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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

    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 of explanted hearts from patients with progressive cardiac disease. METHODS: The pathological findings...... of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure...

  2. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Sarpong Charity; Alidu Huseini; Amidu Nafiu; Owiredu William KBA; Gyasi-Sarpong Christian K

    2011-01-01

    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 Hos...

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

    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 (γGT≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT 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, γGT 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.

  4. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    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.

  5. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    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. The importance of biopsy in clinically diagnosed metastatic lesions in patients with breast cancer

    Qu, Qing; Zong, Yu; Fei, Xiao-chun; Chen, Xiao-song; Xu, Cheng; Lou, Gu-yin; Shen, Kun-wei

    2014-01-01

    Background Receptor status discordance, such as estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and metastatic lesions has been reported. The aim of this study was to evaluate the biopsy of clinically diagnosed metastatic lesions and to determine the changes in hormonal receptor and HER2 status of the metastatic lesions. Methods Sixty-three patients with clinically diagnosed metastatic breast cancer un...

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

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

    Koray Karabekiroğlu

    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.

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

    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.

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

    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiones-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 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months 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 7.6 months 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

  11. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Klaus Damgaard Jakobsen; Thomas Hansen; Henrik Dam; Ejnar Bundgaard Larsen; Ulrik Gether; Thomas Werge

    2008-01-01

    Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT) were used. The sensitivity, specificity, positive and negative pr...

  12. Clinical Utility of CA125 Levels in Predicting Laparoscopically Confirmed Salpingitis in Patients With Clinically Diagnosed Pelvic Inflammatory Disease

    Moore, E.; Soper, D. E.

    1998-01-01

    Objective: The purpose of this study was to determine the utility of serum CA125 determinations in diagnosing acute salpingitis.Methods: CA125 levels were determined for 34 women with the clinical diagnosis of pelvic inflammatory disease (PID). Acute salpingitis was confirmed laparoscopically in 28 women (82.3%).Results: Twenty patients (71.4%) with laparoscopically confirmed acute salpingitis had CA125 levels greater than 7.5 units, compared with no patients (0/6) with laparoscopically norma...

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

    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)

  14. A CLINICAL STUDY OF 276 PATIENTS DIAGNOSED AS SUFFERING FROM HYSTERIA

    Subramanian, Deepa; K. SUBRAMANIAN; Devaky, M. N.; Verghese, Abraham

    1980-01-01

    SUMMARY A clinical study of 276 patients diagnosed as Hysteria in the Department of Psychiatry, Unit-2, Christian Medical College, Vellore, during the period of 1970—1974 is described. This group of 276 patients formed 10.81% of the total new consultations during this period. 61.2% of these were females. The peak age of onset was 10-20 years. The majority were married. 75% of them had conversion symptoms, 20.3% had dissociative states, and 4.7% had both features. 52.5% showed possible precipi...

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

    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.

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

    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

  17. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik; Larsen, Ejner Bundgaard; Gether, Ulrik; Werge, Thomas Mears

    2008-01-01

    ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted K-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative...... = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses, on bipolar vs. non-bipolar disorders was high, K = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, K = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of...

  18. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient.

    Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Kawaguchi, Satoshi; Yokoi, Yoshihiko; Shigematsu, Hiroshi; Masuda, Munetaka

    2014-01-01

    We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients. PMID:23774613

  19. Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

    Tropp Hans

    2005-06-01

    Full Text Available Abstract Background The tissue origin of low back pain (LBP or referred lower extremity symptoms (LES may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use multiple tests and select from a range of possible diagnoses. There is a need for studies that evaluate the diagnostic performance of clinical diagnoses against available reference standards. Methods We compared blinded clinical diagnoses with diagnoses based on available reference standards for known causes of LBP or LES such as discography, facet, sacroiliac or hip joint blocks, epidurals injections, advanced imaging studies or any combination of these tests. A prospective, blinded validity design was employed. Physiotherapists examined consecutive patients with chronic lumbopelvic pain and/or referred LES scheduled to receive the reference standard examinations. When diagnoses were in complete agreement regardless of complexity, "exact" agreement was recorded. When the clinical diagnosis was included within the reference standard diagnoses, "clinical agreement" was recorded. The proportional chance criterion (PCC statistic was used to estimate agreement on multiple diagnostic possibilities because it accounts for the prevalence of individual categories in the sample. The kappa statistic was used to estimate agreement on six pathoanatomic diagnoses. Results In a sample of chronic LBP patients (n = 216 with high levels of disability and distress, 67% received a patho-anatomic diagnosis based on available reference standards, and 10% had more than one tissue origin of pain identified. For 27 diagnostic categories and combinations, chance clinical agreement (PCC was estimated at 13%. "Exact" agreement between clinical and reference standard diagnoses was 32% and "clinical agreement" 51%. For six pathoanatomic categories (disc, facet joint, sacroiliac joint, hip joint, nerve root and spinal stenosis, PCC was 33% with actual agreement 56%. There was no overlap of 95% confidence intervals on any comparison. Diagnostic agreement on the six most common patho-anatomic categories produced a kappa of 0.31. Conclusion Clinical diagnoses agree with reference standards diagnoses more often than chance. Using available reference standards, most patients can have a tissue source of pain identified.

  20. Impact of diabetes mellitus on clinical parameters and treatment outcomes of newly diagnosed pulmonary tuberculosis patients in Thailand

    Duangrithi, D; Thanachartwet, V; Desakorn, V; Jitruckthai, P; Phojanamongkolkij, K; Rienthong, S; Chuchottaworn, C; Pitisuttithum, P.

    2013-01-01

    Background To assess the clinical and laboratory parameters, response to therapy and development of antituberculosis (TB) drug resistance in pulmonary TB (PTB) patients with diabetes mellitus (DM) and without DM. Methods Using a prospective design, 227 of 310 new cases of culture-positive PTB diagnosed at the Queen Savang Vadhana Memorial Hospital and the Chonburi Hospital between April 2010 and July 2012 that met the study criteria were selected. Data regarding clinical and laboratory parame...

  1. Registration of symptoms and diagnoses in patients of a Belarussian-Dutch outpatient clinic in Gomel, October 1991 - September 1993

    Van Oostrum, I.E.A.; Svalkoul, T.J.F. [National Poison Control Centre, RIVM, Bilthoven (Netherlands); Joore, J.C.A. [Department of Intensive Care and Clinical Toxicology, AZU, Utrecht (Netherlands); Volkova, G.V.; Savkova, M.I.; Derzhitski, V.E. [Gomel Regional Specialized Dispensary, Gomel (Belarus); Bootsma, P.A. [Bureau for International Cooperation, RIVM, Bilthoven (Netherlands)

    1995-09-01

    The results of a survey of the medical consumption of 4,500 patients at the Belarussian-Dutch Outpatient Clinic in Gomel during 1991-1993 are presented and discussed. Analysis of the patient registration data was focused on complaints related to possible enhanced radiation exposure of the patients since the reactor incident at Chernobyl in 1986. The pattern of complaints and diagnoses was comparable to the situation in a Dutch outpatient clinic, except for a higher number of goitre, gastritis, gastric and duodenal ulcers. Diagnoses that could be attributed to increased radiation exposure were not enhanced compared to the pattern in a Dutch population of similar size, except for a higher number of thyroid disease. 19 refs.

  2. Registration of symptoms and diagnoses in patients of a Belarussian-Dutch outpatient clinic in Gomel, October 1991 - September 1993

    The results of a survey of the medical consumption of 4,500 patients at the Belarussian-Dutch Outpatient Clinic in Gomel during 1991-1993 are presented and discussed. Analysis of the patient registration data was focused on complaints related to possible enhanced radiation exposure of the patients since the reactor incident at Chernobyl in 1986. The pattern of complaints and diagnoses was comparable to the situation in a Dutch outpatient clinic, except for a higher number of goitre, gastritis, gastric and duodenal ulcers. Diagnoses that could be attributed to increased radiation exposure were not enhanced compared to the pattern in a Dutch population of similar size, except for a higher number of thyroid disease. 19 refs

  3. Lifestyle and clinical factors associated with elevated C-reactive protein among newly diagnosed Type 2 diabetes mellitus patients

    Svensson, Elisabeth; Mor, Anil; Rungby, Jørgen; Berencsi, Klara; Nielsen, Jens Steen; Stidsen, Jacob V; Friborg, Søren; Brandslund, Ivan; Christiansen, Jens Sandahl; Beck-Nielsen, Henning; Toft Sørensen, Henrik; Thomsen, Reimar W

    2014-01-01

    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...

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

    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 pat...

  5. Generating Evidence for Clinical Benefit of PET/CT in Diagnosing Cancer Patients

    Vach, Werner; Høilund-Carlsen, Poul Flemming; Gerke, Oke; Weber, Wolfgang A

    For diagnostic methods such as PET/CT, not only diagnostic accuracy but also clinical benefit must be demonstrated. However, there is a lack of consensus about how to approach this task. Here we consider 6 clinical scenarios to review some basic approaches to demonstrating the clinical benefit of...... PET/CT in cancer patients: replacement of an invasive procedure, improved accuracy of initial diagnosis, improved accuracy of staging for curative versus palliative treatment, improved accuracy of staging for radiation versus chemotherapy, response evaluation, and acceleration of clinical decisions....... We also develop some guidelines for the evaluation of clinical benefit. First, it should be clarified whether there is a direct benefit of the use of PET/CT or an indirect benefit because of improved diagnostic accuracy. If there is an indirect benefit, then decision modeling should be used initially...

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

    Ana Carolina Souza, Porto; Renata Borges Fortes Costa, Figueira; Jaison Antnio, Barreto; Jos 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 So 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 So Paulo. METHODS: Retrospective descriptive study. Data of all new leprosy cases diagnosed between 01/2007 and 12/2011 were raised in So 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

  7. Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Lebers Hereditary Optic Neuropathy

    Haluk Esgin

    2012-09-01

    Full Text Available Objective: To investigate possible mitochondrial DNA (mtDNA mutations in patients with Lebers 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.

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

    '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)

  9. Identification of the c.2448-25G>A Polymorphism in Patients Clinically Diagnosed with Wilson's Disease

    Yulia Clark Feoktistova

    2015-11-01

    Full Text Available Background: Wilson's disease is characterized by copper accumulation in the liver, brain and cornea. It is caused by mutations in the ATP7B gene. Several polymorphisms in the ATP7B gene have been reported in the literature.Objective: to identify conformational changes in the fragment comprising intron 9-exon 10 for detecting the c.2448-25G> A polymorphism in the ATP7B gene of Cuban patients clinically diagnosed with Wilson's disease.Methods: a descriptive study including 100 patients with clinical diagnosis of Wilson's disease was conducted at the National Medical Genetics Center from 2008 to 2012. The polymerase chain reaction was used to amplify the fragment of interest and the single-strand conformation polymorphism was applied in the intron 9-exon 10 region of the ATP7B gene to identify conformational changes. Presence of the c.2448-25G> A polymorphism was detected by sequencing this fragment.Results: the conformational change called b corresponded to the c.2448-25G> A polymorphism in heterozygous state. The allele frequency of the c.2448-25G> A polymorphism in 100 Cuban patients clinically diagnosed with Wilson's disease was 8.5%. The most common manifestations in patients with this polymorphism were related to the liver.Conclusion: the c.2448-25G> A polymorphism was identified in Cuba for the first time, which will enable molecular studies by indirect methods.

  10. Clinical, Radiographic, and Pathologic Findings in Patients Undergoing Reoperation Following Radiation Therapy and Temozolomide for Newly Diagnosed Glioblastoma

    Ellsworth, Susannah; Ye, Xiaobu; Grossman, Stuart A.

    2016-01-01

    Purpose Patients with glioblastoma (GBM) frequently deteriorate clinically and radiographically after chemoradiation and may require repeat surgical intervention. We attempted to correlate pathologic findings with preoperative clinical characteristics and survival in patients undergoing reoperation for GBM. Materials and Methods Patients eligible for this retrospective analysis had pathologically confirmed GBM diagnosed between 2005 and 2010, received standard radiation and temozolomide, and underwent repeat resection within 18 months of diagnosis. Results Thirty-eight patients were identified. Median age was 56 years (range, 30 to 80 y), 55% were male, and 66% had baseline performance status ≥90%. Median survival was 16.3 months (95% confidence interval [CI], 13.3–19.8) from initial surgery. At reoperation, 21% of patients had no pathologically evident tumor. Median time from initial diagnosis to second surgery was similar in patients with and without evident tumor (8.5 vs. 8.8 mo, respectively). Patients without evident tumor tended to have a worse performance status. Median overall survival from second surgery was 7 months (95% CI, 4.2–10.1) and 9.1 months (95% CI, 2.1–25.3) for patients with and without evident tumor, respectively. Multivariate proportional hazards analysis showed a hazard ratio for death of 0.61 (95% CI, 0.25–1.49) for patients without evident tumor after adjusting for Karnofsky performance status and second surgical procedure. Conclusions GBM patients with and without disease recurrence have similar clinical characteristics at the time of second surgical resection. Pathologic outcomes were not correlated with specific clinical or radiologic characteristics, including the time from diagnosis to reoperation. There was a trend toward improved overall survival among patients without evident tumor at reoperation. PMID:26491903

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

    Raza Syed A

    2009-12-01

    Full Text Available 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 diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved by consensus. Results Twenty-six patients agreed to participate and formed the study population. Of these, 6 subjects were not included in the final assessment following the pre-scan clinical investigation. This is because one subject had complete cessation of symptoms between the time of the referral and entry into the trial. Another five had developed bilateral shoulder pain during the same period. The mean age of the 20 subjects forming the study population was 50.2 (range 32-69 years (SD = 10.9 and the mean duration of symptoms was 22.6 (range .75 to 132 months (SD = 40.1. Of the 20 subjects included in the formal analysis, 13 subjects (65% demonstrated neovascularity in the symptomatic shoulder and 5 subjects (25% demonstrated neovascularity in the asymptomatic shoulder. The subject withdrawn due to complete cessation of symptoms was not found to have neovascularity in either shoulder and of the 5 withdrawn due to bilateral symptoms; two subjects were found to have signs of bilateral neovascularity, one subject demonstrated neovascularity in one shoulder and two subjects in neither shoulder. Conclusions This study demonstrated that neovascularity does occur in subjects with a clinical diagnosis of rotator cuff tendinopathy and to a lesser extent in asymptomatic shoulders. In addition, the findings of this investigation did not identify an association between the presence of neovascularity; and pain, duration of symptoms or shoulder function. Future research is required to determine the relevance of these findings.

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

    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)

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

    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)

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

    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. (orig.)

  15. Patients Newly Diagnosed with Clinical Type 2 Diabetes during Oral Glucocorticoid Treatment and Observed for 14 Years: All-Cause Mortality and Clinical Developments

    Olivarius, Niels de Fine; Siersma, Volkert; Dyring-Andersen, Beatrice; Drivsholm, Thomas Bo; Hansen, Lars J; Henriksen, Jan Erik

    2010-01-01

    ? Chronic exposure to glucocorticoids (GCs) has many side effects including glucose intolerance and diabetes and may accelerate the occurrence of cardiovascular disease and increase mortality. We studied the 14-year clinical development of diabetes in patients diagnosed with diabetes during GC...... treatment. A population-based sample of 1369 people newly diagnosed with clinical type 2 diabetes underwent a clinical examination at diagnosis, and surviving patients were followed up 6 and 14?years later. Patients receiving oral GC treatment at diagnosis were compared with the other patients. Of 1369...... patients, 35 (2.6%) were treated with oral GCs at diabetes diagnosis. At that point, patients on GC therapy were older (69.9 versus 65.3?years, p?=?0.007, sex-adjusted) and tended to have lower BMI (26.1 versus 29.1?kg/m(2) , p?=?0.023), also 6?years after diagnosis (24.8 versus 28.4, p?=?0.011), than...

  16. Patients newly diagnosed with clinical type 2 diabetes during oral glucocorticoid treatment and observed for 14 years: all-cause mortality and clinical developments

    Olivarius, Niels de Fine; Siersma, Volkert Dirk; Dyring-Andersen, B.; Drivsholm, Thomas Bo; Hansen, L.J.; Henriksen, J.E.

    2011-01-01

    treatment. A population-based sample of 1369 people newly diagnosed with clinical type 2 diabetes underwent a clinical examination at diagnosis, and surviving patients were followed up 6 and 14 years later. Patients receiving oral GC treatment at diagnosis were compared with the other patients. Of 1369...... patients, 35 (2.6%) were treated with oral GCs at diabetes diagnosis. At that point, patients on GC therapy were older (69.9 versus 65.3 years, p = 0.007, sex-adjusted) and tended to have lower BMI (26.1 versus 29.1 kg/m(2) , p = 0.023), also 6 years after diagnosis (24.8 versus 28.4, p = 0.011), than......Chronic exposure to glucocorticoids (GCs) has many side effects including glucose intolerance and diabetes and may accelerate the occurrence of cardiovascular disease and increase mortality. We studied the 14-year clinical development of diabetes in patients diagnosed with diabetes during GC...

  17. Clinical and Autopsy Diagnoses of Visceral Affections of Patients Who Died Because of Complicated Burns with Multi-organ Failure.

    Taran, A; Baciu, N; Rafulea, V; German, A

    2005-12-31

    The anatomicopathological investigations carried out in a total number of 186 cadavers during the last decade were reviewed. In these retrospective studies of necropsy protocols related to different affections of visceral organ systems that evolved asymptomatically, 30.1% involved the neurological system, 36.0% the uropoiesis system, 34.4% the gastrointestinal system, 52.0% the hepatobiliary system, and 39.7% the cardiovascular system, with a prevalence in the pulmonary system of 64.2%. A comparative analysis of the incidence of affections detected in various visceral organs (on the basis of necropsy data in the 186 burn patients) and the incidence of their clinical manifestations showed that in 35% of patients with extensive and deep burns all of these conditions developed asymptomatically and were diagnosed only through autopsy. PMID:21991003

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

    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)

  19. Modifiable clinical and lifestyle factors are associated with elevated alanine aminotransferase levels in newly diagnosed type 2 diabetes patients

    Mor, Anil; Svensson, Elisabeth; Rungby, Jørgen; Ulrichsen, Sinna Pilgaard; Berencsi, Klara; Nielsen, Jens Steen; Stidsen, Jacob Volmer; Friborg, Søren; Brandslund, Ivan; Christiansen, Jens Sandahl; Beck-Nielsen, Henning; Sørensen, Henrik Toft; Thomsen, Reimar Wernich

    2014-01-01

    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....../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 <40 years old at diabetes debut [adjusted prevalence ratio (aPR): 1.96, 95% confidence interval (CI): 1.15-3.33], in those with alcohol overuse (>14...... increased C-peptide (β = 0.14, 95% CI: 0.06-0.21) and fasting blood glucose (β = 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....

  20. Clinical characteristics of emergency department heart failure patients initially diagnosed as non-heart failure

    Collins, Sean P.; Lindsell, Christopher J; Peacock, W. Frank; Eckert, Daniel C; Askew, Jeff; Storrow, Alan B

    2006-01-01

    Background Since previous studies suggest the emergency department (ED) misdiagnosis rate of heart failure is 10–20% we sought to describe the characteristics of ED patients misdiagnosed as non-decompensated heart failure in the ED. Methods We analyzed a prospective convenience sample of 439 patients at 4 emergency departments who presented with signs or symptoms of decompensated heart failure. Patients with a cardiology criterion standard diagnosis of decompensated heart failure and an ED di...

  1. Patients newly diagnosed with clinical type 2 diabetes mellitus but presenting with HbA1c within normal range: 19-year mortality and clinical outcomes

    Veloso, A.G.; Siersma, V.; Heldgaard, P.E.; Olivarius, N.de F.

    2013-01-01

    AIMS: To investigate whether long-term mortality or clinical outcomes differed between patients diagnosed with type 2 diabetes mellitus and presenting with HbA1c within or above normal range at time of diagnosis. METHODS: Data were from a population-based sample of 1136 individuals with newly...... diagnosed type 2 diabetes mellitus. The diagnosis was confirmed with a single fasting whole blood/plasma glucose ≥7.0/8.0mmol/l. The median time from day of diagnosis until end of follow up was 18.8years. Patients were grouped according to normal HbA1c and elevated HbA1c at diagnosis. The effect of elevated...

  2. The feasibility of white matter volume reduction analysis using SPM8 plus DARTEL for the diagnosis of patients with clinically diagnosed corticobasal syndrome and Richardsons syndrome

    Keita Sakurai; Etsuko Imabayashi; Tokumaru, Aya M.; Shin Hasebe; Shigeo Murayama; Satoru Morimoto; Kazutomi Kanemaru; Masaki Takao; Yuta Shibamoto; Noriyuki Matsukawa

    2015-01-01

    Purpose: Diagnosing corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP) is often difficult due to the wide variety of symptoms and overlaps in the similar clinical courses and neurological findings. The purpose of this study was to evaluate the utility of white matter (WM) atrophy for the diagnosis of patients with clinically diagnosed CBD (corticobasal syndrome, CBS) and PSP (Richardsons syndrome, RS). Methods: We randomly divided the 3D T1-weighted MR images of 18 C...

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

    Erinç SEVİNÇ

    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

  4. Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses

    Ferrari Pierre

    2008-07-01

    Full Text Available Abstract Background Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (Kiddie-SADS-PL into an in-patient adolescent clinical setting. Methods Participants were all adolescents admitted through the years 2001–2004 (N = 333 admissions, age 12–17 years. The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. Results The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. Conclusion The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings.

  5. 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

    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 20112012 influenza season in Belgium. Half of the 2250 respondents so...

  6. Frequency of the HFE C282Y and H63D mutations in Danish patients with clinical haemochromatosis initially diagnosed by phenotypic methods

    Milman, Nils; Koefoed, Pernille; Pedersen, Palle; Nielsen, Finn Cilius; Eiberg, Hans

    2003-01-01

    AIM: To assess the frequency of the C282Y and H63D mutations on the HFE gene in Danish patients with clinical hereditary haemochromatosis initially diagnosed by phenotypic methods. METHODS: In the period 1950-1985, an epidemiological survey in Denmark identified 179 patients with clinical...... idiopathic haemochromatosis diagnosed by phenotypic methods (serum transferrin saturation, serum ferritin, liver biopsy and mobilisable body iron stores). In 32 unrelated patients, frozen blood samples were available for genetic analysis. In a subsequent series of 26 unrelated Danish patients, a phenotypic...... diagnosis of clinical idiopathic haemochromatosis was made before blood samples were taken for HFE genotyping. The total series consisted of 58 patients (40 men and 18 women) with a median age of 60 yrs (range 18-74). HFE genotyping was performed by the polymerase chain reaction (PCR) technique. RESULTS...

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

    Manuel Menndez-Gonzlez

    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 Xassociated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinsons 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.

  8. A Review of the Clinical Outcomes for Patients Diagnosed with Brainstem Metastasis and Treated with Stereotactic Radiosurgery

    Lamm, Andrew F.; Elaimy, Ameer L; Lamoreaux, Wayne T; Mackay, Alexander R.; Fairbanks, Robert K.; Demakas, John J.; Cooke, Barton S.; Christopher M. Lee

    2013-01-01

    Only 3%5% of all brain metastases are located in the brainstem. We present a comprehensive review of the clinical outcomes from modern studies that treated patients with brainstem metastasis using either a Gamma Knife or a linear accelerator-based stereotactic radiosurgery. The median survival time of patients was compared to better understand what clinical or treatment factors are predictive of improved survival. This information can then be utilized to optimize patient care. The data sugge...

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

    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)

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

    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.

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

    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.

  12. Clinical, molecular, and protein correlations in a large sample of genetically diagnosed Italian limb girdle muscular dystrophy patients.

    Guglieri, Michela; Magri, Francesca; D'Angelo, Maria Grazia; Prelle, Alessandro; Morandi, Lucia; Rodolico, Carmelo; Cagliani, Rachele; Mora, Marina; Fortunato, Francesco; Bordoni, Andreina; Del Bo, Roberto; Ghezzi, Serena; Pagliarani, Serena; Lucchiari, Sabrina; Salani, Sabrina; Zecca, Chiara; Lamperti, Costanza; Ronchi, Dario; Aguennouz, Mohammed; Ciscato, Patrizia; Di Blasi, Claudia; Ruggieri, Alessandra; Moroni, Isabella; Turconi, Anna; Toscano, Antonio; Moggio, Maurizio; Bresolin, Nereo; Comi, Giacomo P

    2008-02-01

    Limb girdle muscular dystrophies (LGMD) are characterized by genetic and clinical heterogeneity: seven autosomal dominant and 12 autosomal recessive loci have so far been identified. Aims of this study were to evaluate the relative proportion of the different types of LGMD in 181 predominantly Italian LGMD patients (representing 155 independent families), to describe the clinical pattern of the different forms, and to identify possible correlations between genotype, phenotype, and protein expression levels, as prognostic factors. Based on protein data, the majority of probands (n=72) presented calpain-3 deficiency; other defects were as follows: dysferlin (n=31), sarcoglycans (n=32), alpha-dystroglycan (n=4), and caveolin-3 (n=2). Genetic analysis identified 111 different mutations, including 47 novel ones. LGMD relative frequency was as follows: LGMD1C (caveolin-3) 1.3%; LGMD2A (calpain-3) 28.4%; LGMD2B (dysferlin) 18.7%; LGMD2C (gamma-sarcoglycan) 4.5%; LGMD2D (alpha-sarcoglycan) 8.4%; LGMD2E (beta-sarcoglycan) 4.5%; LGMD2F (delta-sarcoglycan) 0.7%; LGMD2I (Fukutin-related protein) 6.4%; and undetermined 27.1%. Compared to Northern European populations, Italian patients are less likely to be affected with LGMD2I. The order of decreasing clinical severity was: sarcoglycanopathy, calpainopathy, dysferlinopathy, and caveolinopathy. LGMD2I patients showed both infantile noncongenital and mild late-onset presentations. Age at disease onset correlated with variability of genotype and protein levels in LGMD2B. Truncating mutations determined earlier onset than missense substitutions (20+/-5.1 years vs. 36.7+/-11.1 years; P=0.0037). Similarly, dysferlin absence was associated with an earlier onset when compared to partial deficiency (20.2+/-standard deviation [SD] 5.2 years vs. 28.4+/-SD 11.2 years; P=0.014). PMID:17994539

  13. Reliability of clinical ICD-10 schizophrenia diagnoses

    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...... value (87%) of ICD-10 schizophrenia and an overall good agreement between clinical and OPCRIT-derived diagnoses (kappa=0.60). An even higher positive predictive value was obtained when diagnoses were amalgamated into a diagnostic entity of schizophrenia-spectrum disorders (98%). Near perfect agreement...... was seen between OPCRIT-derived ICD-10 and DSM-IV diagnoses (kappa=0.87). Thus, this study demonstrates high reliability of the clinical diagnosis of schizophrenia and even more so of the diagnosis of schizophrenia-spectrum disorder....

  14. Low incidence of limb-girdle muscular dystrophy type 2C revealed by a mutation study in Japanese patients clinically diagnosed with DMD

    Maruyama Koichi

    2010-03-01

    Full Text Available Abstract Background Limb-girdle muscular dystrophy type 2C (LGMD2C is an autosomal recessive muscle dystrophy that resembles Duchenne muscular dystrophy (DMD. Although DMD is known to affect one in every 3500 males regardless of race, a widespread founder mutation causing LGMD2C has been described in North Africa. However, the incidence of LGMD2C in Japanese has been unknown because the genetic background remains uncharacterized in many patients clinically diagnosed with DMD. Methods We enrolled 324 patients referred to the Kobe University Hospital with suspected DMD. Mutations in the dystrophin or the SGCG genes were analyzed using not only genomic DNA but also cDNA. Results In 322 of the 324 patients, responsible mutations in the dystrophin were successfully revealed, confirming DMD diagnosis. The remaining two patients had normal dystrophin expression but absence of ?-sarcoglycan in skeletal muscle. Mutation analysis of the SGCG gene revealed homozygous deletion of exon 6 in one patient, while the other had a novel single nucleotide insertion in exon 7 in one allele and deletion of exon 6 in the other allele. These mutations created a stop codon that led to a ?-sarcoglycan deficiency, and we therefore diagnosed these two patients as having LGMD2C. Thus, the relative incidence of LGMD2C among Japanese DMD-like patients can be calculated as 1 in 161 patients suspected to have DMD (2 of 324 patients = 0.6%. Taking into consideration the DMD incidence for the overall population (1/3,500 males, the incidence of LGMD2C can be estimated as 1 per 560,000 or 1.8 per million. Conclusions To the best of our knowledge, this is the first study to demonstrate a low incidence of LGMD2C in the Japanese population.

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

    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.

  16. Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome

    Martić Vesna

    2015-01-01

    Full Text Available Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS. The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ± 14 years and 52 ± 16 years, respectively. All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95. Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is the need for neurophysiological evaluation of patients with complains in the arm.

  17. 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

    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)

  18. Reliability of clinical ICD-10 schizophrenia diagnoses

    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 ...... was seen between OPCRIT-derived ICD-10 and DSM-IV diagnoses (kappa=0.87). Thus, this study demonstrates high reliability of the clinical diagnosis of schizophrenia and even more so of the diagnosis of schizophrenia-spectrum disorder....

  19. The endoscopic and clinical characteristics of patients with erosive reflux disease diagnosed in gastroscopy unit of a regional hospital

    Mustafa Yakut

    2012-06-01

    Full Text Available Objectives: Gastroesophageal reflux disease (GERDis a common gastrointestinal disorder, presenting witha broad spectrum of symptoms and can be associatedwith a variety of complication. It has been defined intothree groups of patients: nonerosive reflux disease, erosiveesophagitis, and Barrett’s esophagus. The aim of thestudy was to evaluate patients with erosive reflux diseasein our endoscopic unit.Materials and methods: All patients underwent gastroscopywere evaluated retrospectively. H.pylori statuseswere evaluated in erosive reflux disease (ERD patients.All patients were evaluated by videoendoscopy. Evaluationwas made by the same operator at single center.Biopsy specimen was taken for H.pylori. Diagnosis ofesophagitis was done based on Los Angeles classificationcriteria.Results: All patients that underwent gastroscopy in ourEndoscopy Unit are evaluated. Endoscopically ERD wasdetected in 104 (13.5% of 773 patients. The mean age ofthe ERD patients evaluated in the study was 43.74±18.79years. Sixty five (62.3% patients were female, and 39(38.7% were male. In 104 patients with ERD, the slidinghiatal hernia and Barrett’s esophagus was seen in 18 and10 patients, respectively. H.pylori was positive in 50.9% of104 ERD patients.Conclusion: GERD is a common gastrointestinal disorderand should always be considered during gastroscopy.J Clin Exp Invest 2012; 3(2: 260-262

  20. Agreement between diagnoses reached by clinical examination and available reference standards: a prospective study of 216 patients with lumbopelvic pain

    Tropp Hans; McDonald Barry; Laslett Mark; Aprill Charles N; Öberg Birgitta

    2005-01-01

    Abstract Background The tissue origin of low back pain (LBP) or referred lower extremity symptoms (LES) may be identified in about 70% of cases using advanced imaging, discography and facet or sacroiliac joint blocks. These techniques are invasive and availability varies. A clinical examination is non-invasive and widely available but its validity is questioned. Diagnostic studies usually examine single tests in relation to single reference standards, yet in clinical practice, clinicians use ...

  1. CHD7 mutations in patients initially diagnosed with Kallmann syndrome – the clinical overlap with CHARGE syndrome

    2008-01-01

    Kallmann syndrome (KS) is the combination of hypogonadotropic hypogonadism and anosmia or hyposmia, two features that are also frequently present in CHARGE syndrome. CHARGE syndrome is caused by mutations in the CHD7 gene. We performed analysis of CHD7 in 36 patients with KS and 20 patients with normosmic idiopathic hypogonadotropic hypogonadism (nIHH) in whom mutations in KAL1, FGFR1, PROK2 and PROKR2 genes were excluded. Three of 56 KS/nIHH patients had de novo mutations in CHD7. In retrosp...

  2. Quantification of the APE2 gene expression level in Candida albicans clinical isolates from patients with diagnosed fungal infections.

    Staniszewska, M; Bondaryk, M; ?ukowski, K; Chudy, M

    2015-07-01

    The production of hydrolytic enzymes is considered a key virulence determinant of Candida albicans. Aminopeptidase 2 (Ape2) facilitates the penetration of C. albicans into the host tissue, by providing free amino acids to support fungal growth and proliferation. The objective of this study was to estimate the APE2 expression profile in C. albicans cells during invasion of the human epithelium. Sixty-one clinical fungal isolates and five reference strains were included in this study. The wild-type APE2 sequence was analyzed by polymerase chain reaction (PCR) amplification using genomic DNA from pathogenic isolates. Amplicons were verified in 1% agarose gel and visualized by illumination with ultraviolet (UV) light. The APE2 expression levels were analyzed with reverse transcription quantitative real-time PCR (RT-qPCR) and APE2 quantification was normalized against the reference gene in C. albicans cells grown in YEPD and during Caco-2 invasion. The APE2-specific PCR product band was found in all C. albicans and C. dubliniensis strains, but not in other common pathogenic fungi. APE2 transcript abundance was elevated in the clinical isolates growing on the Caco-2 cell line in comparison to their counterparts grown in YEPD. Our data indicate a potential role for Ape2 in the invasion of epithelial cells. APE2 expression is also strain-specific, and it is not related to isolation site or disease entity. PMID:25877008

  3. Frequency of nursing diagnoses in a surgical clinic

    Andreza Cavalcanti Vasconcelos

    2015-12-01

    Full Text Available Objective: to identify the frequency of Nursing Diagnoses of patients in a surgical clinic. Methods: cross-sectional study, performed with 99 patients in the postoperative of general surgery. Data were collected through a questionnaire validated according to domains of NANDA International, including physical and laboratory examination. Results: 17 nursing diagnoses were found; eight had a frequency higher than 50.0% (infection risk, impaired tissue integrity, constipation risk, anxiety, bleeding risk, acute pain, delayed surgical recovery, dysfunctional gastrointestinal motility. It was observed in all patients the Nursing Diagnostics: risk of infection, impaired tissue integrity and risk of constipation. Conclusion: the frequency of the most prevalent diagnosis is inserted in the domains safety/protection and nutrition, which determines the need to redirect nursing care, prioritizing the patient's clinic.

  4. The value of pretreatment clinical and biochemical parameters in patients with newly diagnosed untreated prostate carcinoma and no indications for bone metastases on the bone scintigram

    To determine the value of clinical and biochemical parameters for assessment of prognosis at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases. Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class 2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases were used as controls. For all parameters tested, no statistically significant differences were found between the three bone scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the risk of development of metastases only PSA was found to be a significant correlate. However, when tumour stages were clustered in limited disease (T0-2) and extensive disease (T3-4), the incidence of metastases was significantly higher in patients with extensive disease than in those with limited disease. Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise analysis PSA was selected as the most prognostic variable. In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time of diagnosis is not a poor prognostic parameter of the risk of death. (orig.)

