiérrez-Nicuesa Laura; Blanca-Tamayo Milagrosa; Sicras-Mainar Antoni; Navarro-Artieda Ruth

    2010-01-01

    Abstract Background Major depression (MD) is one of the most frequent diagnoses in Primary Care. It is a disabling illness that increases the use of health resources. Aim: To describe the concordance between remission according to clinical assessment and remission obtained from the computerized prescription databases of patients with MD in a Spanish population. Methods Design: multicenter cross-sectional. The population under study was comprised of people from six primary care facilities, who...

  12. Lung cancer in patients aged 50 years and younger: clinical characteristics, treatment details and outcome

    International Nuclear Information System (INIS)

    The aims of this retrospective study are to review the clinical characteristics, treatment details and outcome of patients aged 50 years or younger diagnosed with lung cancer (small cell and non-small-cell). Over a period of 34 months, 497 lung cancer patients were treated at the Liverpool Hospital Cancer Therapy Centre from which 37 (7.4%) were aged 50 or younger. Adenocarcinoma was predominant histological subtype (32%). Almost 90% of patients were smokers. Median survival following diagnosis was 12 months, with 70 % having died by the close of the study. The clinical characteristics and outcomes of young patients (10 % of all lung cancer patients) in this study were comparable to other similar series reporting surgery only, radiotherapy or multimodality treatment. Lung cancer proved to be lethal as it remain, in the most part, incurable. Copyright (1999) Blackwell Science Pty Ltd

  13. Auto-antibodies and their association with clinical findings in women diagnosed with microscopic colitis.

    OpenAIRE

    Roth, Bodil; Gustafsson, Rita; Ohlsson, Bodil

    2013-01-01

    Microscopic colitis (MC) is a disease manifested by diarrhoea and is divided into collagenous and lymphocytic colitis. The aetiology is unknown, but auto-immunity is suggested. Auto-antibodies have been only rarely examined in this entity. The aim of the study was to examine the prevalence of auto-antibodies, and to examine associations between the presence of antibodies and clinical findings.

  14. De novo point mutations in patients diagnosed with ataxic cerebral palsy

    Science.gov (United States)

    Parolin Schnekenberg, Ricardo; Perkins, Emma M.; Miller, Jack W.; Davies, Wayne I. L.; D’Adamo, Maria Cristina; Pessia, Mauro; Fawcett, Katherine A.; Sims, David; Gillard, Elodie; Hudspith, Karl; Skehel, Paul; Williams, Jonathan; O’Regan, Mary; Jayawant, Sandeep; Jefferson, Rosalind; Hughes, Sarah; Lustenberger, Andrea; Ragoussis, Jiannis

    2015-01-01

    Cerebral palsy is a sporadic disorder with multiple likely aetiologies, but frequently considered to be caused by birth asphyxia. Genetic investigations are rarely performed in patients with cerebral palsy and there is little proven evidence of genetic causes. As part of a large project investigating children with ataxia, we identified four patients in our cohort with a diagnosis of ataxic cerebral palsy. They were investigated using either targeted next generation sequencing or trio-based exome sequencing and were found to have mutations in three different genes, KCNC3, ITPR1 and SPTBN2. All the mutations were de novo and associated with increased paternal age. The mutations were shown to be pathogenic using a combination of bioinformatics analysis and in vitro model systems. This work is the first to report that the ataxic subtype of cerebral palsy can be caused by de novo dominant point mutations, which explains the sporadic nature of these cases. We conclude that at least some subtypes of cerebral palsy may be caused by de novo genetic mutations and patients with a clinical diagnosis of cerebral palsy should be genetically investigated before causation is ascribed to perinatal asphyxia or other aetiologies. PMID:25981959

  15. Leucocyte scintigraphy for diagnosing of inflammation in patients with vascular prostheses

    International Nuclear Information System (INIS)

    The purpose of the study is to determine the usefulness of 99mTc-HMPAO-labeled leukocyte scan in the diagnosis of prosthetic vascular graft infection. We studied 18 patients with vascular graft for a period of 9 years (1996-2004): 11-aorto-femoral by-pass, 4-aorto-bifemoral bypass, 3-ileo-femoral bypass. The typical clinical symptoms for inflammatory process we observed in 16 from them. We used in vitro method for 99mTc-HMPAO-labeled leukocytes with 270-370 MBq 99mTc. Scintigraphic images were performed at 30 min, 60 min and 120 min. On the scan imaging we observed - 7 patients with raised accumulation of the 99mTc-HMPAO-labeled leukocytes (active inflammatory process); 7 - with lightly raised accumulation; 2 - with minimal accumulation (inflammatory process with low activity) and 2 - without accumulation (no inflammatory process). In witness of precision of the scan imaging we used microbiology and/or surgery and we followed the progress of diseases. The 99mTc-HMPAO-labeled leukocyte scan shows high sensitivity and specificity. It is an accurate and valuable diagnostic method for proving localizing and visualizing of suspected inflammation and for determination of its activity in patients with prosthetic vascular graft

  16. Clinical Characteristics of Patients on Hemodialysis With Peripheral Arterial Disease.

    Science.gov (United States)

    Matsuzawa, Ryota; Aoyama, Naoyoshi; Yoshida, Atsushi

    2015-11-01

    Patients on hemodialysis (HD; n = 210) were examined for peripheral arterial disease (PAD) using ankle-brachial index (ABI) and toe-brachial index (TBI). The prevalence of PAD was 38.1%. Among patients with PAD, 87.5% were newly diagnosed with PAD, 42.5% were diagnosed with TBI insufficient daily activity to experience exertional leg symptoms. Screening for PAD using the ABI and TBI increased diagnostic efficiency in patients on HD and may lead to effective early treatments, including pharmacotherapy, revascularization therapy, and exercise rehabilitation to avoid the worst possible scenario such as lower limb amputation, cardiovascular event, and death. PMID:25694516

  17. Clinical utility of Standardised Assessment of Personality - Abbreviated Scale (SAPAS) among patients with first episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bock, Camilla

    2010-01-01

    BACKGROUND: Personality disorder frequently co-occurs with depression and seems to be associated with a poorer outcome of treatment and increased risk for recurrences. However, the diagnosing of personality disorder can be lengthy and requires some training. Therefore, a brief screening interview for comorbid personality disorder among patients suffering from depression would be of clinical use. METHOD: The present study aimed to assess the utility of the Standardised Assessment of Personality - Abbreviated Scale (SAPAS) as a screen for personality disorder in a population of patients recently diagnosed with first episode depression. A total number of 394 patients with an ICD-10 diagnosis of a single depressive episode were sampled consecutively via the Danish Psychiatric Central Research Register during a 2years inclusion period and assessed by the screening interview and, subsequently, by the Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: We found, that a cut-off of 3 on the screen correctly identified the presence of comorbid personality disorder in 73.1% of the patients. The sensitivity and specificity were 0.80 and 0.70, respectively. LIMITATIONS: The findings cannot be generalized to patients outside hospital settings. CONCLUSION: The study provides evidence for the clinical utility of SAPAS as a screening interview for comorbid personality disorder in a population of patients with a primary diagnosis of depression.

  18. The clinical features, laboratory findings, treatment and follow-up results of patients with morphea

    Directory of Open Access Journals (Sweden)

    Nehir Parlak

    2013-12-01

    Full Text Available Objective: Morphea, also known as localized scleroderma, is a rare skin disease of unknown pathogenesis, characterized by fibrosis in the skin and subcutaneous tissue. In this study, we aim to evaluate the demographic features, clinical characteristics, laboratory findings, and response to treatment in patients diagnosed with morphea. Materials and Methods: The findings of fifty eight patients diagnosed with morphea were retrospectively evaluated between 1995-2011. All patients' clinical symptoms, concomitant diseases, symptoms, immunological features and presence of peripheral eosinophilia were investigated. Treatment methods, response to therapy of 40 patients whose treatment continued for 2-12 months were examined. Fourty nine patients (84.5% were female and 9 patients (15.5% were male of 58 patients who were diagnosed with morphea. The mean age of patients was 42.33±18.44 years (range: 7-75 years. Diagnosis was made histopathologically in all cases. Borrelia antibodies were negative in all patients enrolling the study. Thirty six patients (62.1% had plaque type, 17 patients (29.3% had generalized type, 3 patients (5.2% had mixed type (linear + plaque and 2 patients (3.4% had linear type of morphea. ANA was found to be positive in 12 (26.2% of 46 patients. Considering the relationship between the clinical types of morphea with ANA, 38.5% of plaque type, 53.8% of generalized type, 7.7% of mixed type patients showed ANA positivity. ANA positivity was statistically significant in patients with generalized morphea (p=0.027. Peripheral eosinophilia was detected in one case in whom lesions were generalized (2.1%. Colchicine therapy was given to 23 cases. Complete and partial response rates are 47.8% and 26.1%, respectively. However, 17.4% of patients remained stable and progression was noted in 8.7% of the cases. Conclusion: In conclusion, plaque type morphea is the most common type of morphea. ANA positivity was statistically significant in patients with generalized skin lesions. Colchicine is an effective and safe treatment option.

  19. The role of radiation therapy in the management of granulocytic sarcomas (chloromas) in pediatric patients with newly diagnosed acute myeloid leukemia: a report from the Children's Cancer Group

    International Nuclear Information System (INIS)

    Purpose: To describe the clinical, pathologic and prognostic features of a large cohort of patients with granulocytic sarcomas (GS) enrolled in sequential Children's Cancer Group (CCG) protocols with newly diagnosed acute myeloid leukemia (AML) and to determine whether localized radiation therapy (RT) improves outcome. Methods: From (10(79)) through (7(95)), a total of 2,529 patients with newly diagnosed AML were entered on CCG trials 251, 213, 2861, or 2891 evaluating different combination chemotherapy regimens. At entry 163 patients (6.4%) were identified as having 1 or more GS. Sites of GS were known in 89 patients. Head and neck sites were most common (49%), followed by soft tissue/bone (18%) CNS/spinal (10%) and skin (12%), or multiple sites (9%). Among 65 GS patients in whom cytogenetic analyses were available, 15 (23%) had t(8;21)(q22;q22) and 13(20%) had an abnormality of chromosome 11. GS patients tended to be younger (median age 4.4 vs 7.4 yrs, p=0.0001), less often had initial WBCs over 20,000 (37% vs 45%, p=0.04), and were more likely to have concurrent CNS leukemic involvement (defined by ?5 WBCs in the CSS and blasts on cytospin) than patients without GS (15% vs 7%, p=0.002). Among GS patients, records confirmed that local RT was given in 44, no RT was given in 40, and it was unknown whether RT was given in the remainder. RT doses ranged from 4.5 to 30 Gy (median 20 Gy) given 0 to 20 weeks (median 3 weeks) after diagnosis. Results: Complete remission was achieved in 75% of GS patients compared to 69% of others (p=0.68). The estimated 5 year EFS was 45% (95% CI 36-54%) for GS patients compared to 31% (95% CI 29-33%) for others (log rank p=0.017). Patients with GS and 20,000 EFS advantage for GS patients was no longer apparent (38% vs 27% respectively, log rank p=0.34). There was no difference in estimated EFS between patients who did and did not receive RT (50% vs 49%, log-rank p=0.89). Conclusion: GS patients had a better DFS than those without GS, with GS patients presenting with <5% marrow blasts having a particularly good outcome. No advantage for RT was seen in this uncontrolled group

  20. Prevalence of elevated C-reactive protein among newly diagnosed type 2 diabetes patients in Denmark: Results from the population-based DD2 study

    DEFF Research Database (Denmark)

    Thomsen, Reimar W.; Mor, Anil

    Objectives: Levels of high-sensitivity C-reactive protein (CRP) are increased in patients with prevalent type 2 diabetes (T2D) and may predict coronary heart disease. There is limited knowledge of CRP levels among newly diagnosed T2D patients in the population-based setting. We determined the prevalence of elevated CRP in T2D patients included in the Danish DD2 study, and factors associated with such elevation. Methods: Measurements of CRP were performed in the first 1,036 T2D patients included in the DD2 project, a large nationwide prospective research project enrolling new T2D patients from general practitioners and hospital specialist outpatient clinics. We calculated median value and interquartile range of CRP, and examined the number of T2D patients within tertiles of CRP values, and within clinically relevant cutoff points of CRP (=6.0 mg/L). We also examined demographic, clinical, and lifestyle characteristics associated with elevated CRP. Results: The distribution of CRP was right skewed, with a median value of 2.1 mg/L (inter-tertile range, 1.3 - 3.6 mg/L). 20.6% of patients had a CRP level of 3.0 - 5.99 mg/L and 19.6% had a CRP of >=6 mg/L. As compared to the 361 people with CRP values in the lowest tertile (3.6 mg/L) were younger (median age 58 vs. 62 years, p=1 in 35.2% vs. 26.1%) and more previous cardiovascular disease (20.4% vs. 16.9%) and chronic pulmonary disease (12.4% vs. 6.6%). Nonetheless, fewer in the elevated CRP group were on statin therapy (58.9% vs. 69.3%). Conclusions: Among newly diagnosed T2D patients in Denmark, 19.6% had CRP values of more than 6 mg/L. Patients in the highest CRP tertile were more likely to be female, obese, physically inactive, and comorbid, with worse blood glucose control compared to those with low CRP.

  1. Association of Clinical Complications with Nutritional Status and the Prevalence of Leukopenia among Arsenic Patients in Bangladesh

    OpenAIRE

    Azizul I. Kazi; Monsur A. Khan; M Mahfuzur Rahman; AHM Nurun Nabi; Laila N. Islam

    2004-01-01

    This study conducted in Bangladesh reports the relationship of clinical complications with nutritional status and the prevalence of leukopenia among arsenic exposed patients living in the rural villages. A total of 115 exposed individuals diagnosed as arsenicosis patients were randomly selected from four known arsenic endemic villages, and age-matched 120 unexposed subjects were enrolled in the study program. The duration of arsenic exposure in about 37% of the patients was at least 10 yrs, w...

  2. A Phase I Trial of Tipifarnib With Radiation Therapy, With and Without Temozolomide, for Patients With Newly Diagnosed Glioblastoma

    International Nuclear Information System (INIS)

    Purpose: To determine the maximum tolerated dose (MTD) of tipifarnib in combination with conventional radiotherapy for patients with newly diagnosed glioblastoma. The MTD was evaluated in three patient cohorts, stratified based on concurrent use of enzyme-inducing antiepileptic drugs (EIAED) or concurrent treatment with temozolomide (TMZ): Group A: patients not receiving EIAED and not receiving TMZ; Group A-TMZ: patients not receiving EIAED and receiving treatment with TMZ; Group B: any patients receiving EIAED but not TMZ. Patients and Methods: After diagnostic surgery or biopsy, treatment with tipifarnib started 5 to 9 days before initiating radiotherapy, twice daily, in 4-week cycles using discontinuous dosing (21 out of 28 days), until toxicity or progression. For Group A-TMZ, patients also received TMZ daily during radiotherapy and then standard 5/28 days dosing after radiotherapy. Dose-limiting toxicity (DLT) was determined over the first 10 weeks of therapy for all cohorts. Results: Fifty-one patients were enrolled for MTD determination: 10 patients in Group A, 21 patients in Group A-TMZ, and 20 patients in Group B. In the Group A and Group A-TMZ cohorts, patients achieved the intended MTD of 300 mg twice daily (bid) with DLTs including rash and fatigue. For Group B, the MTD was determined as 300 mg bid, half the expected dose. The DLTs included rash and one intracranial hemorrhage. Thirteen of the 20 patients evaluated in Group A-TMZ were alive at 1 year. Conclusion: Tipifarnib is well tolerated at 300 mg bid given discontinuously (21/28 days) in 4-week cycles, concurrently with standard chemo/radiotherapy. A Phase II study should evaluate the efficacy of tipifarnib with radiation and TMZ in patients with newly diagnosed glioblastoma and not receiving EIAED.

  3. Acceptability of Unified Medical Language System terms as substitute for natural language general medicine clinic diagnoses.

    OpenAIRE

    Rosenberg, K. M.; Coultas, D B

    1994-01-01

    The acceptability of using the Unified Medical Language System (UMLS) concept phrases to substitute for physicians' diagnosis statements was investigated. Physician diagnosis statements recorded in the University of New Mexico's General Medicine Clinic were input into a computer program that automatically finds the best matching UMLS concept phrases. The computer program written in C++ integrates UMLS searching and browsing with a graphical user interface. Five attending physicians in the Dep...

  4. A case study exploration of the value of acupuncture as an adjunct treatment for patients diagnosed with schizophrenia: results and future study design

    Directory of Open Access Journals (Sweden)

    Patricia Ronan

    2011-05-01

    Full Text Available Objective: This study explored the effects of individualized acupuncture when used alongside routine care for patients diagnosed with schizophrenia in order to assess the possibility and nature of potential benefits for this patient group. This study used an exploratory case study approach that included both quantitative and qualitative research tools, in order to generate a hypothesis questioning the possible benefits of acupuncture and develop future study designs. Methods: Eleven patients diagnosed with schizophrenia were given multiple validated quantitative and qualitative assessments before, during and after a 10-week acupuncture intervention. A range of qualitative and quantitative assessments were employed including review of acupuncture, general practitioner and mental health clinical case notes. Qualitative data were interrogated to explore the reliability of participants’ reports to researchers, their clinicians and their carers while acting as informants in the study.Results: Eight out of eleven participants completed a course of acupuncture treatment and all eleven reported positive benefits as a result of acupuncture, including improvements in the symptoms of schizophrenia, side effects of medication, energy, motivation, sleep, addictions and other associated physical problems. However, participants’ reports to the researcher and the acupuncturists varied at times and were often inconsistent between treatments, with participants revealing more information to the team towards the end of the study.Conclusion: The study indicates that patients diagnosed with schizophrenia would benefit from acupuncture treatment alongside conventional treatment. Triangulation of the data highlights some inconsistencies in reporting from participants, but also that this can be overcome through the use of mixed research methods. Comparison of data also shows that future studies would benefit from using a Positive and Negative Syndrome Scale, the Standards for Reporting Interventions in Controlled Trials of Acupuncture and an enhanced questionnaire regarding side effects of medication, exercise, sleep and daily routine. It is also worth noting that future studies of this nature must maintain consideration for the vulnerability of participants as they recover and make support easily accessible.