  5. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999–2008

    Schnell Kerry

    2012-07-01

    Full Text Available Abstract Background Treatment of chronic diseases such as chronic obstructive pulmonary disease (COPD is complicated by the presence of comorbidities. The objective of this analysis was to estimate the prevalence of comorbidity in COPD using nationally-representative data. Methods This study draws from a multi-year analytic sample of 14,828 subjects aged 45+, including 995 with COPD, from the National Health and Nutrition Examination Survey (NHANES, 1999–2008. COPD was defined by self-reported physician diagnosis of chronic bronchitis or emphysema; patients who reported a diagnosis of asthma were excluded. Using population weights, we estimated the age-and-gender-stratified prevalence of 22 comorbid conditions that may influence COPD and its treatment. Results Subjects 45+ with physician-diagnosed COPD were more likely than subjects without physician-diagnosed COPD to have coexisting arthritis (54.6% vs. 36.9%, depression (20.6% vs. 12.5%, osteoporosis (16.9% vs. 8.5%, cancer (16.5% vs. 9.9%, coronary heart disease (12.7% vs. 6.1%, congestive heart failure (12.1% vs. 3.9%, and stroke (8.9% vs. 4.6%. Subjects with COPD were also more likely to report mobility difficulty (55.6% vs. 32.5%, use of >4 prescription medications (51.8% vs. 32.1, dizziness/balance problems (41.1% vs. 23.8%, urinary incontinence (34.9% vs. 27.3%, memory problems (18.5% vs. 8.8%, low glomerular filtration rate (16.2% vs. 10.5%, and visual impairment (14.0% vs. 9.6%. All reported comparisons have p  Conclusions Our study indicates that COPD management may need to take into account a complex spectrum of comorbidities. This work identifies which conditions are most common in a nationally-representative set of COPD patients (physician-diagnosed, a necessary step for setting research priorities and developing clinical practice guidelines that address COPD within the context of comorbidity.

  6. A Hybrid Approach to Determining Modification of Clinical Diagnoses

    Pakhomov, Serguei; Christopher G Chute

    2006-01-01

    Health care providers that use electronic medical records maintain an administrative database of diagnoses generated by physicians in the course of medical care delivery. This database is subsequently used for billing and reimbursement but can also be used to identify patients for clinical research. In this paper we present a hybrid rule-based and machine learning technique for automatic determination of whether a diagnosis is confirmed, probable or represents a history of a disorder. The rul...

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

    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.

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

    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)

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

    Toogood, Andrew; Brabant, Georg; Maiter, Dominique; Jonsson, Björn; Feldt-Rasmussen, Ulla; Koltowska-Haggstrom, Maria; Rasmussen, Åse Krogh; Buchfelder, Michael; Saller, Bernhard; Biller, Beverly M K

    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 μg/L is used.......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 μg/L is used....

  10. Clinical characteristics and outcome of cancer diagnosed during pregnancy

    Shim, Min Hee; Mok, Chi-Won; Chang, Kylie Hae-Jin; Sung, Ji-Hee; Oh, Soo-young; Roh, Cheong-Rae; Kim, Jong-Hwa

    2016-01-01

    Objective The aim of this study is to describe the clinical characteristics and outcome of cancer diagnosed during pregnancy. Methods This is a retrospective cohort study of women who were diagnosed with cancer during pregnancy at a tertiary academic hospital between 1995 and 2013. Maternal characteristics, gestational age at diagnosis, and type, stage, symptoms and signs of cancer for each patient were retrieved from the medical records. The cancer treatment, pregnancy management and the subsequent perinatal and maternal outcomes for each cancer were assessed. Results A total of 87 women were diagnosed with cancer during pregnancy (172.6 cases per 100,000 deliveries). The most common cancer was breast cancer (n=20), followed by gastrointestinal (n=17), hematologic (n=13), thyroid (n=11), central nervous system (n=7), cervical (n=7), ovarian (n=5), lung (n=3), and other cancers (n=4). Eighteen (20.7%) patients terminated their pregnancies. In the 69 (79.3%) patients who maintained their pregnancies, one patient miscarried and 34 patients delivered preterm. Of the preterm babies, 24 (70.6%) were admitted to the neonatal intensive care unit and 3 (8.8%) of those expired. The maternal mortality rate was 31.0%, with highest rate seen with lung cancers (66.7%), followed by gastrointestinal (50.0%), central nervous system (50.0%), hematologic (30.8%), breast (25.0%), ovarian (20.0%) cervical (14.3%), and thyroid cancers (0%). Conclusion The clinical characteristics and outcome of cancer during pregnancy were highly variable depending on the type of cancer. However, timely diagnosis and appropriate management of cancer during pregnancy may improve both maternal and neonatal outcome. PMID:26866029

  11. Study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings

    The study obtained the following conclusions by making a comparative study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings. I surveyed the value of abdominal ultrasound in 400 patients without clinical symptoms at C Health Clinic Center, Seoul. Compare with blood pressure was high (systolic/diastolic) in 7.5%/4.5% on persons who were diagnosed fatty liver. At the time of the diagnosis, Total cholesterol level was increased in fatty liver patients, HDL-cholesterol level was high in fatty liver patients. And Trigryceride level was increased in fatty liver persons, LDL-cholesterol was high in fatty liver persons. SGOT level was increased in 5.5% on patients who were diagnosed fatty liver, 0% on persons who were normal and SGPT level was high in 29.5% on people who were diagnosed fatty liver, 0% on patients who were diagnosed normal

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

    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.

  13. Factors associated with travel to non-local genitourinary medicine clinics for gonorrhoea: an analysis of patients diagnosed in London, 2009-10.

    Le Polain de Waroux, Olivier; Hughes, Gwenda; Maguire, Helen; Crook, Paul D

    2014-03-01

    We analysed factors associated with travelling to non-local genitourinary medicine clinics for gonorrhoea care in London. We used surveillance data on London residents attending genitourinary medicine clinics in 2009-10 and calculated distances between patients' areas of residence and both the nearest genitourinary medicine clinic and the clinic attended. Non-local clinics were attended by 5408 (46.7%) patients. Men having sex with men attended non-local services more than heterosexuals (OR 3.83, p Asians less likely, to attend non-local services compared to whites (OR [95%CI] 1.33 [1.04-1.72], 1.36 [1.11-1.67] and 0.46 [0.31-0.70] respectively). Similar associations, although not statistically significant, were found in women. People were more likely to attend local services if their local clinic provided walk-in and young people's services, weekend consultations and long opening hours. These findings could help design services meeting local population needs and facilitate prompt and equitable access to care. PMID:23970635

  14. Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more

    Nogueras, MaMercedes; Navarro, Gemma; Antón, Esperança; Sala, Montserrat; Cervantes, Manel; Amengual, MaJosé; Segura, Ferran

    2006-01-01

    Background Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients. Methods A prospective cohort study (1998–2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13–40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors. Results G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). Conclusion Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed. PMID:17087819

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

    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.)

  16. The long-term clinical implications of clonal chromosomal abnormalities in newly diagnosed chronic phase chronic myeloid leukemia patients treated with imatinib mesylate.

    Lee, Sung-Eun; Choi, Soo Young; Bang, Ju-Hee; Kim, Soo-Hyun; Jang, Eun-Jung; Byeun, Ji-Young; Park, Jin Eok; Jeon, Hye-Rim; Oh, Yun Jeong; Kim, Myungshin; Kim, Dong-Wook

    2012-11-01

    The aim of this study was to evaluate the long-term clinical significance of an additional chromosomal abnormality (ACA), variant Philadelphia chromosome (vPh) at diagnosis, and newly developed other chromosomal abnormalities (OCA) in patients with chronic myeloid leukemia (CML) on imatinib (IM) therapy. Sequential cytogenetic data from 281 consecutive new chronic phase CML patients were analyzed. With a median follow-up of 78.6 months, the 22 patients with vPh (P = 0.034) or ACA (P = 0.034) at diagnosis had more events of IM failure than did the patients with a standard Ph. The 5-year overall survival (OS), event-free survival (EFS), and failure-free survival (FFS) rates for patients with vPh at diagnosis were 77.8%, 75.0%, and 53.3%, respectively; for patients with ACA at diagnosis, 100%, 66.3%, and 52.1%, respectively; and for patients with a standard Ph, 96.0%, 91.3%, and 83.7%, respectively. During IM therapy, eight patients developed an OCA, which had no impact on outcomes as a time-dependent covariate in our Cox proportional hazards regression models. This study showed that vPh was associated with poor OS and FFS and that ACA had adverse effects on EFS and FFS. In addition, no OCA, except monosomy 7, had any prognostic impact, suggesting that the development of OCA may not require a change in treatment strategy. PMID:23111092

  17. Anatomical Findings in Patients with Infective Endocarditis Diagnosed at Autopsy

    Miguel Angel Serra Valds

    2013-12-01

    Full Text Available Background: Infective endocarditis continues to challenge modern medicine despite its rare occurrence in the general population. Its incidence depends on risk groups. Correlation of anatomical and pathological findings with clinical and epidemiological elements may explain the current features of this condition. Objective: to describe the anatomical features of patients with infective endocarditis diagnosed at autopsy. Methods: A descriptive study including cases of infective endocarditis diagnosed at autopsy between 1986 and 2008 was conducted in the Provincial Clinical-Surgical Hospital Celia Sanchez, Granma. The variables analyzed were: age, sex, previous anatomical lesions, location of vegetations, multi-organ embolic infarcts and embolic abscesses, complications, culture of lesions and direct causes of death. Results: frequency of infective endocarditis diagnosed at necropsy ranged annually from 0.4 to 1.5%. Native valve endocarditis without previous damage was the most frequent. The anatomical findings were more common in the left side of the heart. Right-sided nosocomial endocarditis accounted for almost a third of the deceased patients and risk factors were identified. Embolic lesions affecting various organs, systemic complications and direct causes of death showed acute infectious endocarditis. The most common pathogen was Staphylococcus aureus. Conclusion: knowing the anatomical findings may contribute to the understanding of the clinical and epidemiological aspects of this condition. Correlation between anatomical and clinical findings was low; therefore difficulties in establishing the diagnosis during life are inferred.

  18. Diagnosing patients with longstanding shoulder joint pain

    Nørregaard, J; Krogsgaard, M R; Lorenzen, T; Jensen, E M

    2002-01-01

    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. RESULTS: Tests for impingement showed poor to moderate agreement. Tenderness of muscles, muscle weakness, and tests for labral...

  19. [Clinical guidelines for diagnosing, treatment and monitoring patients with prostate cancer--Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association].

    Solarić, Mladen; Grgić, Mislav; Omrcen, Tomislav; Petković, Marija; Fröbe, Ana; Belaj, Nenad; Zorica, Robert; Kruslin, Bozo; Dordević, Gordana; Kastelan, Zeljko; Ruzić, Boris; Gilja, Ivan; Krolo, Ivan; Vilović, Katarina; Librenjak, Davor; Vrdoljak, Eduard; Situm, Marijan; Padovan, Ranka Stern; Vojnović, Zeljko

    2013-01-01

    Prostate adenocarcinoma is the second most common solid neoplasm in male population in Croatia. It rarely causes symptoms unless it is advanced. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, Gleason score and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, management, treatment and monitoring of patients with prostate cancer in the Republic of Croatia. PMID:24490329

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

    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 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 < 333 pmol/l and not LADA...

  1. [Clinical guidelines for diagnosing, treatment and monitoring patients with testicular cancer--Croatian Oncology Society and Croatian Urology Society, Croatian Medical Association].

    Grgić, Mislav; Bolanca, Ante; Ledina, Dubravka; Gugić, Damir; Solarić, Mladen; Omrcen, Tomislav; Zorica, Robert; Galić, Josip; Trnski, Davor; Pasini, Josip; Padovan, Ranka Stern; Petkovic, Marija; Balenović, Antonija; Juretić, Antonio; Kastelan, Zeljko; Gamulin, Marija

    2013-01-01

    Testicular tumors are the most common solid tumors in men between 15 and 34 years of age. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant tumors arising in the testes and they are classified either as seminoma or nonseminoma. Testicular cancers have a high cure rates even in disseminated stage of the disease. The chemotherapy mostly contributed to these results but surgery is an inevitable part of successful treatment. In a significant number of these patients treatment algorithms with minimum side effects are designed with the intention to maintain same cure rates as previously used, more aggressive therapy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis, management, treatment and follow-up of patients with testicular cancer in Republic of Croatia. PMID:24490327

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

    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...... spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence......., 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...

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

    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.

  4. Psychiatric Diagnoses among an HIV-Infected Outpatient Clinic Population.

    Shacham, Enbal; Önen, Nur F; Donovan, Michael F; Rosenburg, Neal; Overton, E Turner

    2016-03-01

    As individuals with HIV infection are living longer, the management of psychiatric disorders has increasingly been incorporated into comprehensive care. Individuals were recruited from an outpatient HIV clinic to assess the prevalence and related associations of current psychiatric disorders and biomarkers. Of the 201 participants who completed the interviews, the median age was 43.5 years, and the majority was male and African American. Most were receiving HIV therapy and 78% of those had achieved virologic suppression. Prevalent psychiatric diagnoses included major depressive disorder, generalized anxiety, and agoraphobia. Alcohol and cocaine/crack abuse and dependence were common substance use disorders. Current receipt of HIV therapy was less common among those diagnosed with generalized anxiety disorder. Agoraphobia was the only disorder associated with unsuppressed viral load. Psychiatric and substance use disorders are highly prevalent among an urban HIV clinic population, although we identified few associations between psychiatric diagnoses and HIV diseases status. PMID:25348798

  5. 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

    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%…

  6. Clinical spectrum of pulmonary hamartoma diagnosed by surgical resection

    We retrospectively reviewed our institutional experience of pulmonary hamartomas. We analyzed the records of 23 patients with pulmonary hamartomas which were diagnosed by surgical resection. There were 12 males and 11 females. Their mean age was 53.5 years old (range: 28 to 71 years). Twenty patients were asymptomatic, 2 had chest pain and 1 had a cough. Twenty-two patients had solitary and only 1 patient had multiple lesions. The tumor sizes ranged from 0.5 to 3.0 cm (mean: 1.5 cm). Graphically, 6 patients had calcification which was not popcorn-like. We could not diagnose nodules by bronchoscopic biopsy, which was preoperatively performed in 17 patients. Surgery was performed because we could not rule out malignancy in all patients. Surgical procedures consisted of 6 enucleation, 16 wedge resection and 1 lobectomy. Video-assisted thoracic surgery was performed in 17 patients. To diagnose pulmonary nodule, whose malignancy is difficult to determine, surgical resection should be considered. (author)

  7. Clinical Significance of Perineal Descent in Pelvic Outlet Obstruction Diagnosed by using Defecography

    Baek, Hyun Nam; Hwang, Yong Hee; Jung, Yong Hwan

    2010-01-01

    Purpose The aim of this study was to evaluate the clinical significance of perineal descent (PD) in pelvic outlet obstruction patients diagnosed by using defecography. Methods One hundred thirty-six patients with pelvic outlet obstruction (POO; median age 49 years) had more than one biofeedback session after defecography. Demographic finding, clinical bowel symptoms and anorectal physiological studies were compared for PD at rest and PD with dynamic changes. Results Age (r = 0.33; P < 0.001),...

  8. Survival of breast cancer patients diagnosed during pregnancy or lactation.

    Tretli, S; Kvalheim, G.; Thoresen, S.; Høst, H.

    1988-01-01

    This survival study includes 20 breast cancer patients diagnosed during pregnancy and 15 patients diagnosed during the lactation period. The survival rate of these patients is compared with that of ordinary breast cancer patients taking stage of the disease, age and calendar-year at diagnosis into account. The pregnancy group showed a significantly poorer prognosis compared with the control groups. Only 3 out of 20 survived more than 4 years. The tendency of a worse prognosis for the lactatio...

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

    Toogood, Andy; Brabant, Georg; Maiter, Dominique; Jonsson, Björn; Feldt-Rasmussen, Ulla; Koltowska-Haggstrom, Maria; Rasmussen, Åse Krogh; Buchfelder, Michael; Saller, Bernhard; Biller, Beverly M K

    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...

  10. Audiological evaluation of hearing levels in patients diagnosed with migraine

    Müjde Karadag

    2015-01-01

    Full Text Available Introduction: Based on the hypothesis that neurovascular events involving in the pathophysiology of migraine can cause hearing loss by influencing blood flow of inner ear, it was aimed to determine whether migraine with or without aura in our clinics patients are at risk for hearing loss by assessing hearing levels via a high-frequency audiometry, acoustic reflex and transient otoacoustic emission responses; to discriminate whether hearing loss is cochlear or retrocochlear originated, if present; and to evaluate whether or not migraine treatment affect hearing level in patients received treatment for migraine in this study. Materials and Methods: The study included patients who were diagnosed as migraine between December 2011 and December 2012 at Neurology Department of Cumhuriyet University, Medicine School according to ICD-II classification and accepted to receive medical therapy. In all patients, hearing levels were measured at baseline and after treatment by using high-frequency audiometry, transient otoacoustic emission and acoustic reflex tests. Results: In the present study, hearing thresholds measured in the right ear was normal in migraine patients with or without aura at baseline, while mild hearing loss was detected in right ear at the frequency of 500 Hz after treatment when hearing thresholds at different frequencies were compared. This difference was significant (P 0, 05. Conclusion: Differently from literature, hearing loss in our patients developed at lower frequencies and after treatment. The results we obtained from our study also presented that there might be a relationship between migraine disease and sensorineural hearing loss.

  11. 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)

    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)

  12. Patient specific modelling in diagnosing depression

    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...... 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...

  13. Comparação entre os diagnósticos clínicos e os achados de necropsia: análise retrospectiva de 680 pacientes Correlation between clinical and autopsy diagnoses: a retrospective analysis of 680 patients

    Marcos Emanuel de Alcântara Segura

    2006-12-01

    Full Text Available OBJETIVO: Analisar a concordância entre os diagnósticos clínicos e os achados anatomopatológicos obtidos por meio do exame necroscópico, a fim de determinar a freqüência com que a necropsia revela diagnósticos principais inesperados, que são relevantes para a causa do óbito. MÉTODOS: Foram analisadas retrospectivamente 680 necropsias realizadas no Hospital de Base do Distrito Federal (HBDF, de janeiro de 1997 a dezembro de 2002. Para a comparação entre os achados clínicos e anatomopatológicos utilizou-se a classificação de Goldman, e fez-se a correlação segundo o sexo, a idade do paciente, a unidade de internação e o tempo de permanência hospitalar. Foram utilizados, como fonte de dados, os pedidos de necropsia, preenchidos pelos médicos-assistentes, e os laudos finais de necropsia. RESULTADOS: A necropsia confirmou os diagnósticos principais formulados pela clínica em 69% das amostras. Em relação aos casos discordantes, 18% foram classificados como classe I (com potencial impacto na sobrevida do paciente e 13% como classe II (sem o questionável impacto na sobrevida do paciente. Os principais diagnósticos discordantes mais freqüentes foram doenças do aparelho circulatório (acidente vascular cerebral, insuficiência cardíaca congestiva e miocardiopatia hipertrófica, moléstias infecciosas (meningite bacteriana, tuberculose miliar e neurotoxoplasmose e neoplasias (linfomas. CONCLUSÕES: Evidenciou-se significativa discordância entre os diagnósticos clínicos e anatomopatológicos post mortem, mostrando que a necropsia ainda é um procedimento importante para o esclarecimento diagnóstico, bem como para a melhoria dos serviços de saúde.OBJECTIVE: To analyze the discrepancies between clinical and postmortem diagnoses in order to determine the frequency of relevant missed diagnoses detected at autopsy. METHOD: Six hundred and eighty patients autopsied at the Hospital de Base do Distrito Federal, Brazil, between January 1997 and December 2002 were retrospectively investigated. Agreement between clinical and postmortem findings was compared using Goldman's system. Medical records and final autopsy reports were reviewed. RESULTS: Major clinical diagnoses were confirmed in 69% of analyzed autopsies. Eighteen percent of cases were classified as Goldman class I missed diagnosis (if known before death, might have led to prolonged survival and 13% as class II (clinically missed major diagnosis for which survival would not have been changed. Most frequent missed major diagnoses were cardiovascular diseases (cerebral hemorrhagic infarction, congestive heart failure and hypertrophic cardiomyopathy, infectious diseases (purulent meningitis, miliar tuberculosis and neurotoxoplasmosis and neoplasia (lymphoma. CONCLUSION: This study has found significant disagreement between clinical and postmortem examinations and reinforces the importance of autopsy in improving clinical diagnosis and in providing data that could be integrated in quality assurance programs.

  14. Immune system markers of neuroinflammation in patients with clinical diagnose of neuromyelitis optica / Marcadores imunolgicos em pacientes com diagnstico de neuromielite ptica

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

    Full Text Available A neuromielite ptica (NMO) doena inflamatria do sistema nervoso central, caracterizada por mielite aguda ou subaguda grave e neurite ptica unilateral ou bilateral. Este estudo objetiva analisar parmetros imunolgicos de pacientes com critrios de Wingerchuck et al. (1999) para NMO. O mtodo d [...] e ELISA avaliou a produo de IgG e IgA para antgenos da protena bsica da mielina (MBP), o proteolipdeo (PLP) 95-116, a glicoproteina associada ao oligodendrcito (MOG) 92-106 e as citocinas interleucina-4 (IL-4) e interferon-gama (INF-?). Foram inclu?dos 28 pacientes com NMO pareados com controles saudveis. Pacientes com NMO apresentaram nveis 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

  15. Excess mortality in patients diagnosed with hypothyroidism

    Thvilum, Marianne; Brandt, Frans; Pedersen, Dorthe Almind; Christensen, Kaare; Hegedüs, Laszlo; Brix, Thomas Heiberg

    2013-01-01

    Background: Although hypothyroidism is associated with increased morbidity, an association with increased mortality is still debated. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism influences mortality. Methods: In an observational cohort study from...... January 1, 1978 until December 31, 2008 using record-linkage data from nationwide Danish health registers, 3587 singletons and 682 twins diagnosed with hypothyroidism were identified. Hypothyroid individuals were matched 1:4 with nonhypothyroid controls with respect to age and gender and followed over a...... mean period of 5.6 years (range 0-30 years). The hazard ratio (HR) for mortality was calculated using Cox regression analyses. Comorbidity was evaluated using the Charlson score (CS). Results: In singletons with hypothyroidism, the mortality risk was increased (HR 1.52; 95% confidence interval [CI]: 1...

  16. Estudo clnico e laboratorial de pacientes com artrite reumatoide diagnosticados em servios 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

    Juliano Maximiano David

    2013-02-01

    Full Text Available INTRODUO: Estudos epidemiolgicos brasileiros sobre artrite reumatoide so bastante escassos, e os dados existentes hoje so majoritariamente de literatura internacional. OBJETIVOS: Determinar a incidncia e algumas caractersticas clnicas e laboratoriais de pacientes com artrite reumatoide em Cascavel, PR, Brasil. PACIENTES E MTODOS: Os dados foram coletados entre agosto de 2010 e julho de 2011 em todos os servios de sade do municpio que possuam atendimento na especialidade de reumatologia: um hospital universitrio, o Centro Regional de Especialidades do Consrcio Intermunicipal de Sade do Oeste do Paran (CRE-CISOP e quatro clnicas privadas da cidade. RESULTADOS: Foram identificados 38 pacientes com diagnstico de artrite reumatoide, resultando em uma incidncia estimada de 13,4 casos/100.000 habitantes/ano. Trinta e dois pacientes eram do gnero feminino, com mdia de idade de 47,6 anos. A faixa etria com maior incidncia foi > 40 anos. O tempo mdio entre os primeiros sintomas e o diagnstico foi de 12,4 meses. O fator reumatoide foi positivo em 68,4% dos casos, e 18,4% j apresentavam alteraes radiolgicas no momento do diagnstico. O tratamento farmacolgico dos pacientes tambm foi avaliado e mostrou estar de acordo com o encontrado na literatura. CONCLUSO: A incidncia de artrite reumatoide obtida em Cascavel est abaixo das incidncias observadas em estudos internacionais.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 municipality of Cascavel, state of Paran, 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.

  17. Core criteria for diagnosing borderline patients.

    Nurnberg, H G; Feldman, A; Hurt, S W; Suh, R

    1986-01-01

    This study compares 17 hospitalized borderline personality disorder (BPD) patients with 20 normal control subjects. Four criteria sets--DSM III, Grinker, Gunderson, and Kernberg--were combined and used with the semistructured DIAGNOSTIC INTERVIEW BORDERLINES (DIB) Scale. Findings indicate that among BPD patients the following were most prominent: 1) impulsive episodes 2) unstable relationships 3) chronic feelings of depressive emptiness/loneliness 4) acting out behavior and, somewhat less prevalent, 5) identity disturbance. BPD patients can be discriminated by different patterns of disturbance while sharing other features in common with them. While DSM III requires five of eight items for BPD diagnosis, from the above group significantly less than five adequately made a positive diagnosis in this study. BPD seems to identify a heterogeneous group of patients with behavioral disturbances without particular personality specificity which share certain core characteristics among which additional features may further subtype component members. PMID:3557288

  18. Correlation between clinical and autopsy diagnoses in a community hospital

    Gough, James

    1985-01-01

    Forty-six consecutive autopsies performed in 1 year on patients who died in a 120-bed urban community hospital were analysed with respect to clinical-pathological correlation. The mean age of the patients was 71 years. Errors in clinical diagnosis were assigned to one of four classes: class I, a missed major diagnosis, the detection of which before death would probably have changed management and resulted in longer survival or possible cure; class II, a major missed diagnosis that, if detecte...

  19. Clinical signs in the Wernicke-Korsakoff complex: a retrospective analysis of 131 cases diagnosed at necropsy.

    Harper, C. G.; M. Giles; Finlay-Jones, R

    1986-01-01

    A recent necropsy study has shown that 80% of patients with the Wernicke-Korsakoff syndrome were not diagnosed as such during life. Review of the clinical signs of these cases revealed that only 16% had the classical clinical triad and 19% had no documented clinical signs. The incidence of clinical signs in this and other retrospective pathological studies is very different from that of prospective clinical studies. This discrepancy may relate to "missed" clinical signs but the magnitude of t...

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

    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

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

    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.

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

    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

  3. Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy

    Biscoe, Anna Louise; Bedlow, Alison

    2013-01-01

    A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7–10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was...

  4. Role of Platelet Parameters in Diagnosing Various Clinical Conditions

    Amar R. Shah

    2013-04-01

    Full Text Available Background: With improvement in the technologies, advancement occurs in all field including medicine. Automated cell counters are widely used for diagnosis of different diseases. Hematocrits are important parameters that are used in routine practices. Now a day for analysing platelet abnormalities, plateletcrits are utilized. Among them Platelet counts, mean platelet volume (MPV and platelet distribution width (PDW are important parameters. Aims and objective: To study platelet parameters in various clinical conditions. Materials and Methods: A cross sectional observational study was carried out at one of the rural teaching hospitals of Gujarat. Laboratory Data from 800 patients were analysed using Microsoft excel. Result: Total 800 patients were enrolled in the study. Among them 384 (48% were females and 416 (52% were males. Maximum (47% patients were of 15- 49 yrs age group. 228 (28.5 % patients were having infectious diseases. Whereas 248 (31% of patients have attended clinics with chronic diseases. Patients having illnesses related to haematological causes were 144 (18.0%. Significant increase in Platelet Distribution Width & Mean platelet volume was observed among Pregnant women. Thrombocytosis was found in cases of anemia. Significantly lower platelet count were observed in Acute Myeloid leukemia (AML and Immunothrombocytopenic pupura (ITP. Patients with ITP were having high Mean platelet count and Platelet distribution width. Inverse relationship was observed between MPV and Platelet count in cases of Anaemia. Linear relationship was observed between MPV and Platelet count among patients of ITP. Conclusion: Platelet parameters vary in different clinical conditions and they should be used routinely to aid in diagnosis. [Natl J Med Res 2013; 3(2.000: 162-165

  5. Nursing diagnoses according to OREM self-care theory in hemodialysis patients

    Maria Luiza Rêgo Bezerra; Paulo Roberto da Silva Ribeiro; Adriana Alves de Sousa; Aline Isabela Saraiva Costa; Talita de Sousa Batista

    2012-01-01

    This transversal quantitative - qualitative, descriptive, exploratory and bibliography study, is the result from the implementation of the Antihypertensive therapy in patients with chronic kidney disease (CKD) Project on dialysis at the Renal Clinic (CDR) in Imperatriz- MA. The objectives are to analyze nursing diagnoses identified in NANDA-I II self-care theory-based taxonomy of and identify the socioeconomic profile of patients with chronic kidney disease. For this purpose, 40 patients with...

  6. Peripheral vascular disease is associated with reduced glycosuria in newly diagnosed type 2 diabetic patients

    Olivarius, Niels de Fine; Holstein-Rathlou, N H; Siersma, V; Witt, K; Vestbo, E; Andreasen, A H; Mogensen, C E

    2004-01-01

    OBJECTIVES: We examined whether the finding of glycosuria and its level in themselves give information of clinical relevance, apart from being an unreliable indicator of glycemic control. METHODS: Subjects were a population-based sample of 1,284 newly diagnosed type 2 diabetic patients. Median age...

  7. Newly diagnosed breast cancer in a patient receiving imatinib mesylate

    Isik Kaygusuz-Atagunduz; Tayfur Toptas; Fulden Yumuk; Tulin Firatli-Tuglular; Mahmut Bayik

    2014-01-01

    Imatinib mesylate is the standard treatment of chronic myeloid leukemia (CML). Despite imatinib is being used in the treatment of other malignancies as well, its potential role on de novo tumor growth is not known. Secondary malignancies are rarely seen in patients with CML and particularly in those receiving imatinib. Here, we present a CML patient taking imatinib therapy that was diagnosed to have breast cancer and received adjuvant chemo-and radiotherapy with imatinib. We tried to explain ...

  8. Nutrient intake and nutritional status of newly diagnosed patients with cancer from the East Coast of Peninsular Malaysia

    Menon, Kavitha; RAZAK, Shariza Abdul; Ismail, Karami A; Krishna, Bhavaraju Venkata Murali

    2014-01-01

    Background Cancer therapy in Malaysia primarily focuses on the clinical management of patients with cancer and malnutrition continues to be one of the major causes of death in these patients. There is a dearth of information on the nutrient intake and status of newly diagnosed patients with cancer prior to the initiation of treatment. The present study aims to assess the nutrient intake and status of newly diagnosed patients with cancer from the East Coast of Peninsular Malaysia. Methods A cr...

  9. Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India

    Saptarshi Bishnu; Dipanjan Bandyopadhyay; Samiran Samui; Indrani Das; Pradip Mondal; Pramit Ghosh; Deeptarka Roy; Sukanta Manna

    2014-01-01

    Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, o...

  10. Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India

    Bishnu, Saptarshi; Bandyopadhyay, Dipanjan; Samui, Samiran; Das, Indrani; Mondal, Pradip; Ghosh, Pramit; Roy, Deeptarka; Manna, Sukanta

    2014-01-01

    Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, obser...

  11. Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma

    Deirdre P Cronin-Fenton, Margaret M Mooney, Limin X Clegg, Linda C Harlan

    2008-01-01

    AIM: To examine the extent of use of specific therapies in clinical practice, and their relationship to therapies validated in clinical trials.METHODS: The US National Cancer Institutes’ Patterns of Care study was used to examine therapies and survival of patients diagnosed in 2001 with histologically-confirmed gastroesophageal adenocarcinoma (n = 1356). The study re-abstracted data and verified therapy with treating physicians for a population-based stratified random sample.RESULTS: Approxim...

  12. 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

    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.

  13. Value of ABCD2 in predicting early ischemic stroke in patients diagnosed with transient ischemic attack.

    Mojtaba Chardoli; Alireza Khajavi; Mohsen Nouri; Vafa Rahimi-Movaghar

    2013-01-01

    As a significant number of patients diagnosed with transient ischemic attack (TIA) at emergency department are at risk to develop TIA or cerebral vascular accident (CVA), several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. We aimed to evaluate the role of ABCD2 scoring which includes age, blood pressure, clinical symptoms, diabetes mellitus, and duration of symptoms in predicting short term outcome of the patients presenting with T...

  14. Should physicians fake diagnoses to help their patients?

    Helgesson, G; Lynöe, N

    2008-03-01

    Are fake diagnoses and false or misleading certificates permissible means of helping patients? This question is examined in relation to four examples from Swedish health care: the sterilisation case, the asylum case, the virginity case, and the adoption case. We argue that both consequentialist and deontological ethical theories, to be reasonable, need to balance values, principles, and interests such as wellbeing, truthfulness, autonomy, personal integrity, trust in the medical profession, and abidance by national legislation. We conclude that it can be justifiable for physicians to fake diagnoses and write false or misleading certificates in order to help patients when not doing so has dire consequences. However, physicians must also consider the long-term effects of making exceptions to honest, non-deceitful behaviour based on the best empirical evidence available. Otherwise valuable social practices might erode and public confidence in physicians be threatened. PMID:18316450

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

    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...... 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....

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

    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.

  17. How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?

    Yuki, Kumi; Bhagia, Jyoti; Mrazek, David; Jensen, Peter S

    2016-01-01

    AIM: To investigate child and adolescent psychiatrists’ (CAPs) attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children (mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales (VADRSs), CAPs’ diagnoses of ADHD and ODD, and CAPs’ treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs’ ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs’ treatment recommendations against established ADHD and ODD guidelines. RESULTS: Among 63 ADHD subjects, the majority of the subjects (92%) met full ADHD diagnostic criteria at least in one setting (parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings (parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found (95%CI: -0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these case-positives, which is considered as a fair agreement between CAPs and VADRSs (95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy. CONCLUSION: CAPs’ ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD’s most common comorbid condition - ODD - may be under-recognized. PMID:27014602

  18. Anaesthetic management of previously non-diagnosed phaeochromocytoma: Clinical vigilance, the ultimate saviour of anaesthesiologist

    Paramita Trivedi

    2013-01-01

    Full Text Available A 39-year-old male, post nephrectomy and adrenalectomy (right, was planned for adrenalectomy (left and radiofrequency ablation of left renal mass. Clinical evaluation indicated a possibility of phaeochromocytoma, whereas biochemical parameters were found to be within normal limits. Intraoperatively, massive fluctuations in haemodynamic parameters were noticed while the tumour was being handled. Patient was stabilised with inotropes, vasopressors, fluids and careful titration of anaesthetic agents. Preoperatively diagnosed coronary disease could have complicated anaesthetic care. Optimum and modern anaesthetic care leads to safe execution of surgery.