  5. Pharmacokinetics of Isoniazid, Pyrazinamide, and Ethambutol in newly diagnosed pulmonary TB patients in Tanzania

    DEFF Research Database (Denmark)

    Denti, Paolo; Jeremiah, Kidola

    2015-01-01

    Exposure to lower-than-therapeutic levels of anti-tuberculosis drugs is likely to cause selection of resistant strains of Mycobacterium tuberculosis and treatment failure. The first-line anti-tuberculosis (TB) regimen consists of rifampicin, isoniazid, pyrazinamide, and ethambutol, and correct management reduces risk of TB relapse and development of drug resistance. In this study we aimed to investigate the effect of standard of care plus nutritional supplementation versus standard care on the pharmacokinetics of isoniazid, pyrazinamide and ethambutol among sputum smear positive TB patients with and without HIV. In a clinical trial in 100 Tanzanian TB patients, with or without HIV infection, drug concentrations were determined at 1 week and 2 months post initiation of anti-TB medication. Data was analysed using population pharmacokinetic modelling. The effect of body size was described using allometric scaling, and the effects of nutritional supplementation, HIV, age, sex, CD4+ count, weight-adjusted dose, NAT2 genotype, and time on TB treatment were investigated. The kinetics of all drugs was well characterised using first-order elimination and transit compartment absorption, with isoniazid and ethambutol described by two-compartment disposition models, and pyrazinamide by a one-compartment model. Patients with a slow NAT2 genotype had higher isoniazid exposure and a lower estimate of oral clearance (15.5 L/h) than rapid/intermediate NAT2 genotype (26.1 L/h). Pyrazinamide clearance had an estimated typical value of 3.32 L/h, and it was found to increase with time on treatment, with a 16.3% increase after the first 2 months of anti-TB treatment. The typical clearance of ethambutol was estimated to be 40.7 L/h, and was found to decrease with age, at a rate of 1.41% per year. Neither HIV status nor nutritional supplementations were found to affect the pharmacokinetics of these drugs in our cohort of patients.

  6. Differential diagnoses and management strategies in patients with schizophrenia and bipolar disorder

    Directory of Open Access Journals (Sweden)

    A Carlo Altamura

    2008-03-01

    Full Text Available A Carlo Altamura1, Jose M Goikolea21Department of Psychiatry, University of Milan, IRCCS Fondazione Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy; 2Bipolar Disorder Program, Hospital Clinic i Universitari, Barcelona, SpainAbstract: Successful treatment of psychiatric disorders, including bipolar disorder and schizophrenia, is complicated and is affected by a broad range of factors associated with the diagnosis, choice of treatment and social factors. In these patients, treatment management must focus on accurate and early diagnosis, to ensure that correct treatment is administered as soon as possible. In both disorders, the treatment of the disease in the acute phase must be maintained long term to provide continuous relief and normal function; the treatment choice in the early stages of the disease may impact on long-term outcomes. In schizophrenia, treatment non-compliance is an important issue, with up to 50% of patients discontinuing treatment for reasons as diverse as efficacy failure, social barriers, and more commonly, adverse events. Treatment non-compliance also remains an issue in bipolar disorder, as tolerability of mood stabilizers, especially lithium, is not always good, and combination treatments are frequent. In order to achieve an optimal outcome in which the patient continues with their medication lifelong, treatment should be tailored to each individual, taking into account treatment and family history, and balancing efficacy with tolerability to maximize patient benefit and minimize the risk of discontinuation. These case studies illustrate how treatment should be monitored, tailored and often changed over time to meet these needs.Keywords: bipolar disorder, recurrence, treatment management, schizophrenia, non-compliance, adverse events

  7. Pharmacokinetics of Isoniazid, Pyrazinamide, and Ethambutol in Newly Diagnosed Pulmonary TB Patients in Tanzania

    Science.gov (United States)

    Chigutsa, Emmanuel; Faurholt-Jepsen, Daniel; PrayGod, George; Range, Nyagosya; Castel, Sandra; Wiesner, Lubbe; Hagen, Christian Munch; Christiansen, Michael; Changalucha, John; McIlleron, Helen; Friis, Henrik; Andersen, Aase Bengaard

    2015-01-01

    Exposure to lower-than-therapeutic levels of anti-tuberculosis drugs is likely to cause selection of resistant strains of Mycobacterium tuberculosis and treatment failure. The first-line anti-tuberculosis (TB) regimen consists of rifampicin, isoniazid, pyrazinamide, and ethambutol, and correct management reduces risk of TB relapse and development of drug resistance. In this study we aimed to investigate the effect of standard of care plus nutritional supplementation versus standard care on the pharmacokinetics of isoniazid, pyrazinamide and ethambutol among sputum smear positive TB patients with and without HIV. In a clinical trial in 100 Tanzanian TB patients, with or without HIV infection, drug concentrations were determined at 1 week and 2 months post initiation of anti-TB medication. Data was analysed using population pharmacokinetic modelling. The effect of body size was described using allometric scaling, and the effects of nutritional supplementation, HIV, age, sex, CD4+ count, weight-adjusted dose, NAT2 genotype, and time on TB treatment were investigated. The kinetics of all drugs was well characterised using first-order elimination and transit compartment absorption, with isoniazid and ethambutol described by two-compartment disposition models, and pyrazinamide by a one-compartment model. Patients with a slow NAT2 genotype had higher isoniazid exposure and a lower estimate of oral clearance (15.5 L/h) than rapid/intermediate NAT2 genotype (26.1 L/h). Pyrazinamide clearance had an estimated typical value of 3.32 L/h, and it was found to increase with time on treatment, with a 16.3% increase after the first 2 months of anti-TB treatment. The typical clearance of ethambutol was estimated to be 40.7 L/h, and was found to decrease with age, at a rate of 1.41% per year. Neither HIV status nor nutritional supplementations were found to affect the pharmacokinetics of these drugs in our cohort of patients. PMID:26501782

  8. Outcomes for patients who are diagnosed with breast and endometrial cancer

    OpenAIRE

    MARTIN-DUNLAP, TONYA M.; WACHTEL, MITCHELL S.; Margenthaler, Julie A.

    2013-01-01

    The present study sought to determine the survival outcomes for women diagnosed with breast and endometrial cancer. Using SEER data, a population-based cohort study of women diagnosed with breast and endometrial cancer was conducted. Kaplan-Meier survival curves were created for disease-specific survival rates. A total of 2,027 women diagnosed with breast and endometrial cancer were identified. Of these, 1,296 (63.9%) developed breast cancer first and 731 (36.1%) developed endometrial cancer ...

  9. Pacientes con Giardia lamblia diagnosticada por frotis duodenal / Patients with Giardia lamblia diagnosed through duodenal smear

    Scientific Electronic Library Online (English)

    Hidelisa, Herrero Aguirre; Jesús, Fernández Duharte; Suleidy, Vega Sam; José Antonio, Candel Herrero.

    2014-12-01

    Full Text Available Se efectuó un estudio descriptivo y transversal de 105 pacientes mayores de 15 años con infección por Giardia lamblia, diagnosticada por frotis duodenal mediante endoscopia en el Servicio de Gastroenterología del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturn [...] ino Lora Torres" de Santiago de Cuba, desde enero hasta diciembre del 2012, con vistas a caracterizarles. Entre las variables analizadas figuraron: edad, sexo, síntomas digestivos referidos, positividad del frotis e imagen endoscópica. Se utilizó el porcentaje como medida de resumen. Predominaron el sexo femenino (58,0 %), el grupo etario de 29-39 años (38,0 %), la epigastralgia como síntoma principal (66,6 %) y las imágenes endoscópicas grados I y II como las más frecuentes (68,4 y 41,3 %, respectivamente). El índice de positividad a la giardiasis fue relevante Abstract in english A descriptive and cross sectional study of 105 patients older than 15 years with infection by Giardia lamblia, diagnosed through duodenal smear by means of endoscopy was carried out in the Gastroenterology Service of the Specialties Polyclinic from "Saturnino Lora Torres" Teaching Provincial Clinica [...] l Surgical Hospital in Santiago de Cuba, from January to December, 2012, with the objective of characterizing them. Among the analyzed variables there were: age, sex, referred digestive symptoms, positivity of the smear and endoscopic image. The percentage was used as summary measure. Female sex (58.0%), the age group 29-39 years (38.0%), the epigastralgia as main symptom (66.6%) and the endoscopic images grades I and II prevailed as the most frequent (68.4 and 41.3%, respectively). The positivity index for giardiasis was relevant

  10. Disfunción endotelial en hipertensos de reciente diagnóstico / Endothelial Dysfunction in Newly Diagnosed Hypertensive Patients

    Scientific Electronic Library Online (English)

    Jorge Luis, León Álvarez; Guillermo, Guerra Ibáñez; Miguel Ángel, Yanes Quesada; Raúl Orlando, Calderín Bouza; Ángela, Gutiérrez Rojas.

    2014-12-01

    Full Text Available Introducción: la aterosclerosis, la disfunción endotelial y la hipertensión arterial están estrechamente relacionadas. La vasorreactividad dependiente del endotelio es un equivalente de disfunción endotelial. Objetivo: evaluar la utilidad del diámetro basal de la arteria braquial medido por técnicas [...] ultrasonográficas en el diagnóstico de disfunción endotelial como lesión vascular subclínica, su asociación con factores de riesgo cardiovascular y el riesgo cardiovascular global. Métodos: investigación analítico transversal en 60 hipertensos de reciente diagnóstico sin lesión en órgano diana en comparación con 60 no hipertensos. Se pesquisaron los factores de riesgo cardiovascular, se les realizó microalbuminuria, colesterol total, colesterol HDL, triglicéridos, colesterol no HDL, medición por ultrasonografía del grosor íntima media carotídeo y del diámetro basal de la arteria braquial y se calculó el riesgo cardiovascular global. Resultados: en el grupo de hipertensos, el sexo masculino constituyó el 55 % del total y en el de los no hipertensos, el sexo femenino representó el 78,3 %. La microalbuminuria estuvo presente en 25 % de los hipertensos por el 13,3 % de los no hipertensos. Se encontraron valores medios más altos de colesterol total y colesterol-no HDL en los hipertensos (4,6 mmol/L y 3,6 mmol/L, respectivamente). La media del grosor íntima media en los hipertensos fue 0,6 mm y la de los no hipertensos fue 0,4 mm. En los hipertensos, el valor medio de diámetro basal de la arteria braquial fue 3,8 mm frente a 3,5 mm en los no hipertensos. En ambos grupos de estudio, a mayores valores medios de colesterol-HDL, hubo mayores valores medios de diámetro basal de la arteria braquial. Conclusiones: se encontró asociación positiva para el colesterol total, el colesterol-HDL, el grosor íntima media carotídeo, la microalbuminuria y el riesgo cardiovascular global con el diámetro basal de la arteria braquial. Se concluye que la determinación del diámetro basal de la arteria braquial mostró resultados promisorios como marcador de disfunción endotelial en la hipertensión arterial. Abstract in english Introduction: atherosclerosis, endothelial dysfunction and hypertension are closely related. Endothelium-dependent vasoreactivity is an equivalent of endothelial dysfunction. Objective: To evaluate the usefulness of baseline diameter of the brachial artery measured by ultrasonographic techniques in [...] the diagnosis of endothelial dysfunction and subclinical vascular lesion, its association with cardiovascular risk factors, and overall cardiovascular risk. Methods: Across-sectional analytical research was conducted in 60 newly diagnosed hypertensive patients without target organ damage. They were compared with 60 non-hypertensive subjects. Cardiovascular risk factors were screened; these patients underwent several tests such as microalbuminuria, total cholesterol, HDL cholesterol, triglycerides, non-HDL cholesterol, ultrasound measurement of carotid intima-media thickness and basal diameter of the brachial artery. The global cardiovascular risk was calculated. Results: In the hypertensive group, males constituted 55 % of the total and in the non-hypertensive group, females accounted for 78.3 %. Microalbuminuria was present in 25 % of hypertensive subejcts by 13.3 % of patients without the disease. Higher mean values of total cholesterol and non-HDL in hypertensive subjects (4.6 mmol / L and 3.6 mmol / L, respectively) were found. The mean intima-media thickness was 0.6 mm in hypertensive patients and 0.4 mm in non hypertensive subjects. In hypertensive patients, the mean baseline brachial artery diameter was 3.8 mm versus 3.5 mm in non-hypertensive subjects. In both study groups, higher mean levels of baseline diameter of the brachial artery when there were higher mean values of HDL-cholesterol. Conclusions: There is a positive association for total cholesterol, HDL-cholesterol, the carotid intima media thickness, microalbuminuria and global cardiovascular risk

  11. Comparison of clinical and laboratory methods to diagnose the early pregnancy in pigs

    International Nuclear Information System (INIS)

    A group of 39 sows was examined for early pregnancy on the days 21, 28, 31, 35 after insemination using four different methods: the vaginal inspection, the rectal palpation, the Doppler-ultrasound examination and the measurement of blood progesterone; three different tests were applied: Serozyme-progesterone (EIA), radioimmunoassay and the blood spotted paper method (EIA). On the first date (day 21) the best results were achieved by measuring the progesterone level (94.9% in blood spotted paper method, 92.3% in Serozyme-progesteron and radioimmunoassay). A high accuracy (87.2%) combined with low costs and time-consume were obtained for the vaginal inspection and rectal palpation. These methods are based upon the exclusion of pregnancy by detecting the estrous. The vaginal findings were evaluated in two steps. First of all animals which had one typical sign and then those with a combination of the most frequent findings were classified as nonpregnant. This led to a percentage of 87.2 right diagnosis on day 21. The rectal palpation showed an increase of cervical tension in estrous pigs on day 21, 87.2% were diagnosed correctly. Furthermore, the rectal examination enabled to detect changes in the blood flow of the A. uterina from day 28 on. Its percentage of correct diagnosis increased from 76.9% to 100% on day 35. The pregnancy diagnosis by vaginal inspection also increased from 69.2% (day 28), 79.5% (day 31) to 76.9% (day 35), it was still based on nonpregnant sows. With the ultrasound examination satisfying results could not be achieved before day 28 (89.7%). Note: Serozyme is a registered trademark. (author)

  12. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry.

    Science.gov (United States)

    Behr, Jürgen; Kreuter, Michael; Hoeper, Marius M; Wirtz, Hubert; Klotsche, Jens; Koschel, Dirk; Andreas, Stefan; Claussen, Martin; Grohé, Christian; Wilkens, Henrike; Randerath, Winfried; Skowasch, Dirk; Meyer, F Joachim; Kirschner, Joachim; Gläser, Sven; Herth, Felix J F; Welte, Tobias; Huber, Rudolf Maria; Neurohr, Claus; Schwaiblmair, Martin; Kohlhäufl, Martin; Höffken, Gert; Held, Matthias; Koch, Andrea; Bahmer, Thomas; Pittrow, David

    2015-07-01

    After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±SD age 68.7±9.4?years, 77.9% males) with a mean disease duration of 2.3±3.5?years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320?m (mean 268±200?m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially. PMID:25837040

  13. The efficacy of a brief group CBT program in treating patients diagnosed with bulimia nervosa: a brief report

    DEFF Research Database (Denmark)

    Jones, A.; Clausen, Loa

    2013-01-01

    OBJECTIVE: The aim of the study was to evaluate the efficacy of a brief group cognitive behavior therapy (CBT) program in treating a large cohort of patients diagnosed with bulimia nervosa. METHOD: Treatment outcome defined as reductions in bulimia related behavioral symptoms and bulimia related distress was examined in 205 consecutive new patients enrolled in an eight-session group CBT program. RESULTS: Significant reductions in eating disorder pathology were found on all measures of bulimia related behavioral symptoms, as well as on all measures of bulimia related distress. DISCUSSION: There is strong evidence for the efficacy of brief group CBT in treating patients with bulimia nervosa.

  14. Stability of HE4 and CA125 in blood samples from patients diagnosed with ovarian cancer

    DEFF Research Database (Denmark)

    Sandhu, Noreen; Karlsen, Mona A

    2014-01-01

    OBJECTIVE: To investigate the influence of handling and storage on HE4 and CA125 serum and EDTA plasma levels to clarify any important consequences for a clinical setting. METHODS: Blood samples from 13 ovarian cancer (OC) patients were collected and allowed to clot or sediment for up to 72 hours at 4 °C or 20 °C, then processed into serum and EDTA plasma. Furthermore, the effects of up to eight repetitive cycles of freeze/thaw were investigated. HE4 and CA125 were analyzed using a Chemiluminescent Microparticle Immunoassay on the Architect i2000sr System. RESULTS: No significant effect of processing time for HE4 could be shown. HE4 EDTA plasma levels were insignificantly lower (3%) than serum levels (p = 0.41). Similarly, no significant effect of processing time for CA125 could be demonstrated. CA125 levels at 4 °C were significantly reduced compared to levels at 20 °C (p = 0.024). No significant difference between CA125 serum and plasma levels were found (p = 0.46). Serum and EDTA plasma samples were stable during the eight cycles of freezing and thawing (CA125: all p > 0.2; HE4: all p > 0.5). CONCLUSION: No systematic difference could be demonstrated for HE4. CA125 is not dependent on processing time, EDTA plasma or serum. Levels of CA125 are significantly reduced at 4 °C compared to levels at 20°C, but this difference was less than 6% and is not considered clinically relevant.

  15. [Cancer treatment in elderly patients: evidence and clinical research].

    Science.gov (United States)

    Repetto, Lazzaro; Luciani, Andrea

    2015-01-01

    In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). IADL (Instrumental Activities of Daily Living) have the best predictive role in oncological setting and their impairment significantly correlate with overall survival, chemotherapy toxicities and thirty days postoperative morbidities. The CGA is universally accepted as the most appropriate instrument to analitically evaluate the age related problems of elderly patients. The role of CGA is crucial to identify geriatric issues not easily diagnosed, to predict treatment toxicities, functional or cognitive decline, post operative complications and to estimate life expectancy. The CGA items are predictive of severe toxicity, however it is not clearly established which are the best performers and the best cut-offs points. Today CGA is integrated with physical performance tests (the most widely used is the "time up and go" test) and laboratory assay of Interleukin 6 and D-Dimer that correlate with mortality and physical decline. There are few prospective studies that evaluated the role of CGA in treatment choice. The first is a phase II study in solid tumors, the second is a haematological trial on non Hodgkin lymphoma. The largest trial is a 571 patients observational series that confirmed the role of CGA in decision making. The administration of CGA is time consuming and consequently some screening tools were developed. VES-13 is a 13 items tool that explores prevalently the functional status and the self reported health status. VES-13 showed a good sensibility (87.3%) but a low specificity (62%) with respect to CGA for the diagnosis of patients with disabilities. Overcash et al. proposed an abbreviated form of CGA using a reduced number of items of ADL, IADL, MMSE and GDS. There was a good correlation between complete and reduced scales (coefficient of correlation 0.8). G8 is a screening tool composed of 8 questions that explore functional, cognitive and nutritional status. The score with the best equilibrium between sensibility and specificity was 14 (sensibility 85% and specificity 65%). In the first observational trial age, hystotype, chemotherapy dose, haemoglobin (man: 11 g/dL; women: 10 g/dL), creatinine clearance less than 34 mL/min (Jelliffe formula), earing problems, at least a fall in the last six months, walking problems, low social activity, were related to a major risk of toxicity; in another trial IADL, diastolic blood pressure, LDH and MAX2 index were predictive of haematological toxicity, while performance status, Mini-Mental Status score, Mini-Nutritional Assessment (MNA) score and MAX2 index were predictive of non haematological toxicity. Based on these parameters a 0-2 score was developed. A recent "position article" of EORTC (European organization for Research and Treatment of Cancer) and SIOG analyzed the pro and the contra of the use of some indicators in elderly patients. The overall survival (OS) frequently used in classical clinical trial could give wrong messages as there are some competitive risks of death in elderly patients. Another important indicator is the disease specific survival (DSS). Concerning the design of clinical trials, a possible strategy is to enrol elderly patients without upper age limit and to plan stratification. An interesting trial design is the so called "extended trial" that allow to re-open the arm of a trial in which a too low number of older patients was enrolled. PMID:25621776

  16. Comparison of the effects of Sertindole and Olanzapine on Cognition (SEROLA) : a double-blind randomized 12-week study of patients diagnosed with schizophrenia

    DEFF Research Database (Denmark)

    Ernst Nielsen, René; Odur, Florence

    2014-01-01

    OBJECTIVE: To assess the cognitive effects of sertindole and olanzapine in patients diagnosed with schizophrenia. Cognition was the primary outcome of the study. METHOD: This was a 12-week double-blinded randomized clinical controlled trial. Participants were randomized to either 16-24 mg of sertindole or 10-20 mg of olanzapine. RESULTS: The study had a low recruitment rate (N = 9) and was terminated before the expected number of patients was reached. No significant differences between groups were found at study end on any of the 32 cognitive subtests. A simple sign test did not show any of the comparator drugs trending towards being superior on the majority of tests. Mean change on Positive and Negative Syndrome Scale (PANSS) total and PANSS subscales from baseline to end of study were not significantly different between treatment groups. Similar results on cognition and PANSS was seen on completers and last observation carried forward analysis. CONCLUSION: In this study we did not find any significant differences between sertindole or olanzapine on PANSS subscales or neurocognitive tests in a population consisting of patients diagnosed with schizophrenia.

  17. Post-operative breast cancer patients diagnosed with skeletal metastasis without bone pain had fewer skeletal-related events and deaths than those with bone pain

    Directory of Open Access Journals (Sweden)

    Koizumi Mitsuru

    2010-08-01

    Full Text Available Abstract Background Skeletal metastases are often accompanied by bone pain. To investigate the clinical meaning of bone pain associated with skeletal metastasis in breast cancer patients after surgery, we explored whether the presence of bone pain was due to skeletal-related events (SREs or survival (cause specific death, CSD, retrospectively. Methods Consecutive breast cancer patients undergoing surgery between 1988 and 1998 were examined for signs of skeletal metastasis until December 2006. Patients who were diagnosed as having skeletal metastasis were the subjects of this study. Bone scans were performed annually for 5, 7 or 10 years; they were also conducted if skeletal metastasis was suspected. Data concerning bone pain and tumor markers at the time of skeletal metastasis diagnosis, and data relating to various factors including tumors, lymph nodes and hormone receptors at the time of surgery, were investigated. The relationships between factors such as bone pain, SRE and CSD were analyzed using the Kaplan-Meier method and Cox's analysis. Results Skeletal metastasis occurred in 668 patients but the pain status of two patients was unknown, therefore 666 patients were included in the study. At the time of skeletal metastasis diagnosis 270 patients complained of pain; however, 396 patients did not. Analysis of data using Cox's and Kaplan-Meier methods demonstrated that patients without pain had fewer SREs and better survival rates than those with pain. Hazard ratios regarding SRE (base = patients without pain were 2.331 in univariate analysis and 2.243 in multivariate analysis. Hazard ratios regarding CSD (base = patients without pain were 1.441 in univariate analysis and 1.535 in multivariate analysis. Similar results were obtained when analyses were carried out using the date of surgery as the starting point. Conclusion Bone pain at diagnosis of skeletal metastasis was an indicator of increased SRE and CSD. However, these data did not support recommendations of follow-up bone surveys in breast cancer patients.

  18. Variety of genotypes in males diagnosed as dichromatic on a conventional clinical anomaloscope

    OpenAIRE

    Neitz, Maureen; Carroll, Joseph; RENNER, AGNES; KNAU, HOLGER; Werner, John S.; Neitz, Jay

    2004-01-01

    The hypothesis that dichromatic behavior on a clinical anomaloscope can be explained by the complement and arrangement of the long- (L) and middle-wavelength (M) pigment genes was tested. It was predicted that dichromacy is associated with an X-chromosome pigment gene array capable of producing only a single functional pigment type. The simplest case of this is when deletion has left only a single X-chromosome pigment gene. The production of a single L or M pigment type can also result from r...

  19. Comparison Between Clinical and Echocardiographic Findings in Infants and Children Diagnosed with Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Cristina Blesneac

    2015-06-01

    Full Text Available Background: Hypertrophic cardiomyopathy is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because it’s late gene expression. Hypertrophic cardiomyopathy presenting in infancy has been shown to have a very high mortality.

  20. Clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Paraná, Brazil

    Directory of Open Access Journals (Sweden)

    Andréa Thomaz-Soccol

    2011-06-01

    Full Text Available The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL in patients from the endemic areas of leishmaniasis were assessed. Different methods used in diagnosing the disease and the polymerase chain reaction (PCR technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14.3% presented other etiologies such as vasculitis, syphilis, and paracoccidioidomycosis, with all tests negative for leishmaniasis. Out of the remaining 15 patients, 6.7% cases were confirmed for leishmaniasis by direct examination; 46.67% were positive for culture, which allowed isolating and identifying the parasite and - with the PCR technique - it was possible to diagnose 100% MCL patients for all the three repetitions of exams. The PCR optimized for the present work proved to be an auxiliary method for diagnosing leishmaniasis applicable in the patients carrying MCL due to Leishmania (Viannia braziliensis and did not need culture to be performed, resulting in a faster diagnosis.

  1. Clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Paraná, Brazil

    Scientific Electronic Library Online (English)

    Andréa, Thomaz-Soccol; Marcos, Mocellin; Fabiane, Mulinari; Edilene Alcântara de, Castro; Flávio de, Queiroz-Telles; Fernanda de Souza, Alcântara; Marcello Tortelli, Bavaresco; Luciane, Hennig; Anielo, Andraus; Ennio, Luz; Vanete, Thomaz-Soccol.

    2011-06-01

    Full Text Available The aim of the present work was to study the clinical aspects and relevance of molecular diagnosis in late mucocutaneous leishmaniasis patients in Parana, Brazil. Twenty one suspected cases of mucocutaneous leishmaniasis (MCL) in patients from the endemic areas of leishmaniasis were assessed. Differ [...] ent methods used in diagnosing the disease and the polymerase chain reaction (PCR) technique were compared in order to establish the sensitivity of each method. Out of the 21 patients analyzed, 14.3% presented other etiologies such as vasculitis, syphilis, and paracoccidioidomycosis, with all tests negative for leishmaniasis. Out of the remaining 15 patients, 6.7% cases were confirmed for leishmaniasis by direct examination; 46.67% were positive for culture, which allowed isolating and identifying the parasite and - with the PCR technique - it was possible to diagnose 100% MCL patients for all the three repetitions of exams. The PCR optimized for the present work proved to be an auxiliary method for diagnosing leishmaniasis applicable in the patients carrying MCL due to Leishmania (Viannia) braziliensis and did not need culture to be performed, resulting in a faster diagnosis.

  2. Can advanced paramedics in the field diagnose patients and predict hospital admission?

    LENUS (Irish Health Repository)

    Cummins, Niamh Maria

    2013-02-13

    BACKGROUND: Accurate patient diagnosis in the prehospital environment is essential to initiate suitable care pathways. The advanced paramedic (AP) is a relatively recent role in Ireland, and refers to a prehospital practitioner with advanced life-support skills and training. OBJECTIVES: The objectives of this study were to compare the diagnostic decisions of APs with emergency medicine (EM) physicians, and to investigate if APs, as currently trained, can predict the requirement for hospital admission. METHODS: A prospective study was initiated, whereby each emergency ambulance call received via the statutory 999 system was recorded by the attending AP. The AP was asked to provide a clinical diagnosis for each patient, and to predict if hospital admission was required. The data was then cross-referenced with the working diagnosis of the receiving emergency physician and the hospital admission records. RESULTS: A total of 17 APs participated in the study, and 1369 emergency calls were recorded over a 6-month period. Cases where a general practitioner attended the scene were excluded from the concordance analysis. Concordance with the receiving emergency physician represents 70% (525\\/748) for all cases of AP diagnosis, and is mirrored with 70% (604\\/859) correct hospital admission predictions. CONCLUSIONS: AP diagnosis and admission prediction for emergency calls is similar to other emergency medical services systems despite the relative recency of the AP programme in Ireland. Recognition of non-concordance case types may identify priorities for AP education, and drive future AP practice in areas such as \\'treat and refer\\'.

  3. Negative and positive childhood experiences across developmental periods in psychiatric patients with different diagnoses – an explorative study

    Directory of Open Access Journals (Sweden)

    Schauer Margarete

    2004-11-01

    Full Text Available Abstract Background A high frequency of childhood abuse has often been reported in adult psychiatric patients. The present survey explores the relationship between psychiatric diagnoses and positive and negative life events during childhood and adulthood in psychiatric samples. Methods A total of 192 patients with diagnoses of alcohol-related disorders (n = 45, schizophrenic disorders (n = 52, affective disorders (n = 54, and personality disorders (n = 41 completed a 42-item self-rating scale (Traumatic Antecedents Questionnaire, TAQ. The TAQ assesses personal positive experiences (competence and safety and negative experiences (neglect, separation, secrets, emotional, physical and sexual abuse, trauma witnessing, other traumas, and alcohol and drugs abuse during four developmental periods, beginning from early childhood to adulthood. Patients were recruited from four Psychiatric hospitals in Germany, Switzerland, and Romania; 63 subjects without any history of mental illness served as controls. Results The amount of positive experiences did not differ significantly among groups, except for safety scores that were lower in patients with personality disorders as compared to the other groups. On the other side, negative experiences appeared more frequently in patients than in controls. Emotional neglect and abuse were reported in patients more frequently than physical and sexual abuse, with negative experiences encountered more often in late childhood and adolescence than in early childhood. The patients with alcohol-related and personality disorders reported more negative events than the ones with schizophrenic and affective disorders. Conclusions The present findings add evidence to the relationship between retrospectively reported childhood experiences and psychiatric diagnoses, and emphasize the fact that a emotional neglect and abuse are the most prominent negative experiences, b adolescence is a more 'sensitive' period for negative experiences as compared to early childhood, and c a high amount of reported emotional and physical abuse occurs in patients with alcohol-related and personality disorders respectively.

  4. Extending the KCNQ2 encephalopathy spectrum: clinical and neuroimaging findings in 17 patients

    DEFF Research Database (Denmark)

    Weckhuysen, S.; Ivanovic, V.

    2013-01-01

    OBJECTIVES: To determine the frequency of KCNQ2 mutations in patients with neonatal epileptic encephalopathy (NEE), and to expand the phenotypic spectrum of KCNQ2 epileptic encephalopathy. METHODS: Eighty-four patients with unexplained NEE were screened for KCNQ2 mutations using classic Sanger sequencing. Clinical data of 6 additional patients with KCNQ2 mutations detected by gene panel were collected. Detailed phenotyping was performed with particular attention to seizure frequency, cognitive outcome, and video-EEG. RESULTS: In the cohort, we identified 9 different heterozygous de novo KCNQ2 missense mutations in 11 of 84 patients (13%). Two of 6 missense mutations detected by gene panel were recurrent and present in patients of the cohort. Seizures at onset typically consisted of tonic posturing often associated with focal clonic jerking, and were accompanied by apnea with desaturation. One patient diagnosed by gene panel had seizure onset at the age of 5 months. Based on seizure frequency at onset and cognitive outcome, we delineated 3 clinical subgroups, expanding the spectrum of KCNQ2 encephalopathy to patients with moderate intellectual disability and/or infrequent seizures at onset. Recurrent mutations lead to relatively homogenous phenotypes. One patient responded favorably to retigabine; 5 patients had a good response to carbamazepine. In 6 patients, seizures with bradycardia were recorded. One patient died of probable sudden unexpected death in epilepsy. CONCLUSION: KCNQ2 mutations cause approximately 13% of unexplained NEE. Patients present with a wide spectrum of severity and, although rare, infantile epilepsy onset is possible.

  5. Radiology clinical synopsis: a simple solution for obtaining an adequate clinical history for the accurate reporting of imaging studies on patients in intensive care units

    International Nuclear Information System (INIS)

    Lack of clinical history on radiology requisitions is a universal problem. We describe a simple Web-based system that readily provides radiology-relevant clinical history to the radiologist reading radiographs of intensive care unit (ICU) patients. Along with the relevant history, which includes primary and secondary diagnoses, disease progression and complications, the system provides the patient's name, record number and hospital location. This information is immediately available to reporting radiologists. New clinical information is immediately entered on-line by the radiologists as they are reviewing images. After patient discharge, the data are stored and immediately available if the patient is readmitted. The system has been in routine clinical use in our hospital for nearly 2 years. (orig.)

  6. Clinical significance of conventional rib series in patients with minor thoracic trauma

    International Nuclear Information System (INIS)

    Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated by CR to exclude fracture-associated complications such as hemo- and pneumothorax. (orig.)

  7. Clinical significance of conventional rib series in patients with minor thoracic trauma

    Energy Technology Data Exchange (ETDEWEB)

    Hoffstetter, P.; Dornia, C. [Asklepios Medical Center, Bad Abbach (Germany). Radiology; University Medical Center Regensburg (Germany). Radiology; Wagner, M.; Niessen, C.; Dendl, L.M.; Stroszczynski, C.; Schreyer, A.G. [University Medical Center Regensburg (Germany). Radiology; Al Suwaidi, M.H. [Asklepios Medical Center, Bad Abbach (Germany). Rheumatology/Clinical Immmunology

    2014-09-15

    Background: Conventional rib series (RS) represent a dedicated radiographic technique to visualize the bony parts of the chest wall. The method is commonly used to evaluate minor thoracic trauma, frequently in combination with chest radiographs (CRs). The aim of this study is to asses the clinical relevance of rib fractures diagnosed by RS in minor thoracic trauma. Methods: Retrospective study of 669 patients who received RS for the evaluation of minor thoracic trauma. 405 of the 669 patients received an additional CR. Radiological reports were classified into fracture versus no fracture. Patients were divided into four groups depending on the clinical follow-up. The findings of RS and CR were analyzed using the McNemar test. The statistical significance between the results of the radiographic examinations and the clinical follow-up was analyzed by the Chi-Square test and the Kruskal-Wallis test. Results: We included 669 patients (61.4% men, 38.6% women, median age: 51 years, range: 13-92 years). Analyzing the reports of 669 patients who received RS, 157 (23.5%) patients were diagnosed with at least one fractured rib while no fracture was found in 512 (76.5%) patients. Considering the 157 patients with fractured ribs, 73 (46.8%) had a single fracture, 38 (24.4%) and two fractures and 45 (28.8%) had more than two fractures. When assessing the 405 CRs, we detected 69 (17%) fractures while the corresponding RS of the same patients revealed 87 (21.5%) fractures (p < 0.05). Concerning all patients with rib fractures, 63.1% received medical therapy, while 64.5% of those patients without a radiologically documented fracture also received therapy (p = 0.25). Conclusion: Our results suggest a limited clinical value of detected rib fractures based on RS. Despite being superior compared to CR in diagnosing rib fractures, the results from RS seem to have no significant influence on further clinical management and therapeutic measures. Minor thoracic trauma should be evaluated by CR to exclude fracture-associated complications such as hemo- and pneumothorax. (orig.)