  19. Warfarin-induced skin necrosis diagnosed on clinical grounds and treated with maggot debridement therapy.

    Biscoe, Anna Louise; Bedlow, Alison

    2013-01-01

    A patient with a history of deep vein thrombosis presented with painful bruising and blistering on his left leg 7-10 days after warfarin treatment. A complicated 2-month treatment followed, where vasculitis was originally diagnosed from histological findings before the final diagnosis of warfarin-induced skin necrosis (WISN) was made on clinical grounds. Warfarin was stopped, reversed and low molecular weight heparin started but, the lesions had progressed to full thickness necrosis. This was originally treated with conventional surgical debridement before introducing maggot debridement therapy (MDT) in an effort to try to salvage the limb. PMID:23362073

  20. Bone Disease in Newly Diagnosed Lupus Nephritis Patients

    Resende, Aline Lázara; dos Reis, Luciene Machado; Dias, Cristiane Bitencourt; Custódio, Melani Ribeiro; Jorgetti, Vanda; Woronik, Viktoria

    2014-01-01

    Introduction Bone loss in Lupus Nephritis (LN) patients is common and multifactorial. The aim of this study was to evaluate the bone status of newly diagnosed LN patients and their correlation with inflammatory factors involved in LN physiopathology. Methods We studied 15 pre-menopausal patients with ≤2 months of diagnosed SLE and LN. Patients with prior kidney or bone disease were excluded. In addition to biochemical evaluation (including 25-hydroxyvitamin D3 [25(OH)D] and Monocyte Chemotactic Protein (MCP1) dosage), we performed bone biopsies followed by osteoblast culture, histomorphometric and immunohistochemistry analysis. Results LN patients presented a mean age of 29.5±10 years, a proteinuria of 4.7±2.9 g/day and an estimated glomerular filtration rate (GFR) of 37(31–87) ml/min/1,73 m2. They were on glucocorticoid therapy for 34±12 days. All patients presented vitamin D insufficiency (9.9±4.4 ng/ml, range 4–20). Urinary MCP1 correlated negatively with 25(OH)D (r = −0.53, p = 0.003) and positively with serum deoxypyridinoline (r = 0.53, p = 0.004). Osteoblasts isolated from LN bone biopsies presented a significantly higher expression of MCP-1 when compared to controls (32.0.±9.1 vs. 22.9±5.3 mean fluorescence intensities, p = 0.01). LN patients presented a significantly reduced osteoid volume, osteoid thickness, osteoid surface, mineralization surface and bone formation rate, associated with an increased eroded surface and osteoclast surface. Patient’s bone specimens demonstrated a reduced immunostaining for osteoprotegerin (0.61±0.82 vs. 1.08±0.50%, p = 0.003), and an increased expression of Receptor Activator of NF-κB ligand (RANKL) (1.76±0.92 vs. 0.41±0.28%, p<0.001) when compared to controls. Discussion Newly diagnosed LN patients presented a significant disturbance in bone metabolism, characterized by an impaired bone formation and mineralization, associated with an increase in resorption parameters. Glucocorticoid use, vitamin D insufficiency and inflammation might be involved in the physiopathology of bone metabolism disturbance. PMID:25229495

  1. Incidence and Presentation of Fungal Sinusitis in Patient Diagnosed with Chronic Rhinosinusitis

    P. Karthikeyan; Nirmal Coumare, V.

    2010-01-01

    Significant number of patients diagnosed with chronic rhino sinusitis often tend to have a final diagnosis of fungal sinusitis. We wanted to find out (a) The incidence of patients with fungal sinusitis in those patients who were initially diagnosed as chronic rhinosinusitis. (b) The presentation of fungal sinusitis patients who were initially diagnosed as CRS. Retrospective chart review of 242 patients diagnosed as CRS from May 2006 to April 2009. The various symptoms and signs of those diagn...

  2. A graded prognostic assessment scale to predict overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery

    Shahzadi, Sohrab; Azimi, Parisa; Bitaraf, Mohammad Ali; Azar, Maziar; Alikhani, Mazdak; Zali, Alireza; Sadeghi, Sohrab; Salmanian, Soraya

    2012-01-01

    Abstract: Background: The present study aims to evaluate the Graded Prognostic Assessment (GPA) score for predicting overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery. Methods: This was a cross sectional study conducted on the patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery during 2003 to 2011. Clinical and radiological parameters were evaluated, and the GPA score were determined. Kaplan–Meier and log-rank tests were ...

  3. Comparisons of Prognosis between Surgically and Clinically Diagnosed Idiopathic Pulmonary Fibrosis Using Gap Model: A Korean National Cohort Study.

    Lee, Sang Hoon; Kim, Song Yee; Kim, Dong Soon; Kim, Young Whan; Chung, Man Pyo; Uh, Soo Taek; Park, Choon Sik; Jeong, Sung Hwan; Park, Yong Bum; Lee, Hong Lyeol; Shin, Jong Wook; Lee, Eun Joo; Lee, Jin Hwa; Jegal, Yangin; Lee, Hyun Kyung; Kim, Yong Hyun; Song, Jin Woo; Park, Moo Suk

    2016-03-01

    Although a multidisciplinary approach has become an important criterion for an idiopathic pulmonary fibrosis (IPF) diagnosis, lung biopsies remain crucial. However, the prognosis of patients with surgically diagnosed IPF (sIPF) is uncertain. We aimed to investigate the prognosis of patients with clinically diagnosed IPF (cIPF) and sIPF.In this retrospective observational study, the Korean Interstitial Lung Disease Study Group conducted a national survey to evaluate the clinical, physiological, radiological, and survival characteristics of patients with IPF from January 1, 2003 to December 31, 2007. Patients were recruited from 54 universities and teaching hospitals across the Republic of Korea. IPF diagnoses were established according to the 2002 American Thoracic Society (ATS)/European Respiratory Society criteria (ERS) guideline. A total of 1685 patients with IPF (1027 cIPF and 658 sIPF) were enrolled.Patients with sIPF were significantly younger, predominantly female, and nonsmokers (all P influence on patient prognosis. However, there was no significant difference in prognosis between the cIPF and sIPF groups after adjusting for GAP (gender, age, physiology) stage.The patients with sIPF had better clinical features than those with cIPF. However, after adjusting for GAP stage, the sIPF group showed similar prognoses as the cIPF group. This study showed that after adjusting for GAP stage, the prognosis of patients with IPF is the same regardless of the diagnostic method used. PMID:26986154

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

    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.

  5. Knowledge and Lifestyle-Associated Prevalence of Obesity among Newly Diagnosed Type II Diabetes Mellitus Patients Attending Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Hospital-Based Cross-Sectional Study

    Obirikorang, Yaa; Obirikorang, Christian; Odame Anto, Enoch; Acheampong, Emmanuel; Dzah, Nyalako; Akosah, Caroline Nkrumah; Nsenbah, Emmanuella Batu

    2016-01-01

    This study aimed to determine the knowledge and prevalence of obesity among Ghanaian newly diagnosed type 2 diabetics. This cross-sectional study was conducted among diagnosed type 2 diabetics. Structured questionnaire was used to obtain data. Anthropometric measurements and fasting blood sugar levels were also assessed. Participants had adequate knowledge about the general concept of obesity (72.0%) and method of weight measurement (98.6%) but were less knowledgeable of ideal body weight (4.2%). The commonly known cause, complication, and management of obesity were poor diet (76.9%), hypertension (81.8%), and diet modification (86.7%), respectively. The anthropometric measures were higher among females compared to males. Prevalence of obesity was 61.3% according to WHR classification, 40.8% according to WHtR classification, 26.1% according to WC, and 14.8% according to BMI classification. Being female was significantly associated with high prevalence of obesity irrespective of the anthropometric measure used (p < 0.05). Taking of snacks in meals, eating meals late at night, physical inactivity, excessive fast food intake, and alcoholic beverage intake were associated with increased prevalence of obesity (p < 0.05). Prevalence of obesity is high among diabetic patient and thus increasing effort towards developing and making education programs by focusing on adjusting to lifestyle modifications is required.

  6. Knowledge and Lifestyle-Associated Prevalence of Obesity among Newly Diagnosed Type II Diabetes Mellitus Patients Attending Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: A Hospital-Based Cross-Sectional Study.

    Obirikorang, Yaa; Obirikorang, Christian; Odame Anto, Enoch; Acheampong, Emmanuel; Dzah, Nyalako; Akosah, Caroline Nkrumah; Nsenbah, Emmanuella Batu

    2016-01-01

    This study aimed to determine the knowledge and prevalence of obesity among Ghanaian newly diagnosed type 2 diabetics. This cross-sectional study was conducted among diagnosed type 2 diabetics. Structured questionnaire was used to obtain data. Anthropometric measurements and fasting blood sugar levels were also assessed. Participants had adequate knowledge about the general concept of obesity (72.0%) and method of weight measurement (98.6%) but were less knowledgeable of ideal body weight (4.2%). The commonly known cause, complication, and management of obesity were poor diet (76.9%), hypertension (81.8%), and diet modification (86.7%), respectively. The anthropometric measures were higher among females compared to males. Prevalence of obesity was 61.3% according to WHR classification, 40.8% according to WHtR classification, 26.1% according to WC, and 14.8% according to BMI classification. Being female was significantly associated with high prevalence of obesity irrespective of the anthropometric measure used (p food intake, and alcoholic beverage intake were associated with increased prevalence of obesity (p < 0.05). Prevalence of obesity is high among diabetic patient and thus increasing effort towards developing and making education programs by focusing on adjusting to lifestyle modifications is required. PMID:26881262

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

    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 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...

  8. Clinical challenges in diagnosing and managing adult hypertension.

    Handler, Joel

    2015-12-01

    Although there is still no consensus on how to diagnose hypertension, opinion is moving toward incorporating out-of-office blood pressure measurements into the process. The SPRINT trial poses potential opportunities and challenges. Simplified antihypertensive drug regimens incorporating single pill combinations are very effective. PMID:26694890

  9. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    Shinto, A. S.; Selvakumar, J. [Amala Institute of Medical Sciences, Amalanagar (India)

    2010-12-15

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

  10. Predicting value of ABCD2 in early ischemic stroke in patients diagnosed with transient ischemic attack

    Chardoli, Mojtaba; Khajavi, Alireza; Nouri, Mohsen; Rahimi-Movaghar, Vafa

    2012-01-01

    Abstract: Background: As a significant number of patients diagnosed with transient ischemic attack (TIA) at emergency department are at risk to develop TIA or cerebral vascular accident (CVA), several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. Therefore, the present study was aimed to evaluate the role of ABCD2 scoring including age, blood pressure, clinical features, duration, and diabetes mellitus (DM), in predicting short term ...

  11. Unexpectedly Diagnosed Caroli’s Disease on HIDA Scintigraphy in a Patient with Calculous Cholecystitis

    Shinto, Ajit S.; Selvakumar, Job

    2010-01-01

    Caroli’s disease, which is a rare condition with congenital dilatation of the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli’s dis...

  12. Unexpectedly diagnosed Caroli's disease on HIDA scintigraphy in a patient with calculous cholecystitis

    Caroli's disease, which is a rare condition with congenital dilatation if the intrahepatic bile ducts, is usually diagnosed postoperatively. The clinical suspicion in a patient with gallstones and choledocholithiasis presenting with dilated intrahepatic biliary radicles and jaundice is usually an obstructive etiology. However, scintigraphic evaluation of this entity, as in this case, gives additional information on liver function, biliary drainage and predisposing conditions like Caroli's disease, which could be missed otherwise

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

    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…

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

    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

  15. [Danish Cholinesterase Research Unit diagnoses patients with prolonged paralysis after succinylcholine and mivacurium].

    Eskildsen, Katrine Zwicky; Gtke, Mona Ring

    2015-04-27

    The Danish Cholinesterase Research Unit (DCRU) is a nationwide unit for patients carrying mutations in the butyrylcholinesterase enzyme (BChE). BChE hydrolyzes the neuromuscular blocking drugs succinylcholine and mivacurium. Patients with mutations in the butyrylcholinesterase gene are at risk of experiencing a prolonged effect of the drugs, such as weakness or paralysis for hours. In order to diagnose the referred patients correctly, DCRU combines results such as BChE activity, genotyping, pedigree and clinical reactions to succinylcholine or mivacurium. PMID:26539575

  16. Inpatient diagnoses during Adolf Meyer's tenure as director of the Henry Phipps Psychiatric Clinic, 1913-1940.

    Stephens, J H; Ota, K Y; More, W W; Shaffer, J W; Covi, L

    1986-12-01

    Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed. PMID:3537208

  17. Chronic Inflammatory Periodontal Disease in Patients Diagnosed with Human Immunodeficiency Virus/AIDS in Cienfuegos

    Nivia Gontán Quintana

    2013-08-01

    Full Text Available Background: human immunodeficiency virus increases patients´ susceptibility to infections. Consequently, a high incidence of periodontal diseases is observed among them. It is often associated with other lesions of the oral mucous. Objective: to determine the evolution of chronic inflammatory periodontal disease in patients diagnosed with human immunodeficiency virus/AIDS.Methods: a case series study involving HIV-positive patients who attended the Stomatology consultation in Cienfuegos was conducted. The Russell Periodontal Index and the Simplified Oral Hygiene Index were used. Patients were classified taking into account clinical and immunological categories. Statistical processing was performed through SPSS program version 15.0 and Chi-square tests were applied.Results: a high prevalence of chronic inflammatory periodontal disease was observed in patients with human immunodeficiency virus. Correlation with the oral hygiene of the patients studied was found. CD4 count showed no statistical significance in periodontal disease severity. All patients classified as A2 suffer from some stage of periodontal disease, which was the most affected clinical category in spite of presenting mild immunodeficiency.Conclusions: there is a high prevalence of chronic inflammatory periodontal disease in patients diagnosed with Human Immunodeficiency Virus in Cienfuegos and it is correlated with patient’s oral hygiene.

  18. The Characteristics of Male Patients Diagnosed with Osteoporosis - Original Investigation

    İlknur Aktaş; Selma Eşen; Merih Sarıdoğan; Şansın Tüzün; Ülkü Akarırmak

    2006-01-01

    Aims: Evaluating the characteristics of male osteoporosis cases followed up in outpatient clinic. Material and Methods: The age, education status, alcohol, cigarette and coffee consumption, and nutritive habits of the male cases followed up in outpatient clinic between 2004-2005 were evaluated. Usage of toxic drugs and low energy fracture presence in the patient and his family were recorded. Sexual function was evaluated. Total blood count, comprehensive biochemical analyses, and bone mine...

  19. Clinically diagnosed glomus vagale tumour treated with external beam radiotherapy: a review of the published reports

    Full text: The aim of the study was to present a case of clinically diagnosed glomus vagale in a 42-year-old Aboriginal woman treated with external beam radiotherapy and to carry out a review of the published work. The details of presentation, diagnosis, treatment and follow up of the patient are discussed. A review of the published work was carry out using MEDLINE database with respect to aetiology, clinical presentation, diagnosis, treatment and expected outcomes. Glomus vagale tumours are a subtype of paragangliomas of the head and neck derived from extra-adrenal paraganglia of the autonomic nervous system. They are typically slow-growing, benign masses that are often asymptomatic and rarely show signs of hypersecretion. Treatment options include embolization, surgical excision, radiotherapy or surveillance. Radiotherapy is often used for extensive lesions where surgery is considered prohibitively morbid. Following treatment relapse rates are low with the most patients achieving long-term control. Our patient presented with an extensive lesion compressing the wall of the carotid artery and invading the jugular fossa to involve the clivus. Surgery was offered; however, the patient opted for external beam radiotherapy. A dose of 45 Gy in 25 fractions was delivered with 6-MV photons employing a CT-planned, wedge pair technique. Glomus vagale tumours are rare and should be managed in a multidisciplinary head and neck clinic with both surgical and radiation oncology opinions offered. The toxicities and outcomes of both methods should be discussed

  20. [Clinical recommendations for diagnosing, treatment and monitoring of patients with endometrial cancer -- Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology].

    Karnjus-Begonja, Ruzica; Vrdoljak, Eduard; Corusić, Ante; Haller, Herman; Jelavic, Tihana Boraska; Matković, Visnja; Strinić, Tomislav; Barisić, Dubravko; Tomic, Snjezana; Kukura, Vlastimir; Ban, Marija; Padovan, Ranka Stern; Skalec, Suzana Lide; Belaj, Nenad; Puljiz, Mario; Ferari, Ani Mihaljević; Hajredini, Adem; Babic, Damir; Mahovlić, Vesna; Pajtler, Marija

    2013-01-01

    Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia. PMID:24364198

  1. A comparison of arthrography to clinical diagnostics for diagnosing meniscal lesions

    A comparative investigation as to the exactness of clinical and arthrographical diagnostics was carried out on 176 patients who were clinically examined and operated on in the period of 1972-1980. Using solely clinical diagnostics, the total rate of exactness was 90,9%, the exactness regarding the internal meniscal lesion being significantly higher (94.2%) than that regarding external meniscal lesion (76.7%). Using solely arthrographic diagnostics, the total rate of exactness was 82%, the rate for internal meniscus being significantly lower (83.9%) than that obtained using clinical diagnostics. As for the external meniscus, the exactness of arthrography differs only slightly from clinical diagnostics with 74.7%. The most frequent sources of error in arthorgraphy were found to be lesions of the posterior horn at the internal meniscus. In cases of external meniscal lesions, especially when an internal meniscal lesion was existing at the same time, both examination methods failed in 5 cases. For routine diagnosing of meniscal lesions, arthrography is not necessary. An accurate clinical examination and anamnesis bring very good and exact results and should therefore be given absolute priority. (orig./MG)

  2. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study

    Juma Kaseem

    2008-04-01

    Full Text Available Abstract Background Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. Methods In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. Results Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. Conclusion Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the variety of social influences into account.

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

    Lu, Hui; Zeng, Binghui; Yu, Dongsheng; Jing, Xiangyi; Hu, Bin; Zhao, Wei; Wang, Yiming

    2015-09-01

    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. PMID:26389062

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

    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

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

    Lu, Hui; Zeng, Bing Hui; Yu, Dong Sheng; Jing, Xiang Yi; Hu, Bin; Zhao, Wei; Wang, Yi Ming [Sun Yat-Sen University, Guangzhou (China)

    2015-09-15

    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.

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

    Kerrn-Jespersen, B M; Lindelof, Mette; Illes, Zsolt; Blaabjerg, Morten; Lund, E L; Klausen, Camilla; Christiansen, Ingelise; Sellebjerg, F; Kondziella, D

    ", "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......-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...... 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...

  7. The utility of clinical decision tools for diagnosing osteoporosis in postmenopausal women with rheumatoid arthritis

    Brand Caroline

    2008-01-01

    Full Text Available Abstract Background Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. Methods A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score Results One hundred and twenty seven women participated. The median age was 62 (IQR 5671 years. Median disease duration was 108 (60168 months. Seventy two (57% women had no record of a previous DXA examination. Eighty (63% women had T scores at femoral neck or lumbar spine less than -1. The area under the ROC curve for clinical decision tool prediction of T score Conclusion There was limited utility of clinical decision tools for predicting osteoporosis in this patient population. Fracture prediction tools that include risk factors independent of BMD are needed.

  8. Diagnsticos de enfermagem em clnica cirrgica / Nursing diagnoses in surgical clinic

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

    2015-02-01

    Full Text Available Objetivo Identificar a frequncia dos diagnsticos de enfermagem em pacientes de clnica cirrgica. Mtodos Estudo transversal, descritivo e exploratrio, de abordagem quantitativa, com dados referentes a 28 pacientes. O instrumento de coleta de dados foi desenvolvido pelos pesquisadores, com base e [...] m padres funcionais de sade. Resultados Foram encontrados 301 diagnsticos de enfermagem, com mdia de 12 por paciente. Somente quatro diagnsticos apresentaram frequncia acima de 50%. Os mais frequentes foram: risco de infeco, integridade da pele/tissular prejudicada, disposio para bem-estar espiritual, disfuno sexual e padro do sono perturbado. Diagnsticos que se enquadram no domnio 13 (Crescimento/Desenvolvimento) no foram documentados nesta amostra. Concluso Os achados demostraram ampla variedade de diagnsticos na populao estudada, reflexo da diversidade de cuidados a serem prestados. A identificao das necessidades de cuidados favorece a implantao de intervenes especficas, contribuindo para a qualidade da assistncia 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.

  9. Manejo clínico de pacientes con diagnóstico dual. Evaluación diagnóstica de los pacientes farmacodependientes que sufren de comorbilidad psiquiátrica Clinical Management of Dually Diagnosed Patients. Diagnostic Evaluation of Drug Abuse and Dependence in Patients with Psychiatric Comorbidities

    Juan Francisco Gálvez Flórez

    2008-09-01

    Full Text Available Introducción: La coexistencia de trastornos psiquiátricos con abuso/dependencia al tabaco, alcohol y sustancias ilícitas es un problema de salud pública en el mundo. Esto ha generado grandes retos diagnósticos en situaciones clínicas donde tienden a sobreponerse ambas condiciones psicopatológicas y que oscurecen el panorama de intervención terapéutica. Objetivos: Fomentar e implementar un adecuado diagnóstico de la patología dual en Colombia, a fin de encaminar al paciente por el tratamiento correcto en su proceso de rehabilitación. Método: Se buscó la literatura biomédica en los servidores de Medline, OVID, Proquest, Scielo y EMBASE, cruzando la expresión del MeSH diagnóstico dual con trastornos relacionados con el consumo de sustancias, tabacco y epidemiología, delimitando los resultados a los estudios clínicos, revisiones sistemáticas o metanálisis publicados en español o inglés en los últimos 25 años en la población farmacodependiente adulta. Resultados: Se encontraron 209 estudios que cumplían con los criterios de inclusión, de los cuales, de acuerdo con su resumen, se seleccionaron los 100 más relevantes. Conclusiones: La implementación rigurosa de estas guías diagnósticas debe encaminar al especialista en contacto con la población farmacodependiente a realizar el diagnóstico dual de forma más frecuente y certera, para que los pacientes obtengan mejores resultados y beneficios a largo plazo.Introduction: Dually Diagnosed Patients with major psychiatric disorders are considered an important public health issue worldwide. Objective: Our main goal was to establish practical guidelines for psychiatrists in charge of the treatment of dually diagnosed patients. Method: We searched the Biomedical Literature in Medline, OVID, Proquest, Scielo, and EMBASE for articles matching the Medical Subjects headings (MeSH "Dual Diagnosis" with "Substance Related Disorders", "Tobacco", and "Epidemiology", limiting the results only to clinical trials, systematic reviews and meta-analysis published in the last 25 years in the adult addicted population. Results: We found 209 articles that met the initial inclusion criteria for the development of our clinical guidelines for dually diagnosed patients. All abstracts were carefully revised, and only 100 of the 209 articles were selected to be included in the main framework, based on their methodology and clinical significance of their results. Conclusions: Making a precise and accurate diagnosis of dual pathology in psychiatry should be the main goal of everyone involved in the care of patients with tobacco, substance and alcohol-related disorders. Due to the complexity of dual diagnosis, every patient with substance abuse and alcohol-related problems should received an adequate and structured screening during his initial clinical evaluation.

  10. Neurophysiological features in relation to clinical signs in clinically diagnosed corticobasal degeneration.

    Monza, D; Ciano, C; Scaioli, V; Soliveri, P; Carella, F; Avanzini, G; Girotti, F

    2003-04-01

    We investigated the association between clinical and neurophysiological characteristics in patients with a clinical diagnosis of probable corticobasal degeneration (CBD), and searched for neurophysiological features supporting the diagnosis in life. Ten patients with clinically probable CBD underwent comprehensive neurological evaluation and brain MRI. Long latency reflexes (LLR), upper limb somatosensory (SEP) and motor evoked (MEP) potentials were recorded. The mini-mental state examination (MMSE), the phonemic verbal fluency test (PVFT) and the De Renzi ideomotor apraxia test were also performed. Polygraphic EEG was performed in the six patients with myoclonus. The SEP N30 frontal component was absent bilaterally in four patients, was absent on the left side in one, and had increased latency in other three. MEPs were abnormal in four patients (three had prolonged central motor conduction time, one of whom also had increased MEP threshold, and one had increased MEP threshold). All six patients with myoclonus had enhanced LLRs at rest, which were also of abnormally increased amplitude during motor activation; latencies were generally shorter than in classic cortical reflex myoclonus. On back-averaging, no EEG spikes time-locked to EMG activity were found in any myoclonus patient. Five patients were demented by MMSE, eight had ideomotor apraxia scores in the ideomotor apraxia range and five had defective verbal fluency. Brain MRI revealed asymmetric cortical atrophy in all patients, particularly evident frontoparietally. Neurophysiological techniques, particularly LLR, can assist CBD diagnosis especially in patients with myoclonus. Patients with evident parkinsonism had greater SEP N30 (frontal) abnormalities, while most patients with marked paresis had slower MEP times. PMID:12754652

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

    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…

  12. RT-24EXTENT OF CEREBRAL RADIONECROSIS IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA (GBM) TREATED ON A CLINICAL TRIAL WITH HYPOFRACTIONATED INTENSITY-MODULATED RADIATION THERAPY (HYPO-IMRT) COMBINED WITH TEMOZOLOMIDE (TMZ) AND BEVACIZUMAB (BEV)

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

    2014-01-01

    BACKGROUND: Hypofractionated RT schemes may result in increased occurrence of clinically-significant radionecrosis (CSRN), but this potentially might be mitigated by bevacizumab (BEV). METHODS: 30 patients received hypo-IMRT to the surgical cavity and residual tumor with a 1cm margin (PTV1) to a total dose of 60 Gy in 10 daily fractions and to the T2 abnormality with a 1cm margin (PTV2) to 30 Gy. Concurrent TMZ (75mg/m2 daily) and BEV (10mg/kg every 2 weeks) was administered followed by adjuv...

  13. [Clinical recommendations for diagnosing, treatment and monitoring of patients with uterine cervical cancer -- Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology].

    Vrdoljak, Eduard; Haller, Herman; Corusić, Ante; Jelavić, Tihana Boraska; Matković, Visnja; Strinić, Tomislav; Karnjus-Begonja, Ruzica; Barisić, Dubravko; Tomić, Snjezana; Babić, Damir; Kukura, Vlastimir; Mise, Branka Petric; Padovan, Ranka Stern; Matić, Mate; Puljiz, Mario; Krasević, Maja; Fröbe, Ana; Topolovec, Zlatko; Hajredini, Adem; Vrdoljak-Mozetic, Danijela; Mamula, Ozren; Bolanca, Ines Krivak; Brnić-Fischer, Alemka

    2013-01-01

    Cervical cancer, in comparison with other gynecological malignancies, mainly affects younger women. It can be prevented trough educational programs, screening and early detection. It also can be efficiently treated when it appears. Treatment modalities include surgery, chemotherapy and radiotherapy, according to the stage of the disease and patient condition. Treatment decisions should be made after multidisciplinary team discussion. Due to the significance of this disease it is important to define and implement standardized approach for diagnostic, treatment and monitoring algorithm as well. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with uterine cervical cancer in the Republic of Croatia. PMID:24364197

  14. Audiological evaluation of hearing levels in patients diagnosed with migraine

    Müjde Karadag; Emine Elif Altuntas; Serkan Sanli; Ismail Önder Uysal

    2015-01-01

    Introduction: Based on the hypothesis that neurovascular events involving in the pathophysiology of migraine can cause hearing loss by influencing blood flow of inner ear, it was aimed to determine whether migraine with or without aura in our clinics patients are at risk for hearing loss by assessing hearing levels via a high-frequency audiometry, acoustic reflex and transient otoacoustic emission responses; to discriminate whether hearing loss is cochlear or retrocochlear originated, if pres...

  15. The role of fat pad sign in diagnosing occult elbow fractures in the pediatric patient

    Al-Aubaidi, Zaid; Torfing, Trine

    2012-01-01

    In 1954, Norell described the 'fat pad sign' for the first time. This refers to the radiological visualization of the elbow fatty tissue. This is a prospective study with the aim of clarifying the relation between the presence of a positive fat pad sign on the lateral radiograph and the type of...... injury verified on MRI. From January to December 2010, 31 children were diagnosed primarily with a positive fat pad sign. An above-the-elbow cast was applied and all patients were referred for an MRI within a few days. All patients were recommended a clinical follow-up and informed about the MRI results...... studies, pediatric patients who presented with elbow effusion verified on conventional radiographs could be treated with a cast for 2-3 weeks and extra clinical or radiological controls did not seem to be indicated. Level of evidence: Level III, development of diagnostic criteria on the basis of...

  16. Agreement between premortem and postmortem diagnoses in patients with acquired immunodeficiency syndrome observed at a brazilian teaching hospital

    BORGES, Aércio Sebastião; Marcelo Simão FERREIRA; NISHIOKA Sérgio de Andrade; SILVESTRE Marco Túlio Alvarenga; Arnaldo Moreira SILVA; ROCHA Ademir

    1997-01-01

    Acquired immunodeficiency syndrome (AIDS) is one of the main causes of death in adults worldwide. More commonly than in the general population, in patients with AIDS there is substantial disagreement between causes of death which are clinically suspected and those established by postmortem examination. The findings of 52 postmortem examinations were compared to the premortem (clinical) diagnoses, and there was 46% agreement between them. Fifty two percent of the patients had more than one pos...

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

    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)

  18. Asymmetric Dimethylarginine Plasma Levels and Endothelial Function in Newly Diagnosed Type 2 Diabetic Patients

    Francesco Perticone

    2012-10-01

    Full Text Available It is now well established that major risk factors for cardiovascular diseases (CVD impact upon endothelial function by decreasing nitric oxide (NO bioavailability. Asymmetric dimethylarginine (ADMA, an endogenous analog of l-arginine, is able to inhibit the activity of endothelial-NO synthase, promoting endothelial dysfunction. Type 2 diabetes (T2D is characterized by a reduced endothelium-dependent vasodilation and increased ADMA levels and ADMA is strongly associated with micro- and macrovascular diabetic complications. However, there are not a lot of data about the role of ADMA on endothelial function in newly diagnosed T2D patients without cardiovascular (CV complications. For this aim, we have enrolled forty-five newly diagnosed T2D patients, evaluated by a oral glucose tolerance test, and thirty normal subjects. Endothelium-dependent and -independent vasodilatation was investigated by intra-arterial infusion of increasing doses of acetylcholine (ACh and sodium nitroprusside. ADMA was measured by high-performance liquid chromatography and insulin resistance (IR by HOMA. Newly diagnosed T2D patients showed higher ADMA and l-arginine mean values in comparison with normal subjects and a significantly reduced ACh-stimulated forearm blood flow (FBF. In T2D patients FBF was significantly and inversely correlated with ADMA (r = ?0.524, p < 0.0001 and in a multivariate regression analysis, ADMA resulted the stronger predictor of FBF, explaining the 27.5% of variability (p < 0.0001. In conclusion, ADMA was strongly related to endothelial dysfunction also in patients with newly diagnosed T2D, without clinically manifest vascular complications. This field is of great interest for understanding the mechanisms underlying the pathogenesis of diabetic disease and its CV complications.

  19. Analysis of epidemiological and clinical characteristics of patients admitted diagnosed with acute ischemic cerebrovascular event in internal medicine services and neurology of the Hospital Mexico in March 2013 to March 2014

    Records of 100 patients were revised with diagnosis of ischemic cerebrovascular event in the neurology and internal medicine at the Hospital Mexico since March 2013 to March 2014. A total of 46 patients were men and 54 were women. The overall mean age was 69 years, for men have been 66 years and for women from 71. Patients of all provinces were entered main of San Jose with 56% followed by 19% Alajuela. The hospital management by specialty was distributed 60% to internal medicine and 40% neurology. The risk factors most frequently found were: hypertension 85%, diabetes mellitus 40%, smoking 35%, and dyslipidemia 35%. Overweight was observed in 23% of patients and 22% obese. As for the initial clinical manifestations documented in the first physical examination, the 6 most frequently found have been: faciobrachiocrural hemiparesis 60%, delirium 22%, dysarthria 22%, headache 20%, nausea and/or vomiting 17% and aphasia 15%. A total of 13% of patients have altered the consciousness and 5% have required ventilatory support for first 24 hours of evolution. 27% of patients have arrived within the first 3 hours of onset of symptoms, 11% between 3 to 4.5 hours and the remaining 62% beyond 4.5 hours of duration. 70% of patients have had 1 or more comorbidities prior to the event, the top 5 have been: ischemic heart disease 31%, 29% atrial fibrillation, cerebrovascular disease 19%, 16% chronic kidney disease and congestive heart failure by 12%. Regarding the topographic classification of stokes, 16% were TACI, PACI 46%, 27% LACI and POCI only 11%. The average NIHSS scale has been 9 points to admission, 10 to 48 hours and 6 points at the time of discharge. Regarding brain scan on admission to 98% of the patients were performed while that between 48-72 hours alone to 74%. The most common initial tomographic CT findings have been: 49% lucency of more than 1/3 of middle cerebral artery territory, without alteration 46%, 8% cerebral edema data and 8% midline deviation. Hemorrhagic transformation was documented in 6% of cases. 70% of patients were performed Doppler ultrasound of neck vessels. Without injuries 82%, 9% with obstruction between 50-70% and 9% with over 70% lumen obstruction. Echocardiography was performed in 54% of cases and 76% was obtained left ventricular hypertrophy, left atrial dilation 37% and 2% intramural thrombus. With respect to functionality 81% of patients had no or minimal dependence upon admission, to the time of discharge 74% have had moderated to severe disability, 12% mild and only 14% had no disability or this was minimal. 51% of patients have presented one or more complications during hospitalization, the 5 most frequent have been: bronchopneumonia 25%, bronchial aspiration and urinary tract infection 19%, 16% cognitive impairment and 10% cardiac arrhythmias. The average overall stay has been 13 days. Internal medicine has been 14± days and in neurology has been 12 ± days. The mortally rate has been 19% while 71% of patients were discharged to home and 10% were moved to the medical center. (author)

  20. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

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

    2013-01-01

    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

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

    Rodkjaer, L; Laursen, T; Balle, N; Sodemann, M

    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 an......, 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....... 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...... 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...

  2. Value of ABCD2 in predicting early ischemic stroke in patients diagnosed with transient ischemic attack.

    Mojtaba Chardoli

    2013-09-01

    Full Text Available As a significant number of patients diagnosed with transient ischemic attack (TIA at emergency department are at risk to develop TIA or cerebral vascular accident (CVA, several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. We aimed to evaluate the role of ABCD2 scoring which includes age, blood pressure, clinical symptoms, diabetes mellitus, and duration of symptoms in predicting short term outcome of the patients presenting with TIA. One hundred consecutive patients visited between 2009 and 2010 in Hazrat Rasoul Akram Hospital and diagnosed with TIA were enrolled and their ABCD2 scores were registered. The incidence of death, CVA, or TIA during the first week after the attack was recorded. Eleven patients suffered new TIA/CVA after 1 week. Sensitivity and specificity of ABCD2 score for predicting CVA/TIA at cut-off point of 4 were 72.7% and 52.8%, respectively. At the same cut-off point for ABCD2, positive and negative predictive values were 16% and 94 %, respectively. Our results show that although patients with ABCD2 score greater than 4 were more likely to develop recurrent TIA/CVA in short term, those with lesser score still harbour a considerable risk for TIA/CVA. Though ABCD2 as an easily applicable tool is very helpful in management of TIA patients at emergency department, but it should not be the only measure to rely on in our decision making.

  3. Which patients with newly diagnosed prostate cancer need a radionuclide bone scan? An analysis based on 631 patients

    Purpose: Although radionuclide bone scans are frequently recommended as part of the staging evaluation for newly diagnosed prostate cancer, most scans are negative for metastases. We hypothesized that Gleason score, prostate-specific antigen (PSA), and clinical stage could predict for a positive bone scan (BS), and that a low-risk group of patients could be identified in whom BS might be omitted. Methods: All patients who had both pathologic review of their prostate cancer biopsies and radionuclide BS at our institution between 1/90 and 5/96 were studied. Gleason score, PSA, and clinical stage (AJCC, 4th edition) were evaluated by univariate and multivariate analyses for their ability to predict a positive BS. Groups analyzed were Gleason of 2-6 vs. 7 vs. 8-10; PSA of 0-15 vs. greater than 15-50 vs. greater than 50; and clinical stage of T1a-T2b vs. T2c-T4. Univariate analysis using χ2 and multivariate analysis using logistic regression were performed. Results: Of the 631 consecutive patients, 88 (14%) had positive BS. Multivariate analysis (64 excluded due to missing PSA and/or clinical stage) showed Gleason score, PSA, and clinical stage to be significant independent predictors for positive BS (p 50 vs. 0-15; 2.25 (CI, 1.43-3.54) for Gleason of 8-10 vs. 2-6; 2.15 (CI, 1.54-2.99) for clinical stage T2c-T4 vs. T2b or less. Three of 308 (1%) had a positive BS in patients with Gleason 2-7, PSA of 50 or less, and clinical stage of T2b or less. In the subset of the same risk group with PSA of 15 or less, all 237 had negative bone scans. In patients with PSA greater than 50, 49/99(49.5%) had positive BS. Conclusion: Gleason score, PSA, and clinical stage were independent predictors for a positive radionuclide BS in newly diagnosed prostate cancer patients. PSA is the major predictor for positive BS. About one-half of the patients analyzed were in the low-risk group (Gleason 2-7, PSA ≤ 50, clinical stage ≤ T2b) and elimination of BS in these patients would result in considerable economic savings.

  4. [Hypokalemia, a key clinical data for diagnosing primary hyperaldosteronism].

    Rodríguez Maya, B; Rodríguez Goncer, I; Diego Hernández, C

    2016-01-01

    We report a case of a 37 year-old man with a long history of hypertension under treatment, who was admitted at our institution with intense fatigue and weakness of lower limbs. The laboratory results at Emergency Department showed severe hypokalemia. A study of secondary hypertension was carried out. With the initial suspicion of primary hyperaldosteronism, complete blood test was done including plasma renine activity, which was completely suppressed, and plasma aldosterone concentration, which resulted normal. Likewise, an abdomen CT was performed and revealed a left adrenal mass consistent of suprarrenal adenoma. Therefore, a salt loading suppression test was done with subsequent measure of plasmatic renine activity, which was still suppressed, plasma aldosterone concentration, that persisted normal, and a 24-h urinary aldosterone excretion rate, which was clearly high, supporting the suspected diagnosis. After the adrenalectomy, the patient remained asymptomatic with normal blood pressure without treatment and with normal serum potassium levels. PMID:26869044

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

    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; Szilvssy, Judit; Horkay, Edit; Hgel, 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

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

    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...... 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...

  7. Prevalence of mixed hepatitis C virus (HCV genotypes among recently diagnosed dialysis patients with HCV infection

    Mohammed A Al Balwi

    2011-01-01

    Full Text Available Hepatitis C virus (HCV infection is considered a major health problem recognized globally. HCV is a major cause of chronic liver disease that may lead to cirrhosis and hepatocellular carcinoma. The aim of this study was to investigate the prevalence of multiple (mixed HCV genotypes in Saudi patients recently diagnosed with HCV infection and their association with various clinical risk factors. We examined a total of 1,292 newly diagnosed HCV-positive cases between January 2006 and July 2009 at the Molecular Pathology Laboratory, King Abdulaziz Medical City, Riyadh. The clinical and laboratory data of the study patients were collected. The HCV-RNA viral load and its genotyping were carried out with RT-PCR technology to assist in the follow-up and management of HCV-infected patients undergoing antiviral therapy. Twenty-two patients (1.7% were found to have mixed HCV genotypes; of them, mixed genotypes associated with genotype-4 were seen in 19 patients (86%, mixed genotypes associated with genotype-1 were found in 68.4%, with genotype-3 in 26.3% and with genotype-2 in 5.3%. Additionally, mixed genotypes associated with genotype-1 were seen in three cases (13.6%; they were associated with genotype-2 in two (66.7% and with genotype-5 in one patient (33.3%. In conclusion, the prevalence rate of mixed HCV genotypes in the cohort of the newly infected Saudi patients was 1.7%, with genotype-4 being the most frequent genotype encountered.

  8. New Breast Cancer Recursive Partitioning Analysis Prognostic Index in Patients With Newly Diagnosed Brain Metastases

    Purpose: The aim of the study was to present a new breast cancer recursive partitioning analysis (RPA) prognostic index for patients with newly diagnosed brain metastases as a guide in clinical decision making. Methods and Materials: A prospectively collected group of 441 consecutive patients with breast cancer and brain metastases treated between the years 2003 and 2009 was assessed. Prognostic factors significant for univariate analysis were included into RPA. Results: Three prognostic classes of a new breast cancer RPA prognostic index were selected. The median survival of patients within prognostic Classes I, II, and III was 29, 9, and 2.4 months, respectively (p < 0.0001). Class I included patients with one or two brain metastases, without extracranial disease or with controlled extracranial disease, and with Karnofsky performance status (KPS) of 100. Class III included patients with multiple brain metastases with KPS of ?60. Class II included all other cases. Conclusions: The breast cancer RPA prognostic index is an easy and valuable tool for use in clinical practice. It can select patients who require aggressive treatment and those in whom whole-brain radiotherapy or symptomatic therapy is the most reasonable option. An individual approach is required for patients from prognostic Class II.

  9. Treatment and survival in a population-based sample of patients diagnosed with gastroesophageal adenocarcinoma

    Deirdre P Cronin-Fenton, Margaret M Mooney, Limin X Clegg, Linda C Harlan

    2008-05-01

    Full Text Available AIM: To examine the extent of use of specific therapies in clinical practice, and their relationship to therapies validated in clinical trials.METHODS: The US National Cancer Institutes’ Patterns of Care study was used to examine therapies and survival of patients diagnosed in 2001 with histologically-confirmed gastroesophageal adenocarcinoma (n = 1356. The study re-abstracted data and verified therapy with treating physicians for a population-based stratified random sample.RESULTS: Approximately 62% of patients had stomach adenocarcinoma (SAC, while 22% had gastric-cardia adenocarcinoma (GCA, and 16% lower esophageal adenocarcinoma (EAC. Stage IV/unstaged esophageal cancer patients were most likely and stage I-III stomach cancer patients least likely to receive chemotherapy as all or part of their therapy; gastric-cardia patients received chemotherapy at a rate between these two. In multivariable analysis by anatomic site, patients 70 years and older were significantly less likely than younger patients to receive chemotherapy alone or chemoradiation for all three anatomic sites. Among esophageal and stomach cancer patients, receipt of chemotherapy was associated with lower mortality; but no association was found among gastric-cardia patients.CONCLUSION: This study highlights the relatively low use of clinical trials-validated anti-cancer therapies in community practice. Use of chemotherapy-based treatment was associated with lower mortality, dependent on anatomic site. Findings suggest that physicians treat lower esophageal and SAC as two distinct entities, while gastric-cardia patients receive a mix of the treatment strategies employed for the two other sites.

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

    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.)

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

    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.

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

    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).

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

    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)

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

    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.

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

    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.

  16. Ebstein's anomaly. Clinical profile in 174 patients.

    Attie, F; Casanova, J M; Zabal, C; Buenda, A; Miranda, I; Rijlaarsdam, M; Iturralde, P; Kuri, J; Caldern, J

    1999-01-01

    The study population consisted of 148 patients who did not undergo surgical treatment and 26 who were operated, most of them diagnosed after the age of 2, with a follow-up from 6 months to 25.3 years. Patients were divided in three groups of clinical deterioration according to their functional class and cardiothoracic index (CTR) long-term follow-up in 148 nonoperated patients showed significant differences for mortality between groups I and III (p or = 65% with either cyanosis or arrhythmias (p or = 65% (63.5%), in patients who had functional class IV (52.5%) and in patients included in group III of clinical deterioration (38.2%). Despite the fact that the association of functional class III or IV plus CTR > or = 65% with either cyanosis or arrhythmias is a good predictor for death, the mortality in patients who had only one of these variables was lower. Patients included in group II of clinical deterioration in stable condition presented long survival with medical treatment. Due to the high mortality rate found in group III, surgical treatment of Ebstein's anomaly must be done before deteriorating into group III. Surgical indication must be done considering the surgical risk of each group according to the experience of the Institution and comparing the rate of surgical mortality with the rate of survival without surgery. PMID:10367089

  17. Ultrasound-diagnosed disorders in shoulder patients in daily general practice: a retrospective observational study

    Ottenheijm, Ramon PG; van’t Klooster, Inge GM; Starmans, Laurens MM; Vanderdood, Kurt; Bie, Rob A. de; Dinant, Geert-Jan; Cals, Jochen WL

    2014-01-01

    Background Ultrasound imaging (US) is considered an accurate and widely available method to diagnose subacromial disorders. Yet, the frequency of the specific US-diagnosed shoulder disorders of patients with shoulder pain referred from general practice is unknown. We set out to determine the frequency of specific US-diagnosed shoulder disorders in daily practice in these patients and to investigate if the disorders detected differ between specific subgroups based on age and duration of pain. ...

  18. Symptoms and investigative findings in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy and biopsy over a five year period.

    A. Manohar; Simjee, A E; Haffejee, A A; Pettengell, K E

    1990-01-01

    This study analysed clinical features and laboratory investigations in 145 patients with tuberculous peritonitis diagnosed by peritoneoscopy at this hospital between 1984 and 1988. Tuberculous peritonitis was found in 2% of all patients with tuberculosis and in 59.8% of all those with abdominal tuberculosis admitted to the hospital during the study period. Tuberculous peritonitis was more common in women than men (1.4:1) and was most frequently encountered in the third and fourth decades of l...

  19. Long-term mortality in patients diagnosed with pneumococcal meningitis: a Danish nationwide cohort study

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

    2010-01-01

    The objective of the study was to determine the long-term mortality and the causes of death in patients diagnosed with pneumococcal meningitis. The authors performed a nationwide, population-based cohort study including all Danish patients diagnosed with pneumococcal meningitis from 1977 through ...

  20. The Characteristics of Male Patients Diagnosed with Osteoporosis - Original Investigation

    İlknur Aktaş

    2006-12-01

    Full Text Available Aims: Evaluating the characteristics of male osteoporosis cases followed up in outpatient clinic. Material and Methods: The age, education status, alcohol, cigarette and coffee consumption, and nutritive habits of the male cases followed up in outpatient clinic between 2004-2005 were evaluated. Usage of toxic drugs and low energy fracture presence in the patient and his family were recorded. Sexual function was evaluated. Total blood count, comprehensive biochemical analyses, and bone mineral density (BMD measurement (DXA Hologic were applied. Results: The mean age of the 55 study subjects was 61.7 ± 14.69 (age range: 22-85. 49.09% of the cases graduated from university, 29.09% high school, and 21.81% primary school. 78.2% of the cases were not using alcohol at all, 5.5% of them drinks alcohol one glass a day, and 3.6% of them have a few glasses a week. The nonsmokers were 89%, the ones that smokes up to 5 cigarettes a day were 7.3%, and the ones who smokes more than 5 cigarettes a day were 3.7%. The percentage of cases that drinks more than 3 cups of coffee a day were 3.6%, the people who receive calcium-rich food were 69.1%, and the regularly exercising people were 49%. 40% of the cases manifested sexual dysfunction. Secondary diseases were determined in 67.3% of cases and 29.1% of them had a history of toxic drug usage. The percentages of having fracture history in patients and their families were, respectively, 16.4% and 10.9%. Mean total hip densitometry value T-score was -2.19 ± 0.89, and Lumbar 1-4 T-score was -2.63 ± 0.80. Conclusion: We can affirm about osteoporosis that it should be considered in men at advanced ages, secondary diseases and sexual hormones play significant roles as etiologic causes, and it effects especially lumbar region. (Osteoporoz Dünyasından 2006;12:84-6

  1. Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography

    Fatty liver is one of the most commonly found disease by abdominal ultrasonography. The status of fatty liver is classified into mild, moderate and severe degrees. The study was conducted to investigate the clinical significance of fatty liver using ultrasonography. Test set consisted of 2,185 patients who visited D healthcare center in Daejeon to receive an abdominal ultrasonic test from January to December 2007. Out of the 2185 patients, 524 patients was diagnosed as fatty liver (290 male and 234 female patients). They were divided into three groups, group I for mild degree. II for moderate degree, and III for severe degree, depending on the echo of liver parenchyma, the sound attenuation, and the visibility of intrahepatic blood vessels and diaphragm. Then the correlation of obesity indices, liver function tests and metabolic syndrome was analyzed for males and females separately. As for the degree of fatty liver, 350 cases (66.8%) were classified as group I, 153 cases (29.2%) as group II, and 21 cases (4.1%) as group III. In addition, severe degree of fatty liver was more frequently found in males than in females. The mean ages of three groups for males were 46.1, 44.5, and 39.1, and those for females were 48.8, 50.2, 52.4, respectively. Males with lower mean ages have severely of fatty liver for both males and females. The results in this study show that the classification into three degrees of fatty liver in ultrasonography practice is helpful to treat and observe the progress of fatty liver. In addition, careful examination is required to measure the severity of fatty liver as well as detection of it. A standardized method to classify the degree of fatty liver is also needed for more objective measurement.

  2. Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway

    Sørgaard Knut W

    2013-01-01

    Full Text Available Abstract Background We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. Method All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP. Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian with univariate and multivariate statistics. Results Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. Conclusion Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services (“dispensaries”. Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.

  3. Hepatitis C virus positive patient diagnosed after detection of atypical cryoglobulin.

    Ongen, Belkiz; Aksungar, Fehime Benli; Cicek, Bahattin; Akyar, Isin; Coskun, Abdurrahman; Serteser, Mustafa; Unsal, Ibrahim

    2016-03-16

    A 60-year-old male patient presented with jaundice and dark urine for three days, icteric sclerae and skin rash on his legs for six months. Laboratory investigations revealed an atypical cryoglobulinemia with high hepatitis C virus (HCV)-RNA levels. Imaging studies showed cholestasis was accompanying HCV. Capillary zone electrophoresis using immunosubtraction method revealed a polyclonal immunoglobulin G and immunoglobulin A (IgA) monoclonal cryoglobulin and that IgA lambda was absent in immunofixation electrophoresis. After a liver biopsy, chronic hepatitis C, HCV related mixed cryoglobulinemia and cryoglobulinemic vasculitis were diagnosed and antiviral therapy was initiated. Our HCV patient presented with cryoglobulinemic symptoms with an atypical cryoglobulinemia that was detected by an alternative method: Immunosubtraction by capillary electrophoresis. Different types of cryoglobulins may therefore have a correlation with clinical symptoms and prognosis. Therefore, the accurate immunotyping of cryoglobulins with alternative methods may provide more information about cryoglobulin-generated pathology. PMID:26989673

  4. Clinical aspects of pneumocystis pneumonia in patients with lung cancer

    Pneumocystis pneumonia (PCP) is known to be a potentially fatal opportunistic infection. PCP is sometimes encountered by lung cancer patients during cancer treatment. In this study, we retrospectively examined the frequency of PCP in lung cancer patients in terms of the clinical characteristics and the treatment method. We studied 297 patients with lung cancer treated in our department between January, 2004 and December, 2005. PCP was diagnosed when the clinical conditions and clinical findings agreed with PCP, and Pneumocystis jiroveci was detected by microscopic inspection or polymerase chain reaction method of airway biopsy specimen from patient PCP was diagnosed in 13 patients (4.4%) out of 297 lung cancer patients. Of the 13 patients with PCP, 4 patients had received chemo-radiotherapy, and 7 patients received chemo-therapy with palliative radiotherapy in 4 cases. One patient received radiotherapy only. Surgical excision had been done in one patient. Ten of 13 patients with PCP had received glucocorticoid therapy until PCP was diagnosed. PCP was more frequent in lung cancer patients who had received chemotherapy or radiotherapy, or both. Glucocorticoid therapy with chemotherapy, or radiotherapy, or both was also a risk factor for PCP. It is thought that great caution is necessary in PCP when glucocorticoid is used additionally in lung cancer patients who have received either chemotherapy, or radiotherapy. (author)

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

    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...

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

    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.......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....

  7. Bevacizumab treatment for newly diagnosed glioblastoma: Systematic review and meta-analysis of clinical trials

    FU, PENG; HE, YUN-SONG; HUANG, QIN; DING, TAO; CEN, YONG-CUN; ZHAO, HONG-YANG; WEI, XIANG

    2016-01-01

    High-grade glioma is a richly neovascularized brain solid tumor with a poor prognosis. Bevacizumab is a recombinant humanized monoclonal antibody that inhibits vascular endothelial cell proliferation and angiogenesis, which has shown clinical efficacy in recurrent glioblastoma. MEDLINE/PubMed, EMBASE and Web of Science databases were searched for relevant studies that compared bevacizumab plus combined radiotherapy/temozolomide (RT/TMZ) with RT/TMZ alone in newly diagnosed glioblastoma (GBM). Of all the studies identified, three comparative trials were included in the systematic review. All three enrolling trials, including a total of 1,738 patients, investigated bevacizumab or placebo plus combined RT/TMZ treatment in glioblastoma. The result showed no increased overall survival (OS) (pooled hazard ratio (HR), 1.04; 95% confidence interval (CI), 0.84–1.29; P=0.71) but increased progression-free survival (HR, 0.74; 95% CI, 0.62–0.88; P=0.0009). However, the two randomized double-blind placebo-control trials exemplified a high rate of adverse events of the bevacizumab compared with the placebo group while discrepant points were noted in term of quality-of-life outcome. Additionally, bevacizumab plus RT/TMZ did not increase the 6-month survival rate [odd ratios (ORs), 0.65; 95% CI, 0.37–1.13; P=0.13). Overall, addition of bevacizumab to radiotherapy-temozolomide treatment may be an effective therapy strategy for improving progression-free survival. OS and the 6-month survival rate was not prolonged and there was questionable efficacy of bevacizumab on the quality-of-life of glioblastoma patients, thus further clinical trials should be performed.

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

    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-κB, 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

  9. Diagnoses and Presenting Symptoms in an Infant Psychiatry Clinic: Comparison of Two Diagnostic Systems.

    Frankel, Karen A.; Boyum, Lisa A.; Harmon, Robert J.

    2004-01-01

    Objective: To present data from a general infant psychiatry clinic, including range and frequency of presenting symptoms, relationship between symptoms and diagnoses, and comparison of two diagnostic systems, DSM-IV and Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). Method: A…

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

    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.

  11. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state

    Staii Anca

    2010-12-01

    Full Text Available Abstract Background Our Thyroid-Multidisciplinary Clinic is a large referral site for thyroid diseases. Thyroid biopsies are mainly performed for thyroid cancer screening. Yet, Hashimoto thyroiditis (HT is being too frequently diagnosed. The prevalence of HT is reported as 0.3-1.2% or twice the prevalence of type 1 diabetes. However, the prevalence of HT confirmed by cytology is still uncertain. To evaluate different aspects of thyroid physiopathology including prevalence of Hashimoto's, a database of clinical features, ultrasound images and cytology results of patients referred for FNA of thyroid nodules was prospectively developed. Methods We retrospectively studied 811 consecutive patients for whom ultrasound guided thyroid FNA biopsies were performed at our clinic over 2.5 year period (Mar/2006-Sep/2008. Results The analysis of our database revealed that from 761 patients, 102 (13.4% had HT, from whom 56 (7.4% were euthyroid or had sub-clinical (non-hypothyroid disease, and 46 (6% were clinically hypothyroid. Conclusions This is the first study to show such a high prevalence of HT diagnosed by ultrasound-guided FNA. More strikingly, the prevalence of euthyroid HT, appears to be >5% similar to that of type 2 diabetes. Based on our results, there might be a need to follow up on cytological Hashimoto's to monitor for thyroid failure, especially in high risk states, like pregnancy. The potential risk for thyroid cancer in patients with biopsy-proven inflammation of thyroid epithelium remains to be established prospectively. However, it may explain the increased risk for thyroid cancer observed in patients with elevated but within normal TSH.

  12. External validation of a nomogram predicting overall survival of patients diagnosed with endometrial cancer

    Polterauer, Stephan; Zhou, Qin; Grimm, Christoph; Seebacher, Veronika; Reinthaller, Alexander; Hofstetter, Gerda; Concin, Nicole; Leitao, Mario M.; Barakat, Richard R.; Abu-Rustum, Nadeem R.; Iasonos, Alexia

    2016-01-01

    Objectives Nomograms are predictive models that provide the overall probability of a specific outcome. Nomograms have shown better individual discrimination than currently used staging systems in numerous tumor entities. Recently, a nomogram for predicting overall survival (OS) in women with endometrial cancer was introduced by Memorial Sloan-Kettering Cancer Center (MSKCC). The aim of this study was to test the validity of the MSKCC endometrial cancer nomogram using an independent, external patient cohort. Methods The MSKCC nomogram is based on five readily available clinical characteristics. A multi-institutional endometrial cancer database was used to test the nomogram’s validity. All consecutive patients treated for endometrial cancer between December 1995 and May 2011 and who had all nomogram variables documented were identified for analysis. Results Seven hundred sixty-five eligible patients were identified and used for external validation analysis. In the Austrian patient cohort, median OS was 134 months, and 3-year and 5-year OS rates were 83.8% (95% CI, 80.6–86.5%) and 77.2% (95% CI, 43.5–80.5%), respectively. The nomogram concordance index was 0.71 (SE=0.017; 95% CI, 0.68–0.74). The correspondence between the actual OS and the nomogram predictions suggests a good calibration of the nomogram in the validation cohort. Conclusion The MSKCC endometrial cancer nomogram was externally validated and was shown to be generalizable to a new and independent patient population. The nomogram provides a more individualized and accurate estimation of OS for patients diagnosed with endometrial cancer following primary therapy. The nomogram can be used for counseling patients more accurately and for better stratifying patients for clinical trials. PMID:22449735

  13. Acute porphyrias: clinical spectrum of hodpitalized patients

    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)

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

    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.

  15. Incidence of Severe Pain in Newly Diagnosed Ambulatory Patients with Stage IV Cancer

    Isaac, Thomas; STUVER, SHERRI O.; Davis, Roger B.; Block, Susan; Weeks, Jane C.; Berry, Donna L.; WEINGART, SAUL N.

    2012-01-01

    BACKGROUND: Pain is common among cancer patients.OBJECTIVE: To characterize the incidence of severe pain among newly diagnosed patients with stage IV cancer in ambulatory care.METHODS: A retrospective cohort of 505 ambulatory oncology patients with newly diagnosed stage IV solid tumours at a comprehensive cancer centre (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) was followed from January 1, 2004, to December 31, 2006. Pain intensity scores were extracted from electronic medical...

  16. Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India

    Saptarshi Bishnu

    2014-01-01

    Full Text Available Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. Results: Mean age of patients was 36.38 ± 10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44% and intercourse with HIV seropositive spouses (89, 68.46%, respectively. Fever (104, 28.89%, weight loss (103, 28.61% and generalized weakness (80, 22.22% were the predominant symptoms. Overall mean CD4 count was 176.04 ± 163.49 cells/μl (males 142.19 ± 139.33 cells/μl; females 235.92 ± 185.11 cells/μl. Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22% and pulmonary tuberculosis (39, 10.83% being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83% patients were eligible for initiation of first-line antiretrovirals at presentation. Interpretation & conclusions: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.

  17. Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India

    Bishnu, Saptarshi; Bandyopadhyay, Dipanjan; Samui, Samiran; Das, Indrani; Mondal, Pradip; Ghosh, Pramit; Roy, Deeptarka; Manna, Sukanta

    2014-01-01

    Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. Results: Mean age of patients was 36.38 ± 10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04 ± 163.49 cells/μl (males 142.19 ± 139.33 cells/μl; females 235.92 ± 185.11 cells/μl). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. Interpretation & conclusions: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation. PMID:25109725

  18. Physical therapy and health-related outcomes for patients with common orthopaedic diagnoses.

    Di Fabio, R P; Boissonnault, W

    1998-03-01

    Assessing both physical and mental health is necessary in clinical settings to quantify the scope of disability and to evaluate the effectiveness of treatment programs. Changes in health-related quality of life following physical therapy treatment for many patients with orthopaedic-related diagnoses is not known. The purposes of this study were to describe changes in health-related quality of life between the initial assessment and the time of discharge from physical therapy for the most common orthopaedic diagnoses and to compare the patterns of deficit among diagnostic categories. Patient outcomes in this study were evaluated from a large database generated by the Focus on Therapeutic Outcomes (FOTO) network. Health-related and employment outcomes were described for adult patients who were classified using ICD-9-CM codes. The most common orthopaedic diagnostic categories were sacroiliac sprain, back sprain, low back pain (radiating and nonradiating), neck sprain, neck pain (radiating and nonradiating), adhesive capsulitis of the shoulder, rotator cuff injury, shoulder sprain, knee dislocation, knee sprain, and knee derangement. The primary outcome measure was a 17-item questionnaire (the MOS-17) derived from the RAND 36-Item Health Survey (SF-36) and the 12-item Short Form Health Survey (SF-12). The comparison of each cohort to population norms was made by calculating a standard score on patient data adjusted for age and gender. An effect size was calculated to measure the change in health or employment status between the initial assessment and discharge from physical therapy. For all diagnostic categories, health-related quality of life with respect to norms and employment status showed a consistent pattern of improvement at the time of discharge compared with the initial assessment. There were only small changes in physical function for neck and shoulder diagnostic categories. Nearly all of the diagnostic categories had large reductions in bodily pain. The amount of clinical change in the physical components of health-related quality of life--especially the physical function and role physical domains--differed substantially across specific diagnostic categories. The largest improvements in the physical function occurred for patients with knee dislocation and knee sprain. Patients with knee dislocation also had the largest improvement in role limitations due to physical problems. The design of this study does not permit conclusions about the efficacy of physical therapy. Further study is needed to determine if the finding of different levels of health status improvement across diagnostic categories was due to the nature of the outcome measure, the type of treatments given to each patient, or other confounding variables, like depression or preinjury functional level. PMID:9513868

  19. The HYPERFlax trial for determining the anti-HYPERtensive effects of dietary flaxseed in newly diagnosed stage 1 hypertensive patients: study protocol for a randomized, double-blinded, controlled clinical trial

    Caligiuri, Stephanie PB; Penner, Brian; Pierce, Grant N

    2014-01-01

    Background In 2013 the World Health Organization deemed hypertension as a global crisis as it is the leading risk factor attributed to global mortality. Therefore, there is a great need for effective alternative treatment strategies to combat a condition that affects 40% of adults worldwide. Recently, the FlaxPAD Trial observed a significant reduction in systolic and diastolic blood pressure in hypertensive patients with peripheral arterial disease that consumed 30 g of milled flaxseed per da...

  20. Bony injuries in trauma patients diagnosed by radiological examination

    This study was carried out to determine the incidence of bony injuries in trauma patients who had plain radiographs done at the Central Regional Hospital in Cape Coast. This is a retrospective study based on plain radiographs taken by trauma patients who reported to the Central Regional Hospital. The case notes of all patients with a discharge diagnosis of Road Traffic Accident or trauma of all aetiologies that presented to the hospital between January 2005 and December 2011 were retrieved, and those patients that had skeletal radiographic examinations were included in this study. The total number of cases seen was 1,133. The ages of the patients ranged between 1 and 72 years. Sixty-nine (6.1%) of the patients were between 1 and 4 years old, with the majority between 20 and 49 years old, constituting 52.3%, with patients 60 years and above at 9.2%. There was statistically significant difference between male and female patients (p=0.001). A total of 912 (80.5%) patients had radiographic examination done out of which only 324 (35.5%) radiographs could be retrieved. There were 106 (32.7%) radiographs with various bony injuries which was statistically significant (p=0.001). Rib fractures represented 19/106 (17.9%) of which 62.5% had multiple rib fractures. Fifty-eight (54.7%) had long bone fractures. Other anatomical sites included the pelvis and the skull. Conclusion: Trauma is a major public health problem in the country, involving mainly the productive age group. Unnecessary exposure to X-rays is common. Inadequate management of trauma patients negatively impacts on the outcome of trauma patients. Trauma prevention is the best way forward.(au)

  1. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial

    James, N. D.; Spears, M. R.; Clarke, N W; Dearnaley, D.P.; Mason, M.D.; Parker, C C; Ritchie, A. W.; Russell, J.M.; Schiavone, F.; Attard, G.; de Bono, J S; Birtle, A; Engeler, D. S.; Elliott, T; Matheson, D.

    2015-01-01

    Importance: The natural history of patients with newly diagnosed high-risk nonmetastatic (M0) prostate cancer receiving hormone therapy (HT) either alone or with standard-of-care radiotherapy (RT) is not well documented. Furthermore, no clinical trial has assessed the role of RT in patients with node-positive (N+) M0 disease. The STAMPEDE Trial includes such individuals, allowing an exploratory multivariate analysis of the impact of radical RT. Objective: To describe survival and the impact o...

  2. Association between treatment-related lymphopenia and overall survival in elderly patients with newly diagnosed glioblastoma.

    Mendez, Joe S; Govindan, Ashwin; Leong, Jacqueline; Gao, Feng; Huang, Jiayi; Campian, Jian L

    2016-04-01

    Management of patients with glioblastoma (GBM) often includes radiation (RT) and temozolomide (TMZ). The association between severe treatment-related lymphopenia (TRL) after the standard chemoradiation and reduced survival has been reported in GBM patients with the median age of 57. Similar findings were described in patients with head and neck, non-small cell lung, and pancreatic cancers. This retrospective study is designed to evaluate whether elderly GBM patients (age ≥65) develop similar TRL after RT/TMZ and whether such TRL is associated with decreased survival. Serial total lymphocyte counts (TLC) were retrospectively reviewed in patients (age ≥65) with newly diagnosed GBM undergoing RT/TMZ and associated with treatment outcomes. Seventy-two patients were eligible: median KPS 70, median age 71 years (range 65-86) with 56 % of patients >70 years, 53 % female, 31 % received RT ≤45 Gy. Baseline median TLC was 1100 cells/mm(3) which fell by 41 % to 650 cells/mm(3) 2 months after initiating RT/TMZ (p TLC <500 cells/mm(3) at 2 months had a shorter survival than those with higher TLCs with a median overall survival of 4.6 versus 11.6 months, respectively. Multivariate analysis revealed a significant association between TRL and survival (HR 2.76, 95 % CI 1.30-5.86, p = 0.008). Treatment-related lymphopenia is frequent, severe, and an independent predictor for survival in elderly patients with GBM. These findings add to the body of evidence that immunosuppression induced by chemoradiation is associated with inferior clinical outcomes. Prospective studies are needed to confirm these findings suggesting that immune preservation is important in this cancer. PMID:26725885

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

    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.)

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

    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

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

    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...... 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...

  6. Safety of thalidomide in newly diagnosed elderly myeloma patients

    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......), (HR 1.23, 95%CI 1.03-1.47). In addition to the occurrence of AEs, PFS and OS were also negatively affected by advanced ISS stage, high creatinine levels and poor performance status. Age had a negative impact on OS as well. Conclusions. Although MPT improved outcome, it increased the incidence of...

  7. 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

    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.

  8. Impact of malignant stem cell burden on therapy outcome in newly diagnosed chronic myeloid leukemia patients.

    Mustjoki, S; Richter, J; Barbany, G; Ehrencrona, H; Fioretos, T; Gedde-Dahl, T; Gjertsen, B T; Hovland, R; Hernesniemi, S; Josefsen, D; Koskenvesa, P; Dybedal, I; Markevärn, B; Olofsson, T; Olsson-Strömberg, U; Rapakko, K; Thunberg, S; Stenke, L; Simonsson, B; Porkka, K; Hjorth-Hansen, H

    2013-07-01

    Chronic myeloid leukemia (CML) stem cells appear resistant to tyrosine kinase inhibitors (TKIs) in vitro, but their impact and drug sensitivity in vivo has not been systematically assessed. We prospectively analyzed the proportion of Philadelphia chromosome-positive leukemic stem cells (LSCs, Ph+CD34+CD38-) and progenitor cells (LPCs, Ph+CD34+CD38+) from 46 newly diagnosed CML patients both at the diagnosis and during imatinib or dasatinib therapy (ClinicalTrials.gov NCT00852566). At diagnosis, the proportion of LSCs varied markedly (1-100%) between individual patients with a significantly lower median value as compared with LPCs (79% vs 96%, respectively, P=0.0001). The LSC burden correlated with leukocyte count, spleen size, hemoglobin and blast percentage. A low initial LSC percentage was associated with less therapy-related hematological toxicity and superior cytogenetic and molecular responses. After initiation of TKI therapy, the LPCs and LSCs rapidly decreased in both therapy groups, but at 3 months time point the median LPC level was significantly lower in dasatinib group compared with imatinib patients (0.05% vs 0.68%, P=0.032). These data detail for the first time the prognostic significance of the LSC burden at diagnosis and show that in contrast to in vitro data, TKI therapy rapidly eradicates the majority of LSCs in patients. PMID:23328954

  9. Intellectual Impairment in Patients with Newly Diagnosed HIV Infection in Southwestern Nigeria

    Sunmonu, Taofiki A.; Sellner, Johann; Ogunrin, Olubunmi A.; Imarhiagbe, Frank A.; Komolafe, Morenikeji A.; Afolabi, Olusegun T.; Ilesanmi, Olayinka S.; Olanrewaju, Fatai; Oladimeji, Benedicta Y.

    2015-01-01

    Neurocognitive impairment is a detrimental complication of HIV infection. Here, we characterized the intellectual performance of patients with newly diagnosed HIV infection in southwestern Nigeria. We conducted a prospective study at Owo Federal Medical Center by using the adapted Wechsler Adult Intelligence Scale (WAIS). The raw scores were converted to standardized scores (z-scores) and correlated with clinical and laboratory findings. Fifty-eight HIV positive patients were recruited; 72% were in WHO stages 3 and 4. We detected a high rate of intellectual impairment in HIV positive patients and controls (63.8% and 10%, resp.; P < 0.001). HIV positive patients performed worse throughout the subtests of both verbal and performance intelligence quotients. Presence of opportunistic infections was associated with worse performance in the similarities and digit symbol tests and performance and full scale scores. Lower body weight correlated with poor performance in different WAIS subtests. The high rate of advanced disease stage warrants measures aimed at earlier diagnosis and treatment. Assessment of neurocognitive performance at diagnosis may offer the opportunity to improve functioning in daily life and counteract disease progression. PMID:26295033

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

    Lu, Hui; Zeng, Binghui; Yu, Dongsheng; Jing, Xiangyi; Hu, Bin; Zhao, Wei; Wang, Yiming

    2015-01-01

    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 supernu...

  11. Factors Influencing Chemotherapy Goal Perception in Newly Diagnosed Cancer Patients.

    Gumusay, Ozge; Cetin, Bulent; Benekli, Mustafa; Gurcan, Gamze; Ilhan, Mustafa N; Bostankolu, Basak; Ozet, Ahmet; Uner, Aytug; Coskun, Ugur; Buyukberber, Suleyman

    2016-06-01

    Cancer patients who start receiving chemotherapy have difficulty in understanding the state of their disease, the prognosis, and the purpose of treatment. We used a survey to evaluate the extent of perception of chemotherapy goal among cancer patients. Two hundred sixteen cancer patients who received chemotherapy for the first time participated in the study. The presence of depression and anxiety was assessed using the "Hospital Anxiety and Depression Scale" (HAD). The consistency between the patients' perception of the chemotherapy goal and the physician's perception was described as "right," and the inconsistency was described as "wrong." Among the patients who participated in the survey, 53.2 % (n = 115) were receiving adjuvant treatment and 46.8 % (n = 101) were receiving palliative treatment for metastatic disease. The rate of right and wrong perception of the chemotherapy goal was 51.9 % (n = 108) and 32.2 % (n = 67), respectively, and the rate of confused patients was 18.9 % (n = 41). The level of education was shown to be the only parameter involved in accurate perception of the treatment purpose (hazard ratio (HR) = 0.444, p = 0.025, 95 % confidence interval (CI) 0.219-0.903). In this study, there was a 51.9 % consistency between the physician's perception and that of the patient regarding the purpose of treatment. We demonstrated that the level of education was the unique factor in accurate perception of chemotherapy goal among cancer patients. PMID:25851203

  12. Standardized Peridialytic Blood Pressures for Diagnosing Arterial Hypertension in Patients on Chronic Hemodialysis

    Raluca Moldovan; Mirela Gherman-Căprioară

    2014-01-01

    Background. The relevance of peridialytic blood pressures for diagnosing hypertension is controversial. Standardized peridialytic BPs have not yet been evaluated for the positive diagnosis and evaluation of hypertension severity in chronic hemodialysis patients.Aim. To evaluate the utility of standardized peridialytic BP for diagnosing hypertension, defined according to the results of 24-hour ambulatory blood pressure monitoring(ABPM).Methods. Thirty-five chronic hemodialysis patients with a ...