  8. Características clínicas e histopatológicas del cáncer de próstata diagnosticado a partir de la tercera biopsia / Clinical features and histopathology of prostate cancer diagnosed from the third biopsy

    Scientific Electronic Library Online (English)

    M.P., Bahílo Mateu; M., Ramírez Backhaus; M., Trassierra Villa; C., Di Capua Sacoto; S., Arlandis Guzmán; J.F., Jiménez Cruz.

    2008-12-01

    Full Text Available Objetivo: Estudiar las características histopatológicas y clínicas de los tumores diagnosticados a partir de terceras biopsias para valorar la relevancia clínica de éstos y descartar el sobrediagnóstico en el cáncer de próstata. Material y método: Revisamos las historias clínicas de 61 pacientes con [...] al menos tres o más biopsias de próstata transrectales, sextantes o de saturación según el esquema preestablecido, desde el año 2000 al 2006. Las variables analizadas son: edad del paciente, PSA, cociente PSA libre/PSA total, PSA densidad, tacto rectal, volumen prostático, hallazgos ecográficos y lesión premaligna fuertemente asociadas a la presencia de tumor en biopsias previas. Y estudiamos la anatomía patológica de los tumores diagnosticados a partir de la tercera biopsia, abordaje terapéutico y su evolución con un seguimiento mínimo de 3 meses. Resultados: De 61 pacientes con más de tres biopsias, a 15 pacientes se les diagnostica cáncer (24,6%) en la tercera biopsia. A 14 se les realiza nueva biopsia (cuarta), encontrando tumor en 5 de ellos (35,7%). Se realiza quinta biopsia en 2 pacientes siendo positiva en uno de ellos (50%). Según los resultados de la biopsia, 6 pacientes presentaban criterios de cáncer clínicamente no significativo (28,6%). En todos los pacientes se procedió a tratamiento curativo: 5 braquiterapia, 6 radioterapia externa y a 10 se les realizó una prostatectomía radical, que evidenció tumores clínicamente significativos: 2 tumores pT2b y 7 tumores pT2c sin invasión de los márgenes quirúrgicos y con un excelente control de la enfermedad tras un seguimiento mínimo de 13 meses y un pT4 por invasión del cuello vesical. Conclusiones: En nuestro medio, la tercera, cuarta y quinta biopsia alcanza una positividad del 34,42% y se corresponde con tumores que se benefician de un tratamiento con intención curativa. Abstract in english Objective: To study of histological and clinical features of prostate cancer diagnosed after three or more prostate biopsies in order to assess its clinical relevance and to discard the overdiagnosis of prostate cancer. Material and methods: We reviewed the clinical records of 61 patients who underw [...] ent three or more prostate biopsies between January 2000 and December 2006. The analyzed variables were: age, PSA level, free/total PSA ratio, PSA density, digital rectal examination, prostate volume, sonographic findings and previous malignant lesion strongly associated to the presence of tumor on previous biopsy. We studied the pathology of the tumors diagnosed from the third biopsy, therapeutical approach and its evolution with a minimum follow-up of 3 months. Results: Fifteen out of 61 patients with more than three biopsies had prostate cancer (24,59%) in the third biopsy, 5 out of 14 patients with 4 biopsies (35,71%) and 1 of the 2 cases (50%) who underwent a fifth biopsy. According to the results of biopsy, 6 patients met the criteria of clinically insignificant cancer (28,57%). Curative treatment was performed in all patients: brachytherapy in 5, external beam radiotherapy in 6 and radical prostatectomy in 10. Clinically significant tumors were found in all cases: 2 pT2b tumors and 7 pT2c tumors with negative surgical margins and with an excellent control of the cancer after a minimum follow up of 13 months, and one pT4 tumor with bladder neck infiltration. Conclusion: In our practice, overall detection rate of the third, fourth and fifth biopsy is 34,42% corresponding with tumors that could benefit from curative treatment.

  9. A steroid-independent regimen of bortezomib, liposomal doxorubicin and thalidomide demonstrate high response rates in newly diagnosed multiple myeloma patients

    Science.gov (United States)

    Sher, Taimur; Ailawadhi, Sikander; Miller, Kena C.; Manfredi, Debbie; Wood, Margaret; Tan, Wei; Wilding, Gregory; Czuczman, Myron S.; Hernandez-Ilizaliturri, Francisco J.; Hong, Fredrick; Sood, Raman; Soniwala, Saif; Lawrence, William; Jamshed, Saad; Masood, Aisha; Iancu, Daniel; Lee, Kelvin; Chanan-Khan, Asher

    2014-01-01

    Novel agents have provided new a foundation for multiple myeloma therapies. When combined with other anti-myeloma agents, these compounds significantly enhance clinical efficacy. High-dose steroids are frequently used in anti-myeloma combination regimens; however, the doses employed are often poorly tolerated, especially in patients with concurrent comorbid conditions. We hypothesized that a steroid-independent combination regimen could be developed without significant compromise of efficacy. The availability of such a regimen will be important for patients whose concurrent ailments make them poor candidates for steroid containing anti-myeloma regimens. A phase II single institute, non-randomized clinical trial was conducted to investigate a novel steroid-free three-drug combination of bortezomib (V), pegylated liposomal doxorubicin (D), and thalidomide (T), the VDT regimen. Forty-three newly diagnosed multiple myeloma patients requiring treatment were enrolled on this study. The overall response rate and complete response (CR) + near complete response (nCR) rate was 78% and 35%, respectively. Median time to progression was 29.5 months. Fatigue, rash, neuropathy, constipation and infections were the most common side effects. We concluded that VDT is a tolerable and an effective regimen capable of inducing high response rates and can be employed in patients considered to be poor candidates for steroid-based treatment regimens. PMID:21554260

  10. Clinical and Imaging Findings in 18 Patients with Eosinophilic Pneumonia

    OpenAIRE

    M Bakhshayesh Karam; N. Montazami; S. Zahiri Fard; O. Tahbaz; M. Ashtarian

    2007-01-01

    Background/Objective: Eosinophilic pneumonia is a rare cause of lung disease in adulthood. The relatively non-specific clinical presentations of this disease process make the diagnosis a unique challenge. Herein, we reported on clinical and radiological manifestations of this rare clinical entity in 18 patients. "nPatients and Methods: We retrospectively reviewed the medical records of 18 patients with acute eosinophilic pneumonia in Masih Daneshvari Medical Center. Diagnostic criteria w...

  11. Epidemiological and clinical characteristics of Reiter's syndrome in Jordanian patients

    International Nuclear Information System (INIS)

    Objective: To study the epidemiological and clinical features of Reiter's syndrome in patients who visited the rheumatology clinic in King Hussein Medical Centre (KHMC), Jordan. Methods: A prospective study, including 43 patients with the diagnosis of Reiter's syndrome was done. Patients were assessed by taking complete history, physical examination and appropriate investigations including urinalysis and culture, stool examination and culture, synovial fluid analysis, complement fixation test for Chlamydia trachomatis, complete blood count, erythrocyte sedimentation rate, rheumatoid factor, antinuclear antibodies. HLA-B27 and radiological study. Results: All patients in this study were white men, with mean age of 26.3 years. HLA-B27 was positive in 37 patients (86%). Most cases were post venereal (32 patients, 74%) while the rest were dysenteric. The clinical manifestations were arthritis in all patients (100%), urethritis in 21 patients (48%), ocular involvement in 20 patients (46%), diarrhea in 12 patients (28%), painless oral ulcers in 11 patients (26%), skin lesions in 5 patients (12%) and constitutional symptoms in 7 patients (16%). Arthritis was mostly oligoarticular (25 patients, 58%) with asymmetrical pattern in 34 patients (78%). Large joints of lower extremity were most involved (29 patients, 68%). Rheumatoid factor and antinuclear antibodies were negative in all patients. Relapses occurred in 7 patients (16%) after a mean period of 6.2 months. Conclusion: It is concluded that the epidemiological and clinical features of Reiter's syndrome in Jordan are not different from those in the literature. (author)

  12. Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies

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    Chen Chien-Yuan

    2011-11-01

    Full Text Available Abstract Background Diseases caused by Mycobacterium tuberculosis (TB among adult patients with hematological malignancies have rarely been investigated. Methods Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes. Results Fifty-three of 2984 patients (1.78% were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41. Thirty-eight patients (72% with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%, pleural effusion (47% and fibrocalcific lesions (43% on chest imaging. The 15 (28% patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03 and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004 compared to those with disease confined to the lungs. Conclusions TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity.

  13. A phase II neoadjuvant trial of anastrozole, fulvestrant and gefitinib in patients with newly diagnosed estrogen receptor positive breast cancer

    OpenAIRE

    Massarweh, Suleiman; Tham, Yee L; HUANG, JIAN; Sexton, Krystal; Weiss, Heidi; Tsimelzon, Anna; Bayer, Amanda; Rimawi, Mothaffar; Cai, Wei Yen; Hilsenbeck, Susan; Fuqua, Suzanne; Elledge, Richard

    2011-01-01

    Endocrine therapy in patients with breast cancer can be limited by the problem of resistance. Preclinical studies suggest that complete blockade of the estrogen receptor (ER) combined with inhibition of the epidermal growth factor receptor (EGFR) can overcome endocrine resistance. We tested this hypothesis in a phase II neoadjuvant trial of anastrozole and fulvestrant combined with gefitinib in postmenopausal women with newly diagnosed ER-positive breast cancer. After a baseline tumor core bi...

  14. Comparison of antigen and antibody detection tests used for diagnosing the Helicobacter pylori infection in symptomatic patients

    OpenAIRE

    Alim, Ahmet; ATA?, Mehmet; Güne?, Turabi; ÖZKAN, Suzan; Dündar, Nilgün

    2013-01-01

    AbstractHelicobacter pylori (H. pylori) infection is usually acquired in early childhood. H. pylori infection can be diagnosed by noninvasive techniques (serology, urea breath test, urine or blood, detection of H. pylori antigen in stool specimen) and by invasive techniques requiring endoscopy and biopsy (histological examination, culture, polymerase chain reaction). Recently, fecal antigen testing has been used successfully for the diagnosis of H. pylori infection in the Symptomatic Patients...

  15. INFLUENCE OF IMMUNOLOGICAL DISORDERS ON AN OUTCOME FOR THE FIRST TIME DIAGNOSED INFILTRATIVE TUBERCULOSIS IN SOCIALLY SAFE PATIENTS

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    A. V. Mordyk

    2015-02-01

    Full Text Available The assessment of immunological indicators in 76 first time diagnosed infiltrative tuberculosis of lungs in socially safe patients prior to treatment and in 2 months of chemotherapy was carried out. It is revealed that immunological disorders are connected with efficiency of tuberculosis treatment . It can be criterion of quality of provided chemotherapy. The activation of cell immunity, stimulation of phagocytosis activity of neutrophils would contribute for effective treatment of tuberculosis.

  16. Clinical and pathologic factors associated with survival in young adult patients with fibrolamellar hepatocarcinoma

    International Nuclear Information System (INIS)

    Fibrolamellar Carcinoma (FLC), a subtype of hepatocellular carcinoma (HCC), is a rare primary hepatic malignancy. Several aspects of the clinic features and epidemiology of FLC remain unclear because most of the literature on FLC consists of case reports and small cases series with limited information on factors that affect survival. We did a retrospective analysis of the clinical and histological characteristics of FLC. We also determined the rate of cellular proliferation in biopsies of these tumors. We assessed whether these variables were associated with survival. We found 15 patients with FLC out of 174 patients with HCC (8.6%). Between patients with these neoplasms, we found statistically significant survival, age at onset, level of alpha fetoprotein, and an earlier stage of the disease. The 1, 3 and 5 year survival in patients with FLC was of 66, 40 and 26% respectively. The factors associated with a higher survival in patients with FLC were age more than 23 years, feasibility of surgical resection, free surgical borders, absence of thrombosis or invasion to hepatic vessels and the absence of alterations in liver enzymes. The size of the tumor, gender, cellular proliferation and atypia did not affect the prognosis. We concluded that FLC patients diagnosed before 23 years of age have worse prognosis than those diagnosed after age 23. Other factors associated with worse prognosis in this study are: lack of surgical treatment, presence of positive surgical margins, vascular invasion, and altered hepatic enzymes

  17. Assessment of spleen size using gamma camera scintigraphy in newly diagnosed patients with essential thrombocythaemia and polycythaemia vera

    International Nuclear Information System (INIS)

    By using gamma camera imaging the spleen size was assessed in 18 consecutive patients with essential thrombocythaemia (ET) and in 18 consecutive patients with polycythaemia vera (PV). All ET and PV patients were newly diagnosed and had not received any myelosuppressive therapy prior to study. The spleen areas in both posterior and left lateral projections were determined. Eighteen consecutive patients with idiopathic thrombocytopenic purpura (ITP) served as a control group since by definition they do not present with splenic enlargement; in these latter subjects the mean posterior and left lateral splenic areas were almost identical (48 ± 15 and 47 ± 17 cm2, respectively). In comparison with this control group patients with ET an dPV had significantly larger spleens. In both ET and in PV patients the left lateral spleen scan area exceeded the posterior one. Patients with PV had larger splenic areas in both projections than did patients with ET, but the differences were not statistically significant. Compared to the ITP patients it was found that at least 50% of the ET patients and at least 61% of the PV patients at diagnosis presented with splenomegaly. (au) 35 refs

  18. Assessment of spleen size using gamma camera scintigraphy in newly diagnosed patients with essential thrombocythaemia and polycythaemia vera

    Energy Technology Data Exchange (ETDEWEB)

    Carneskog, J.; Wadenvik, H.; Kutti, J. [Univ. of Goeteborg, Sahlgrenska Univ. Hospital, Dept. of Medicine, Haematology Section, Goeteborg (Sweden); Fjaeelling, M. [Univ. of Goeteborg, Sahlgrenska Univ. Hospital, Dept. of Clinical Physiology, Section of Nuclear Med., Goeteborg (Sweden)

    1996-03-01

    By using gamma camera imaging the spleen size was assessed in 18 consecutive patients with essential thrombocythaemia (ET) and in 18 consecutive patients with polycythaemia vera (PV). All ET and PV patients were newly diagnosed and had not received any myelosuppressive therapy prior to study. The spleen areas in both posterior and left lateral projections were determined. Eighteen consecutive patients with idiopathic thrombocytopenic purpura (ITP) served as a control group since by definition they do not present with splenic enlargement; in these latter subjects the mean posterior and left lateral splenic areas were almost identical (48 {+-} 15 and 47 {+-} 17 cm{sup 2}, respectively). In comparison with this control group patients with ET an dPV had significantly larger spleens. In both ET and in PV patients the left lateral spleen scan area exceeded the posterior one. Patients with PV had larger splenic areas in both projections than did patients with ET, but the differences were not statistically significant. Compared to the ITP patients it was found that at least 50% of the ET patients and at least 61% of the PV patients at diagnosis presented with splenomegaly. (au) 35 refs.

  19. Clinical Features in 23 Lung Cancer Patients Complicated with Pulmonary Thromboembolism

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    Na LI

    2014-03-01

    Full Text Available Background and objective Malignant tumors are often complicated with pulmonary thromboembolism (PTE, particularly in lung cancer (LC. This study investigated the clinical characteristics, risk factors, and survival time of patients with PTE and LC. Methods We retrospectively reviewed the clinical data of patients with LC in Medical Oncology of Tianjin Medical University General Hospital between June 2009 and July 2013. A total of 23 patients suffered from both PTE and LC. A total of 46 cases were used as control subjects. The survival of these patients was compared with that of the control subjects by Kaplan-Meier analysis. Results A total of 1128 cases were diagnosed with LC, in which 23 were clearly diagnosed with PTE, and 16 (69.6% patients who suffered from both LC and PTE developed adenocarcinoma. These patients also exhibited a higher incidence of unexplained dyspnea than those who were diagnosed with LC only (P0.05. Ten cases (43.48% with deep venous thrombosis were observed in the PTE and LC group, and six patients (26.09% were at a high risk of acute pulmonary embolism. Hb11×109/L, D-Dimer>500 ng/ml, PO2<80 mmHg, ALB<30 g/L were the risk factors of LC with PTE (odds ratio values were listed as follows: 5.50, 11.03, 4.83, 4.68, 9.63, respectively. On July 29, 2013, the median survival time of patients with PTE and LC was 7.77 months. This result was significantly lower than that (19.27 months of patients with LC only (P=0.02. The survival time of patients suffering from both LC and PTE and undergoing chemotherapy was higher than that of patients who did not undergo such treatment. Conclusion The common pathological type observed in patients with both LC and PTE was adenocarcinoma. The common clinical manifestations were unexplained dyspnea and cough. The first five months after LC diagnosis corresponded to a high period of PTE. Patients with LC and PTE exhibited less survival time. As such, chemotherapy is beneficial for the survival of patients with LC and PTE.