  13. Unroofed coronary sinus newly diagnosed in adult patients after corrected congenital heart disease

    Prez Matos, A. J.; Planken, R. N.; Bouma, B.J.; Groenink, M.; Backx, A. P. C. M.; de Winter, R.J.; Koolbergen, D.R.; Mulder, B.J.M.; Boekholdt, S. M.

    2014-01-01

    Patients with congenital heart disease corrected in early childhood may later in life present with cardiac symptoms caused by other associated congenital anomalies that were initially not diagnosed. Nowadays, several noninvasive imaging modalities are available for the visualisation of cardiac anatomy in great detail. We describe two patients with an unroofed coronary sinus, a rare congenital anomaly which could be diagnosed using a combination of modalities including echocardiography, cardia...

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

    Mæland, Silje; Werner, Erik L.; Rosendal, Marianne; Jonsdottir, Ingibjorg H.; Magnussen, Liv Heide; Ursin, Holger; Eriksen, Hege Randi

    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 cross-secti...

  15. Association between metabolic syndrome and sexual dysfunction among men with clinically diagnosed diabetes

    Amidu, Nafiu; Owiredu, William KBA; Alidu, Huseini; Sarpong, Charity; Gyasi-Sarpong, Christian K; Quaye, Lawrence

    2013-01-01

    Background The worldwide epidemic of diabetes and obesity has resulted in a rapid upsurge in the prevalence of metabolic syndrome (MetS). MetS makes the individual liable to endothelial dysfunction which can initiate sexual dysfunction (SD). This study assessed the association between MetS and SD among clinically diagnosed diabetic subjects in Tema, Greater Accra Region of Ghana. Method Sexual functioning was assessed using Golombok Rust Inventory of Sexual Satisfaction in 300 consecutive dia...

  16. Non-epileptic clinical diagnoses in children referred for an outpatient EEG using video monitoring.

    Apakama, Okwuchi; Appleton, Richard

    2006-06-01

    Simultaneous video (closed circuit television [CCTV]) and EEG recordings are important in the differentiation of epileptic and non-epileptic paroxysmal episodes and in the classification of epilepsy syndromes. An additional benefit from the observation of the child on CCTV is the possible identification of specific clinical, including genetic, conditions. This three-year prospective study of 2780 consecutive children undergoing routine EEG investigations identified 17 conditions that had not previously been diagnosed by the clinicians who had requested the EEG. PMID:16793578

  17. Proposal for a new clinical test for diagnosing lateral hip snapping☆☆☆

    de Amorim Cabrita, Henrique Antonio Berwanger; de Campos Gurgel, Henrique Melo; Marques, Ricardo; Santos, Leandro Emilio Nascimento; Vicente, José Ricardo Negreiros; de Camargo Leonhardt, Marcos; Ejnisman, Leandro; Croci, Alberto Tesconi

    2014-01-01

    Lateral hip snapping is a nosological entity that is often unknown to many orthopedists and even to some hip surgery specialists. It comprises palpable and/or audible snapping on the lateral face of the hip that is sometimes painful, caused by muscle-tendon friction on the greater trochanter during flexion and extension of the coxofemoral joint. In the following, we describe a new test for diagnosing lateral hip snapping, which is eminently clinical. PMID:26229857

  18. Proposal for a new clinical test for diagnosing lateral hip snapping☆☆☆

    Henrique Antonio Berwanger de Cabritaa Amorim; Henrique Melo de Campos Gurgela; Ricardo Marques; Leandro Emilio Nascimento Santos; José Ricardo Negreiros Vicentea; Marcos de Camargo Leonhardta; Leandro Ejnismana; Alberto Tesconi Croci

    2014-01-01

    Lateral hip snapping is a nosological entity that is often unknown to many orthopedists and even to some hip surgery specialists. It comprises palpable and/or audible snapping on the lateral face of the hip that is sometimes painful, caused by muscle-tendon friction on the greater trochanter during flexion and extension of the coxofemoral joint. In the following, we describe a new test for diagnosing lateral hip snapping, which is eminently clinical.

  19. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis. PMID:26620686

  20. Risk factors for pulmonary embolism in patients preliminarily diagnosed with community-acquired pneumonia: a prospective cohort study.

    Zhang, Yunfeng; Zhou, Qixing; Zou, Ying; Song, Xiaolian; Xie, Shuanshuan; Tan, Min; Zhang, Guoliang; Wang, Changhui

    2016-05-01

    D-dimer levels are increased in patients with acute pulmonary embolism (PE). However, D-dimer levels are also increased in patients with community-acquired pneumonia (CAP). The aim of this prospective cohort study was to examine the incidence and clinical features of patients preliminarily diagnosed with CAP and with increased D-dimer levels, and who finally were diagnosed with PE. Patients diagnosed with CAP and hospitalized in the Respiratory Department of the Tenth People's Hospital Affiliated to Tongji University between May 2011 and May 2013 were enrolled. D-dimer levels were measured routinely after admission. For patients with increased D-dimer levels, those suspected with PE underwent computed tomography pulmonary angiography (CTPA). A total of 2387 patients with CAP was included: 724 (30.3 %) had increased D-dimer levels (median of 0.91 mg/L). CTPA was performed for 139 of the 724 patients (median D-dimer levels of 1.99 mg/L). Among the 139 patients, 80 were diagnosed with PE, and 59 without PE; D-dimer levels were 2.83 and 1.41 mg/L, respectively (p pulmonary disease (COPD), lower limb varicosity, chest pain, shortness of breath, hemoptysis, fever, and increased levels of troponin I were independent risk factors for PE. Presentation of PE and CAP are similar. Nevertheless, these results indicated that for hospitalized patients with CAP and elevated D-dimer levels, PE should be considered for those >60 years; with CHD, COPD, or lower limb varicosity; with chest pain, shortness of breath, hemoptysis, increased troponin I, or low fever. PMID:26370200

  1. Treatment response, safety, and tolerability of paliperidone extended release treatment in patients recently diagnosed with schizophrenia

    Peuskens, Joseph; Vauth, Roland; Sacchetti, Emilio; bij de Weg, Haye; Herken, Hasan; Lahaye, Marjolein; Schreiner, Andreas

    2015-01-01

    Objective: This study was designed to explore the efficacy and tolerability of oral paliperidone extended release (ER) in a sample of patients who were switched to flexible doses within the crucial first 5 years after receiving a diagnosis of schizophrenia. Methods: Patients were recruited from 23 countries. Adults with nonacute but symptomatic schizophrenia, previously unsuccessfully treated with other oral antipsychotics, were transitioned to paliperidone ER (3–12 mg/day) and prospectively treated for up to 6 months. The primary efficacy outcome for patients switching for the main reason of lack of efficacy with their previous antipsychotic was at least 20% improvement in Positive and Negative Syndrome Scale (PANSS) total scores. For patients switching for other main reasons, such as lack of tolerability, compliance or ‘other’, the primary outcome was non-inferiority in efficacy compared with the previous oral antipsychotic. Results: For patients switching for the main reason of lack of efficacy, 63.1% achieved an improvement of at least 20% in PANSS total scores from baseline to endpoint. For each reason for switching other than lack of efficacy, efficacy maintenance after switching to paliperidone ER was confirmed. Statistically significant improvement in patient functioning from baseline to endpoint, as assessed by the Personal and Social Performance scale, was observed (p paliperidone ER. Paliperidone ER was generally well tolerated, with frequently reported treatment-emergent adverse events being insomnia, anxiety and somnolence. Conclusions: Flexibly dosed paliperidone ER was associated with clinically relevant symptomatic and functional improvement in recently diagnosed patients with non-acute schizophrenia previously unsuccessfully treated with other oral antipsychotics. PMID:26301075

  2. Current recommendations for the molecular evaluation of newly diagnosed holoprosencephaly patients.

    Pineda-Alvarez, Daniel E; Dubourg, Christèle; David, Véronique; Roessler, Erich; Muenke, Maximilian

    2010-02-15

    Holoprosencephaly (HPE) is the most common structural malformation of the developing forebrain in humans and is typically characterized by different degrees of hemispheric separation that are often accompanied by similarly variable degrees of craniofacial and midline anomalies. HPE is a classic example of a complex genetic trait with "pseudo"-autosomal dominant transmission showing incomplete penetrance and variable expressivity. Clinical suspicion of HPE is typically based upon compatible craniofacial findings, the presence of developmental delay or seizures, or specific endocrinological abnormalities, and is then followed up by confirmation with brain imaging. Once a clinical diagnosis is made, a thorough genetic evaluation is necessary. This usually includes analysis of chromosomes by high-resolution karyotyping, clinical assessment to rule-out well recognized syndromes that are associated with HPE (e.g., Pallister-Hall syndrome, Smith-Lemli-Opitz syndrome and others), and molecular studies of the most common HPE associated genes (e.g., SHH, ZIC2 and SIX3). In this review, we provide current step-by-step recommendations that are medically indicated for the genetic evaluation of patients with newly diagnosed HPE. Moreover, we provide a brief review of several available methods used in molecular diagnostics of HPE and describe the advantages and limitations of both currently available and future tests as they relate to high throughput screening, cost, and the results that they may provide. PMID:20104604

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

    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.

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

    Ray, Lara A.; Hutchison, Kent E.; Adam M. Leventhal; 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 ...

  5. Vitamin D deficiency in newly diagnosed breast cancer patients

    Saba Imtiaz

    2012-01-01

    Full Text Available Aim: The aim was to determine serum vitamin D levels in breast cancer patients and to assess its risk association with grade and stage of the tumor. Materials and Methods: Ninety breast cancer patients and equal number of age-matched healthy females were recruited into the study by consecutive sampling over a period of 6 months for this case control study. Serum 25(OH2D levels and CT bone mineral density was done. Results: The mean age was 46±1.5 years. Age, marital status, menopausal, residential area, parda observing status, and body mass index were similar in distribution among cases and controls. The mean serum vitamin D level in the breast cancer patients was 9.3 ng/ml and in the control group was 14.9 ng/ml (P value <0.001. Vitamin D deficiency was seen in 95.6% (86 breast cancer patients and in 77% (69 of the control group (P value <0.001. Among the breast cancer patients the tumor characteristics (histology, grade, stage, and receptor status did not show any significant associations with serum levels of vitamin D. Premenopausal breast cancer females had a mean serum vitamin D level of 10.5 ng/ml and postmenopausal females had a mean value of 13.5 ng/ml (P value 0.015. Low BMD did not correlate significantly with vitamin D deficiency (P value 0.787. Conclusion: Invariably almost all patients with breast cancer were vitamin D deficient. Tumor characteristics did not show any significant associations with serum levels of vitamin D. Bone mineral density did not correlate significantly with vitamin D deficiency.

  6. Visceral leishmaniasis diagnosed in a patient with MALT lymphoma

    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 leishmaniasis, appears to have aggravated the symptoms of the intestinal lymphoma. Leishmaniasis should be...... suspected even among asymptomatic patients with immune compromising illnesses and a travel history to areas where leishmaniasis is endemic....

  7. Knowledge and Practices of Doctors and Nurses in Oncology Clinics Regarding Sperm Bank Use in Adolescent Boys Diagnosed with Cancer

    Ay?e Sonay Kurt

    2013-12-01

    Full Text Available Introduction: This descriptive study aimed to identify the knowledge and practices regarding sperm banks among doctors and nurses treating young male patients with cancer. Materials and Methods: The study population comprised 71 doctors and 150 nurses working in the oncology clinics of hospitals affiliated with the Istanbul Health Directorate between January 1st and March 30th, 2012. No sampling was carried out, because the study aimed to reach the whole population. Results: Among the participants, 70% of the doctors and 42% of the nurses stated that there were no written rules on sperm preservation in their current institutions. Those wishing to have children, who are single, and who have to start chemotherapy immediately were the 3 most important patient groups doctors recommended for sperm preservation. Meanwhile, the nurses reported those wishing to have children, who were diagnosed recently, and who have to start chemotherapy immediately as the most important patients for fertility preservation. Doctors and nurses practices related to sperm freezing were unsatisfactory; the main factors influencing this situation were cultural factors, religious beliefs, and work load. Conclusions: Although health personnel are aware of the importance of sperm preservation in young male patients diagnosed with cancer, the related practices are not at desirable levels. (Journal of Current Pediatrics 2013; 11: 114-20

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

    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.

  9. Observational Study of a French and Belgian Multicenter Cohort of 23 Patients Diagnosed in Adulthood With Mevalonate Kinase Deficiency.

    Durel, Cécile-Audrey; Aouba, Achille; Bienvenu, Boris; Deshayes, Samuel; Coppéré, Brigitte; Gombert, Bruno; Acquaviva-Bourdain, Cécile; Hachulla, Eric; Lecomte, Frédéric; Touitou, Isabelle; Ninet, Jacques; Philit, Jean-Baptiste; Messer, Laurent; Brouillard, Marc; Girard-Madoux, Marie-Hélène; Moutschen, Michel; Raison-Peyron, Nadia; Hutin, Pascal; Duffau, Pierre; Trolliet, Pierre; Hatron, Pierre-Yves; Heudier, Philippe; Cevallos, Ramiro; Lequerré, Thierry; Brousse, Valentine; Lesire, Vincent; Audia, Sylvain; Maucort-Boulch, Delphine; Cuisset, Laurence; Hot, Arnaud

    2016-03-01

    The aim of this study was to describe the clinical and biological features of Mevalonate kinase deficiency (MKD) in patients diagnosed in adulthood.This is a French and Belgian observational retrospective study from 2000 to 2014. To constitute the cohort, we cross-check the genetic and biochemical databases. The clinical, enzymatic, and genetic data were gathered from medical records.Twenty-three patients were analyzed. The mean age at diagnosis was 40 years, with a mean age at onset of symptoms of 3 years. All symptomatic patients had fever. Febrile attacks were mostly associated with arthralgia (90.9%); lymphadenopathy, abdominal pain, and skin lesions (86.4%); pharyngitis (63.6%); cough (59.1%); diarrhea, and hepatosplenomegaly (50.0%). Seven patients had psychiatric symptoms (31.8%). One patient developed recurrent seizures. Three patients experienced renal involvement (13.6%). Two patients had angiomyolipoma (9.1%). All but one tested patients had elevated serum immunoglobulin (Ig) D level. Twenty-one patients had genetic diagnosis; most of them were compound heterozygote (76.2%). p.Val377Ile was the most prevalent mutation. Structural articular damages and systemic AA amyloidosis were the 2 most serious complications. More than 65% of patients displayed decrease in severity and frequency of attacks with increasing age, but only 35% achieved remission.MKD diagnosed in adulthood shared clinical and genetic features with classical pediatric disease. An elevated IgD concentration is a good marker for MKD in adults. Despite a decrease of severity and frequency of attacks with age, only one-third of patients achieved spontaneous remission. PMID:26986117

  10. Using a patient image archive to diagnose retinopathy

    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.

  11. Aetiology analysis of 35 patients firstly diagnosed with oculomotor palsy

    Yi-Min Pu

    2013-08-01

    Full Text Available AIM: To analyze the causes and characteristics of 35 patients suffering from oculomotor palsyMETHODS: The outcomes in a series of 35 patients with oculomotor palsy from January, 2009 to December, 2012 in our hospital were retrospectively evaluated. Blood glucose, computed tomography(CT, magnetic resonance imaging(MRI, magnetic resonance angiography(MRA, and digital subtraction angiography(DSAwere underwent to analyze its causes and characteristics.RESULTS: In 35 cases, causes were head injury in 10 patients(29%, intracalvarium inflammation in 8 cases(23%, diabetes in 6 cases(17%, intracranial aneurysm in 4 cases(11%, intracranial neoplasm in 4 cases(11%, cerebral infarction, cerebrovascular hemorrhage and unknown in 1 case(3%, respectively.CONCLUSION: The causes resulting oculomotor palsy were multiplicity, head injury is the most common cause of oculomotor palsy. The other common causes include intracalvarium inflammation and diabetes mellitus. The causes exist some characteristics in different age stages, determine the causes is important extremely for treatment in correct.

  12. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer

    James, Nicholas D.; Spears, Melissa R.; Clarke, Noel W.; Dearnaley, David P.; Mason, Malcolm D.; Parker, Christopher C.; Ritchie, Alastair W. S.; Russell, J. Martin; Schiavone, Francesca; Attard, Gerhardt; de Bono, Johann S.; Birtle, Alison; Engeler, Daniel S.; Elliott, Tony; Matheson, David; O’Sullivan, Joe; Pudney, Delia; Srihari, Narayanan; Wallace, Jan; Barber, Jim; Syndikus, Isabel; Parmar, Mahesh K. B.; Sydes, Matthew R.

    2016-01-01

    IMPORTANCE The natural history of patients with newly diagnosed high-risk nonmetastatic (M0) prostate cancer receiving hormone therapy (HT) either alone or with standard-of-care radiotherapy (RT) is not well documented. Furthermore, no clinical trial has assessed the role of RT in patients with node-positive (N+) M0 disease. The STAMPEDE Trial includes such individuals, allowing an exploratory multivariate analysis of the impact of radical RT. OBJECTIVE To describe survival and the impact on failure-free survival of RT by nodal involvement in these patients. DESIGN, SETTING, AND PARTICIPANTS Cohort study using data collected for patients allocated to the control arm (standard-of-care only) of the STAMPEDE Trial between October 5, 2005, and May 1, 2014. Outcomes are presented as hazard ratios (HRs) with 95% CIs derived from adjusted Cox models; survival estimates are reported at 2 and 5 years. Participants were high-risk, hormone-naive patients with newly diagnosed M0 prostate cancer starting long-term HT for the first time. Radiotherapy is encouraged in this group, but mandated for patients with node-negative (N0) M0 disease only since November 2011. EXPOSURES Long-term HT either alone or with RT, as per local standard. Planned RT use was recorded at entry. MAIN OUTCOMES AND MEASURES Failure-free survival (FFS) and overall survival. RESULTS A total of 721 men with newly diagnosed M0 disease were included: median age at entry, 66 (interquartile range [IQR], 61-72) years, median (IQR) prostate-specific antigen level of 43 (18-88) ng/mL. There were 40 deaths (31 owing to prostate cancer) with 17 months’ median follow-up. Two-year survival was 96% (95% CI, 93%-97%) and 2-year FFS, 77% (95% CI, 73%-81%). Median (IQR) FFS was 63 (26 to not reached) months. Time to FFS was worse in patients with N+ disease (HR, 2.02 [95% CI, 1.46-2.81]) than in those with N0 disease. Failure-free survival outcomes favored planned use of RT for patients with both N0M0 (HR, 0.33 [95% CI, 0.18-0.61]) and N+M0 disease (HR, 0.48 [95% CI, 0.29-0.79]). CONCLUSIONS AND RELEVANCE Survival for men entering the cohort with high-risk M0 disease was higher than anticipated at study inception. These nonrandomized data were consistent with previous trials that support routine use of RT with HT in patients with N0M0 disease. Additionally, the data suggest that the benefits of RT extend to men with N+M0 disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00268476; ISRCTN78818544 PMID:26606329

  13. 16-year excess all-cause mortality of newly diagnosed type 2 diabetic patients: a cohort study

    Hansen, Lars Jørgen; Olivarius, Niels de Fine; Siersma, V.

    2009-01-01

    investigate the age- and sex-specific all-cause mortality pattern in patients with type 2 diabetes in comparison with the Danish background population. METHODS: Population-based cohort study of 1323 patients, diagnosed with clinical type 2 diabetes in 1989-92 and followed for 16 years. Median (interquartile...... population, diabetic patients had a 1.5-2.5 fold higher risk of dying depending on age. The over-mortality was higher for men than for women. It decreased with age in both sexes, and among patients over 80 years at diagnosis the difference between the observed and the expected survival was small. CONCLUSION......BACKGROUND: Studies have shown that type 2 diabetic patients have higher all-cause mortality than people without diabetes, but it is less clear how diabetes affects mortality in elderly patients and to what degree mortality differs between diabetic men and women. The aim of the present study is to...

  14. Clinical results of proton beam therapy for twenty older patients with esophageal cancer

    Ono Takashi; Nakamura Tatsuya; Azami Yusuke; Yamaguchi Hisashi; Hayashi Yuichiro; Suzuki Motohisa; Hatayama Yoshiomi; Tsukiyama Iwao; Hareyama Masato; Kikuchi Yasuhiro; Nemoto Kenji

    2015-01-01

    Background In an aging society, increasing number of older patients are diagnosed with esophageal cancer. The purpose of this study was to assess the clinical efficacy and safety of proton beam therapy for older patients with esophageal cancer. Patients and methods. Older patients (age: ≥ 65 years) newly diagnosed with esophageal cancer between January 2009 and June 2013 were enrolled in this study. All patients underwent either proton beam therapy alone or proton beam therapy with initial X-...

  15. Granulocyte-macrophage colony stimulating factor (GM-CSF) enhances the clinical responses to Interferon-α (IFN) in newly diagnosed chronic myeloid leukemia (CML)

    Zeidner, Joshua F; Gladstone, Douglas E; Zahurak, Marianna; Matsui, William H.; Gocke, Christopher; Jones, Richard J; Smith, B Douglas

    2014-01-01

    The majority of chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) remain with residual disease. In contrast to TKIs, interferon (IFN) is directly toxic to CML progenitor cells, and myeloid growth factors such as GM-CSF may enhance IFN’s cytotoxicity. We performed a phase 2 study of IFN+GM-CSF in 58 newly diagnosed CML patients before imatinib approval. Short-term clinical responses included: 60% major cytogenetic response, 28% complete cytogenetic response...

  16. Utility of serum thymidine kinase activity measurements for cases of bovine leukosis with difficult clinical diagnoses.

    Tawfeeq, Mohammad Monir; Miura, Saori; Horiuchi, Noriyuki; Kobayashi, Yoshiyasu; Furuoka, Hidefumi; Inokuma, Hisashi

    2013-01-01

    This study evaluated the clinical usefulness of serum thymidine kinase (TK) activity for diagnosing bovine leukosis cases for which clinical diagnosis was difficult ('BL with difficult diagnosis'). Median TK activity values in 24 'BL with difficult diagnosis' and 36 cattle for which BL was clinically confirmed by cytology findings of enlarged superficial lymph nodes ('clinically confirmed BL') were 36.8 and 39.4 U/l, respectively (no significant difference). The percentage with positive TK activity (> 5.4 U/l) was also similar in both groups (83.3% for 'BL with difficult diagnosis' and 97.2% for 'clinically confirmed BL'). TK activity was significantly higher in cows with 'BL with difficult diagnosis' compared to those with other tumors (N = 13) and those with inflammatory diseases (N = 14). Maximum TK activity in cows with other tumors and inflammatory diseases was not high (cows with other tumors and those with inflammatory diseases were 1.8 and 1.4 IU/l, respectively. Positive TK activity was found in a significantly higher percentage of cows with 'BL with difficult diagnosis' (83.3%) relative to the percentages of cows with other tumors (15.3%) and inflammatory diseases (21.4%). Thus, TK activity is an appropriate marker for detecting BL onset in cows with 'BL with difficult diagnosis' as well as 'clinically confirmed BL' group. While the specificity of TK activity required for BL diagnosis is not clear, simultaneous evaluation of serum lactate dehydrogenase activity may assist in the differential diagnoses of other tumors and inflammatory diseases from BL. PMID:23628971

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

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

    Patienter med symptomer, der ikke umiddelbart passer med en kendt medicinsk diagnose, er hyppige i almen praksis. Praktiserende læger blev i denne undersøgelse bedt om at sætte en diagnosekode på disse patienter, og der viste sig at være en meget stor variation i valget med op til 31 forskellige ...

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

    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 sy...

  19. Clinical characteristics of patients with conjunctivochalasis

    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

  20. Clinical nurses' characterizations of patient coping problems.

    Becket, N

    1991-01-01

    The author reports the findings from a qualitative study of diagnostic data obtained and interpreted by hospital nurses on the coping of adult patients and their families. Clinical data taken from taped interviews were transcribed and analyzed using grounded theory and analytic induction techniques. The data were then compared with diagnoses accepted for testing by NANDA. The phenomena described by the research did not match the NANDA constructs for individual and family coping problems. Nurses' assessments of coping response, however, fit within transactional theory. The use of the term "ineffective" to qualify coping was generally avoided. Ineffective coping, suggesting an outcome or product of coping, was not often considered applicable to the coping responses nurses found appropriate at specific times in specific situations. PMID:1873103

  1. Clinical Characteristics of Vivax Malaria and Analysis of Recurred Patients

    Kwak, Yee Gyung; Lee, Hyo Keun; Kim, Min; Um, Tae Hyun; Cho, Chong Rae

    2013-01-01

    Background Plasmodium vivax malaria is an acute debilitating illness characterized by recurrent paroxysmal fever and relapses from hypnozoites in the liver. Although a few studies reported clinical characteristics of vivax malaria in civilians after reemergence in the Republic of Korea, only a small group of patients was analyzed. Materials and Methods We retrospectively reviewed the medical records of patients who had been diagnosed with vivax malaria by peripheral blood smear in a universit...

  2. Using Clinical Data to Predict Accurate ADHD Diagnoses Among Urban Children.

    Silverstein, Michael; Hironaka, L Kari; Feinberg, Emily; Sandler, Jenna; Pellicer, Michelle; Chen, Ning; Cabral, Howard

    2016-04-01

    Diagnosing attention deficit hyperactivity disorder (ADHD) requires reports of child behavior from 2 settings-most commonly home and school. Obtaining this information from teachers, however, is often challenging. We sought to determine if clinical data, supplementary to parent symptom scales, could be useful in predicting DSM-compliant diagnoses. Parents and teachers reported ADHD symptoms for 156 children using Vanderbilt scales; care managers collected clinical data; a team of specialists determined whether children met diagnostic criteria for ADHD. The ability of a parent Vanderbilt alone to predict an ADHD diagnosis was 56% (95% confidence interval = 45%, 67%). By adding child age and grade retention history to the multivariable model, the probability rose to 78% (95% confidence interval = 59%, 93%). In the maximally predictive model-which included 5 covariates-the predictive validity rose to 84% (95% confidence interval = 52%, 99%). Supplementing parent symptom reports with clinical data may be a viable alternative in certain cases when teacher reports are unavailable. PMID:26130393

  3. Telomere Length and Pulse Pressure in Newly Diagnosed, Antipsychotic-Naive Patients With Nonaffective Psychosis

    Fernandez-Egea, Emilio; Bernardo, Miguel; Heaphy, Christopher M.; Griffith, Jeffrey K.; Parellada, Eduard; Esmatjes, Enric; Conget, Ignacio; Nguyen, Linh; George, Varghese; Stppler, Hubert; Kirkpatrick, Brian

    2009-01-01

    Introduction: Recent studies suggest that in addition to factors such as treatment side effects, suicide, and poor health habits, people with schizophrenia may have an increased risk of diabetes prior to antipsychotic treatment. Diabetes is associated with an increased pulse pressure (PP) and a shortened telomere. We tested the hypothesis that prior to antipsychotic treatment, schizophrenia and related disorders are associated with a shortened telomere, as well as an increased PP. Methods: Telomere content (which is highly correlated with telomere length) and PP were measured in newly diagnosed, antipsychotic-naive patients with schizophrenia and related disorders on first clinical contact and in matched control subjects. Both groups were also administered an oral glucose tolerance test. Results: Compared with control subjects, the patients with psychosis had decreased telomere content and an increased PP. As previously reported, they also had increased glucose concentrations at 2 hours. These differences could not be attributed to differences in age, ethnicity, smoking, gender, body mass index, neighborhood of residence, socioeconomic status, aerobic conditioning, or an increased cortisol concentration in the psychotic subjects. Discussion: These results suggest that prior to antipsychotic use, nonaffective psychosis is associated with reduced telomere content and increased PP, indices that have been linked to an increased risk of diabetes and hypertension. PMID:19279086

  4. Epidemiological, clinical, virological features of hepatitis B newly diagnosed in 2011 in Marseille University hospitals, southeastern France.

    Moussa, Sahada; Brah, Souleymane; Parola, Philippe; Gerolami, René; Gamerre, Marc; Boubli, Léon; Ruiz, Jean-Marie; Ravaux, Isabelle; Mokhtari, Saada; Mancini, Julien; Romera, Marie-Hélène; Motte, Anne; Tamalet, Catherine; Colson, Philippe

    2016-05-01

    Hepatitis B virus (HBV) infection is a public health problem. In France, 0.68% of adults are chronically infected. We aimed to describe the epidemiological, virological and clinical characteristics of HBV infections newly diagnosed in 2011 in University hospitals of Marseille, the second largest French city. HBV serology was performed for 18,130 sera from 15,744 patients. A total of 167 patients were newly-diagnosed with HBV based upon the detection of hepatitis B surface antigen and anti-hepatitis B core antibodies. Clinico-epidemiological features were analyzed for 78 patients. Patients included a majority of men (59%), women being significantly younger with a mean age of 36 ± 17 versus 43.5 ± 16.2 years (P = 0.009). Country of birth was available for 52 patients and 35% of them originated from sub-Saharan Africa. Levels of the liver biological parameters were significantly lower in women compared to men, in whom mean alanine aminotransferase and gammaglutamyl transferase levels were 24 ± 39 versus 37 ± 36 IU/l (P = 0.0001) and 20 ± 20 versus 51 ± 53 IU/l (P = 0.0001), respectively. Co-infections with hepatitis C and human immunodeficiency viruses were found in 5% and 6% of the patients, respectively. HBV DNA was detectable in 90% of the HBeAg-negative patients. In addition, there was a positive correlation between the HBsAg titer and the HBV DNA level (P = 0.001). Genotype D was the most common HBV genotype and was found in 53% of the patients tested, followed by genotype E (21%). HBV remains a major concern with a slightly greater number of new diagnoses than in 2004. HBV genetic diversity was substantial in the present cohort. J. Med. Virol. 88:828-836, 2016. © 2015 Wiley Periodicals, Inc. PMID:26439319

  5. Diagnosing Depression in Chronic Pain Patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI)

    2016-01-01

    Background Diagnosing depression in chronic pain is challenging due to overlapping somatic symptoms. In questionnaires, such as the Beck Depression Inventory (BDI), responses may be influenced more by pain than by the severity of depression. In addition, previous studies have suggested that symptoms of negative self-image, a key element in depression, are uncommon in chronic pain-related depression. The object of this study is to assess the relationship of the somatic and cognitive-emotional items of BDI with the diagnosis of depression, pain intensity, and disability. Methods One hundred consecutive chronic pain patients completed the Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depressive disorder (MDD) according to DSM-IV. Two subscales of BDI (negative view of self and somatic-physical function) were created according to the factor model presented by Morley. Results In the regression analysis, the somatic-physical function factor associated with MDD, while the negative view of self factor did not. Patients with MDD had higher scores in several of the BDI items when analysed separately. Insomnia and weight loss were not dependent on the depression diagnosis. Limitations The relatively small sample size and the selected patient sample limit the generalisability of the results. Conclusions Somatic symptoms of depression are also common in chronic pain and should not be excluded when diagnosing depression in pain patients. Regardless of the assessment method, diagnosing depression in chronic pain remains a challenge and requires careful interpretation of symptoms. PMID:27008161

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

    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.

  7. FDG PET/CT findings in a clinically diagnosed case of childhood autism

    Manglunia, Ashmi S.; Puranik, Ameya D.

    2016-01-01

    Autism is a neurodevelopmental disorder with multifactorial etiology and varied presentation, in which early diagnosis is crucial to the implementation of early treatment. A 6-year-old child clinically diagnosed with autism, and a normal magnetic resonance imaging underwent dedicated 18F-fluorodeoxyglucose brain positron emission tomography (PET) as an ancillary investigation. PET image showed diffuse bilateral temporal hypometabolism. Although PET imaging is currently not indicated in the evaluation of autism, characteristic imaging patterns on PET can provide corroborative information and increase the diagnostic confidence for the same.

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

    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.

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

    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

  10. Errors in fracture diagnoses in the emergency department – characteristics of patients and diurnal variation

    Ellingsen Trond

    2006-02-01

    Full Text Available Abstract Background Evaluation of the circumstances related to errors in diagnosis of fractures at an Emergency Department may suggest ways to reduce the incidence of such errors. Methods Retrospective analysis of all cases during a two year period (2002–2004 where a fracture had been overlooked or an injury had been erroneously diagnosed as a fracture (n = 61. 100 random selected patients with correctly diagnosed fractures served as control group. Results In the two year period 5879 patients visited the ED with injuries. 1% of all visits to the ED resulted in an error in fracture diagnosis and 3.1% of all fractures were not diagnosed at the initial visit to the ED. 86% of such errors had consequences for treatment. No patient characteristics could be identified as risk factors for a misdiagnosis of a fracture. There was a peak in errors in fracture diagnoses between 8 pm and 2 am (47% against 20% in controls, p Conclusion A considerable number of fractures were not correctly diagnosed at the initial ED visit. There was a diurnal variation in the rate of misdiagnosis of fractures with a significant peak from 8 pm to 2 am. Where there was an error in fracture diagnosis, the patients did not appear to have a characteristic profile as regarding e.g. age, sex or capability to communicate with the ED staff. Increased consultancy service in radiology may reduce the frequency of errors in diagnosis, particularly in the evenings between 8 pm and 2 am.

  11. Clinical value of diagnosing intracranial aneurysms with fly-around of multislice helical

    Objective: To exploring the clinical value of multislice helical CT fly-around as a new method for diagnosing micro intracranial aneurysms (≤2 mm in diameter). Methods: In this retrospective study, the authors compared the usefulness of multislice helical computed tomographic three dimensional angiography (MS 3D-CTA), digital subtraction angiography (DSA) and surgery for the detection and assessment of clinical suspected intracranial aneurysms in 104 patients, 86 patients who presented with acute, non-traumatic SAH. Row data was acquired by Multislice helical CT-Aquilion (Toshiba). The parameters of scanning and images reconstructing were: slice thickness 1.0 mm, helical pitch 3.5, scan speed was 0.5 s per rotation, delay time was 15 - 23 s; Nonionic contrast medium was injected intravenously (2.0 ml/kg) at speed of 3.0 - 5.0 ml/s. Source images were processed using a workstation SGI-O2, images post-processing software was Alatoview, ver: 1.42. The reconstructed images were then processed into fly-around and shaded volume rendering (SVR) and maximal intensity projection (MIP), and Entire brain DSA was performed. Images of MS 3D-CTA and DSA were analyzed by 3 radiologists at double blinded. Results: 70 aneurysms were proved at DSA and surgery, largest aneurysms was 24.0 mm in diameter and smallest aneurysms was 1.0 mm in diameter. Five of 70 aneurysms was large aneurysms, 40 was small aneurysms and 25 was micro aneurysms: fly-around found out 25 micro aneurysms, SVR and MIP found out 23 of them, DSA found out only 21 of them. For detected micro aneurysm, accuracy of fly-around was 95.71%, sensitivity was 100.0% and specificity was 93.33%, positive predictive value was 89.29, negative predictive value was 100.0%, accuracy of SVR and MIP was 95.71%, sensitivity was 92.0% and specificity was 97.78%, positive predictive value was 95.83%, negative predictive value was 95.65%, accuracy of DSA was 94.29%, sensitivity was 84.0% and specificity was 100.0%, positive predictive value was 100.0%, negative predictive value was 91.84%. Statistic t test values of aneurysms diameter in images of fly-around and DSA was 1.52, P > 0.05. There was non distinct deference, Kruskal-Wallis test value for interobserver was 57.04, P < 0.01. Conclusion: Accuracy and sensitivity and specificity for fly-around was higher than SVR and DSA in integrated establish, so fly-around is a new and reliable MS 3D-CTA method for detecting intracranial aneurysms and micro intracranial aneurysms

  12. A randomised controlled trial of a self-management plan for patients with newly diagnosed angina.

    Lewin, R J P; Furze, G; J. Robinson; Griffith, K; Wiseman, S.; Pye, M; Boyle, R.