  20. Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients

    Directory of Open Access Journals (Sweden)

    Kochhar P

    2007-01-01

    Full Text Available Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India. Aims: Translation and validation of the brief patient health questionnaire (BPHQ as a screening tool for depression in major Indian languages. Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods. Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil. Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.

  1. Clinical profile of pulmonary aspergilloma complicating residual tubercular cavitations in Northen Indian patients

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    Gupta P

    2010-01-01

    Full Text Available Background: Little is known regarding the clinical profile of Aspergilloma in Indian patients. Such a study was undertaken at Hospital for Chest and TB, Jaipur. Materials and Methods: Old, treated patients of pulmonary tuberculosis showing ball like lesion/s inside cavity/ies or a recent thickening of cavity wall were enrolled. Morning sputa samples were collected in the patients who were able to raise sputum and were examined by KOH mount and fungal culture. Serum anti-aspergillus antibodies were estimated in all the patients. Twenty normal healthy subjects were included to serve as control. All patients showing a positive or borderline positive serology were diagnosed as pulmonary aspergilloma (PA group. The remaining patients formed the non-aspergilloma group (Non PA group. Results: A total of 98 study patients could be classified as PA group (54 patients by serology alone, 44 patients by serology as well as sputum culture. The remaining 152 patients were classified as non PA group. Hemoptysis alone or along with other chest symptoms was significantly more common in PA group as compared to non PA group patients (P<0.001, more so in those with ball like lesions. But chest symptoms other than hemoptysis were more common in non PA group. Within the PA group, 21 (13 with ball like lesions and 8 with thickening of cavity wall had clinical symptoms suggestive of CNPA and two patients (one each with ball like lesions and thickening of cavity wall had clinical symptoms suggestive of ABPA. Conclusion: The clinical profile of pulmonary Aspergilloma in Indian patients is very protean ranging from saprophytic disease to CNPA and less commonly to ABPA.

  2. How to define, diagnose and treat poor responders? Responses from a worldwide survey of IVF clinics.

    Science.gov (United States)

    Patrizio, Pasquale; Vaiarelli, Alberto; Levi Setti, Paolo E; Tobler, Kyle J; Shoham, Gon; Leong, Milton; Shoham, Zeev

    2015-06-01

    Poor responders represent a significant percentage of couples treated in IVF units (10-24%), but the standard definition of poor responders remains uncertain and consequently optimal treatment options remain subjective and not evidence-based. In an attempt to provide uniformity on the definition, diagnosis and treatment of poor responders, a worldwide survey was conducted asking IVF professionals a set of questions on this complex topic. The survey was posted on www.IVF-worldwide.com, the largest and most comprehensive IVF-focused website for physicians and embryologists. A total of 196 centres replied, forming a panel of IVF units with a median of 400 cycles per year. The present study shows that the definition of poor responders is still subjective, and many practices do not use evidence-based treatment for this category of patients. Our hope is that by leveraging the great potential of the internet, future studies may provide immediate large-scale sampling to standardize both poor responder definition and treatment options. PMID:25892496

  3. The implication of de novo 21-hydroxylase mutation in clinical and prenatal molecular diagnoses.

    Science.gov (United States)

    Mao, Rong; McDonald, Jamie; Cantwell, Maureen; Tang, Wei; Ward, Kenneth

    2005-01-01

    We studied 37 unrelated families with a history of 21-hydroxylase deficiency (CYP21D) for eight common mutations and gene deletions in the 21-hydroxylase (CYP21) gene. We found de novo mutations in the CYP21 gene in two CYP21D patients. Analysis for eight common mutations in the 21-hydroxylase gene as well as large gene deletions was accomplished using polymerase chain reaction (PCR) followed by amplified created restriction site (ACRS) or restriction fragment length polymorphism (RFLP) and Southern blot followed by hybridization to a CYP21-specific probe. Linkage analysis was performed using microsatellite markers flanking the CYP21 gene. Ten short tandem repeat (STR) markers were used to confirm parentage in the two de novo mutation cases. In two prenatal diagnosis cases, an intron 2-13A/C>G mutation was identified in the proband, but not in the fetus, although the proband and fetus had identical linkage markers. Subsequently, the mutation was confirmed to be absent in the parents' genome and misparentage was ruled out. Our findings are consistent with previous studies showing a de novo mutation frequency of approximately 1.0-1.5% in the CYP21 gene. This new mutation rate is high relative to the rate of approximately one in one million for other autosomal recessive disorders. Thus, the de novo mutation rate in the CYP21 gene is not negligible. It must be considered and discussed in prenatal diagnosis and genetic counseling for this relatively common inherited disorder. PMID:15943551

  4. A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

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    Caio Robledo D'Angioli Costa Quaio

    2012-08-01

    Full Text Available OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant clinical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment.

  5. The expression and significance of serum IP-10 and IL-8 in patients with recently diagnosed type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Objective: To investigate the significance of IP-10 and IL-8 in the pathogenesis of type 2 diabetes mellitus (DM2). Methods: The serum levels of IP-10 and IL-8 were measured in 37 patients with recently diagnosed type 2 diabetes mellitus and 33 controls. Results; The serum levels of IP-10 and IL-8 in patients with DM2 were significantly higher than those in controls (P<0.001). Conclusion: The higher levels of IP-10 and IL-8 might play some role in the pathogenesis of DM2. (authors)

  6. Diagnosticando o TDAH em adultos na prática clínica / Diagnosing adult ADHD in clinical practice

    Scientific Electronic Library Online (English)

    Gabriela, Dias; Daniel, Segenreich; Bruno, Nazar; Gabriel, Coutinho.

    Full Text Available Embora a forma adulta do transtorno de déficit de atenção e hiperatividade (TDAH) seja oficialmente reconhecida e respaldada cientificamente, esse diagnóstico ainda é motivo de embates entre especialistas. A maior parte do conhecimento existente ainda se deve à extrapolação dos achados de estudos co [...] m populações de crianças e adolescentes, havendo necessidade de novos estudos para validar os critérios com populações adultas. O critério de idade de início dos sintomas, o ponto de corte de seis sintomas e a necessidade de atestar comprometimento funcional em ao menos dois ambientes distintos são algumas das principais dificuldades encontradas na prática clínica para o estabelecimento do diagnóstico em adultos que freqüentemente apresentam dificuldades para resgatar informações remontando à infância. Muitos sintomas descritos são também alvos de críticas, uma vez que são claramente inapropriados para adultos. A utilização de instrumentos adaptados para adultos (como o ASRS-18), a coleta de informações com outros informantes (cônjuge e pais, por exemplo), a flexibilização da idade de início dos sintomas e uma investigação abrangente dos ambientes comprometidos pelos sintomas podem minimizar essas dificuldades. Abstract in english Although attention deficit hyperactivity disorder (ADHD) has been officially recognized as a valid disorder into adulthood, this diagnosis is still an issue of debates between specialists. Most of the existing knowledge regarding this condition is due to the excess of findings of studies with childr [...] en. As the field studies that determined DSM-IV diagnostic criteria comprised only children and adolescents, more studies with adult populations are required to validate the criteria for this population. The age of onset criteria, the cut-off of six symptoms and the requirement of impairment in at least two different settings are some of the difficulties faced by clinicians to make the diagnosis in clinical practice. Moreover, adults with ADHD often show difficulties to recall the symptoms in childhood. The symptoms described by DSM-IV are also criticized. To minimize the aforementioned problems, the use of instruments adapted to adults (as ASRS-18), reports of other informants (like partner and parents), the broadened of the age of onset criterion and a broaden investigation of the different settings that might be impaired by the symptoms are recommended.

  7. Diagnosticando o TDAH em adultos na prática clínica Diagnosing adult ADHD in clinical practice

    Directory of Open Access Journals (Sweden)

    Gabriela Dias

    2007-01-01

    Full Text Available Embora a forma adulta do transtorno de déficit de atenção e hiperatividade (TDAH seja oficialmente reconhecida e respaldada cientificamente, esse diagnóstico ainda é motivo de embates entre especialistas. A maior parte do conhecimento existente ainda se deve à extrapolação dos achados de estudos com populações de crianças e adolescentes, havendo necessidade de novos estudos para validar os critérios com populações adultas. O critério de idade de início dos sintomas, o ponto de corte de seis sintomas e a necessidade de atestar comprometimento funcional em ao menos dois ambientes distintos são algumas das principais dificuldades encontradas na prática clínica para o estabelecimento do diagnóstico em adultos que freqüentemente apresentam dificuldades para resgatar informações remontando à infância. Muitos sintomas descritos são também alvos de críticas, uma vez que são claramente inapropriados para adultos. A utilização de instrumentos adaptados para adultos (como o ASRS-18, a coleta de informações com outros informantes (cônjuge e pais, por exemplo, a flexibilização da idade de início dos sintomas e uma investigação abrangente dos ambientes comprometidos pelos sintomas podem minimizar essas dificuldades.Although attention deficit hyperactivity disorder (ADHD has been officially recognized as a valid disorder into adulthood, this diagnosis is still an issue of debates between specialists. Most of the existing knowledge regarding this condition is due to the excess of findings of studies with children. As the field studies that determined DSM-IV diagnostic criteria comprised only children and adolescents, more studies with adult populations are required to validate the criteria for this population. The age of onset criteria, the cut-off of six symptoms and the requirement of impairment in at least two different settings are some of the difficulties faced by clinicians to make the diagnosis in clinical practice. Moreover, adults with ADHD often show difficulties to recall the symptoms in childhood. The symptoms described by DSM-IV are also criticized. To minimize the aforementioned problems, the use of instruments adapted to adults (as ASRS-18, reports of other informants (like partner and parents, the broadened of the age of onset criterion and a broaden investigation of the different settings that might be impaired by the symptoms are recommended.

  8. Multi-institutional phase 2 clinical and pharmacogenomic trial of tipifarnib plus etoposide for elderly adults with newly diagnosed acute myelogenous leukemia

    Science.gov (United States)

    Vener, Tatiana I.; Raponi, Mitch; Ritchie, Ellen K.; Smith, B. Douglas; Gore, Steven D.; Morris, Lawrence E.; Feldman, Eric J.; Greer, Jacqueline M.; Malek, Sami; Carraway, Hetty E.; Ironside, Valerie; Galkin, Steven; Levis, Mark J.; McDevitt, Michael A.; Roboz, Gail R.; Gocke, Christopher D.; Derecho, Carlo; Palma, John; Wang, Yixin; Kaufmann, Scott H.; Wright, John J.; Garret-Mayer, Elizabeth

    2012-01-01

    Tipifarnib (T) exhibits modest activity in elderly adults with newly diagnosed acute myelogenous leukemia (AML). Based on preclinical synergy, a phase 1 trial of T plus etoposide (E) yielded 25% complete remission (CR). We selected 2 comparable dose levels for a randomized phase 2 trial in 84 adults (age range, 70-90 years; median, 76 years) who were not candidates for conventional chemotherapy. Arm A (T 600 mg twice a day × 14 days, E 100 mg days 1-3 and 8-10) and arm B (T 400 mg twice a day × 14 days, E 200 mg days 1-3 and 8-10) yielded similar CR, but arm B had greater toxicity. Total CR was 25%, day 30 death rate 7%. A 2-gene signature of high RASGRP1 and low aprataxin (APTX) expression previously predicted for T response. Assays using blasts from a subset of 40 patients treated with T plus E on this study showed that AMLs with a RASGRP1/APTX ratio of more than 5.2 had a 78% CR rate and negative predictive value 87%. This ratio did not correlate with outcome in 41 patients treated with conventional chemotherapies. The next T-based clinical trials will test the ability of the 2-gene signature to enrich for T responders prospectively. This study is registered at www.clinicaltrials.gov as #NCT00602771. PMID:22001391

  9. Using a Narrative Approach to Enhance Clinical Care for Patients With Asthma.

    Science.gov (United States)

    Owton, Helen; Allen-Collinson, Jacquelyn; Siriwardena, A Niroshan

    2015-07-01

    There are currently > 230 million people in the world with asthma, and asthma attacks result in the hospitalization of someone every 7 min. The National Heart, Lung, and Blood Institute outlines four components of clinical practice guidelines for the diagnosis and management of asthma, which tend to take a biomedical focus: (1) measures of assessment and monitoring, obtained by objective tests, physical examination, patient history, and patient report, to diagnose and assess the characteristics and severity of asthma and to monitor whether asthma control is achieved and maintained; (2) education for a partnership in asthma care; (3) control of environmental factors and comorbid conditions that affect asthma; and (4) pharmacologic therapy. Many national guidelines include providing patients with asthma with (1) written action plans, (2) inhaler technique training, and (3) structured annual reviews. Although current guidelines help improve clinical processes of care for asthma, there is also a need to improve self-care of asthma by empowering individuals to take more control of their condition. There is a growing appreciation that a narrative approach with patients with asthma, which focuses on the illness experience and aims to enhance patient-clinician understanding, might improve self-care. We explore how a framework for clinicians to listen to patients' stories, developed from research on individuals with asthma, might enhance communication, improve patient-clinician relationship, and foster better patient self-care. The article closes with the implications of this approach for clinical practice and future research. PMID:25789925

  10. Medical yoga for patients with stress-related symptoms and diagnoses in primary health care: a randomized controlled trial.

    Science.gov (United States)

    Köhn, Monica; Persson Lundholm, Ulla; Bryngelsson, Ing-Liss; Anderzén-Carlsson, Agneta; Westerdahl, Elisabeth

    2013-01-01

    An increasing number of patients are suffering from stress-related symptoms and diagnoses. The purpose of this study was to evaluate the medical yoga treatment in patients with stress-related symptoms and diagnoses in primary health care. A randomized controlled study was performed at a primary health care centre in Sweden from March to June, 2011. Patients were randomly allocated to a control group receiving standard care or a yoga group treated with medical yoga for 1 hour, once a week, over a 12-week period in addition to the standard care. A total of 37 men and women, mean age of 53 ± 12 years were included. General stress level (measured using Perceived Stress Scale (PSS)), burnout (Shirom-Melamed Burnout Questionnaire (SMBQ)), anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), insomnia severity (Insomnia Severity Index (ISI)), pain (visual analogue scale (VAS)), and overall health status (Euro Quality of Life VAS (EQ-VAS)) were measured before and after 12 weeks. Patients assigned to the Yoga group showed significantly greater improvements on measures of general stress level (P yoga is effective in reducing levels of stress and anxiety in patients with stress-related symptoms in primary health care. PMID:23533465

  11. Patient Income Level and Cancer Clinical Trial Participation

    Science.gov (United States)

    Unger, Joseph M.; Hershman, Dawn L.; Albain, Kathy S.; Moinpour, Carol M.; Petersen, Judith A.; Burg, Kenda; Crowley, John J.

    2013-01-01

    Purpose Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation. Patients and Methods We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost. Results From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ? 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001). Conclusion Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels. PMID:23295802

  12. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  13. Evaluation of NANDA nursing diagnoses of healthcare college final year students during the clinical application of the mental health and disease nursing course

    OpenAIRE

    Gülay Ta?demir; Mehtap K?z?lkaya

    2013-01-01

    The aim of this descriptive study was to evaluate the NANDA nursing diagnoses of Pamukkale University Denizli Healthcare College final year students for the patients they undertook the care of and to determine the aims and interventions relevant to these diagnoses.The study universe consisted of all Pamukkale University Denizli Healthcare College final year students who were continuing their education during the 2009-2010 educational year and took the Mental Health and Disease Nursing course ...

  14. When is Genomic Testing Cost-Effective? Testing for Lynch Syndrome in Patients with Newly-Diagnosed Colorectal Cancer and Their Relatives

    Science.gov (United States)

    Grosse, Scott D.

    2015-01-01

    Varying estimates of the cost-effectiveness of genomic testing applications can reflect differences in study questions, settings, methods and assumptions. This review compares recently published cost-effectiveness analyses of testing strategies for Lynch Syndrome (LS) in tumors from patients newly diagnosed with colorectal cancer (CRC) for either all adult patients or patients up to age 70 along with cascade testing of relatives of probands. Seven studies published from 2010 through 2015 were identified and summarized. Five studies analyzed the universal offer of testing to adult patients with CRC and two others analyzed testing patients up to age 70; all except one reported incremental cost-effectiveness ratios (ICERs) and it is unclear how sensitive such models are in routine clinical practice. Key model parameters that are influential in ICER estimates included 1) the number of first-degree relatives tested per proband identified with LS and 2) the cost of gene sequencing. Others include the frequency of intensive colonoscopic surveillance, the cost of colonoscopy, and the inclusion of extracolonic surveillance and prevention options. PMID:26473097

  15. The interference in the suicide ideation of patients with malignant tumors by mental clinical nursing pathway

    Directory of Open Access Journals (Sweden)

    Xu Z

    2014-12-01

    Full Text Available Zhaofen Xu, Baoan Chen, Guohong Li, Wenjun Dai Department of Gynaecology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China Background: The purpose of this study was to examine the effect of mental clinical nursing pathways on suicidal ideation and life quality of patients with malignant tumors. Methods: Two hundred patients with malignant tumors were randomly divided into a study group and a control group, with 100 patients in each group. During the treatment, patients in the study group received mental clinical nursing pathway care, while those in the control group were given the usual nursing care, such as timely inspection, nurse’s reactions to patient’s behavior, and execution of medical orders. Thereafter, the “self-rating idea of suicide scale” and Karnofsky Performance Status (KPS were used to compare the differences in the suicidal ideation of patients with malignant tumors between the two groups before and after the treatment. Results: There were no statistical differences in the scores of despair factor, optimistic factor, sleep factor, and cover factor between the two groups before the treatment (P>0.05. After different styles of nursing, the former four factors of patients in the study group were significantly lower than those in the control group (P<0.01, while there were no significant differences in the score of cover factor between the two groups (P>0.05. The KPS of patients receiving mental clinical nursing pathway care was higher than those receiving usual nursing care, and there was a statistical significant difference between the two groups (P<0.01. Interestingly, the patients’ suicidal ideation scale was negatively correlated with KPS (r=?0.29, P<0.05. Conclusion: For individuals diagnosed with a malignant tumor, using a mental health clinical nursing pathway can effectively decrease the degree of suicidal ideation and positively impact the quality of life. Keywords: mental clinical nursing pathway, suicidal ideation, malignant tumor

  16. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients

    International Nuclear Information System (INIS)

    PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosis of PHACE syndrome. (orig.)

  17. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer; Robinson, Ian; Snow, Aisling; Rea, David; Phelan, Ethna [Our Lady' s Children' s Hospital, Department of Radiology, Dublin (Ireland); Watson, Rosemarie; Irvine, Alan D. [Our Lady' s Children' s Hospital, Department of Dermatology, Dublin (Ireland)

    2011-09-15

    PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosis of PHACE syndrome. (orig.)

  18. PHACE syndrome: MRI of intracerebral vascular anomalies and clinical findings in a series of 12 patients.

    LENUS (Irish Health Repository)

    Bracken, Jennifer

    2012-02-01

    BACKGROUND: PHACE (posterior fossa defects, haemangioma, arterial anomalies, coarctation of the aorta and cardiac defects, eye abnormalities) syndrome describes a constellation of abnormalities that can occur in association with segmental craniofacial infantile haemangioma. OBJECTIVE: To report the spectrum of clinical and imaging abnormalities seen in a cohort of children. MATERIALS AND METHODS: A retrospective review of the clinical and imaging records of all patients diagnosed with PHACE syndrome between 1998 and 2009 was performed. Information sought included patient demographics, craniofacial segments involved, imaging findings and other extracutaneous abnormalities. RESULTS: Twelve patients were diagnosed with PHACE syndrome over 11 years. All patients had a segmental craniofacial haemangioma. Involved facial segments, in order of frequency, were frontotemporal (12), maxillary (8), mandibular (5) and frontonasal (1). The most common extracutaneous abnormalities were neurovascular anomalies (10), with many patients having multiple anomalies. The spectrum of arterial anomalies ranged from hypoplasia (9) to ectasia (3), anomalous origin\\/course (2) and persistent fetal anastomosis (2). Other anomalies found included cardiac anomalies (3), coarctation of the aorta (2), posterior fossa malformations (1) and sternal region anomalies (1). CONCLUSION: Intracranial anomalies are the most common extracutaneous feature of PHACE syndrome. The contribution of the radiologist in the recognition of such anomalies is important for the diagnosis of PHACE syndrome.

  19. Clinical Trials Information for Patients and Caregivers

    Science.gov (United States)

    Perhaps you are thinking about participating in a clinical trial. Or maybe you have a friend or family member with cancer and are wondering if a clinical trial is right for them. This section contains basic information about clinical trials, things to think about when deciding to take part and questions to ask your doctor.

  20. A survey of patients' attitudes to clinical research.

    LENUS (Irish Health Repository)

    Desmond, A

    2011-04-01

    Every year hundreds of patients voluntarily participate in clinical trials across Ireland. However, little research has been done as to how patients find the experience. This survey was conducted in an attempt to ascertain clinical trial participants\\' views on their experience of participating in a clinical trial and to see and how clinical trial participation can be improved. One hundred and sixty-six clinical trial participants who had recently completed a global phase IV cardiovascular endpoint clinical trial were sent a 3-page questionnaire. Ninety-one (91%) respondents found the experience of participating in a clinical trial a good one with 85 (84.16%) respondents saying they would recommend participating in a clinical trial to a friend or relative and eighty-five (87.63%) respondents feeling they received better healthcare because they had participated in a clinical trial.

  1. Predictive Clinical Indicators of Biochemical Progression in Advanced Prostate Cancer Patients Receiving Leuplin Depot as Androgen Deprivation Therapy

    OpenAIRE

    Chen, Chien-Hua; Hsieh, Ju-Ton; Huang, Kuo-How; Pu, Yeong-Shiau; Chang, Hong-Chiang

    2014-01-01

    Therapeutic planning and counseling for advanced prostate cancer patients receiving androgen deprivation therapy (ADT) is complicated because the prognoses are highly variable. The purpose of this study is to identify predictive clinical indicators of biochemical progression (BCP). In this retrospective analysis, data from 107 newly diagnosed patients (from November 1995 to April 2008) with advanced prostate adenocarcinoma receiving Leuprorelin acetate depot were analyzed. Data was collected ...

  2. Genetic and clinical profile of Indian patients of idiopathic restrictive cardiomyopathy with and without hypertrophy

    DEFF Research Database (Denmark)

    Rai, Taranjit Singh; Ahmad, Shamim

    2009-01-01

    Both idiopathic restrictive cardiomyopathy (IRCM) and hypertrophic cardiomyopathy (HCM) are part of the same disease spectrum and are due to sarcomeric gene mutations. A patient with restrictive physiology without left ventricular hypertrophy (LVH) would be diagnosed as IRCM, while one with LVH would be diagnosed as HCM with restrictive physiology. We studied a group of patients with restrictive physiology for mutations in beta-myosin heavy chain (MYH7) and troponin I (TNNI3) gene. Consecutive probands in the HCM and IRCM cohort over a 4-year period were considered for this study. These included 10 IRCM and 102 HCM patients. All were Asian Indians. Among the 17 patients who had restrictive physiology 10 were IRCM patients and seven were HCM patients. Of the HCM patients, seven (6.9%) had restrictive physiology. Mean age of these 17 patients was 40.1 +/- 19.2 years (range: 15-67 ), six (35.3%) were males. Maximal left ventricular wall thickness of the seven HCM probands was 20.7 +/- 5.2 mm (range: 16-31), while it was normal in the IRCM probands. Ten probands (58.8%) were in NYHA class III or IV. Seven patients (41.2%) had atrial fibrillation. All the probands were screened for mutations in selected exons of MYH7 and TNNI3 genes. One IRCM patient was found to have p.Arg721Lys mutation in the MYH7 gene. She died due to progressive congestive cardiac failure at the age of 47 years. One HCM proband with a maximal left ventricular wall thickness of 17 mm had p.Arg192His mutation in the TNNI3 gene. She had features consistent with restrictive physiology. Her father and sister had died of restrictive cardiomyopathy. IRCM and HCM with restrictive physiology, both are part of the clinical expression of MYH7 and TNNI3 mutations and lead to worse clinical onset and progression of the disease.

  3. Unique perception of clinical trials by Korean cancer patients

    Directory of Open Access Journals (Sweden)

    Lee Su Jin

    2012-12-01

    Full Text Available Abstract Background In the past few years, the number of clinical trials has increased rapidly in East Asia, especially for gastric and hepatobiliary cancer that are prevalent in Asian populations. However, the actual degree of understanding or perceptions of clinical trials by cancer patients in East Asian countries have seldom been studied. Methods Between July 1st and November 30th of 2011, we conducted a prospective study to survey cancer patients regarding their awareness of, and willingness to participate in, a clinical trial. Patients with gastrointestinal/hepatobiliary cancer who visited the Hematology-Oncology outpatient clinic at Samsung Medical Center (SMC were enrolled. A total of 21 questions were asked including four questions which used the Visual analogue scale (VAS score. Results In this survey study, 1,000 patients were asked to participate and 675 patients consented to participate (67.5%. The awareness of clinical trials was substantially higher in patients who had a higher level of education (pp=0.004, and had a higher economic status (p=0.001. However, the willingness to participate in a clinical trial was not affected by the level of education or economic status of patients. The most influential factors for patient willingness to participate were a physician recommendation (n=181, 26.8%, limited treatment options (n=178, 26.4%, and expectations of effectiveness of new anti-cancer drugs (n=142, 21.0%. Patients with previous experience in clinical trials had a greater willingness to participate in clinical trials compared to patients without previous experience (p Conclusions This large patient cohort survey study showed that Korean cancer patients are more aware of clinical trials, but awareness did not translate into willingness to participate.

  4. Personality factors in recently diagnosed multiple sclerosis patients: a preliminary investigation with the NEO-FFI scale

    Directory of Open Access Journals (Sweden)

    Aline Braz de Lima

    2015-03-01

    Full Text Available This article describes some prevalent personality dimensions of recently diagnosed multiple sclerosis patients. A sample of 33 female recently diagnosed with relapsing-remitting multiple sclerosis (RRMS was assessed with the NEO-FFI personality scale. Beck depression (BDI and anxiety (BAI scales were also used. No significant levels of anxiety or depression were identified in this group. As for personality factors, conscientiousness was the most common factor found, whereas openness to experience was the least observed. Literature on the relationship between personality and MS is scarce and there are no Brazilian studies on this subject. Some personality traits might complicate or facilitate the experience of living with a chronic, disabling and uncertain neurological condition such as MS.

  5. A clinical follow-up of 35 Brazilian patients with Prader-Willi Syndrome

    Scientific Electronic Library Online (English)

    Caio Robledo D' Angioli Costa, Quaio; Tatiana Ferreira de, Almeida; Lilian Maria José, Albano; Israel, Gomy; Debora Romeo, Bertola; Monica Castro, Varela; Celia P., Koiffmann; Chong Ae, Kim.

    2012-08-01

    Full Text Available OBJECTIVE: Prader-Willi Syndrome is a common etiology of syndromic obesity that is typically caused by either a paternal microdeletion of a region in chromosome 15 (microdeletions) or a maternal uniparental disomy of this chromosome. The purpose of this study was to describe the most significant cli [...] nical features of 35 Brazilian patients with molecularly confirmed Prader-Willi syndrome and to determine the effects of growth hormone treatment on clinical outcomes. METHODS: A retrospective study was performed based on the medical records of a cohort of 35 patients diagnosed with Prader-Willi syndrome. The main clinical characteristics were compared between the group of patients presenting with microdeletions and the group presenting with maternal uniparental disomy of chromosome 15. Curves for height/length, weight and body mass index were constructed and compared between Prader-Willi syndrome patients treated with and without growth hormone to determine how growth hormone treatment affected body composition. The curves for these patient groups were also compared with curves for the normal population. RESULTS: No significant differences were identified between patients with microdeletions and patients with maternal uniparental disomy for any of the clinical parameters measured. Growth hormone treatment considerably improved the control of weight gain and body mass index for female patients but had no effect on either parameter in male patients. Growth hormone treatment did not affect height/length in either gender. CONCLUSION: The prevalence rates of several clinical features in this study are in agreement with the rates reported in the literature. Additionally, we found modest benefits of growth hormone treatment but failed to demonstrate differences between patients with microdeletions and those with maternal uniparental disomy. The control of weight gain in patients with Prader-Willi syndrome is complex and does not depend exclusively on growth hormone treatment.

  6. Patient perspectives on antipsychotic treatments and their association with clinical outcomes

    Directory of Open Access Journals (Sweden)

    Hong Liu-Seifert

    2010-09-01

    Full Text Available Hong Liu-Seifert1, Olawale O Osuntokun1, Jenna L Godfrey2, Peter D Feldman11Lilly Research Laboratories, Indianapolis, IN, USA; 2Durham Veterans Affairs Medical Center, Durham, NC, USAAbstract: This analysis examined patient-reported attitudes toward antipsychotic medication and the relationship of these attitudes with clinical outcomes and pharmacotherapy adherence. The analysis included three randomized, double-blind studies in patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition and randomly assigned to treatment with olanzapine 5–20 mg/day or another antipsychotic (haloperidol 2–20 mg/day, risperidone 2–10 mg/day, or ziprasidone 80–160 mg/day. Patient-reported improvements were significantly greater for olanzapine (n = 488 versus other treatments (haloperidol n = 145, risperidone n = 158, or ziprasidone n = 271 on multiple Drug Attitude Inventory items. A positive attitude toward medication reported by patients was significantly associated with greater clinical improvement on the Positive and Negative Syndrome Scale and lower discontinuation rates. These results suggest that patients’ perceptions of treatment benefits are associated with objective clinical measures, including reduction of symptom severity and lower discontinuation rates. Furthermore, olanzapine may be associated with more positive treatment attitudes. These findings may contribute to a better understanding of reasons for treatment adherence from patients’ own perspectives.Keywords: antipsychotic agents, medication adherence, patient satisfaction, schizophrenia, treatment efficacy

  7. Molecular Epidemiology of HIV Type 1 in Newly Diagnosed Patients in Southern Spain

    OpenAIRE

    McConnell, Michael J; Docobo-Pérez, Fernando; Mata, Rosario C.; Fernandez-Cuenca, Felipe; Viciana, Pompeyo; López-Cortés, Luis F.; Trastoy, Mónica; Pachón, Jerónimo; Pérez-Romero, Pilar

    2008-01-01

    The prevalence of different HIV-1 subtypes in Spain varies by geographic region. In the present study isolates were collected from 72 newly diagnosed individuals in western Andalucia from 2004 to 2006. Viral sequences were amplified and the subtype diversity and prevalence of resistance mutations in the reverse transcriptase and protease genes were determined. The results presented here demonstrate that subtype B virus predominates in this region (88.9%), with the non-B subtypes CRF02_AG (9.7...

  8. Survival analysis in patients with newly diagnosed primary glioblastoma multiforme using pre- and post-treatment peritumoral perfusion imaging parameters.

    Science.gov (United States)

    Bag, Asim K; Cezayirli, Phillip C; Davenport, Jake J; Gaddikeri, Santhosh; Fathallah-Shaykh, Hassan M; Cantor, Alan; Han, Xiaosi S; Nabors, Louis B

    2014-11-01

    The objective of this study was to evaluate if peritumoral (PT) perfusion parameters obtained from dynamic susceptibility weighted contrast enhanced perfusion MRI can predict overall survival (OS) and progression free survival (PFS) in patients with newly diagnosed glioblastoma multiforme (GBM). Twenty-eight newly diagnosed GBM patients, who were treated with resection followed by concurrent chemoradiation and adjuvant chemotherapy, were included in this study. Evaluated perfusion parameters were pre- and post-treatment PT relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF). Proportional hazard analysis was used to assess the relationship OS, PFS and perfusion parameters. Kaplan-Meier survival estimates and log-rank test were used to characterize and compare the patient groups with high and low perfusion parameter values in terms of OS and PFS. Pretreatment PT rCBV and rCBF were not associated with OS and PFS whereas there was statistically significant association of both posttreatment PT rCBV and rCBF with OS and posttreatment rCBV with PFS (association of PFS and posttreatment rCBF was not statistically significant). Neither the Kaplan-Meier survival estimates nor the log-rank test demonstrated any differences in OS between high and low pretreatment PT rCBV values and rCBF values; however, high and low post-treatment PT rCBV and rCBF values did demonstrate statistically significant difference in OS and PFS. Our study found posttreatment, not pretreatment, PT perfusion parameters can be used to predict OS and PFS in patients with newly diagnosed GBM. PMID:25098699

  9. Diagnósticos de Enfermagem sobre alterações urinárias na doença de Parkinson / Nursing diagnoses for urinary disorders in patients with Parkinson's disease

    Scientific Electronic Library Online (English)

    Débora Moraes, Campos; Michelle Hyczy de Siqueira, Tosin; Luciana, Blanco; Rosimere Ferreira, Santana; Beatriz Guitton Renaud Baptista de, Oliveira.

    2015-04-01

    Full Text Available Objetivo: Analisar os Diagnósticos de Enfermagem mapeados e contidos na classe “Função Urinária” do domínio Eliminação e Troca da taxonomia proposta pela NANDA- Internacional, em portadores de doença de Parkinson em programa de reabilitação. Métodos: Estudo descritivo de mapeamento cruzado cuja a f [...] onte primária de dados foram 67 prontuários eletrônicos com registro de cinco ou mais evoluções de enfermagem. A coleta eletrônica de dados foi realizada em três etapas: levantamento dos termos, mapeamento e validação. Resultados: Foi observada a abrangência da taxonomia na identificação das alterações urinárias. Foram mapeados sete diagnósticos de enfermagem. A “Eliminação urinária prejudicada” foi o mais frequente (60%) e, na maioria dos casos, esteve associada a outros diagnósticos específicos, como as incontinências urinárias por urgência (55%), reflexa (25%), por esforço (12%), por transbordamento (10%) e funcional (6%). Conclusão: A análise sobre os diagnósticos de enfermagem mapeados indicam a complexidade das alterações urinárias em pacientes com doença de Parkinson. Abstract in english Objective: To analyze the mapped nursing diagnoses included in the Urinary Function class, Elimination and Exchange domain of the NANDA International taxonomy, for Parkinson's disease patients from a rehabilitation program. Methods: A descriptive, cross mapping study whose primary source of data wa [...] s 67 electronic medical records with five or more nursing assessments recorded. Electronic data collection was performed in three steps: identification of terms, mapping and validation. Results: The scope of the taxonomy was observed for identifying urinary changes. Seven nursing diagnoses were mapped. Impaired urinary elimination was the most common (60%) and, in most cases, was associated with other specific diagnoses, such as urge (55%), reflex (25%) stress (12%), overflow (10%) and functional urinary incontinence (6%). Conclusion: The analysis of the mapped nursing diagnoses indicates the complexity of urinary disturbances in patients with Parkinson's disease.