    2002-01-01

    BACKGROUND: There are approximately 1.8 million patients with angina in the United Kingdom, many of whom report a poor quality of life, including raised levels of anxiety and depression. AIM: To evaluate the effect of a cognitive behavioural disease management programme, the Angina Plan, on psychological adjustment in patients newly diagnosed with angina pectoris. DESIGN OF STUDY: Randomised controlled trial. SETTING: Patients from GP practices in a Northern UK city (York) between April 1999 ...

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

    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...

  14. Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer

    Tokunaga Mari; Taketomi-Takahashi Ayako; Tsushima Yoshito; Horisoko Eri; Endo Keigo

    2010-01-01

    Abstract Background There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC). The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC. Methods In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90) with eEGC which were diagnosed during...

  15. Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: an assessment of clinical potential

    Skld, K; Gorlia, T; Pellettieri, L; Giusti, V.; H-Stenstam, B; Hopewell, J. W.

    2010-01-01

    The purpose of this study was to assess the potential of boron neutron capture therapy (BNCT), with a 6-h infusion of the boron carrier l-boronophenylalanine as a fructose preparation (BPA-f), as first-line radiotherapy for newly diagnosed glioblastoma multiforme (GBM). Patient survival data from a Phase II study using BNCT were compared with retrospective data from the two arms of a Phase III study using conventional radiotherapy (RT) in the reference arm and using RT plus concomitant and ad...

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

    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.

  17. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience

    To clarify the usefulness of 3.0-T MR elastography (MRE) in diagnosing the histological grades of liver fibrosis using preliminary clinical data. Between November 2012 and March 2014, MRE was applied to all patients who underwent liver MR study at a 3.0-T clinical unit. Among them, those who had pathological evaluation of liver tissue within 3 months from MR examinations were retrospectively recruited, and the liver stiffness measured by MRE was correlated with histological results. Institutional review board approved this study, waiving informed consent. There were 70 patients who met the inclusion criteria. Liver stiffness showed significant correlation with the pathological grades of liver fibrosis (rho = 0.89, p < 0.0001, Spearman's rank correlation). Areas under the receiver operating characteristic curve were 0.93, 0.95, 0.99 and 0.95 for fibrosis score greater than or equal to F1, F2, F3 and F4, with cut-off values of 3.13, 3.85, 4.28 and 5.38 kPa, respectively. Multivariate analysis suggested that grades of necroinflammation also affected liver stiffness, but to a significantly lesser degree as compared to fibrosis. 3.0-T clinical MRE was suggested to be sufficiently useful in assessing the grades of liver fibrosis. (orig.)

  18. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience

    Yoshimitsu, Kengo; Mitsufuji, Toshimichi; Shinagawa, Yoshinobu; Fujimitsu, Ritsuko; Morita, Ayako; Urakawa, Hiroshi; Takano, Koichi [Fukuoka University, Department of Radiology, Fukuoka (Japan); Hayashi, Hiroyuki [Fukuoka University, Department of Pathology, Faculty of Medicine, Fukuoka (Japan)

    2016-03-15

    To clarify the usefulness of 3.0-T MR elastography (MRE) in diagnosing the histological grades of liver fibrosis using preliminary clinical data. Between November 2012 and March 2014, MRE was applied to all patients who underwent liver MR study at a 3.0-T clinical unit. Among them, those who had pathological evaluation of liver tissue within 3 months from MR examinations were retrospectively recruited, and the liver stiffness measured by MRE was correlated with histological results. Institutional review board approved this study, waiving informed consent. There were 70 patients who met the inclusion criteria. Liver stiffness showed significant correlation with the pathological grades of liver fibrosis (rho = 0.89, p < 0.0001, Spearman's rank correlation). Areas under the receiver operating characteristic curve were 0.93, 0.95, 0.99 and 0.95 for fibrosis score greater than or equal to F1, F2, F3 and F4, with cut-off values of 3.13, 3.85, 4.28 and 5.38 kPa, respectively. Multivariate analysis suggested that grades of necroinflammation also affected liver stiffness, but to a significantly lesser degree as compared to fibrosis. 3.0-T clinical MRE was suggested to be sufficiently useful in assessing the grades of liver fibrosis. (orig.)

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

    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 (χ2=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

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

    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.

  1. Low Physical Activity Is Associated With Increased Arterial Stiffness in Patients Recently Diagnosed With Type 2 Diabetes

    Funck, Kristian L; Laugesen, Esben; Høyem, Pernille; Fleischer, Jesper; Cichosz, Simon L; Christiansen, Jens S; Hansen, Troels K; Poulsen, Per L

    2015-01-01

    to be elucidated. We investigated the relationship between physical activity and arterial stiffness, an independent predictor of CVD, in patients with type 2 diabetes and controls. METHODS: We included 100 patients with type 2 diabetes and 100 sex- and age-matched controls in a cross-sectional study...... for other determinants of cfPWV including whole body fat percentage (P < 0.01). No significant interaction between diabetes and the effect of low activity was seen. CONCLUSIONS: Low physical activity is associated with increased arterial stiffness in patients recently diagnosed with type 2 diabetes......AIMS: Several studies have indicated that low physical activity is associated with increased risk of cardiovascular disease (CVD) and all-cause mortality among patients with diabetes. The association between physical activity and subclinical cardiovascular changes preceding clinical events remains...

  2. Alternative diagnoses based on CT angiography of the chest in patients with suspected pulmonary thromboembolism

    Ferreira, Eleci Vaz; Gazzana, Marcelo Basso; Sarmento, Muriel Bossle; Guazzelli, Pedro Arends; Hoffmeister, Mariana Costa; Guerra, Vinicius André; Seligman, Renato; Knorst, Marli Maria

    2016-01-01

    Objective : To determine the prevalence of alternative diagnoses based on chest CT angiography (CTA) in patients with suspected pulmonary thromboembolism (PTE) who tested negative for PTE, as well as whether those alternative diagnoses had been considered prior to the CTA. Methods : This was a cross-sectional, retrospective study involving 191 adult patients undergoing CTA for suspected PTE between September of 2009 and May of 2012. Chest X-rays and CTAs were reviewed to determine whether the findings suggested an alternative diagnosis in the cases not diagnosed as PTE. Data on symptoms, risk factors, comorbidities, length of hospital stay, and mortality were collected. Results : On the basis of the CTA findings, PTE was diagnosed in 47 cases (24.6%). Among the 144 patients not diagnosed with PTE via CTA, the findings were abnormal in 120 (83.3%). Such findings were consistent with an alternative diagnosis that explained the symptoms in 75 patients (39.3%). Among those 75 cases, there were only 39 (20.4%) in which the same alterations had not been previously detected on chest X-rays. The most common alternative diagnosis, made solely on the basis of the CTA findings, was pneumonia (identified in 20 cases). Symptoms, risk factors, comorbidities, and the in-hospital mortality rate did not differ significantly between the patients with and without PTE. However, the median hospital stay was significantly longer in the patients with PTE than in those without (18.0 and 9.5 days, respectively; p = 0.001). Conclusions : Our results indicate that chest CTA is useful in cases of suspected PTE, because it can confirm the diagnosis and reveal findings consistent with an alternative diagnosis in a significant number of patients. PMID:26982039

  3. Chronic lymphocytic leukemia and myeloproliferative neoplasms concurrently diagnosed: clinical and biological characteristics.

    Todisco, Gabriele; Manshouri, Taghi; Verstovsek, Srdan; Masarova, Lucia; Pierce, Sherry A; Keating, Michael J; Estrov, Zeev

    2016-05-01

    Chronic lymphocytic leukemia (CLL) and myeloproliferative neoplasms (MPN) may occur concomitantly. However, little is known about the pathobiological characteristics and interaction between the neoplastic clones in these rare cases of coinciding malignancies. We retrospectively examined the clinical and biological characteristics of 13 patients with concomitant CLL and MPN - eight primary myelofibrosis (PMF), three essential thrombocytosis (ET), and two polycythemia vera (PV) - who presented to our institution between 1998 and 2014, and tested all patients for MPN-specific aberrations, such as JAK2, MPL and CALR mutations. Along with epidemiological and molecular characterization of this rare condition, we found that JAK2 mutation can be detected 9 years prior to PMF diagnosis, suggesting that PMF clinical phenotype may require several years to develop and CLL/MPN clinical co-occurrence might be sustained by common molecular events. Some features of these patients suggest that pathobiologies of these diseases might be intertwined. PMID:26402369

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

    Santosh Ramdurg; Santosh Kumar (Corresponding Author); Mukesh Kumar; Vijender Singh; Deepak Kumar; Nimesh G Desai

    2013-01-01

    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...

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

    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.

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

    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 χ2-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.

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

    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

  8. Clinical study of scrotum scintigraphy in 49 patients with acute scrotal pain. A comparison with ultrasonography

    Yuan Zhibin; Luo Quanyong; Chen Libo; Zhu Jifang; Zhu Ruisen [Shanghai 6th People' s Hospital, Shanghai (China)

    2001-06-01

    The significance of scrotum scintigraphy in differentiating acute testicular torsion from acute orchiepididymitis was evaluated. In this report, 49 patients with acute scrotal pain were examined with radionuclide scrotum scintigraphy and ultrasonography in parallel for comparison. Of 37 patients with decreased radioactivity in the abnormal side scrotum, 35 were diagnosed with testicular torsion surgically and the other 2 were diagnosed with indirect inguinal hernia. Only 17 among the 35 patients were diagnosed by ultrasonography as having testicular torsion. The remaining 12 patients with increased radioactivity in the abnormal side of the scrotum were all diagnosed with orchiepididymitis through conservative treatment and clinical follow-up, but only 8 of the 12 were correctly and exactly diagnosed by ultrasonography. In the process of diagnosing acute scrotal pain, radionuclide scrotum scintigraphy has obvious advantage over ultrasonography. It also has the advantage of being simple, fast and accurate but without any detrimental effect on the human body. (author)

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

    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

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

    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 the 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

  11. Accuracy of cryptorchidism diagnoses and corrective surgical treatment registration in the Danish National Patient Registry

    Jensen, M S; Snerum, T M Ø; Olsen, L H; Thulstrup, A M; Bonde, J P; Olsen, J; Henriksen, T B

    2012-01-01

    In recent years several Danish studies of the etiology, time trends and long-term health consequences of cryptorchidism have relied on diagnoses and surgical treatments registered in the National Patient Registry. We evaluated the diagnostic accuracy of these registry data....

  12. Waiting list paradox: Danish cancer patients diagnosed fast have higher mortality after diagnosis

    Tørring, Marie Louise; Frydenberg, Morten; Hansen, Rikke Pilegaard; Olesen, Frede; Vedsted, Peter

    Studies often show that cancer patients diagnosed more rapidly have higher mortality rates than patients with longer waits in the primary and secondary health care sector. Our aim was to examine whether this paradox is manifest in the Danish health care system. The study was based on data on...... hospital discharge diagnoses for the 2004-2005 period, extracted from population-based healthcare databases in the former County of Aarhus, Denmark, and subsequently validated in the National Danish Cancer Registry. All patients with a first-time diagnosis of colon, rectal, lung, skin, breast, or prostate...... after diagnosis, and we used Cox regression to estimate mortality rate ratios as a function of diagnostic delay using restricted cubic splines, and adjusting for gender, age, and co-morbidity. We identified 1080 cancer patients. For all cancers, except breast cancer, mortality after diagnosis decreased...

  13. Influência das concavidades radiculares nas perdas clínicas de inserção, detectadas no exame clínico periodontal inicial The influence of root concavities on clinical attachment loss diagnosed at the initial evaluation of periodontal patients

    Francisco Emilio PUSTIGLIONI

    1999-12-01

    Full Text Available O propósito deste estudo foi estabelecer a influência das concavidades radiculares na perda clínica de inserção (PCI diagnosticada no exame clínico periodontal inicial. Os dados de PCI foram obtidos dos primeiros e segundos pré-molares, caninos, incisivos laterais e centrais superiores e inferiores, de 163 pacientes. Os dados foram coletados das fichas periodontais dos pacientes que procuraram a Clínica do curso de Pós-Graduação em Periodontia da FOUSP. Foi realizada sondagem em todos os dentes para que se obtivesse as seguintes medidas: distância da linha esmalte cemento à margem gengival, profundidade clínica de sondagem (PCS nos sítios distovestibular (DV, centrovestibular (CV, mesiovestibular (MV, distolingual (DL, centrolingual (CL e mesiolingual (ML. Os dados foram incluídos no estudo quando pelo menos um dos sítios apresentasse PCI ³ 4 mm. Após a análise estatística (Friedman ANOVA test CV e CL mostraram valores de PCI estatisticamente menores para todos os dentes superiores e inferiores. Clinicamente CV mostrou os menores valores de perda clínica de inserção entre todos os dentes analisados, seguido de CL. Embora, baseados em nossos resultados, não exista correlação estatística entre PCI e a presença de concavidades radiculares, não podemos subestimar as últimas no exame clínico inicial, diagnóstico, prognóstico, planejamento cirúrgico e na fase de controle e manutenção do tratamento periodontal.The purpose of this study was to establish the influence of root concavities on clinical attachment loss (CAL that was diagnosed at the initial evaluation of periodontal patients. CAL data were analyzed in the following teeth of 163 patients: upper and lower second and first bicuspids, cuspids, lateral and central incisors. Data were retrieved from the initial dental chart of patients seeking treatment at the Periodontics Graduate Clinic, School of Dentistry, University of São Paulo. Probing was accomplished in every tooth. The following measurements were recorded: CEJ-GM, PD and CAL. PD was performed at 6 sites: mesial-buccal (MB, central-buccal (CB, distal-buccal (DB, mesial-lingual (ML, central-lingual (CL and distal-lingual (DL. Data from all teeth present were included when, at least, one site with CAL ³ 4mm was observed. After statistical analysis (Friedman and Kruskal-Wallis ANOVA tests CB and CL sites showed CAL values statistically lower for all upper teeth and for lower first bicuspid, cuspid and lateral incisors. Clinically, CB showed the lowest CAL values in every analyzed teeth, which was followed by CL. The presence of root concavities should not be underestimated either during clinical examination, diagnosis, prognosis, surgical or supportive periodontal treatment. Nevertheless, based on our results, it was not possible to assure that the differences found in CAL values were due to root concavities.

  14. The Relation between Psychiatric Diagnoses and Constipation in Hospitalized Patients: A Cross-Sectional Study

    Jessurun, Janique G.; van Harten, Peter N.; Egberts, Toine C G; Pijl, Ysbrand J.; Wilting, Ingeborg; Tenback, Diederik E.

    2016-01-01

    Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of ...

  15. Accuracy of Alpha Amylase in Diagnosing Microaspiration in Intubated Critically-Ill Patients

    Dewavrin, Florent; Zerimech, Farid; Boyer, Alexandre; Maboudou, Patrice; Balduyck, Malika; Duhamel, Alain; Nseir, Saad

    2014-01-01

    Objectives Amylase concentration in respiratory secretions was reported to be a potentially useful marker for aspiration and pneumonia. The aim of this study was to determine accuracy of α-amylase in diagnosing microaspiration in critically ill patients. Methods Retrospective analysis of prospectively collected data collected in a medical ICU. All patients requiring mechanical ventilation for at least 48 h, and included in a previous randomized controlled trial were eligible for this study, p...

  16. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    Emmanuel Bckryd

    2015-03-01

    Full Text Available Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. opioid epidemic is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of noci-marker is presented as an alternative to pain biomarker, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  17. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine.

    Bckryd, Emmanuel

    2015-01-01

    Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. "opioid epidemic" is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of "noci-marker" is presented as an alternative to "pain biomarker", the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science. PMID:26854144

  18. INTEGRATING CLINICAL LABORATORY MEASURES AND ICD-9 CODE DIAGNOSES IN PHENOME-WIDE ASSOCIATION STUDIES.

    Verma, Anurag; Leader, Joseph B; Verma, Shefali S; Frase, Alex; Wallace, John; Dudek, Scott; Lavage, Daniel R; VAN Hout, Cristopher V; Dewey, Frederick E; Penn, John; Lopez, Alex; Overton, John D; Carey, David J; Ledbetter, David H; Kirchner, H Lester; Ritchie, Marylyn D; Pendergrass, Sarah A

    2016-01-01

    Electronic health records (EHR) provide a comprehensive resource for discovery, allowing unprecedented exploration of the impact of genetic architecture on health and disease. The data of EHRs also allow for exploration of the complex interactions between health measures across health and disease. The discoveries arising from EHR based research provide important information for the identification of genetic variation for clinical decision-making. Due to the breadth of information collected within the EHR, a challenge for discovery using EHR based data is the development of high-throughput tools that expose important areas of further research, from genetic variants to phenotypes. Phenome-Wide Association studies (PheWAS) provide a way to explore the association between genetic variants and comprehensive phenotypic measurements, generating new hypotheses and also exposing the complex relationships between genetic architecture and outcomes, including pleiotropy. EHR based PheWAS have mainly evaluated associations with case/control status from International Classification of Disease, Ninth Edition (ICD-9) codes. While these studies have highlighted discovery through PheWAS, the rich resource of clinical lab measures collected within the EHR can be better utilized for highthroughput PheWAS analyses and discovery. To better use these resources and enrich PheWAS association results we have developed a sound methodology for extracting a wide range of clinical lab measures from EHR data. We have extracted a first set of 21 clinical lab measures from the de-identified EHR of participants of the Geisinger MyCodeTM biorepository, and calculated the median of these lab measures for 12,039 subjects. Next we evaluated the association between these 21 clinical lab median values and 635,525 genetic variants, performing a genome-wide association study (GWAS) for each of 21 clinical lab measures. We then calculated the association between SNPs from these GWAS passing our Bonferroni defined p-value cutoff and 165 ICD-9 codes. Through the GWAS we found a series of results replicating known associations, and also some potentially novel associations with less studied clinical lab measures. We found the majority of the PheWAS ICD-9 diagnoses highly related to the clinical lab measures associated with same SNPs. Moving forward, we will be evaluating further phenotypes and expanding the methodology for successful extraction of clinical lab measurements for research and PheWAS use. These developments are important for expanding the PheWAS approach for improved EHR based discovery. PMID:26776183

  19. INTEGRATING CLINICAL LABORATORY MEASURES AND ICD-9 CODE DIAGNOSES IN PHENOME-WIDE ASSOCIATION STUDIES

    Verma, Anurag; Leader, Joseph B.; Verma, Shefali S.; Frase, Alex; Wallace, John; Dudek, Scott; Lavage, Daniel R.; Van Hout, Cristopher V.; Dewey, Frederick E.; Penn, John; Lopez, Alex; Overton, John D.; Carey, David J.; Ledbetter, David H.; Kirchner, H. Lester; Ritchie, Marylyn D.; Pendergrass, Sarah A.

    2016-01-01

    Electronic health records (EHR) provide a comprehensive resource for discovery, allowing unprecedented exploration of the impact of genetic architecture on health and disease. The data of EHRs also allow for exploration of the complex interactions between health measures across health and disease. The discoveries arising from EHR based research provide important information for the identification of genetic variation for clinical decision-making. Due to the breadth of information collected within the EHR, a challenge for discovery using EHR based data is the development of high-throughput tools that expose important areas of further research, from genetic variants to phenotypes. Phenome-Wide Association studies (PheWAS) provide a way to explore the association between genetic variants and comprehensive phenotypic measurements, generating new hypotheses and also exposing the complex relationships between genetic architecture and outcomes, including pleiotropy. EHR based PheWAS have mainly evaluated associations with case/control status from International Classification of Disease, Ninth Edition (ICD-9) codes. While these studies have highlighted discovery through PheWAS, the rich resource of clinical lab measures collected within the EHR can be better utilized for high-throughput PheWAS analyses and discovery. To better use these resources and enrich PheWAS association results we have developed a sound methodology for extracting a wide range of clinical lab measures from EHR data. We have extracted a first set of 21 clinical lab measures from the de-identified EHR of participants of the Geisinger MyCode biorepository, and calculated the median of these lab measures for 12,039 subjects. Next we evaluated the association between these 21 clinical lab median values and 635,525 genetic variants, performing a genome-wide association study (GWAS) for each of 21 clinical lab measures. We then calculated the association between SNPs from these GWAS passing our Bonferroni defined p-value cutoff and 165 ICD-9 codes. Through the GWAS we found a series of results replicating known associations, and also some potentially novel associations with less studied clinical lab measures. We found the majority of the PheWAS ICD-9 diagnoses highly related to the clinical lab measures associated with same SNPs. Moving forward, we will be evaluating further phenotypes and expanding the methodology for successful extraction of clinical lab measurements for research and PheWAS use. These developments are important for expanding the PheWAS approach for improved EHR based discovery. PMID:26776183

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

    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 Relation between Psychiatric Diagnoses and Constipation in Hospitalized Patients: A Cross-Sectional Study

    van Harten, Peter N.; Egberts, Toine C. G.; Pijl, Ysbrand J.; Wilting, Ingeborg; Tenback, Diederik E.

    2016-01-01

    Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of laxatives) and DSM-IV psychiatric diagnosis was studied in a cross-sectional study with “adjustment disorders” as the reference group. The association was analyzed using logistic regression. Results. Of the 4728 patients, 20.3% had constipation. In the stratum of patients older than 60 years, all psychiatric categories except for substance related disorders were significantly associated with a higher prevalence of constipation (odds ratios ranging from 3.38 to 6.52), whereas no significant associations were found in the stratum of patients between 18 and 60 years (odds ratios ranging from 1.00 to 2.03). Conclusion. In the elderly, all measured psychiatric diagnoses are strongly associated with an increased prevalence of constipation. Physicians should be extra alert for constipation in SMI patients, independent of specific psychiatric diagnoses. PMID:27034921

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

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

    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)

  4. Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes

    Sinclair Alan J

    2012-03-01

    Full Text Available Abstract Aim To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes. Methods In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date and had at least 2 years of follow-up medical history (N = 9,158. Initiation of antihyperglycaemic medication (i.e., treatment was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors. Results Mean (SD HbA1c at diagnosis was 8.1% (2.3. Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- th, 75th percentile time to treatment initiation was 63 (8, 257 days. Of the patients with HbA1c ≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA1c also had shorter time to treatment initiation (adjusted hazard ratio (HR = 2.44 [95% confidence interval (CI: 1.61, 3.70]; p Conclusions In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA1c was the strongest factor associated with initiating antihyperglycaemic medication in these patients.

  5. Prevalence of lean type 2 diabetes mellitus in recently diagnosed type 2 diabetes mellitus patients

    Prateek Chaudhary; Demitrost Laloo; Ranabir Salam

    2013-01-01

    Introduction: Obesity has always been thought to be a risk factor for diabetes; however, some studies in India have reported that even lean people are prone to diabetes. We conducted this study to see if this holds true for this part of the country. Objectives: To determine the prevalence of lean type 2 diabetes mellitus (DM) in recently diagnosed type 2 DM in Manipur. Materials and Methods: All recently diagnosed type 2 DM patients, within a period of 24 weeks, who attended the endocrine cli...

  6. Initial exploration of clinical value for diagnosing intracranial aneurysms with multi-slice helical CT three-dimensional angiography

    Objective: To evaluate the clinical value of Multi-slice helical CT three dimensional angiography (3D-MSCTA) as first method for diagnosing intracranial aneurysms. Methods: The authors studied patients with clinical suspected intracranial aneurysms (13 patients with subarachnoid hemorrhage among cases). All these patients underwent 3D-MSCTA and Digital Subtraction Angiography (DSA), 16 patients of them accepted operation treatment. Row data was acquired by Multi-slice helical CT-AQUILION (Toshiba): scan speed 0.5 s/rot, image slice thickness 1.0 mm, helical pitch 3.0/5.0. Contrast media (Angiografin) was injected intravenously (1.0-2.0 ml/kg) at speed of 2.5-3.0 ml/s, delay time was 15-23 s, reconstruction interval 0.5 mm, reconstruction slice thickness 1.0 mm. Source images were processed using a workstation SGI-02, images post-processing software was ALATOVIEW, Version 1.21. The reconstructed images were then processed into shaded volume rendering (SVR) and maximal intensity projection (MIP) and Fly-through images. Entire brain DSA was performed obtaining anteroposterior, lateral, and oblique images. Images of 3D-MSCTA and DSA were analysed by 3 radiologists and 2 neurosurgeons. Results: 25 aneurysms were detected by 3D-MSCTA. Aneurysms's body, neck, source vessel and the relationship between the aneurysm and surrounding structures was clearly and surely displayed. 22 of 25 aneurysms were detected by DSA, another 3 were (1 anterior communicating artery aneurysm and 2 left middle cerebral artery aneurysm) was not detected. Sixteen of patients underwent operation treatment, and the results of 3D-MSCTA corresponded very well to those of operation. Maximal diameter of aneurysms body was 14.0 mm and minimal diameter was 1.7 mm. Conclusion: 3D-MSCTA is a high sensitivity and rapid and noninvasive method for detecting intracranial aneurysms. The authors suggest that 3D-MSCTA may be the first choice for diagnosing intracranial aneurysms

  7. [Visual presentation of psychiatric clinical decision-making by "graphic assessment sheet for diagnoses and treatments"].

    Ota, Toshio; Yoshida, Sumiko; Tsunashima, Sousuke; Totsuka, Takao; Watanabe, Takafumi; Toyoshima, Ryoichi

    2011-01-01

    Psychiatrists often have to treat patients even when the clinical information is insufficient to make a definite diagnosis. This is the case especially when we are treating first-visit outpatients or inpatients who have just been admitted. One of the causes of information insufficiency is a delay in obtaining clinical information on the patient, and another is a lack of characteristic manifestations of the disease because of an immature developmental stage. Even in such situations, however, clinicians have to make reasonable judgements using the information that is available at that time. The framework for making judgements on such occasions, or "the framework of decision-making under imperfect-information conditions", is becoming more and more important in psychiatric clinical practice in Japan for the following reasons. First, team members in charge of a patient became very heterogeneous in terms of their career and motivation after the start of the new post-graduate clinical training system in Japan several years ago, resulting in a higher risk of miscommunication. Secondly, the need for precise explanation to patients and their families has become crucial in recent years as the result of various social changes. Ota T, one of the authors, once put forward the framework of decision-making under imperfect-information conditions on the basis of Bayesian statistics. In the present paper, in consideration of the above background, we devised a sheet for visualizing the above framework so that relevant staff could share the clinical decision-making process. Specifically, we visually arranged on a sheet of paper the components and variables of the framework, so that the staff could communicate with each other explicitly and precisely about the estimated probability of each possible disease, merits and demerits of each treatment option, etc. We employed the sheet on treating patients in our acute psychiatric ward, 2 of whom are presented in the paper. Discussions were made on the usefulness, limitations, and remaining problems. PMID:21882540

  8. Clinical Approach to Nonresponsive Pneumonia in Adults Diagnosed by a Primary Care Clinician: A Retrospective Study

    Kiley B. Vander Wyst

    2016-04-01

    Full Text Available Purpose: Community-acquired pneumonia (CAP is commonly diagnosed in the primary care setting. Management of nonresponsive pneumonia (NRP, i.e. failure to respond to CAP treatment, is not clearly understood. The purpose of this study was to describe the initial work-up and treatment of CAP in the ambulatory primary care setting and to determine relative proportion of, diagnostic approach to and treatment of NRP. Methods: We retrospectively studied adult patients diagnosed with CAP within our large, integrated health care system from October 2006 through July 2013. Cases were defined as patients with CAP who worsened after 4 days, or did not improve within 10 days, of antibiotic treatment. Controls were CAP patients who did not meet case definition. Mann-Whitney and t-tests were used to analyze continuous variables. Chi-square or Fisher’s exact test was used to analyze categorical variables. Significant variables were used to construct a multivariable logistic regression model. Results: Of 250 total patients studied, there were 85 cases and 165 controls. The case population was significantly older (59 ± 16 vs. 53 ± 19 years, P = 0.02. Multivariable logistic regression revealed former smoker (P < 0.01, initial presentation to urgent care (P = 0.02 and myalgia (P = 0.003 as predictors of NRP. Chest X-rays were more commonly ordered for cases at initial visit (80% vs. 68%, P = 0.06. Overall, 24% of patients had additional testing at the initial visit (39% of cases vs. 16% of controls, P < 0.001. Additionally, a higher proportion of cases underwent antibiotic change at their first (62% vs. 15%, P < 0.001 or second (47% vs. 5%, P < 0.001 follow-up visit. Conclusions: Patients with NRP tended to be former smokers, report myalgia and/or present to urgent care. The majority of providers conducted chest X-rays, but no further pneumonia testing, at the initial visit. Further study is needed to determine if this strategy leads to delayed etiologic diagnosis and definitive treatment.

  9. Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis

    Ronald Salamano

    2016-02-01

    Full Text Available ABSTRACT Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF, especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL, regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients.

  10. Cerebrospinal fluid examination may be useful in diagnosing neurosyphilis in asymptomatic HIV+ patients with syphilis.

    Salamano, Ronald; Ballesté, Raquel; Perna, Abayubá; Rodriguez, Natalia; Lombardo, Diego; García, Natalia; López, Pablo; Cappuccio, Pablo

    2016-02-01

    Lumbar puncture in neurologically asymptomatic HIV+ patients is still under debate. There are different criteria for detecting neurosyphilis through cerebrospinal fluid (CSF), especially in cases that are negative through the Venereal Disease Research Laboratory (VDRL), regarding cellularity and protein content. However, a diagnosis of neurosyphilis can still exist despite negative VDRL. Treponema pallidum hemagglutination assay (TPHA) titers and application of the TPHA index in albumin and IgG improve the sensitivity, with a high degree of specificity. Thirty-two patients were selected for this study. VDRL was positive in five of them. The number of diagnoses reached 14 when the other techniques were added. It was not determined whether cellularity and increased protein levels were auxiliary tools in the diagnosis. According to our investigation, CSF analysis using the abovementioned techniques may be useful in diagnosing neurosyphilis in these patients. PMID:26982990

  11. Newly diagnosed lung cancer patients' preferences for and beliefs about physical activity prior to chemotherapy.

    Karvinen, Kristina H; Vallance, Jeff; Walker, Paul R

    2016-07-01

    Physical activity has been found to have a number of benefits for lung cancer patients yet very little information is available concerning physical activity beliefs and preferences for this population. The purpose of the study was to explore physical activity programming and counseling preferences and beliefs about physical activity in newly diagnosed lung cancer patients scheduled to receive chemotherapy. A total of 43 new diagnosed lung cancer patients completed a researcher-administered survey prior to commencing chemotherapy. Results indicated that only 7 participants (17%) reported meeting public health recommendations for physical activity yet the majority of participants (n = 28) indicated interest or possible interest in physical activity counseling. Many participants also indicated interest or possible interest in an exercise program (n = 29) for lung cancer survivors, preferring it to start during chemotherapy (n = 20), for it to be home based (n = 21), and moderate in intensity (n = 22). The most common behavioral belief (advantage) of physical activity was to build/maintain strength (n = 26) and the most common control belief (barrier) was fatigue (n = 11). These data suggest that physical activity counseling and programming may be well received by newly diagnosed lung cancer patients. Information about physical activity and programming preferences and beliefs from this study may be useful for the design of optimal physical activity interventions for lung cancer patients. PMID:26813963

  12. Clinical value of intravascular ultrasound in diagnosing stent fracture: report of two cases with literature review

    Stent fracture has been implicated as a cause of drug-eluting stent failure. The authors report here 2 cases with stent fractures which were diagnosed by coronary artery angiography and intravascular ultrasound (IVUS). Both of them received multiple-stent-implantation. Five stent fractures altogether were detected in two patients. All the involved stents were sirolimus-eluting ones. Angiographic study showed that three stent fractures were complete transverse linear fracture with stent displacement. IVUS demonstrated that three stent fractures were complete break and two were partial break. One fracture was located close to the overlapping site of two stents and another fracture was accompanied by the formation of a coronary aneurysm. Angiography and IVUS are helpful to identify stent fracture. In addition, IVUS is more likely to clarify the cause of stent failure as well as the mechanism of stent fracture. (authors)

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

    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

  14. Epidemiologic pattern of patients with neurocysticercosis diagnosed by computed tomography in Curitiba, Brazil

    Grazziotin, Ana Laura; Monego, Fernanda [Federal University of Parana (UFPR), Curitiba, PR (Brazil). Coll. of Cellular and Molecular Biology; Fontalvo, Mariana Campos; Santos, Marilis Beckert Feijo; Grazziotin, Ana Line; Kolinski, Victor Hugo Zanini; Bordignon, Rodrigo Henrique; Biondo, Alexander Welker, E-mail: abiondo@illinois.ed [Federal University of Parana (UFPR), Curitiba, PR (Brazil). College of Veterinary Medicine; Antoniuk, Affonso [Federal University of Parana (UFPR), Curitiba, PR (Brazil). Dept. of Neurosurgery

    2010-04-15

    The aim of this study was to drawn an epidemiological pattern of neurocystisticercosis (NCC) patients diagnosed by computed tomography at the major private diagnostic center in Curitiba, Brazil. A total of 1,009 medical files of consecutive patients presenting neurological indications were diagnosed by computed tomography from July 2007 to April 2008. Patient data included sex, age, municipality and tomography findings were analysed by Epi-info version 6.0.1. software. Most patients (81.10%) were living in Curitiba. A total of 91/1,009 cases (9.02%) were considered positive to NCC; 88 (96.7%) patients had inactive form of NCC and only 3 (3.2%) patients had cysts in granulomatous process. No patients had both forms. The prevalence of NCC cases in studied group was greater in patients between 51 to 60 years old, however, difference between sex was not significant. This epidemiological pattern of NCC was similar to the first NCC study in Curitiba, performed in 1995-1996 with 9.24% of positive cases. Key words: neurocysticercosis, cysticercus cellulosae, epidemiology. (author)

  15. Epidemiologic pattern of patients with neurocysticercosis diagnosed by computed tomography in Curitiba, Brazil

    The aim of this study was to drawn an epidemiological pattern of neurocystisticercosis (NCC) patients diagnosed by computed tomography at the major private diagnostic center in Curitiba, Brazil. A total of 1,009 medical files of consecutive patients presenting neurological indications were diagnosed by computed tomography from July 2007 to April 2008. Patient data included sex, age, municipality and tomography findings were analysed by Epi-info version 6.0.1. software. Most patients (81.10%) were living in Curitiba. A total of 91/1,009 cases (9.02%) were considered positive to NCC; 88 (96.7%) patients had inactive form of NCC and only 3 (3.2%) patients had cysts in granulomatous process. No patients had both forms. The prevalence of NCC cases in studied group was greater in patients between 51 to 60 years old, however, difference between sex was not significant. This epidemiological pattern of NCC was similar to the first NCC study in Curitiba, performed in 1995-1996 with 9.24% of positive cases. Key words: neurocysticercosis, cysticercus cellulosae, epidemiology. (author)

  16. A Modified Nottingham Prognostic Index for Breast Cancer Patients Diagnosed in Denmark 1978-1994

    Rostgaard, Klaus; Mouridsen, Henning T.; Vth, Michael; Holst, Helle; Olesen, Knud P.; Lynge, Elsebeth

    2001-01-01

    Stage of disease is a predictor of breast cancer survival. We used data from the Danish Cancer Register amd the Daniish Breast Cancer Cooperative Group to study stage distribution in 0-69-years-old Danish breast cancer patients diagnosed in 1978-1994. We constructed a modified Nottingham Prognostic...... decreased from 27% to 20%. Based on a comparison of the crude 3-year survival of patients with an NPI score and those without, it seems probable that the stage of disease at diagnosis on average improved in Danish breast cancer patients below age 70 during the 1980s and the early 1990s....

  17. 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

    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.

  18. Retrospective study of disease incidence and other clinical conditions diagnosed in owned dogs in Delta State, Nigeria

    Kundu F. Shima; Terzungwe M. Tion; Idusiye J. Mosugu; Ternenge T. Apaa

    2015-01-01

    In Nigeria, knowledge on the epidemiology of diseases of dogs is limited. A retrospective study of data from clinical records of six veterinary clinics was undertaken to determine the incidence of disease in owned dogs in Delta State, Nigeria from 2012 to 2014. Association between the diagnosed diseases and the studied variables was explored using Chi-Squared test statistics. This study revealed that most of the conditions presented to the veterinary clinics were preventable. Thirty-one (31) ...

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

    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%.

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

    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%

  1. Clinical and histopathological characteristics in patients with postmenopausal bleeding

    Mandi? Aljoa

    2013-01-01

    Full Text Available Background: Incidence of endometrial carcinoma in Vojvodina is 15-20/100 000. In 75% cases, endometrial carcinoma is diagnosed in postmenopausal period. In 90 % of patients, the first clinical sign is postmenopausal bleeding. The aim of the study was to investigate clinical and histopathological characteristics in patients with postmenopausal bleeding. Methods: The study included 122 patients with postmenopausal bleeding. All of these patients underwent gynecological examination and vaginal ultrasound. We obtained materials for histopathological analysis by fractionate explorative curettage. Once we had definitive histopathological findings, we divided patients in two groups A (endometrial carcinoma and B (benign changes. Results: We confirmed significant statistical differences between examined group A and B, including age (64.49 compared with 58.81 years, postmenopausal period (13.67 instead 9.11 years, and length of uterine corpus (6.41 instead 5.25 cm. Conclusion: Elderly women with longer postmenopausal interval and postmenopausal bleeding had increased risk for endometrial carcinoma. Measurement of endometrial thickness by transvaginal ultrasound appeared to be insufficient parameter for differentiating the benign from the malignant changes of endometrium. Patients with endometrial carcinoma had significantly longer corpus of uterus comparing to patients with benign changes. Body mass index was not found to be significant risk factor in development of endometrial carcinoma in the examined groups. Obesity was diagnosed in both groups, suggesting that increased body mass index is a risk factor for development of pathological changes in endometrium, which could lead to postmenopausal bleeding.

  2. NI-75QUANTITATIVE TEXTURE DESCRIPTORS ON BASELINE-MRI CAN PREDICT PATIENT SURVIVAL IN NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME PATIENTS

    Tiwari, Pallavi; Prasanna, Prateek; Jiang, Benjamin; Barnholtz-Sloan, Jill; Sloan, Andrew; Ostrom, Quinn; Madabhushi, Anant

    2014-01-01

    OBJECTIVE: Glioblastoma Multiforme (GBM) is the deadliest form of brain tumors with a median survival of 12 months. While methylation of the MGMT gene promoter and IDH1 status have been shown to be associated with prolonged survival in GBM patients, there is controversy about their use as prognostic markers for evaluating response in newly diagnosed patients. The underlying hypothesis of this study is that computer-extracted texture descriptors can capture subtle, multiscale morphologic attri...

  3. Changes of spermatogenesis rates and pampiniform plexus draining vein among newly diagnosed varicocele patients and recurrent ones

    N. G. Osipov

    2014-12-01

    Full Text Available The article touches upon the results of comparative evaluation of spermatogenesis disorder rates and haemodynamic changes of venous basins involved in pampiniform plexus drain among 34 newly diagnosed and recurrent varicocele patients. The essential role of left internal spermatic vein at development and maintenance of varicose transformation of pampiniform plexus veins is emphasized. The interaction of spermatogenesis change rates and haemodynamic changes of left internal spermatic vein is revealed. The limitations of diagnosis of clinically developed diagnostic phlebography are demonstrated through clinical examples during search of venous outflow through external spermatic vein and during evaluation of iliac vein haemodynamic changes. The possible reasons provoked expansion of varicocele false relapse are stated.

  4. Diagnosing microalbuminuria and consequences for the drug treatment of patients with type 2 diabetes: a European survey in primary care

    Aakre, Kristin M; Thue, Geir; Subramaniam-Haavik, Sumathi; Cooper, John; Bukve, Tone; Morris, Howard A; Müller, Mathias; Lovrencic, Marijana V; Plum, Inger Graves; Kallion, Kaja; Aab, Alar; Kutt, Marge; Gillery, Philippe; Schneider, Nathalie; Horvath, Andrea R; Onody, Rita; Oosterhuis, Wytze; Ricos, Carmen; Perich, Carmen; Nordin, Gunnar; Sandberg, Sverre

    2010-01-01

    To assess general practitioners (GPs) knowledge of guideline recommendations on diagnosing microalbuminuria (MA) and to evaluate how this diagnosis influences drug treatment of diabetes patients.......To assess general practitioners (GPs) knowledge of guideline recommendations on diagnosing microalbuminuria (MA) and to evaluate how this diagnosis influences drug treatment of diabetes patients....

  5. Sociodemographic Characteristics and Diagnoses of Individuals Referred to a Child and Adolescent Psychiatry Outpatient Clinic of a University Hospital

    Sevcan Karakoç Demirkaya

    2015-04-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the sociodemographic characteristics, complaints, and diagnoses of individuals who were admitted to a child and adolescent psychiatry outpatient clinic. MATERIALS AND METHODS: Medical charts of the patients who were admitted to the child and adolescent psychiatry unit of Adnan Menderes University between February 1st and July 31st, 2014 were retrospectively studied. RESULTS: The rate of girls and boys from a total of 832 cases who were referred to the child and adolescent psychiatry outpatient clinic in the six month period was 41.8% and 58.2%, respectively. The mean age of the girls and boys was 10.8±4.9 and 8.5±4.7 years, respectively. The most common age range was between 12 and 18 years. The proportion of patients who lived with both parents was 81.1%; however, the proportion of individuals brought in by institutional caregivers was 0.8%. The proportion of consanguineous marriages was 13.7%. The education level of mothers and fathers was mostly a primary school degree (47% and 45.6%, respectively. A positive psychiatric history was present in 13.7% of the mothers and 7.6% of the fathers. Reasons for child psychiatric assessments were as follows: 21.9% for disability report, 13.8% for forensic evaluation, 11.2% for consultation, and 52.9% for general psychiatric evaluation. Referral complaints were irritability/anger (15.7%, attention deficit/hyperactivity (14.8%, delay in speech (10.5%, fear/anxiety (5.9%, and poor school performance (5.7%. The diagnoses were as follows: attention deficit hyperactivity disorder (ADHD (20.6%, other disruptive behaviors (12.4%, and anxiety disorder (10.2%. CONCLUSION: We revealed that the most common referring complaint was irritability/anger and that the most common diagnosis was ADHD in our patient group, which was similar to previous studies. Our results showed that a low parental educational level and a positive history for parental psychopathology were common in child psychiatry referrals. These data may be considered as risk factors for developing protective mental health services.

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

    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

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

    ÜNLÜ ÖZKAN, Feyza; Üstün, Işıl; Soylu Boy, Fatma Nur; Selin BOZKURT; İlknur AKTAŞ

    2014-01-01

    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–ye...

  8. Correlation between clinical features and MECP2 gene mutations in patients with Rett syndrome

    Hisham Megahed

    2015-03-01

    Conclusions: Mutation screening for MECP2 is a fast and reliable method to diagnose patients clinically suspected to suffer from Rett syndrome or female patients with atypical Rett syndrome features, mental retardation, developmental delay and other neurological abnormalities who do not fit any specific diagnosis. Also, patients with MECP2 mutation presented with a more severe phenotype.

  9. Clinical profile of leprosy patients: A prospective study

    Sejal Thakkar

    2014-01-01

    Full Text Available Introduction: Early diagnosis and early adequate drug treatment is very important aspect to reduce the load in cases of leprosy. So, correct labeling of paucibacillary and multibacillary cases is a prerequisite for the adequate treatment. Confirmation of diagnosis is an important indication for histopathological examination in doubtful cases. Objectives: The present study was carried out to know the clinical profile of leprosy patients, concordance between clinical and histopathological diagnosis in cases of leprosy, and to assess the therapeutic efficacy of antileprosy therapy. Study Design: Two hundred and fifty clinically diagnosed leprosy patients attending skin outdoor patient department (OPD were included in the study. Slit skin smear was performed in all the cases. In that case concordance between clinical and histology can be determined only in 30 cases. All the patients were treated with MDT (multidrug therapy as per WHO guideline. Results: A total of 250 patients attended the clinic with male to female ratio of 1.7:1. The highest incidence was noted in 17-40 years of age group. In the clinical disease spectrum, 40% patients were in the borderline spectrum followed by tuberculoid leprosy (TT (29.2%, lepromatous leprosy (LL (26.8%, and 3.9% of indeterminate leprosy (IL. A total of 18% of patients were of primary neuritic leprosy. A total of 8.3% patients had definite history of contact in the family or neighborhood. Clinicopathological correlation was noted in 60% of patients with maximum disparity (52.9% in the borderline group of patients. A total of 52.8% were MB (Multibacillary and 47.2% were PB (Paucibacillary cases. Morphological index became negative after 6 months in all patients. Mean fall of bacteriological index after 6 months was 0.19, while after 1 year, it was 1.05. Conclusion: Timely diagnosis and adequate treatment of cases with MDT is most effective. Histopathological examination is must in doubtful cases of leprosy.

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

    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.

  11. P300 Latency and Neurocognitive Functioning in Recently Diagnosed Human Immunodeficiency Virus Patients

    Ritu Nehra

    2012-01-01

    Full Text Available Aim: To assess the P300 latency and amplitude in recently diagnosed human immunodeficiency virus (HIV-positive patients and compare the same with a healthy control group. Further an attempt was made to study the correlation between P300 amplitude and latency (in milliseconds with neurocognitive functions. Materials and Methods: Thirty newly diagnosed HIV-positive patients who on self report did not have any cognitive dysfunction were recruited. The patients were evaluated for P300 evoked response using the odd-ball paradigm, MMSE and a comprehensive neuropsychological battery. The P300 latencies were compared with 30 normal control subjects. Results: The mean P300 latency (in milliseconds of the HIV-positive subjects was significantly more than the healthy control group. The mean amplitude of HIV group was significantly less than the normal control group. On MMSE, 7 HIV-positive subjects had mild cognitive impairment (MMSE total score 20-23, six patients had minimal cognitive impairment (MMSE total score 24-27 and 17 patients had no cognitive impairment (MMSE total score >27. On neuropsychological test battery only three (10% of HIV-positive subjects had cognitive dysfunction. There was negative correlation between P300 latency (in milliseconds and MMSE total score and performance on Koh′s Block subtest. Conclusion: P300 may be a reliable indicator of cognitive impairments in HIV patients.

  12. Changes in profile of lipids and adipokines in patients with newly diagnosed hypothyroidism and hyperthyroidism.

    Chen, Yanyan; Wu, Xiafang; Wu, Ruirui; Sun, Xiance; Yang, Boyi; Wang, Yi; Xu, Yuanyuan

    2016-01-01

    Changes in profile of lipids and adipokines have been reported in patients with thyroid dysfunction. But the evidence is controversial. The present study aimed to explore the relationships between thyroid function and the profile of lipids and adipokines. A cross-sectional study was conducted in 197 newly diagnosed hypothyroid patients, 230 newly diagnosed hyperthyroid patients and 355 control subjects. Hypothyroid patients presented with significantly higher serum levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDLC), fasting insulin, resistin and leptin than control (p < 0.05). Hyperthyroid patients presented with significantly lower serum levels of high-density lipoprotein cholesterol, LDLC and leptin, as well as higher levels of fasting insulin, resistin, adiponectin and homeostasis model insulin resistance index (HOMA-IR) than control (p < 0.05). Nonlinear regression and multivariable linear regression models all showed significant associations of resistin or adiponectin with free thyroxine and association of leptin with thyroid-stimulating hormone (p < 0.001). Furthermore, significant correlation between resistin and HOMA-IR was observed in the patients (p < 0.001). Thus, thyroid dysfunction affects the profile of lipids and adipokines. Resistin may serve as a link between thyroid dysfunction and insulin resistance. PMID:27193069

  13. 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

    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

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

    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

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

    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.

  16. A Pilot Safety Study of Lenalidomide and Radiotherapy for Patients With Newly Diagnosed Glioblastoma Multiforme

    Purpose: To define the maximum tolerated dose (MTD) of lenalidomide, an analogue of thalidomide with enhanced immunomodulatory and antiangiogenic properties and a more favorable toxicity profile, in patients with newly diagnosed glioblastoma multiforme (GBM) when given concurrently with radiotherapy. Patients and Methods: Patients with newly diagnosed GBM received radiotherapy concurrently with lenalidomide given for 3 weeks followed by a 1-week rest period and continued lenalidomide until tumor progression or unacceptable toxicity. Dose escalation occurred in groups of 6. Determination of the MTD was based on toxicities during the first 12 weeks of therapy. The primary endpoint was toxicity. Results: Twenty-three patients were enrolled, of whom 20 were treated and evaluable for both toxicity and tumor response and 2 were evaluable for toxicity only. Common toxicities included venous thromboembolic disease, fatigue, and nausea. Dose-limiting toxicities were eosinophilic pneumonitis and transaminase elevations. The MTD for lenalidomide was determined to be 15 mg/m2/d. Conclusion: The recommended dose for lenalidomide with radiotherapy is 15 mg/m2/d for 3 weeks followed by a 1-week rest period. Venous thromboembolic complications occurred in 4 patients, and prophylactic anticoagulation should be considered

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

    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. 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. 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 < 0.001). The crude DBF incidence rates in patients with scores of 0-1, 2-3, and 4 were 14.8%, 50.0%, and 76.9%, respectively, (p < 0.001). 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

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

    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.

  19. Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients

    e Silva Machado Luciana

    2012-08-01

    Full Text Available Abstract Background Temporomandibular disorder (TMD patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients’ clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. Methods Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. Results The most common diagnoses were localized masticatory muscle pain (n = 125 and disc displacement without reduction (n = 104. Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36, acute muscle pain (n = 125, acute articular pain (n = 75 and chronic articular impairment (n = 121. Conclusion Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.

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

    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

  1. Clinical application of computed tomography and radioisotope scintigraphy for diagnosing thyroid diseases

    A prospective evaluation of computed tomography (CT) and radioisotope scintigraphy on 50 consecutive patients with thyroid diseases (sixteen diffuse goiters, twenty-eight nodular goiters, etc.). CT is very valuable in detecting thyroidal masses, especially in evaluating their relations to the surrounding tissues and organs, their walls, and their contents such as fluid collections, calcifications, etc. Four of the five nodular goiters with smooth walls were benign adenomas pathologically, and five of the seven nodular goiters with irregular walls were adenocarcinomas. This nature of the wall of the tumor might be clinically useful in differentiating a benign tumor from a malignant tumor. We believe CT is clinically useful as well as radioisotope scintigraphy in evaluating thyroid diseases, especially mass lesions. (author)

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

    Anıl Gülsel Bahalı

    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.

  3. Waiting list paradox: Danish cancer patients diagnosed fast have higher mortality after diagnosis

    Tørring, Marie Louise

    -based healthcare databases in the former County of Aarhus, Denmark. All patients with a first-time diagnosis of breast, skin, lung, prostate, and colorectal cancer were identified and confirmed by each patient’s General Practitioner (GP), who provided a detailed description of the diagnostic pathway. Diagnostic...... 1270 cancer patients. Mortality varied across cancer diagnosis. There were no associations between duration and mortality for breast and skin cancer. For lung, prostate, and colorectal cancer a short diagnostic interval (0-14 days) was associated with highest mortality. CONCLUSION: The waiting......BACKGROUND: Delay in the diagnosis of cancer is generally considered unacceptable. However, observational studies often show an inverse association between the length of the diagnostic interval and mortality. Paradoxically, patients diagnosed more rapidly have higher mortality rates than patients...

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

    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. Investigation of symptoms of referral and distribution of diagnoses among children and adolescents living abroad at a child and adolescent psychiatry outpatient clinic

    bilge burcak annagur

    2012-01-01

    Full Text Available Abstract: The aim of this study is to investigate the symptoms of referral and distribution of diagnoses among children and adolescents living abroad, and to draw attention to and to evaluate their psychiatric problems. Method: Children and adolescents admitted to Gaziantep University Medical Faculty Şahinbey Training and Research Hospital Child and Adolescent Psychiatry Outpatient Clinic, between 1 January 2010 - 31 December 2010 were included in this study. Psychiatric diagnoses made according to the DSM-IV criteria and sociodemographic data were obtained by evaluating hospital records retrospectively. Results: According to the records of 39 children and adolescents, the mean age was 9.07±4.3 years. Children and adolescents living in Germany (28.2% referred most frequently and most of the patients were living in European countries (87.2%. Thirty six cases (92.3% had at least 1 psychiatric disorder, the most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD, Pervasive Developmental Disorder (PDD and Anxiety Disorder. Nine out of 39 cases were admitted to Child and Adolescent Psychiatry Outpatient Clinic in the countries where they have lived because of similar symptoms. In seven of these cases, the diagnoses made in our outpatient clinic were compatible with the previous diagnoses made abroad, but in 2 cases, they were incompatible. Conclusion: Childrens of families living abroad usually referred during holiday seasons and their diagnosis and treatment evaluations have to be completed in a short period of time. In addition, taking into consideration the importance of cooperation between doctor, family and teacher, the need to develop a more comprehensive mental health policy about these children with psychiatric problems becomes obvious.

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

    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.

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

    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.

  8. Essential pre-treatment imaging examinations in patients with endoscopically-diagnosed early gastric cancer

    Tokunaga Mari

    2010-06-01

    Full Text Available Abstract Background There have been no reports discussing which imaging procedures are truly necessary before treatment of endoscopically-diagnosed early gastric cancer (eEGC. The aim of this pilot study was to show which imaging examinations are essential to select indicated treatment or appropriate strategy in patients with eEGC. Methods In 140 consecutive patients (95 men, 45 women; age, 66.4 +/- 11.3 years [mean +/- standard deviation], range, 33-90 with eEGC which were diagnosed during two years, the pre-treatment results of ultrasonography (US and contrast-enhanced computed tomography (CT of the abdomen, barium enema (BE and chest radiography (CR were retrospectively reviewed. Useful findings that might affect indication or strategy were evaluated. Results US demonstrated useful findings in 13 of 140 patients (9.3%: biliary tract stones (n = 11 and other malignant tumors (n = 2. Only one useful finding was demonstrated on CT (pancreatic intraductal papillary mucinous tumor but not on US (0.7%; 95% confidential interval [CI], 2.1%. BE demonstrated colorectal carcinomas in six patients and polyps in 10 patients, altering treatment strategy (11.4%; 95%CI, 6.1-16.7%. Of these, only two colorectal carcinomas were detected on CT. CR showed three relevant findings (2.1%: pulmonary carcinoma (n = 1 and cardiomegaly (n = 2. Seventy-nine patients (56% were treated surgically and 56 patients were treated by endoscopic intervention. The remaining five patients received no treatment due to various reasons. Conclusions US, BE and CR may be essential as pre-treatment imaging examinations because they occasionally detect findings which affect treatment indication and strategy, although abdominal contrast-enhanced CT rarely provide additional information.

  9. Risk of Early Mortality in Patients With Newly Diagnosed Multiple Myeloma.

    Hsu, Pei; Lin, Ting-Wei; Gau, Jyh-Pyng; Yu, Yuan-Bin; Hsiao, Liang-Tsai; Tzeng, Cheng-Hwai; Chen, Po-Min; Chiou, Tzeon-Jye; Liu, Jin-Hwang; Liu, Yao-Chung; Liu, Chia-Jen

    2015-12-01

    The overall survival of patients with multiple myeloma (MM) has been improved greatly over the last 2 decades with the broader use of novel drugs and autologous tandem transplantation. However, more than one tenth of myeloma patients still die shortly after diagnosis. We therefore aim to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with MM. We included in this study 451 consecutive patients with MM, newly diagnosed at an Asian tertiary medical center between January 1, 2002 and April 30, 2015. A total of 57 subjects who experienced early mortality were identified. Risk factors for early mortality in myeloma patients were collected and analyzed. Early mortality occurred in 57 (12.6%) of the myeloma patients. In the multivariate analysis, being male (adjusted OR 2.93, 95% CI 1.17-7.31), serum albumin rate is high (12.6%) in patients with MM. Patients who are male and those with primary plasma cell leukemia, low serum albumin, high-corrected serum calcium, or LDH are at risk of early mortality. Nearly two thirds of the myeloma patients who experienced early mortality in our study (37 of 57, 65%) died of infection. Once a high-risk group is identified, much effort is required to target new approaches for prevention, early detection, and treatment of infections. PMID:26683968

  10. Clinical application of bone marrow scintigraphy in diagnosing some hematological diseases

    The role of the whole-body marrow scintigraphy is studied in evaluating the state of 22 patients (aged 20 to 68 years) with non-Hodgkin lymphoma (NHL), Hodgkin disease (HD), myelomamultiplex, myelofibrosis, polycythaemia vera and anemia aplastica. 99mTc-labeled Nano Albumon (222 Bq) is used. Planar and whole-body scintigraphies are obtained within 30 to 60 min, and 3 to 4 hours post iv injection. Focal and multifocal lesions or diffuse bone marrow infiltration, peripheral extension in the proximal part of long bones, and markedly expressed liver and spleen enlargement are documented. In 17 instances the findings are verified be trephine biopsy. It is concluded that bone marrow scanning is a sensitive and informative method, and in order to make exact diagnosis and staging of patients with systemic disorders the results should be interpreted against the background of clinical and histological findings

  11. Alteraciones neuroftalmolgicas en pacientes con hipertensin endocraneana idioptica Neuro-opththalmologic alterations in patients diagnosed with idiopathic endocranial hypertension

    Yannara Elina Columbi Garbey

    2011-06-01

    Full Text Available OBJETIVO: Determinar el comportamiento de las alteraciones neuroftalmolgicas en pacientes con hipertensin endocraneana idioptica. MTODOS: Estudio prospectivo en 80 pacientes con hipertensin endocraneana idioptica en el Instituto de Oftalmologa "Ramn Pando Ferrer" durante el perodo 2006-2010, con nfasis en manifestaciones clnicas, examen fsico y evaluacin del disco por tomografa de coherencia ptica. RESULTADOS: La hipertensin endocraneana idioptica se present en el 61 % de mujeres entre 15 y 40 aos. Las manifestaciones clnicas predominantes fueron cefalea, oscurecimientos visuales transitorios y diplopa. El examen fsico mostr papiledema en todos los pacientes, afectacin campimtrica en 87 % y alteraciones del contraste en 79 %, relacionados con el tiempo de evolucin. La tomografa de coherencia ptica fue til para diagnstico y seguimiento de los casos estudiados. CONCLUSIONES: La hipertensin endocraneana idioptica produce dao funcional visual irreversible en pacientes diagnosticados tardamente.OBJECTIVE: To determine the behavior of neuro-ophthalmologic alterations of this entity. METHODS: A prospective study was conducted in 80 patients diagnosed with idiopathic endocranial hypertension seen in the "Ramon Pando Ferrer" Cuban Institute of Ophthalmology from 2006 to 2020 emphasizing the clinical manifestations, the physical examination and the assessment of disk by optical coherence tomography. RESULTS: The idiopathic endocranial hypertension was present in the 61 % of women aged between 15 and 40. The predominant clinical manifestations were headache, transient visual darkening and diplopia. The physical examination showed the presence of papilledema in all patients, campimetry affection in the 87 % and contrast alterations in the 79 % related to course time. The optical coherence tomography was useful for diagnosis and follow-up of the study cases. CONCLUSIONS: The idiopathic endocranial hypertension produces a visual functional damage irreversible in patients diagnosed in a late way.

  12. 99Tcm-MIBI gated myocardial perfusion imaging in patients with myocardial bridging diagnosed by CT angiography

    Objective: To explore the clinical value of 99Tcm-MIBI G-MPI in patients diagnosed with myocardial bridging (MB) by CTA. Methods: Forty-five patients with MB and 17 normal controls diagnosed by CTA(64 slices CT) were included. All patients underwent rest 99Tcm-MIBI G-MPI and 17 MB patients and 9 normal controls also underwent stress 99Tcm-MIBI G-MPI. Myocardial ischemia, function and wall motion were assessed. G-MPI results were compared with CTA results by χ2 test, Fisher exact test and t test. Results: In patients with MB, the positive rate of abnormal perfusion by gated stress 99Tcm-MIBI G-MPI was 64.7% (11/17) and 41.2% (7/17) using quantitative analysis and visual evaluation respectively; while the data were 42.2% (19/45) and 22.2% (10/45) by rest G-MPI (P=0.035). The positive rate by rest G-MPI in MB patients was significant different among mural coronary arteries of different depths and different locations. By quantitative analysis of the stress G-MPI, the reversible, fixed, and mixed ischemia patients were 4 (35.3%), 6 (23.5%) and 1 (5.9%) respectively; the reversed, reversible and fixed abnormity of wall motion was found in 4 (23.5%), 4 (23.5%) and 2 (11.8%) patients respectively; the reversed, reversible and fixed wall thickening were found in 6 (35.3%), 5 (29.4%) and 1 (5.9%) patients respectively. There was no significant difference in left ventricular ejection fraction and peak filling rate between MB patients and normal controls in both rest and stress studies (t: from -0.564 to 1.292, all P>0.05). Conclusion: The G-MPI may be useful for the evaluation of myocardial ischemia and myocardial function simultaneously in patients with MB. (authors)

  13. A Report of 134 Newly Diagnosed Multiple Myeloma Patients with Renal Impairment.

    Liu, Aijun; Yang, Guangzhong; Geng, Chuanying; Wang, Huijuan; Li, Lihong; Li, Yanchen; Wu, Yin; Tian, Ying; Leng, Yun; Wang, Guorong; Gao, Wen; Chen, Wenming

    2016-01-01

    To analyze the effects of bortezomib on the prognosis of the newly diagnosed multiple myeloma patients with renal impairment, we assessed the outcomes of 134 multiple myeloma patients with renal impairment (serum creatinine ≥178 μmol/l) who were treated at Beijing Chaoyang Hospital. The patients were divided into two groups: bortezomib (n = 83) and nonbortezomib (n = 51). The overall response rate of the bortezomib group was higher than that of the nonbortezomib group. There was no significant difference in the time to restore renal function, but the complete renal response ratio was significantly higher in the bortezomib group. The 2-year overall survival (OS) rate of the bortezomib group was significantly greater than the nonbortezomib group, as was the 3-year OS rate. Kaplan-Meier analysis revealed significantly better survival for the bortezomib group. The main side effects in the bortezomib group were thrombocytopenia, peripheral neuropathy, infection, and herpes zoster, and there was a low incidence of grades 3 and 4 adverse events. Our findings indicate that bortezomib-based combination chemotherapy can improve the prognosis of the newly diagnosed multiple myeloma patients with renal impairment and should be considered as a first-line therapy. PMID:26587903

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

    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)

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

    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

  16. Tumor Vascular Permeability Pattern Is Associated With Complete Response in Immunocompetent Patients With Newly Diagnosed Primary Central Nervous System Lymphoma

    Chung, Sae Rom; Choi, Young Jun; Kim, Ho Sung; Park, Ji Eun; Shim, Woo Hyun; Kim, Sang Joon

    2016-01-01

    Abstract A dynamic contrast-enhanced MR imaging (DCE-MRI) could provide the information about tumor drug delivery efficacy. We investigated the potential utility of the permeability pattern of DCE-MRI for predicting tumor response to high dose-methotrexate treatment and progression-free survival (PFS) in patients with primary CNS lymphoma (PCNSL). Clinical and conventional imaging parameters were assessed as potential predictors of tumor response in 48 immunocompetent PCNSL patients in a preliminary study. Fifty additional immunocompetent patients (27 men and 23 women; mean age, 60.6 years) with PCNSL underwent DCE-MRI before starting first-line treatment with high dose-methotrexate. The DCE-MRI pattern was categorized as diffuse or nondiffuse. After 4 courses of high dose methotrexate, patients underwent follow-up brain MR imaging to identify their complete response (CR). Predictors of CR and PFS were analyzed using clinical parameters, conventional MRI, and DCE-MRI. CR was noted in 20 (74.1%) of 27 patients with diffuse DCE-MRI pattern and in 4 (17.4%) of 23 patients with nondiffuse DCE-MRI pattern. The diffuse DCE-MRI pattern showed a significantly higher association with CR than the nondiffuse pattern (P < 0.001). Multivariate Cox proportional hazards model revealed that the DCE-MRI pattern (hazard ratio = 0.70; P = 0.045), age (hazard ratio = 1.47; P = 0.041), and adjuvant autologous stem-cell transplantation (hazard ratio = 6.97; P = 0.003) tended to be associated with a PFS. The pretreatment diffuse DCE-MRI pattern can be used as a potential imaging biomarker for predicting CR and a longer PFS in patients with newly diagnosed PCNSLs. PMID:26871782

  17. Retrospective study of disease incidence and other clinical conditions diagnosed in owned dogs in Delta State, Nigeria

    Kundu F. Shima

    2015-12-01

    Full Text Available In Nigeria, knowledge on the epidemiology of diseases of dogs is limited. A retrospective study of data from clinical records of six veterinary clinics was undertaken to determine the incidence of disease in owned dogs in Delta State, Nigeria from 2012 to 2014. Association between the diagnosed diseases and the studied variables was explored using Chi-Squared test statistics. This study revealed that most of the conditions presented to the veterinary clinics were preventable. Thirty-one (31 clinical conditions were diagnosed from 571 cases recorded, involving nonspecific (21.6%, infectious (70.9%; P=0.001 and non-infectious (7.5% diseases. The most occurring clinical conditions comprised helminthoses (21.4%, mange (10.5%, parvovirosis (8.4%, babesiosis (7.9%, septicemia (7.2%, gastroenteritis (7.0%, myiasis (7.0%, trauma (6.3%, poisoning (6.0%, ectoparasitism (3.7%, ascites (2.5%, dermatitis (2.3%, aural hematoma (1.2%, and orchitis (1.1%. Disease incidence was highest in Alsatian (40.3%, mixed/cross (33.1%, Rottweiler (7.0% and toy breeds (4.6%. Details on the least occurring diseases and the association between disease and the studied variables are given. The outcomes demonstrate the prevalence of the clinical conditions diagnosed, inadequate husbandry and veterinary care accorded to owned dogs in the State. Education of dog owners on preventive measures is paramount in alleviating some of these health problems.

  18. A comparison of symptoms and drug use between patients with methamphetamine associated psychoses and patients diagnosed with schizophrenia in two acute psychiatric wards.

    Medhus, Sigrid; Mordal, Jon; Holm, Bjrn; Mrland, Jrg; Bramness, Jrgen G

    2013-03-30

    Psychosis induced by the use of amphetamine or methamphetamine leads to dramatic symptoms and frequent readmissions and poses diagnostic challenges. Earlier studies have often relied on history taking and/or urine samples to reveal drug use. The aim of this study was to compare the psychotic symptoms of two groups: (1) acutely admitted patients who tested positive for methamphetamines and were diagnosed with drug-induced or methamphetamine-induced psychoses and (2) acutely admitted patients who tested negative for methamphetamines and were diagnosed with schizophrenia. Blood and urine samples were used. In addition, we investigated whether the severity of symptoms, in those who tested positive, was related to the blood concentration of methamphetamine. Of 285 patients who volunteered blood and/or urine samples within 48h of admission, 37 (13%) had recently taken methamphetamine. Positive psychotic symptoms between the two groups were compared by PANSS using the positive subscale. The results showed no differences in positive psychotic symptoms between the two groups. The severity of positive psychotic symptoms in patients with three different levels of urine/blood methamphetamine concentrations, were compared. We found no clinically or statistically significant relationship between blood methamphetamine levels and severity of psychotic symptoms. PMID:23036490

  19. Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline.

    Hillegass, Ellen; Puthoff, Michael; Frese, Ethel M; Thigpen, Mary; Sobush, Dennis C; Auten, Beth

    2016-02-01

    The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT. PMID:26515263

  20. Williams-Beuren syndrome: cardiovascular abnormalities in 20 patients diagnosed with fluorescence in situ hybridization

    Sofia Mizuho Miura Sugayama; Regina Lúcia Moisés; Jaqueline Wagënfur; Nana Miura Ikari; Kikue Terada Abe; Cláudio Leone; Clóvis Artur Almeida da Silva; Maria de Lourdes Lopes Ferrari Chauffaille; Ae Kim Chong

    2003-01-01

    OBJECTIVE: To evaluate the cardiovascular findings and clinical follow-up of patients with Williams-Beuren syndrome. METHODS: We studied 20 patients (11 males, mean age at diagnosis: 5.9 years old), assessed for cardiovascular abnormalities with electrocardiography and Doppler echocardiography. Fluorescence in situ hybridization (FISH) was used to confirm the diagnosis of the syndrome. RESULTS: Elastin gene locus microdeletion was detected in 17 patients (85%) (positive FISH), and in 3 patien...

  1. Evaluation of the Correlation Between Body Mass Index and the Severity of Asthma in Recently Diagnosed Patients

    Davood Attaran

    2011-06-01

    Full Text Available Introduction: Asthma and obesity are among diseases that cause several problems and impair quality of life. The concurrence of these diseases, changes in the respiratory physiology, changes associated with obesity and limited activity associated with asthma may cause an interaction between the two conditions. Materials and Methods: We studied the epidemiologic characteristics of all recently diagnosed cases of asthma with no previous treatment who visited the Respiratory Diseases Clinic of the Ghaem Hospital from 2004 to 2007, their Body Mass Indexes (BMI were calculated and then spirometry was performed in all cases. Results: We studied 232 cases with the mean age of 38.9612.94 years and the mean BMI of 27.054.92. Cough and exertional dyspnea were the most common clinical symptoms. In spirometric evaluations, the mean maximum mid-expiratory flow (MMEF increased with weight, which was not, however, insignificant. FVC in obese patients was significantly less than in normal weight cases. A significant correlation was not also seen between BMI and FEV1 (r=-0.023, P=0.729. Conclusion: Except for FVC which had a significant correlation with BMI, other studied indices yielded no significant results, which calls for more extensive studies with larger populations. Considering the fact that mild asthma is less common in obese patients, better weight control in asthmatic patients can promote their quality of life and make asthma management more effective.