  10. Differentiating adolescents at clinical high risk for psychosis from psychotic and non-psychotic patients with the Rorschach.

    Science.gov (United States)

    Ilonen, Tuula; Heinimaa, Markus; Korkeila, Jyrki; Svirskis, Tanja; Salokangas, Raimo K R

    2010-09-30

    This study was designed to assess cognitive functioning in a clinical sample of adolescents with heterogeneous psychiatric diagnoses, with a specific focus on patients at clinical high risk (CHR) for psychosis. The sample comprised 22 patients identified at CHR for psychosis, 67 psychotic and 187 non-psychotic, non-CHR patients. Neuropsychological assessment was conducted as part of the clinical examination and treatment, including Wechsler Intelligence Scale for Children (WISC)-III and/or Wechsler Adult Intelligence Scale (WAIS)-III measures of verbal comprehension, perceptual organisation, working memory and processing speed, Wisconsin Card Sorting Test (WCST) measures of executive function, and the Rorschach Comprehensive System measures of perceptual and thinking accuracy. Patients at CHR for psychosis did not significantly differ from other patient groups in terms of intellectual or executive functions. The Rorschach Perceptual Thinking Index (PTI) distinguished patients at CHR for psychosis from those diagnosed as having non-psychotic disorders, but not from those diagnosed as psychotic. Our results suggest perceptual and thought disturbance as an important indicator of vulnerability to psychosis. PMID:20483480

  11. Propionic acidemia: clinical course and outcome in 55 pediatric and adolescent patients

    Directory of Open Access Journals (Sweden)

    Grünert Sarah C

    2013-01-01

    Full Text Available Abstract Background Propionic acidemia is an inherited disorder caused by deficiency of propionyl-CoA carboxylase. Although it is one of the most frequent organic acidurias, information on the outcome of affected individuals is still limited. Study design/methods Clinical and outcome data of 55 patients with propionic acidemia from 16 European metabolic centers were evaluated retrospectively. 35 patients were diagnosed by selective metabolic screening while 20 patients were identified by newborn screening. Endocrine parameters and bone age were evaluated. In addition, IQ testing was performed and the patients’ and their families’ quality of life was assessed. Results The vast majority of patients (>85% presented with metabolic decompensation in the neonatal period. Asymptomatic individuals were the exception. About three quarters of the study population was mentally retarded, median IQ was 55. Apart from neurologic symptoms, complications comprised hematologic abnormalities, cardiac diseases, feeding problems and impaired growth. Most patients considered their quality of life high. However, according to the parents’ point of view psychic problems were four times more common in propionic acidemia patients than in healthy controls. Conclusion Our data show that the outcome of propionic acidemia is still unfavourable, in spite of improved clinical management. Many patients develop long-term complications affecting different organ systems. Impairment of neurocognitive development is of special concern. Nevertheless, self-assessment of quality of life of the patients and their parents yielded rather positive results.

  12. Clinical and Pathological Heterogeneity of Korean Patients with CAPN3 Mutations

    Science.gov (United States)

    Park, Hyung Jun; Jang, Hoon; Lee, Jung Hwan; Shin, Ha Young; Cho, Sung-Rae; Park, Kee Duk; Bang, Duhee; Lee, Min Goo; Kim, Seung Min

    2016-01-01

    Purpose This study was designed to investigate the characteristics of Korean patients with calpainopathy. Materials and Methods Thirteen patients from ten unrelated families were diagnosed with calpainopathy via direct or targeted sequencing of the CAPN3 gene. Clinical, mutational, and pathological spectra were then analyzed. Results Nine different mutations, including four novel mutations (NM_000070: c.1524+1G>T, c.1789_1790inA, c.2184+1G>T, and c.2384C>T) were identified. The median age at symptom onset was 22 (interquartile range: 15-28). Common clinical findings were joint contracture in nine patients, winged scapula in four, and lordosis in one. However, we also found highly variable clinical features including early onset joint contractures, asymptomatic hyperCKemia, and heterogeneous clinical severity in three members of the same family. Four of nine muscle specimens revealed lobulated fibers, but three showed normal skeletal muscle histology. Conclusion We identified four novel CAPN3 mutations and demonstrated clinical and pathological heterogeneity in Korean patients with calpainopathy. PMID:26632398

  13. Oxidative Dna Damage in Newly Diagnosed and Untreated Patients with Isolated High Blood Pressure: The Acute Effect of Olmesartan

    Directory of Open Access Journals (Sweden)

    Ahmet KIYKIM

    2012-01-01

    Full Text Available OBJECTIVES: Oxidative stress (OS is the most important common pathway in the pathogenesis of endothelial and vascular damage related with the cardiovascular risk factors. Reactive oxygen species damage the macromolecules and DNA. 8-OHdG (8-hydroxy-2'-deoxyguanosine is the reliable marker for oxidative DNA damage (ODD. To date, little is known about the presence of OS or ODD in patients with newly diagnosed and untreated primary hypertension (PHT, and the effects of antihypertensives on the ODD.The aims of the study was 1 to determine the oxidative DNA damage and to compare with normotensive healthy persons, 2 to determine the factors related with 8-OHdG level, and 3 to investigate the acute effect of olmesartan on 8-OHdG levels, in patients with newly diagnosed untreated PHT.MATERIAL and METHODS: We enrolled 49 newly diagnosed, never treated, mild to moderate hypertensive patients with no additional cardiovascular or OS risk factors, and age and sex-matched 20 normotensive healthy persons. At the beginning of the study; biochemical tests, glomerular filtration rate measurement, and urinalysis were performed. Echocardiography was performed. 8-OHdG levels were obtained in all subjects. Olmesartan at a dose of 20 or 40 mg/day was administered for 4 weeks. All measurements were repeated after the treatment period.RESULTS: Baseline mean levels of 8-OHdG (6.1±1.0 ng/ml in patients were significantly higher than the control group (3.8±0.7 ng/ml (p<0.001. Treatment with olmesartan significantly reduced the 8-OHdG levels independent of the blood pressure lowering effect. Mean levels of 8-OHdG after treatment were higher than the controls (4.6±0.9 ng/ml (p<0.01. There was no correlation between 8-OHdG levels and demographic and laboratory values.CONCLUSIONn: ODD is higher in patients with newly diagnosed untreated PHT than normotensive persons, and olmesartan seems to be improve ODD.

  14. Data retention after a patient withdraws consent in clinical trials

    OpenAIRE

    Gabriel A; Mercado CP

    2011-01-01

    André P Gabriel, Charles P MercadoDepartment of Medicine, Columbia University Medical Center, New York, NY, USAAbstract: Patient retention is critically important in the conduct of a successful clinical trial. The power in numbers in multicenter trials is dependent on the completion of follow-up for every patient randomized. If at the end of a clinical trial, a significant number of randomized patients are missing outcome data, there will not be enough pool for data analyses to con...

  15. A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna.

    OpenAIRE

    Hippler, Kathrin; Klicpera, Christian

    2003-01-01

    To date, it is questionable whether the diagnostic criteria for Asperger syndrome (AS) as stated by ICD-10 or DSM-IV still reflect Asperger's original account of 'autistic psychopathy' (AP) from the 1940s. The present study examined 74 clinical case records of children with AP diagnosed by Hans Asperger and his team at the Viennese Children's Clinic and Asperger's private practice between 1950 and 1986. The characteristic features of the children are outlined, including reasons for referral, ...

  16. Birth Order and Sibling Gender Ratio of a Clinical Sample of Children and Adolescents Diagnosed with Attention Deficit Hyperactivity Disorder

    Directory of Open Access Journals (Sweden)

    Ahmad Ghanizadeh

    2012-09-01

    Full Text Available Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD. This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-IV-TR, diagnostic criteria according to face-to-face interview with the children and their parents. ADHD DSM-IV checklist was used to measure inattentiveness and hyperactivity/impulsivity scores.Results: The association of birth order and diagnosis of ADHD was not statistically significant after adjusting for covariate factors. The gender ratio of siblings is not associated with ADHD.Conclusion: Birth order and siblings gender ratio are independent of ADHD diagnosis. The results of this study support the fact that genetic factors rather than environmental factor of birth order is associated with ADHD. Moreover, contrary to autism, the current results do not suggest the androgen theory for ADHD.

  17. Structures of clinical information in patient records.

    OpenAIRE

    Rossi Mori, A.; Consorti, F.

    1999-01-01

    In order to support the preparation of the European Prestandard on "Communication of Electronic Health Care Record--Part 2: Domain Termlist" we carried out an analytical study about names of clinical documents, titles of generic sections, names of data elements, according to our terminological methods. We defined three layers of structures for clinical information: i) documents and sections, ii) clinical statements, iii) systematic details within statements. We prepared in correspondence many...

  18. Clinical outcome of protein-energy malnourished patients in a Brazilian university hospital

    Scientific Electronic Library Online (English)

    T.A.S., Pasquini; H.D., Neder; L., Araújo-Junqueira; D.A., De-Souza.

    2012-12-01

    Full Text Available Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortalit [...] y. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.

  19. Phase II study of HCVIDD/MA in patients with newly diagnosed peripheral T-cell lymphoma.

    Science.gov (United States)

    Chihara, Dai; Pro, Barbara; Loghavi, Sanam; Miranda, Roberto N; Medeiros, L Jeffrey; Fanale, Michelle A; Hagemeister, Fredrick B; Fayad, Luis E; Romaguera, Jorge E; Samaniego, Felipe; Neelapu, Sattva S; Younes, Anas; Fowler, Nathan H; Rodriguez, M Alma; Wang, Michael; Kwak, Larry W; McLaughlin, Peter; Dang, Nam H; Oki, Yasuhiro

    2015-11-01

    A phase II study was performed to evaluate the efficacy of hyper-fractionated cyclophosphamide, vincristine, pegylated liposomal doxorubicin and dexamethasone alternating with methotrexate/cytarabine (HCVIDD/MA) in patients with newly diagnosed peripheral T-cell lymphoma (PTCL), excluding ALK-positive anaplastic large cell lymphoma. Fifty-three patients were enrolled. Treatment was planned for up to 8 cycles but only 9% of patients received more than 6 cycles due primarily to disease progression (n = 13) or prolonged thrombocytopenia (n = 12). The overall response rate was 66% with a complete response rate of 57%. Median progression-free survival (PFS) was 7·5 months. With a median follow-up of 7·6 years, 5-year PFS and overall survival (OS) were 21% and 48%, respectively. The patients with extranodal Natural Killer-cell lymphoma had a shorter PFS (median, 2·4 months) than other subtypes. Grade 3/4 anaemia, neutropenia and thrombocytopenia were observed in 66%, 74% and 79% of patients, respectively. Of note, 23% of patients discontinued therapy due to prolonged thrombocytopenia. In conclusion, HCVIDD/MA for the first-line treatment of PTCL patients is associated with significant myelosuppression leading to poor treatment adherence, and the response and survival outcomes with this regimen are similar to standard CHOP. This study was registered at www.clinicaltrials.gov as #NCT00290433. PMID:26260306

  20. Different facets of schizophrenia illustrated by the analysis of the homes of three patients diagnosed with schizophrenia.

    Science.gov (United States)

    Murawiec, S?awomir; Britmann, Jonathan; Krysta, Krzysztof

    2013-09-01

    Diagnosis and observation of patients' behaviour during outpatient visits or hospitalisations strips the diagnostic process of the opportunity to consider their places of residence as their natural environment. In this way, patients present their symptoms and problems outside of the context of their daily life. Community-based psychiatric care, on the other hand, provides a chance to include, in the diagnostic process the environment created by a patient in their home. This image of a patient's external reality can reflect a certain mental reality. Such elements as furniture and other objects, their number, quality, distribution may reflect the inner mental world of the objects featuring in a person's mind. In some cases, this can become a valuable contribution to a diagnostic process. A description of three patients, all treated for schizophrenia, has been presented in this paper in order to explore this possible relationship. The first individual, "Patient N" lives in a flat in a state of extreme depletion of elements. "Patient N" suffers from chronic schizophrenia with severe negative symptoms. The second individual, "Patient D", has been also diagnosed with schizophrenia. Yet his home is filled with a huge number of elements, writings on the wall, things, figurines and objects of symbolic meaning. A closer examination of his psychopathological symptoms (fantastic, colourful, bizarre content) and history of his illness (unstable diagnosis of schizophrenia), and unpredictable response to antipsychotics may indicate a dissociative type of schizophrenia. Finally, "Patient K's" main living space is dominated by cats that live with him. Patient K was exposed to physical violence as a child and to him cats represent safe, non-threatening objects. He has been also treated for paranoid schizophrenia. The differences between these patients' personal histories and the courses of their illnesses are clearly manifested in the way they create their immediate environment. PMID:23995151

  1. Analysis of clinical features of five multiple sclerosis patients with positive serum aquaporin 4 antibody

    Directory of Open Access Journals (Sweden)

    Yang HE

    2015-03-01

    Full Text Available Objective To investigate the clinical features of multiple sclerosis (MS patients with positive serum aquaporin 4 (AQP4 antibody.  Methods A total of 18 MS patients who had been diagnosed in accord with McDonald Criteria (2010 were enrolled and were divided into AQP4 positive group (N = 5 and AQP4 negative group (N = 13. In combination with accessory examination, clinical features and laboratory data of MS patients were correlatively studied between 2 groups in association with follow-up study in Outpatient Clinic.  Results Five seropositive patients, including 2 men and 3 women, were collected. The median age of onset was 43 years and the median clinical course was 4 months. Compared with patients with negative AQP4 antibody, MS patients with positive AQP4 antibody demonstrated increased spinal cord lesions and optic nerve involvement. MRI revealed multiple abnormal long T1 and long T2 signals in brain and cervicothoracic spinal cord (3/5, and multiple  abnormal long T1 and long T2 signals in cervicothoracic spinal cord (2/5 in seropositive group. Relatively more patients in seropositive group had increased cerebral spinal fluid (CSF IgG index (4/4 and 24 h intrathecal IgG synthesis rate (3/4, and positive oligoclonal bands (OBs, 3/4. Two patients presented with positive anti-nuclear antibody (ANA and one Sjögren's syndrome (SS in seropositive group.  Conclusions There were some differences in clinical features between AQP4 antibody positive MS and classical MS, suggesting distinctive pathogenesis may exist between these two entities, which need to be emphasized and treated accordingly from the diagnostic and therapeutic points of view. HE Yang and YANG Ting-ting contributed equally to this studyDOI: 10.3969/j.issn.1672-6731.2015.03.012

  2. Exploring Patient Activation in the Clinic: Measurement from Three Perspectives

    Science.gov (United States)

    Ledford, Christy J. W.; Ledford, Christopher C.; Childress, Marc A.

    2013-01-01

    Objective. To further conceptualize and operationalize patient activation (PA), using measures from patient, physician, and researcher perspectives. Data Source/Study Setting. Multimethod observation in 2010 within a family medicine clinic. Study Design. Part of an intervention with 130 patients with type 2 diabetes, this observational study…

  3. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea

    OpenAIRE

    Rajesh KUMAR; Farahvar, Salar; Ogren, Jennifer A.; Macey, Paul M; Thompson, Paul M.; Woo, Mary A; Yan-Go, Frisca L.; Harper, Ronald M

    2014-01-01

    Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-we...

  4. Seven-Year Follow-up of Patients Diagnosed with Atypical Odontalgia : A Prospective Study

    DEFF Research Database (Denmark)

    Pigg, Maria; Svensson, Peter

    2013-01-01

    Aims: To examine the long-term prognosis of 46 previously examined atypical odontalgia (AO) patients. Methods: In 2002 and 2009, AO patients completed validated instruments measuring pain characteristics (pain frequency and intensity), physical functioning (Graded Chronic Pain Severity, GCPS) and emotional functioning (Symptoms Checklist, SCL-90R). The main outcome was global improvement. Baseline data on quantitative somatosensory testing and responsiveness to lidocaine injection were available for a subgroup of patients. Paired tests compared baseline and follow-up data, and logistic regression explored the possible prognostic value of baseline data. Results: Data from 37 patients (80%) were obtained. Thirteen patients (35%; 95% confidence intervals [CI] 20.2%-52.5%) rated their overall pain status as significantly improved, 22 (60%; 95% CI 42.1%-75.3%) as a little improved or unchanged, and two patients (5%; 95% CI 0.7%-18.2%) as worse. Five patients (14%; 95% CI 4.5%-28.8%) were pain-free, indicated by a characteristic pain intensity score of 0. Average pain intensity decreased (from 5.7 ± 2.0 to 3.5 ± 2.4; P <.001). Pain frequency (P <.001) and GCPS (P <.001) also decreased, whereas SCL-90R scores remained unchanged and 26 of the 37 patients reported ongoing treatment. Low baseline pain intensity was the only factor predictive of favorable outcome. Conclusion: A third of the AO patients improved considerably over time, but for many of the patients, AO was a persistent and treatment-resistant condition.

  5. Severe myoclonic epilepsy of infancy (Dravet syndrome: Clinical and genetic features of nine Turkish patients

    Directory of Open Access Journals (Sweden)

    Meral Özmen

    2011-01-01

    Full Text Available Purpose: Mutations of the a-1 subunit sodium channel gene (SCN1A cause severe myoclonic epilepsy of infancy (SMEI. To date, over 300 mutations related to SMEI have been described. In the present study, we report new SCN1A mutations and the clinical features of SMEI cases. Materials and Methods: We studied the clinical and genetic features of nine patients diagnosed with SMEI at the Pediatric Neurology Department of Istanbul Medical Faculty. Results: Five patients had nonsense mutations, two had missense mutations, one had a splice site mutation and one had a deletion mutation of the SCN1A gene. Mutations at c.3705+5G splice site, p.trip153X nonsense mutation and deletion at c.2416_2946 have not been previously described. The seizures started following whole cell pertussis vaccination in all patients. The seizures ceased in one patient and continued in the other eight patients. Developmental regression was severe in three patients, with frequent status epilepticus. The type of mutation was not predictive for the severity of the disease. Two of the three patients with severe regression had nonsense and missense mutations. Conclusions : Dravet syndrome can be result of several different types of mutation in SCN1A gene. Onset of the seizures after pertussis vaccination is an important clue for the diagnosis and neuro- developmental delay should be expected in all patients.

  6. Evalution of Clinical and Sociodemograpic Features of Patients with Psoriasis in the Konya Region

    Directory of Open Access Journals (Sweden)

    Caner Aykol

    2011-11-01

    Full Text Available Objective: Psoriasis is a chronic inflammatory dermatosis with silvery-white coloured squamas and is characterized by erythematous papules and plaques. Psoriasis is seen in 1-2% of the normal population. In this study we aim to introduce the clinical and demographic features of patients with psoriasis in our region.Materials and Methods: 640 patients being followed in our psoriasis polyclinic between May 2006 and April 2010 were evaluated retrospectively.Results: Patients diagnosed with psoriasis constituted the 0.7% who visited our polyclinic. Three hundred and twenty one of the patients were female and 319 were male. A history of psoriasis was observed in at least one of the first or second degree relatives of 25.6% of patients with psoriasis. The most common concomitant disease in patients was hypertension. 97.6% of the patients had psoriasis vulgaris and 2.34% had pustular psoriasis. Nail involvement and psoriatic arthritis were detected in 37.6% and 5.62% of the patients.Conclusion: In our study, the clinical and sociodemographic features of psoriasis is found to be similar to other studies carried out in Turkey and in European societies. Female/Male ratio is equal.The most prevalent psoriasis type is plaque type and the most frequent nail finding is pitting. The onset of the disease is more widespread in the third decade. The most common comorbidity is hypertension.

  7. Survey for primary tumor site in patients with initial clinical presentation of bone metastasis

    International Nuclear Information System (INIS)

    Among the patients who were examined with bone scintigraphy between April 1985 and March 1991, there were 27 patients whose initial clinical manifestation was bone metastasis and who were surveyed for the primary tumor site. The primary tumor site could be identified in 20 patients (74%), consisting of 9 patients with lung cancer, 3 with prostate cancer, 3 with hepatoma, 2 with renal cancer, and one each with thyroid cancer, adrenal cancer, and pleural malignant mesothelioma. In 17 of the 20 patients, the primary site had been detected within two months after presentation. Examinations which were helpful in identifying the primary site included chest radiography, sputum cytology, abdominal sonography, serum prostatic acid phosphatase level and pathologic examination of biopsy specimens. 99mTc-pyridoxylenemethyl tryptophan (99mTc-PMT) scintigraphy was useful in the diagnosis of the hepatoma when accumulation was observed at the metastatic sites. In 2 patients, lung cancer had been recognized using follow-up chest, radiography 3 and 6 months after presentation, respectively. One patient was diagnosed at autopsy as having adrenal cancer. In 7 patients the primary site remains unknown. Histology examination of the biopsy specimen performed in 6 of these patients revealed 4 to be adenocarcinoma and 2 undifferentiated carcinoma. The average survival period of the 17 patients who died was 9.5 months. Four patients are alive, and the outcome in the remaining 6 could not be determined. (author)

  8. Epidemiology and clinical study of phenylketonuria (PKU patients in Khorasan Province; Norteast Iran

    Directory of Open Access Journals (Sweden)

    Negar Morovatdar

    2015-03-01

    Full Text Available Epidemiology and clinical study of phenylketonuria (PKU patients in Khorasan Province; Norteast Iran Background: Phenylketonuria is an autosomal recessive disease. Early diagnosis is a important public health intervention to prevent neurological impairment .This study was designed to describe characteristics of phenylketonouria patients in Khorasan ,Northeast of Iran. Methods: We included all ?? patients suffering from PKU in khorasan until September 2013. We gathered the variables like diagnosis age , sib of parents, cause of asking physician and screening based diagnosis or clinical based diagnosis. We use descriptive statistics for analysis. Results: The mean age of diagnosis was 19 months .80% pku patients had a positive history of consanguineous marriage in their parents. Incidence of new cases that identified by screening in 2012-2013 was 57 per 1000000 live birth. 10% patients identified with screening in first week of birth. Conclusion: Nearly all of our patients (90% had been diagnosed without screening in the first days of their life only due to clinical manifestations in the first year of their life . According to efficacy of early diagnosis and dietary treatment, enforcement of public health policy for screening is a critical public health preventive intervention.

  9. Has the time to come leave the “watch-and-wait” strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    International Nuclear Information System (INIS)

    Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the administration of four weekly rituximab doses should be considered

  10. Has the time to come leave the “watch-and-wait” strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    Directory of Open Access Journals (Sweden)

    Rueda Antonio

    2012-05-01

    Full Text Available Abstract Background Historically, the median overall survival for follicular lymphoma (FL has been considered to be 9-10?years, and no treatment had ever prolonged this time period. Studies conducted more than 20?years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10?years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. Discussion The introduction of antiCD-20 monoclonal antibodies, over the last 15?years, has significantly increased the median survival rate to above 14?years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. Summary There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the administration of four weekly rituximab doses should be considered.

  11. Análise retrospectiva das neoplasias de ânus em pacientes atendidos no HC-FMRP-USP de 1979 a 2004 e revisão da literatura Retrospective analysis of patients with anal tumors diagnosed at the school of medicine of Ribeirão Preto Hospital and clinics (HC-FMRP, between 1979 and 2004 and literature review

    Directory of Open Access Journals (Sweden)

    Rogério Serafim Parra

    2007-06-01

    Full Text Available Foram analisados, retrospectivamente, 49 casos de pacientes com neoplasia de ânus, sendo 23 de 1979-1996 e 26 de 1997-2004, 49% masculinos e 51% femininos. Em 81,6% dos pacientes o tratamento foi adjuvante, com radioterapia e esquema de NIGRO, 12,2% metástases à distância e 36,7% perderam o seguimento. Óbitos ocorreram em 20,4%. Notou-se diminuição da necessidade da cirurgia de Miles (30,8% vs 43,3%. A perda de seguimento foi menor (19,5% vs 56,5%, mas a mortalidade foi discretamente maior (23,1% vs 17,4%. O tratamento neo-adjuvante com radio e quimioterapia em 96% dos pacientes com neoplasia anal foi capaz de promover remissão da lesão na maioria dos casos (57,5%, confirmados pela biópsia da cicatriz residual, evitando-se amputação cirúrgica do reto. Dados mais recentes mostram que 45% dos pacientes permanecem sem recidiva (seguimento médio 3,5 anos. A alta taxa de mortalidade e o diagnóstico de lesões avançadas podem decorrer da procura tardia do serviço médico.In total, 49 cases of anal tumor were studied, 23 cases from 1979-1996 and 26 cases from 1997-2004. From the cases studied, 49 % were male and 51 % were female patients. Patients that were submitted to radio and chemotherapy by the "nigro scheme" totalized 81.6 %; 12.2 % presented metastasis, 36.7 % lost follow up and 20.4 % died. There was a reduction of the Miles surgery indication (30.8 % vs 43.3 % and the follow up loss (19.5 % vs 56.5 %. The mortality rate was a little higher (23.1 % vs 17.4 %. Radio and chemotherapy was used in 96 % of patients, and promoted lesion remission in 57.5 % of cases (confirmed by negative anal scar biopsy, avoiding the anal amputation surgery indication. Recent data indicate that 45 % of patients (3.5 years of average follow up are still with no recidivated tumor. The prevalence of high mortality rates and the diagnosis of high stage lesions are due to a delay of patients in search for a diagnosis. This might be due to a difficult access to a medical service and to the low social-economical level of our patients. These conditions make the diagnosis and treatment of anal tumors difficult, impairing its prognosis.

  12. Análise retrospectiva das neoplasias de ânus em pacientes atendidos no HC-FMRP-USP de 1979 a 2004 e revisão da literatura / Retrospective analysis of patients with anal tumors diagnosed at the school of medicine of Ribeirão Preto Hospital and clinics (HC-FMRP), between 1979 and 2004 and literature review

    Scientific Electronic Library Online (English)

    Rogério Serafim, Parra; Andreza Regina de, Brito; José Joaquim Ribeiro da, Rocha; Omar, Féres.

    2007-06-01

    Full Text Available Foram analisados, retrospectivamente, 49 casos de pacientes com neoplasia de ânus, sendo 23 de 1979-1996 e 26 de 1997-2004, 49% masculinos e 51% femininos. Em 81,6% dos pacientes o tratamento foi adjuvante, com radioterapia e esquema de NIGRO, 12,2% metástases à distância e 36,7% perderam o seguimen [...] to. Óbitos ocorreram em 20,4%. Notou-se diminuição da necessidade da cirurgia de Miles (30,8% vs 43,3%). A perda de seguimento foi menor (19,5% vs 56,5%), mas a mortalidade foi discretamente maior (23,1% vs 17,4%). O tratamento neo-adjuvante com radio e quimioterapia em 96% dos pacientes com neoplasia anal foi capaz de promover remissão da lesão na maioria dos casos (57,5%), confirmados pela biópsia da cicatriz residual, evitando-se amputação cirúrgica do reto. Dados mais recentes mostram que 45% dos pacientes permanecem sem recidiva (seguimento médio 3,5 anos). A alta taxa de mortalidade e o diagnóstico de lesões avançadas podem decorrer da procura tardia do serviço médico. Abstract in english In total, 49 cases of anal tumor were studied, 23 cases from 1979-1996 and 26 cases from 1997-2004. From the cases studied, 49 % were male and 51 % were female patients. Patients that were submitted to radio and chemotherapy by the "nigro scheme" totalized 81.6 %; 12.2 % presented metastasis, 36.7 % [...] lost follow up and 20.4 % died. There was a reduction of the Miles surgery indication (30.8 % vs 43.3 %) and the follow up loss (19.5 % vs 56.5 %). The mortality rate was a little higher (23.1 % vs 17.4 %). Radio and chemotherapy was used in 96 % of patients, and promoted lesion remission in 57.5 % of cases (confirmed by negative anal scar biopsy), avoiding the anal amputation surgery indication. Recent data indicate that 45 % of patients (3.5 years of average follow up) are still with no recidivated tumor. The prevalence of high mortality rates and the diagnosis of high stage lesions are due to a delay of patients in search for a diagnosis. This might be due to a difficult access to a medical service and to the low social-economical level of our patients. These conditions make the diagnosis and treatment of anal tumors difficult, impairing its prognosis.

  13. Patient attendance at a UK dental hospital emergency clinic.

    Science.gov (United States)

    Nayee, S; Kutty, S; Akintola, D

    2015-11-27

    A questionnaire survey was performed within a dental emergency clinic at a London teaching hospital to determine patients' reasons for attendance and satisfaction with their care. Questionnaires were distributed to all patients registering for the dental emergency clinic over a four week period. A total of 1,058 questionnaires were returned, with an average satisfaction score of 9.3/10. The majority of patients (58%) reported symptomatic dental attendance. Common reasons for irregular attendance were lack of perceived 'need' for care and concerns about cost of care. Patients with irregular attendance were significantly more likely to report their past dental care had been affected by cost than regular attenders. Fifty-one percent of all respondents had tried to make an appointment with a dentist prior to attending the emergency clinic, and 21% of patients with a GDP reporting difficulty accessing urgent care at their practice. Forty-nine percent of patients attending the emergency clinic were referred to oral surgery clinics. Overall, this survey revealed high levels of satisfaction with care in this dental emergency clinic. Patients' reasons for attendance at the clinic can be considered in terms of 'push' and 'pull' factors, deterring them from primary dental care and drawing them into secondary/tertiary care environments. PMID:26611303

  14. Patient attitudes to clinical trials: development of a questionnaire and results from asthma and cancer patients.

    OpenAIRE

    Jenkinson, C; Burton, JS; Cartwright, J; Magee, H.; Hall, I.; Alcock, C.; Burge, S.

    2005-01-01

    OBJECTIVE: To develop a questionnaire to assess patients' views of clinical trials, and to report the results from the questionnaire in two patient groups: asthma and cancer. DESIGN: A 43 item questionnaire asking patients about their views to clinical trials was developed on the basis of interviews with trialists and focus groups with patients. The questionnaire was mailed to patients with a diagnosis of either asthma or cancer. A set of items was then selected, via statistical analyses, to ...

  15. Lesiones de colon diagnosticadas por colonoscopia en pacientes con sangre oculta positiva / Colon lesion diagnosed by colonoscopy in patients with hidden positive blood

    Scientific Electronic Library Online (English)

    Pedro, del Valle Llufrio; Sandra Rocío, Romero Bareiro; Yenia, Santana Fuentes.

    Full Text Available Se realizó un estudio observacional, descriptivo, transversal, a todos los pacientes con sangre oculta positiva en heces fecales, a los cuales se le realizó colonoscopia, en el servicio de gastroenterología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez, de Matanzas, en el p [...] eríodo comprendido de junio 2013 a junio 2014, con universo de 104 pacientes, previo consentimiento informado, con el objetivo de caracterizar las lesiones diagnosticadas. Se confeccionó una planilla de recolección de información (edad, sexo, positividad de colonoscopia y lesiones diagnosticadas). Los resultados se representaron en números y por cientos, mediante tablas o gráficos. Se concluyó que predominaron los pacientes entre 50 y 55 años, el sexo femenino, de ellos el 76,92 % presentó algún tipo de lesión en el colon, 15,09 % con cáncer de colon y 2,83 % cáncer de recto, lo cual reafirma la importancia de este método de pesquisa para el diagnóstico precoz de estas patologías. Abstract in english We carried out an observational, descriptive, cross-sectional study to all the patients with hidden positive blood in fecal feces who were submitted to colonoscopy in the gastroenterology service of the Teaching Clinic-Surgical Hospital Faustino Pérez, of Matanzas, in the period from June 2013 to Ju [...] ne 2014; the universe were 104 patients who gave their previous informed consent, and the aim was characterizing the diagnosed lesions. We elaborated a form for collecting information (age, gender, colonoscopy positivity and diagnosed lesions). Results were given in numbers and percents and displayed in tables and pictures. We arrived to the conclusion that there was a predominance of female patients aged 50-55 years; 76,92 % of them had some kind of colon lesions; 15,09 % had colon cancer and 2,83 % rectum cancer, confirming the importance of this testing method for the precocious diagnosis of these pathologies.

  16. Validity of the recorded International Classification of Diseases, 10th edition diagnoses codes of bone metastases and skeletal-related events in breast and prostate cancer patients in the Danish National Registry of Patients

    Directory of Open Access Journals (Sweden)

    Annette Østergaard Jensen

    2009-07-01

    Full Text Available Annette Østergaard Jensen1, Mette Nørgaard1, Mellissa Yong2, Jon P Fryzek2, Henrik Toft Sørensen11Department of Clinical Epidemiology, Aarhus University hospital, Århus, Denmark; 2Global Epidemiology, Amgen inc., Thousands Oaks, CA, USAObjective: The clinical history of bone metastases and skeletal-related events (SREs secondary to cancers is not well understood. In support of studies of the natural history of bone metastases and SREs in Danish prostate and breast cancer patients, we estimated the sensitivity and specificity of hospital diagnoses for bone metastases and SREs (ie, radiation therapy to the bone, pathological or osteoporotic fractures, spinal cord compression and surgery to the bone in a nationwide medical registry in Denmark.Study design and setting: In North Jutland County, Denmark, we randomly sampled 100 patients with primary prostate cancer and 100 patients with primary breast cancer diagnoses from the National Registry of Patients (NRP, during the period January 1st, 2000 to December 31st, 2000 and followed them for up to five years after their cancer diagnosis. We used information from medical chart reviews as the reference for estimating sensitivity, and specificity of the NRP International Classification of Diseases, 10th edition (ICD-10 coding for bone metastases and SRE diagnoses. Results: For prostate cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.54 (95% confidence interval [CI]: 0.39–0.69, and the specificity was 0.96 (95% CI: 0.87–1.00. For breast cancer, the overall sensitivity of bone metastases or SRE coding in the NRP was 0.58 (95% CI: 0.34–0.80, and the specificity was 0.95 (95% CI: 0.88–0.99. Conclusion: We measured the validity of ICD-10 coding in the Danish NRP for bone metastases and SREs in prostate and breast cancer patients and found it has adequate sensitivity and high specificity. The NRP remains a valuable tool for clinical epidemiological studies of bone metastases and SREs.Keywords: bone metastases, skeletal-related events (SRE, sensitivity, specificity

  17. Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009

    Directory of Open Access Journals (Sweden)

    Sara Sblano

    2014-03-01

    Full Text Available INTRODUCTION: In spite of the benefits of autopsies, there has been in recent years a drastic decline in