  2. Hospital admissions of HIV-infected patients at a Lisbon reference centre: comparison among previously known and in-ward HIV-diagnosed patients

    A Miranda

    2012-11-01

    Full Text Available Comparison of hospital admission causes for previously known (group A and HIV-infected patients diagnosed during in-ward stay (group B, from 2009 to 2011. Retrospective evaluation of demographic, epidemiologic, clinical, immunologic, virologic and treatment parameters at time of admission. 1167 patients were admitted; of those 617 (52,9% were HIV-infected: 92% HIV-1 and 8% HIV-2. 83% had previously known HIV infection and 15% were diagnosed during hospital stay (missing data in 2%. 66% were male, mean age was 46 years and 52% were Portuguese. The most frequent transmission routes were heterosexual exposure (36% and iv drug use (29%. Mean length of hospital stay was 17 days (group A and 28 days (group B (p = 0,004. At admission, the mean TCD4+ count was 280 cells/mm3 in group A, and 132 cells/mm3 in group B (p<0,001. The majority of group B patients had clinical or immunological AIDS criteria at admission (84% while group A presented a 71% rate for the same parameter (p=0,011. In group A, 52% of patients were on antiretroviral therapy but of those only 33% presented undetectable HIV plasma RNA, non-adherence being an important cause of therapeutic failure identified in 40% of cases. Respiratory infection was the principal cause of hospital admission in both groups (33% in group A vs. 35% in group B. The most prevalent nosological entities were community acquired pneumonia in group A (18,1% vs. 11,5%-p=0,118 and Pneumocystis jirovecii pneumonia in group B (4% vs. 18%-p<0,001. Mycobacterium tuberculosis was frequently identified as an agent of opportunistic infection (10% in group A vs. 24% in group B-p=<0,001. HCV coinfection was a comorbidity found in 37% in group A vs. 11% in group B (p<0,001. Other relevant comorbidities were psychiatric disturbances (16% vs. 3%-p=0,001 and neoplastic conditions (11% vs. 0%-p=0,001, mostly present in group A. Mortality rate was not significantly different between groups (10% group A vs. 11% group B (p=0,773. This analysis evidenced that, a significant percentage of HIV patients diagnosed at admission were late presenters. Slightly a half of patients with previous known HIV infection were prescribed cARV and only a third presented undetectable HIV viral load. Non-adherence was a major concern in this population. Respiratory infections had a significant clinical impact in both groups, justifying the importance of vaccination prevention strategies in immunocompromised individuals.

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

    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. Has Stewart approach improved our ability to diagnose acid-base disorders in critically ill patients?

    Masevicius, Fabio D; Dubin, Arnaldo

    2015-02-01

    The Stewart approach-the application of basic physical-chemical principles of aqueous solutions to blood-is an appealing method for analyzing acid-base disorders. These principles mainly dictate that pH is determined by three independent variables, which change primarily and independently of one other. In blood plasma in vivo these variables are: (1) the PCO2; (2) the strong ion difference (SID)-the difference between the sums of all the strong (i.e., fully dissociated, chemically nonreacting) cations and all the strong anions; and (3) the nonvolatile weak acids (Atot). Accordingly, the pH and the bicarbonate levels (dependent variables) are only altered when one or more of the independent variables change. Moreover, the source of H(+) is the dissociation of water to maintain electroneutrality when the independent variables are modified. The basic principles of the Stewart approach in blood, however, have been challenged in different ways. First, the presumed independent variables are actually interdependent as occurs in situations such as: (1) the Hamburger effect (a chloride shift when CO2 is added to venous blood from the tissues); (2) the loss of Donnan equilibrium (a chloride shift from the interstitium to the intravascular compartment to balance the decrease of Atot secondary to capillary leak; and (3) the compensatory response to a primary disturbance in either independent variable. Second, the concept of water dissociation in response to changes in SID is controversial and lacks experimental evidence. In addition, the Stewart approach is not better than the conventional method for understanding acid-base disorders such as hyperchloremic metabolic acidosis secondary to a chloride-rich-fluid load. Finally, several attempts were performed to demonstrate the clinical superiority of the Stewart approach. These studies, however, have severe methodological drawbacks. In contrast, the largest study on this issue indicated the interchangeability of the Stewart and conventional methods. Although the introduction of the Stewart approach was a new insight into acid-base physiology, the method has not significantly improved our ability to understand, diagnose, and treat acid-base alterations in critically ill patients. PMID:25685724

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

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

    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)

  7. Hypertension associated with venous thromboembolism in patients with newly diagnosed lung cancer

    Zhang, Yuhui; Yang, Yuanhua; Chen, Wenhui; Liang, Lirong; Zhai, Zhenguo; Guo, Lijuan; Wang, Chen; Zhang, Li; Xu, Qixia; Jiang, Luning; Zhang, Xinhong

    2016-01-01

    The aim of this study was to evaluate associations between cardiovascular disease (CVD) risk factors and the occurrence of venous thromboembolism (VTE) in patients with lung cancer that might help estimate an individuals risk for VTE. A total of 632 unselected patients with newly diagnosed lung cancer were investigated for VTE within the three months prior to recruitment, and their major CVD risk factors were assessed at the baseline examination. Eighty-six of the 632 (13.6%) developed a VTE event. Multivariate logistic regression analysis, including age, sex, smoking, body mass index, diabetes, dyslipidemia, hypertension and white blood cell count, found that hypertension (OR 1.8; 95% CI 1.03.3) and leukocytosis (OR 2.7; 95% CI 1.54.8) were significantly associated with VTE in different tumor histology models and that hypertension (OR 1.9; 95% CI 1.13.4) and leukocytosis (OR 2.7; 95% CI 1.54.7) were also significantly associated with VTE in different tumor stage models. Leukocytosis was linearly associated with hypertension and VTE (P for trend?=?0.006), and the ORs for VTE increased with leukocytosis (all P for trend hypertension increased the risk of VTE in patients with newly diagnosed lung cancer, which may be mediated by the presence of inflammation. PMID:26797411

  8. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

    Guo, Dan-Jie; Zhao, Can; Zou, Ya-Dan; Huang, Xu-Hang; Hu, Jing-Min; Guo, Lin

    2015-01-01

    Background: Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results: Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05) in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612–0.746) and 0.655 (95% CI: 0.584–0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE. PMID:25881599

  9. Impact of Optimism and Pessimism on Distress among Newly Diagnosed Prostate Cancer Patients

    Einar Trausti Einarsson 1989

    2012-01-01

    Prostate cancer (PCA), the most common cancer among men in the Western world, can be a major life stressor and heightened levels of psychological distress are common. However, there is a wide variability in distress with some PCA patients reporting little distress. The main aim of the present study was to examine both protective and risk factors for distress after the diagnoses of PCA as such information might be important to identify those that are at risk for impaired quality of life and fo...

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

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; Diederichsen, Axel Cosmus Pyndt; Kim, Won Yong; Hvidsten, Svend; Hougaard, Mikkel; Junker, Peter; Lundberg, Ingrid E; Petersen, Henrik; Hansen, Esben Søvsø Szocska; Eskerud, Karl Sannes; Kay, Susan Due; Jacobsen, Søren

    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......, 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 (99m)technetium pyrophosphate ((99m)Tc-PYP) scintigraphy. RESULTS: Dyspnoea was present...

  11. Phase II Trial of Hypofractionated IMRT With Temozolomide for Patients With Newly Diagnosed Glioblastoma Multiforme

    Reddy, Krishna [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Damek, Denise [Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado (United States); Gaspar, Laurie E. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Ney, Douglas [Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado (United States); Waziri, Allen; Lillehei, Kevin [Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado (United States); Stuhr, Kelly; Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States); Chen Changhu, E-mail: changhu.chen@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States)

    2012-11-01

    Purpose: To report toxicity and overall survival (OS) in patients with newly diagnosed glioblastoma multiforme (GBM) treated with hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ). Methods and Materials: Patients with newly diagnosed GBM after biopsy or resection and with adequate performance status and organ or bone marrow function were eligible for this study. Patients received postoperative hypo-IMRT to the surgical cavity and residual tumor seen on T1-weighted brain MRI with a 5-mm margin to a total dose of 60 Gy in 10 fractions (6 Gy/fraction) and to the T2 abnormality on T2-weighted MRI with 5-mm margin to 30 Gy in 10 fractions (3 Gy/fraction). Concurrent TMZ was given at 75 mg/m{sup 2}/day for 28 consecutive days. Adjuvant TMZ was given at 150 to 200 mg/m{sup 2}/day for 5 days every 28 days. Toxicities were defined using Common Terminology Criteria for Adverse Events version 3.0. Results: Twenty-four patients were treated, consisting of 14 men, 10 women; a median age of 60.5 years old (range, 27-77 years); and a median Karnofsky performance score of 80 (range, 60-90). All patients received hypo-IMRT and concurrent TMZ according to protocol, except for 2 patients who received only 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 6.5 (range, 0-14).With a median follow-up of 14.8 months (range, 2.7-34.2 months) for all patients and a minimum follow-up of 20.6 months for living patients, no instances of grade 3 or higher nonhematologic toxicity were observed. The median OS was 16.6 months (range, 4.1-35.9 months). Six patients underwent repeated surgery for suspected tumor recurrence; necrosis was found in 50% to 100% of the resected specimens. Conclusion: In selected GBM patients, 60 Gy hypo-IMRT delivered in 6-Gy fractions over 2 weeks with concurrent and adjuvant TMZ is safe. OS in this small cohort of patients was comparable to that treated with current standard of care therapy.

  12. Phase II Trial of Hypofractionated IMRT With Temozolomide for Patients With Newly Diagnosed Glioblastoma Multiforme

    Purpose: To report toxicity and overall survival (OS) in patients with newly diagnosed glioblastoma multiforme (GBM) treated with hypofractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent and adjuvant temozolomide (TMZ). Methods and Materials: Patients with newly diagnosed GBM after biopsy or resection and with adequate performance status and organ or bone marrow function were eligible for this study. Patients received postoperative hypo-IMRT to the surgical cavity and residual tumor seen on T1-weighted brain MRI with a 5-mm margin to a total dose of 60 Gy in 10 fractions (6 Gy/fraction) and to the T2 abnormality on T2-weighted MRI with 5-mm margin to 30 Gy in 10 fractions (3 Gy/fraction). Concurrent TMZ was given at 75 mg/m2/day for 28 consecutive days. Adjuvant TMZ was given at 150 to 200 mg/m2/day for 5 days every 28 days. Toxicities were defined using Common Terminology Criteria for Adverse Events version 3.0. Results: Twenty-four patients were treated, consisting of 14 men, 10 women; a median age of 60.5 years old (range, 2777 years); and a median Karnofsky performance score of 80 (range, 6090). All patients received hypo-IMRT and concurrent TMZ according to protocol, except for 2 patients who received only 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 6.5 (range, 014).With a median follow-up of 14.8 months (range, 2.734.2 months) for all patients and a minimum follow-up of 20.6 months for living patients, no instances of grade 3 or higher nonhematologic toxicity were observed. The median OS was 16.6 months (range, 4.135.9 months). Six patients underwent repeated surgery for suspected tumor recurrence; necrosis was found in 50% to 100% of the resected specimens. Conclusion: In selected GBM patients, 60 Gy hypo-IMRT delivered in 6-Gy fractions over 2 weeks with concurrent and adjuvant TMZ is safe. OS in this small cohort of patients was comparable to that treated with current standard of care therapy.

  13. 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.

    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.

  14. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

    Emmanuel Bckryd

    2015-01-01

    Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. opioid epidemic is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of ch...

  15. Neurodegenerative changes in patients with clinical history of bipolar disorders.

    Shioya, Ayako; Saito, Yuko; Arima, Kunimasa; Kakuta, Yukio; Yuzuriha, Takefumi; Tanaka, Noriko; Murayama, Shigeo; Tamaoka, Akira

    2015-06-01

    Neurodegeneration in bipolar disorder (BPD) is poorly understood. Therefore, the current study was designed to assess the immunohistochemical changes in neurodegenerative markers in patients with BPD. Eleven consecutive autopsy cases diagnosed with BPD were analyzed. Sections were obtained from archival paraffin blocks of representative areas and stained using conventional methods, as well as immunostained with several antibodies to screen for neurodegenerative diseases. Age- and non-argyrophilic grains (AGs) degeneration matched controls were selected for each case. Clinical information was retrospectively collected from medical charts. All patients were men, and the average age of death was 70 years. Neuropathological diagnoses included dementia with grains (2), argyrophilic grain disease (2), corticobasal degeneration (CBD, 1), Lewy body disease (1), hypoxic encephalopathy (1) and cerebral infarction (1). All cases showed AGs to various degrees. Three patients died in their 50s; one demonstrated dementia with Lewy bodies, while the other two showed abundant AGs in the thalamus and amygdala. Of the three patients who died in their 60s, one showed AGs preferentially in the thalamus and amygdala, while the others demonstrated limbic predominance. The patients who died in/after their 70s demonstrated AGs similar to controls, except for the patient with CBD. Our data provides potentiality that neurodegenerative diseases may be an underlying pathology in certain cases of BPD. PMID:25819679

  16. Volasertib for AML: clinical use and patient consideration

    Hao Z

    2015-07-01

    Full Text Available Zhonglin Hao,1 Vamsi Kota2 1Cancer Center, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA; 2Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA Abstract: Acute myeloid leukemia (AML is a disease diagnosed mostly in patients >65 years of age. Despite its heterogeneous nature, the different types of AMLs are still managed by standard induction chemotherapy for those who can tolerate it in the beginning. For the elderly and infirm patients, however, this approach leads to unacceptably high induction mortality rate. This article reviews past and current efforts searching for low-intensiveness treatments for the elderly and infirm patients who cannot tolerate the standard induction regimen. Volasertib, currently in Phase III clinical trials in combination with cytarabine, is reviewed as a promising agent for this patient population with AML, from the viewpoints of potential compliance and efficacy. Keywords: volasertib, acute myeloid leukemia, management, induction

  17. Patient representatives' views on patient information in clinical cancer trials

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    consent is possible to provide. We explored patient representatives' views and perceptions on the written trial information used in clinical cancer trials. METHODS: Written patient information leaflets used in four clinical trials for colorectal cancer were used for the study. The trials included phase I...

  18. Prevalence of metabolic syndrome among newly diagnosed hypertensive patients in the hills of Himachal Pradesh, India

    Surender Thakur

    2013-01-01

    Full Text Available To study the prevalence of metabolic syndrome (MS among newly diagnosed hypertensive patients in a tertiary care hospital in the northern hilly state of Himachal Pradesh, India, located in western Himalayas at a moderate altitude of 2200 m above mean sea level. One hundred and eighteen newly diagnosed hypertensive patients above the age of 20 years were studied in a hospital-based cross-sectional study. MS prevalence was estimated by International Diabetes Federation (IDF criteria and modified National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III criteria. Student′s t-test was used to compare the mean of the continuous variables. Chi-square test was used to compare discrete variables. The prevalence of MS in hypertensive patients was 68.6% (modified NCEP-ATP III and 63.6% (IDF criteria. The most common phenotype of MS with the component of hypertension was the coexistence of waist circumference (90.1%, low high-density lipoprotein (HDL; 70.4%, and high triglycerides (67.9% as per the modified NCEP-ATP III criteria, and low HDL (76.2% and high triglycerides (66.4% as per the IDF criteria. Fasting blood glucose (33.2% as per the modified NCEP-ATP III criteria and 32.6% as per the IDF criteria was the least significant factor having an association with MS. The prevalence of MS among hypertensive patients was high and indicates the need for metabolic screening in all hypertensive patients at the first diagnosis.

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

    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).

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

    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 amplitde, 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 amplitdes 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%

  1. Prognostic factors of patients with newly diagnosed acute promyelocytic leukemia treated with arsenic trioxide-based frontline therapy.

    Lou, Yinjun; Ma, Yafang; Suo, Shanshan; Ni, Wanmao; Wang, Yungui; Pan, Hanzhang; Tong, Hongyan; Qian, Wenbin; Meng, Haitao; Mai, Wenyuan; Huang, Jian; Yu, Wenjuan; Wei, Juyin; Mao, Liping; Jin, Jie

    2015-09-01

    Prognostic factors for patients with acute promyelocytic leukemia (APL) treated in the context of arsenic trioxide (ATO)-based frontline regimes have not been established clearly. We retrospectively analyzed the clinical features, immunophenotypes, Fms-like tyrosine kinase-3 internal tandem duplication (FLT3-ITD), and outcomes of 184 consecutive newly diagnosed APL patients treated by intravenous ATO-based therapy. The median age was 40 years (14-77 years). The early death rate was 4.9% (9/184 patients). With a median follow-up time of 36 months (9-74 months), the 3-year relapse-free survival (RFS) and overall survival (OS) were 93.3% and 92.2%, respectively. Interestingly, there was no meaningful association between 3-year RFS and initial white blood cell count, FLT3-ITD status, or type of PML-RARA isoforms. In multivariable analysis, the CD56 expression was the only independent risk factor in terms of RFS (hazard ratio, 4.70; P=0.005). These results suggested that ATO-based therapy may ameliorate the unfavorable influence of previously known high-risk features; moreover, CD56 expression remains to be a potentially unfavorable prognostic factor in APL patients. PMID:26183877

  2. A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy

    Sung, Ji Hee; Kim, Do Hoon; Oh, Mi-Jung; Lee, Kyoung Ju; Bae, Young A; Kwon, Kye Won; Lee, Seung Min; Kang, Ho Joon; Choi, Jinyoung

    2015-01-01

    Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supr...

  3. Relationship between Obstructive Sleep Apnea Severity and Sleep, Depression and Anxiety Symptoms in Newly-Diagnosed Patients

    Macey, Paul M.; Woo, Mary A.; Rajesh KUMAR; Cross, Rebecca L.; Harper, Ronald M.

    2010-01-01

    Obstructive sleep apnea (OSA) occurs in at least 10% of the population, and leads to higher morbidity and mortality; however, relationships between OSA severity and sleep or psychological symptoms are unclear. Existing studies include samples with wide-ranging comorbidities, so we assessed relationships between severity of OSA and common sleep and psychological disturbances in recently diagnosed OSA patients with minimal co-morbidities. We studied 49 newly diagnosed, untreated OSA patients wi...

  4. Relationship between selenium intake and inflammatory markers in newly-diagnosed patients with B-cell non-Hodgkin lymphoma

    Mourad Aribi; Naima Mesli

    2013-01-01

    Background: Non-Hodgkin lymphoma (NHL) is the seventh most common cancer in the world. They are malignancies that develop from lymphoid cells. Selenium can modulate the expression of multiple cellular signaling pathways leading to decreased inflammatory gene expression. Objectives: To determine the relationship between selenium intake and inflammatory markers in newly-diagnosed patients with B-cell NHL. Materials and Methods: Newly-diagnosed patients with B-cell NHL and healthy age- and sex...

  5. Intelligent Virtual Patients for Training Clinical Skills

    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.

  6. Exploring the Clinical Utility of the Development and Well-Being Assessment (DAWBA) in the Detection of Hyperkinetic Disorders and Associated Diagnoses in Clinical Practice

    Foreman, David; Morton, Stephanie; Ford, Tamsin

    2009-01-01

    Background: The clinical diagnosis of ADHD is time-consuming and error-prone. Secondary care referral results in long waiting times, but primary care staff may not provide reliable diagnoses. The Development And Well-Being Assessment (DAWBA) is a standardised assessment for common child mental health problems, including attention…

  7. Virtual glaucoma clinics: patient acceptance and quality of patient education compared to standard clinics

    Court JH

    2015-04-01

    Full Text Available Jennifer H Court,1 Michael W Austin1,21Department of Ophthalmology, Singleton Hospital, Swansea, Wales, UK; 2Department of Ophthalmology, Neath Port Talbot Hospital, Swansea, Wales, UKPurpose: Virtual glaucoma clinics allow rapid, reliable patient assessment but the service should be acceptable to patients and concordance with treatment needs to be maintained with adequate patient education. This study compares experiences and understanding of patients reviewed via the virtual clinic versus the standard clinic by way of an extended patient satisfaction questionnaire (PSQ.Patients and methods: One hundred PSQs were given to consecutive patients attending glaucoma clinics in October 2013. All 135 patients reviewed via the virtual clinic from April 2013 until August 2013 were sent postal PSQs in September 2013. Data were obtained for demographics, understanding of glaucoma, their condition, satisfaction with their experience, and quality of information. Responses were analyzed in conjunction with the clinical records.Results: Eighty-five percent of clinic patients and 63% of virtual clinic patients responded to the PSQ. The mean satisfaction score was over 4.3/5 in all areas surveyed. Virtual clinic patients’ understanding of their condition was very good, with 95% correctly identifying their diagnosis as glaucoma, 83% as ocular hypertension and 78% as suspects. There was no evidence to support inferior knowledge or self-perceived understanding compared to standard clinic patients. Follow-up patients knew more about glaucoma than new patients. Over 95% of patients found our information leaflet useful. Forty percent of patients sought additional information but less than 20% used the internet for this.Conclusion: A substantial proportion of glaucoma pathway patients may be seen by non-medical staff supervised by glaucoma specialists via virtual clinics. Patients are accepting of this format, reporting high levels of satisfaction and non-inferior knowledge to those seen in standard clinics.Keywords: glaucoma, care-pathway, satisfaction, questionnaire, education, service-delivery

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

    Milisavljević 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.

  9. Nephrotoxicity of cyclosporin A in patients with newly diagnosed type 1 diabetes mellitus

    Feldt-Rasmussen, B; Jensen, T; Dieperink, H; Mandrup-Poulsen, T; Nerup, J; Bendtzen, K; Andersen, V; Kemp, E; Leyssac, P P

    1990-01-01

    Renal function was studied in 18 patients with Type 1 diabetes mellitus. All were participating in the Canadian-European randomized placebo-controlled cyclosporin trial in newly diagnosed Type 1 diabetic patients, nine being randomized to placebo, and nine to cyclosporin A. During treatment for 12...... reversible. There are, however, signs of minor and perhaps chronic renal injury....... to 18 months, cyclosporin A caused significant reductions in the glomerular filtration rate (before drug withdrawal, cyclosporin 97 +/- 18 vs placebo 125 +/- 16 ml min-1 1.73-m-2, p less than 0.05), renal plasma flow (454 +/- 83 vs 536 +/- 70 ml min-1 1.73-m-2, p less than 0.05), and lithium...

  10. Retrivability in the Danish National Hospital Registry of HIV and hepatitis B and C coinfection diagnoses of patients managed in HIV centers 1995-2004

    Obel, Niels; Reinholdt, Hanne; Omland, Lars H; Engsig, Frederik; Sørensen, Henrik T; Hansen, Ann-Brit E

    2008-01-01

    BACKGROUND: Hospital-based discharge registries are used increasingly for longitudinal epidemiological studies of HIV. We examined completeness of registration of HIV infections and of chronic hepatitis B (HBV) and hepatitis C (HCV) coinfections in the Danish National Hospital Registry (DNHR......) covering all Danish hospitals. METHODS: The Danish HIV Cohort Study (DHCS) encompasses all HIV-infected patients treated in Danish HIV clinics since 1 January 1995. All 2,033 Danish patients in DHCS diagnosed with HIV-1 during the 10-year period from 1 January 1995 to 31 December 2004 were included in the....... The positive predictive values of being registered with HBV and HCV in DHCS were thereby estimated to 0.88 and 0.97 and in DNHR to 0.32 and 0.54. CONCLUSION: The study demonstrates that secondary data from national hospital databases may be reliable for identification of patients diagnosed with HIV...

  11. Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma.

    Pirzkall, Andrea; McGue, Colleen; Saraswathy, Suja; Cha, Soonmee; Liu, Raymond; Vandenberg, Scott; Lamborn, Kathleen R; Berger, Mitchel S; Chang, Susan M; Nelson, Sarah J

    2009-12-01

    To assess incidence and degree of regrowth in glioblastoma between surgery and radiation therapy (RT) and to correlate regrowth with presurgical imaging and survival, we examined images of 32 patients with newly diagnosed glioblastoma who underwent MR spectroscopic imaging (MRSI), perfusion-weighted imaging (PWI), and diffusion-weighted imaging (DWI) prior to surgery, after surgery, and prior to RT/temozolomide. Contrast enhancement (CE) in the pre-RT MR image was compared with postsurgical DWI to differentiate tumor growth from postsurgical infarct. MRSI and PWI parameters were analyzed prior to surgery and pre-RT. Postsurgical MRI indicated that 18 patients had gross total and 14 subtotal resections. Twenty-one patients showed reduced diffusion, and 25 patients showed new or increased CE. In eight patients (25%), the new CE was confined to areas of postsurgical reduced diffusion. In the other 17 patients (53%), new CE was found to be indicative of tumor growth or a combination of tumor growth and surgical injury. Higher perfusion and creatine within nonenhancing tumor in the presurgery MR were associated with subsequent tumor growth. High levels of choline and reduced diffusion in pre-RT CE suggested active metabolism and tumor cell proliferation. Median survival was 14.6 months in patients with interim tumor growth and 24 months in patients with no growth. Increased volume or new onset of CE between surgery and RT was attributed to tumor growth in 53% of patients and was associated with shorter survival. This suggests that reducing the time between surgery and adjuvant therapy may be important. The acquisition of metabolic and physiologic imaging data prior to adjuvant therapy may also be valuable in assessing regions of new CE and nonenhancing tumor. PMID:19229057

  12. Patient representatives’ views on patient information in clinical cancer trials

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    Background Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informed consent is possible to provide. We explored patient representatives’ views and perceptions on the written trial information used in clinical cancer trials. Methods Written patient information leaflet...

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

    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.

  14. Clinical Characteristics of Refractory Myasthenia Gravis Patients

    Suh, Joome; Goldstein, Jonathan M.; Nowak, Richard J.

    2013-01-01

    Background: A subset of myasthenia gravis (MG) patients is refractory to standard therapies. Identifying the characteristics of this population is essential as newer treatment strategies emerge that may be more effective in this group. Objective: The aim of our study is to describe the clinical features of refractory MG patients and compare them to those of non-refractory patients. Methods: A retrospective chart review was completed of 128 MG patients referred to a tertiary neuromuscular clin...

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

    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.

  16. Psychosocial covariates of physical activity in recently diagnosed Type 2 diabetes patients

    Rajesh Nair

    2013-03-01

    Full Text Available Background Regular physical activity can be effective not only in preventing diabetes and managing its complications but also be effective in minimizing the risk of developing other chronic diseases among diabetics. The overall aim of study was to determine probable causes of change in physical activity so as to generate evidences for future interventions and to identify psychosocial covariates of self reported physical activity in recently diagnosed Type 2 diabetes cases. Methods Participants n=478 (239 intervention arm and 239 control arm of an observational cohort were randomized into the ADDITION Plus trial and were recruited from 36 practices in East Anglia region. Participants were people recently diagnosed with diabetes (screen detected and clinically diagnosed within the preceding 3 years were individually randomized and were between the age group of 40-69 years, (mean age 59.2 years. The self reported data regarding physical activity was measured at baseline and one year were used. Demographic and psychosocial (treatment control, consequences, anxiety covariates were assessed at the baseline. Linear univariate and multivariable linear regression analysis was used to quantify the associations between demographic and psychosocial correlates. Results: With regard to the psychosocial correlates(except for participants’ perceptions about the consequences of diabetes, no significant associations with physical activity were found. Treatment control and anxiety failed to predict physical activity. Conclusion The result suggests to further investigate the change in physical activity by including other variables related to demography, other psycho-social and environment influences. Based on the available literature, it is suggested that other factors were found consistently associated with physical activity such as self efficacy, attitude, sensation seeking, family-friend social support, goal orientation, motivation could be studied.

  17. Carfilzomib, cyclophosphamide, and dexamethasone in patients with newly diagnosed multiple myeloma: a multicenter, phase 2 study.

    Bringhen, Sara; Petrucci, Maria Teresa; Larocca, Alessandra; Conticello, Concetta; Rossi, Davide; Magarotto, Valeria; Musto, Pellegrino; Boccadifuoco, Luana; Offidani, Massimo; Omedé, Paola; Gentilini, Fabiana; Ciccone, Giovannino; Benevolo, Giulia; Genuardi, Mariella; Montefusco, Vittorio; Oliva, Stefania; Caravita, Tommaso; Tacchetti, Paola; Boccadoro, Mario; Sonneveld, Pieter; Palumbo, Antonio

    2014-07-01

    This multicenter, open-label phase 2 trial determined the safety and efficacy of carfilzomib, a novel and irreversible proteasome inhibitor, in combination with cyclophosphamide and dexamethasone (CCyd) in patients with newly diagnosed multiple myeloma (NDMM) ≥65 years of age or who were ineligible for autologous stem cell transplantation. Patients (N = 58) received CCyd for up to 9 28-day cycles, followed by maintenance with carfilzomib until progression or intolerance. After a median of 9 CCyd induction cycles (range 1-9), 95% of patients achieved at least a partial response, 71% achieved at least a very good partial response, 49% achieved at least a near complete response, and 20% achieved stringent complete response. After a median follow-up of 18 months, the 2-year progression-free survival and overall survival rates were 76% and 87%, respectively. The most frequent grade 3 to 5 toxicities were neutropenia (20%), anemia (11%), and cardiopulmonary adverse events (7%). Peripheral neuropathy was limited to grades 1 and 2 (9%). Fourteen percent of patients discontinued treatment because of adverse events, and 21% of patients required carfilzomib dose reductions. In summary, results showed high complete response rates and a good safety profile. This trial was registered at clinicaltrials.gov as #NCT01346787. PMID:24855212

  18. Prevalence of Lynch Syndrome among Patients with Newly Diagnosed Endometrial Cancers

    Egoavil, Cecilia; Alenda, Cristina; Castillejo, Adela; Paya, Artemio; Peiro, Gloria; Sánchez-Heras, Ana-Beatriz; Castillejo, Maria-Isabel; Rojas, Estefanía; Barberá, Víctor-Manuel; Cigüenza, Sonia; Lopez, Jose-Antonio; Piñero, Oscar; Román, Maria-Jose; Martínez-Escoriza, Juan-Carlos; Guarinos, Carla; Perez-Carbonell, Lucia; Aranda, Francisco-Ignacio; Soto, Jose-Luis

    2013-01-01

    Background Lynch syndrome (LS) is a hereditary condition that increases the risk for endometrial and other cancers. The identification of endometrial cancer (EC) patients with LS has the potential to influence life-saving interventions. We aimed to study the prevalence of LS among EC patients in our population. Methods Universal screening for LS was applied for a consecutive series EC. Tumor testing using microsatellite instability (MSI), immunohistochemistry (IHC) for mismatch-repair (MMR) protein expression and MLH1-methylation analysis, when required, was used to select LS-suspicious cases. Sequencing of corresponding MMR genes was performed. Results One hundred and seventy-three EC (average age, 63 years) were screened. Sixty-one patients (35%) had abnormal IHC or MSI results. After MLH1 methylation analysis, 27 cases were considered suspicious of LS. From these, 22 were contacted and referred for genetic counseling. Nineteen pursued genetic testing and eight were diagnosed of LS. Mutations were more frequent in younger patients (<50 yrs). Three cases had either intact IHC or MSS and reinforce the need of implement the EC screening with both techniques. Conclusion The prevalence of LS among EC patients was 4.6% (8/173); with a predictive frequency of 6.6% in the Spanish population. Universal screening of EC for LS is recommended. PMID:24244552

  19. Quality of life, social support and cognitive impairment in heart failure patients without diagnosed dementia.

    Gallagher, Robyn; Sullivan, Anne; Burke, Rhonda; Hales, Susan; Sharpe, Precilla; Tofler, Geoffrey

    2016-04-01

    Improving health-related quality of life (HRQL) is an important goal for heart failure (HF) patients, and understanding the factors that influence HRQL is essential to this process. We investigated the influence of social support and cognitive impairment on HRQL in community dwelling HF patients (n = 104) without diagnosed dementia. Patients were aged mean 80.93 years (SD 11.01) and were classified as New York Heart Association Class 1/II (45%) or III/IV (53%). Age, social support and cognition had important independent effects. Younger people had the most negative effects of HF in all areas of HRQL: emotional (B = -0.32), physical (B = -0.44) and overall (B = -1). Well-supported patients (general social support) had the least negative effect from HF on HRQL: emotional domain (B = -4.62) and overall (B = -11.72). Patients with normal cognition had more negative impact of HF on HRQL: physical domain (B = 5.51) and overall HRQL (B = 10.42). A clearer understanding of the relationships between age, social support and cognition and the effect on the impact of HF on HRQL is needed before interventions can be appropriately developed. PMID:25943781

  20. Analysis of C9orf72 repeat expansions in a large series of clinically and pathologically diagnosed cases with atypical parkinsonism.

    Schottlaender, Lucia V; Polke, James M; Ling, Helen; MacDoanld, Nicola D; Tucci, Arianna; Nanji, Tina; Pittman, Alan; de Silva, Rohan; Holton, Janice L; Revesz, Tamas; Sweeney, Mary G; Singleton, Andy B; Lees, Andrew J; Bhatia, Kailash P; Houlden, Henry

    2015-02-01

    A GGGGCC repeat expansion in the C9orf72 gene was recently identified as a major cause of familial and sporadic amyotrophic lateral sclerosis and frontotemporal dementia. There is suggestion that these expansions may be a rare cause of parkinsonian disorders such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration (CBD). Screening the C9orf72 gene in 37 patients with features of corticobasal syndrome (CBS) detected an expansion in 3 patients, confirmed by Southern blotting. In a series of 22 patients with clinically diagnosed PSP, we found 1 patient with an intermediate repeat length. We also screened for the C9orf72 expansion in a large series of neuropathologically confirmed samples with MSA (n = 96), PSP (n = 177), and CBD (n = 18). Patients were found with no more than 22 GGGGCC repeats. Although these results still need to be confirmed in a larger cohort of CBS and/or CBD patients, these data suggest that in the presence of a family history and/or motor neuron disease features, patients with CBS or clinical PSP should be screened for the C9orf72 repeat expansion. In addition, we confirm that the C9orf72 expansions are not associated with pathologically confirmed MSA, PSP, or CBD in a large series of cases. PMID:25308964

  1. [Clinical, neuropsychological and neuroimaging features of patients with mixed dementia.

    Trusova, N A; Levin, O S; Arablinski?, A V; Makotrova, T A; Vasenina, E E

    2014-01-01

    Objective. Mixed dementia (MD), characterized by a combination of Alzheimer's disease (AD) and cerebrovascular disease, is one of the most common and, at the same time, poorly diagnosed forms of dementia in the elderly. The aim of our study was to investigate features of AD with its combination with cerebrovascular disease on the basis of clinical, neuropsychological and neuroimaging data. Material and methods. Authors examined 79 patients with dementia: 30 patients with AD, 33 patients with MD and 16 patients with vascular dementia. Patients with MD were older, had more often frontal gait disorders (48.5%), postural instability (45%), pseudobulbar syndrome (60%). Results and conclusion. The neuropsychological profile of patients with MD had mixed amnestic-dysexecutive character and, depending on the severity of vascular pathology, in some cases was closer to AD and in others to vascular dementia. A negative effect of vascular risk factors on medial temporal atrophy was found. Neuroimaging changes in MD were correlated with clinical manifestations. Proposed approaches to the diagnosis of MD help to determine more precisely the main directions of the treatment of patients and predict the course of the disease. PMID:25042500

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

    Ahmad Ghanizadeh3; 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. Daily intake of antioxidants in relation to survival among adult patients diagnosed with malignant glioma

    Il'yasova Dora

    2010-05-01

    Full Text Available Abstract Background Malignant glioma is a rare cancer with poor survival. The influence of diet and antioxidant intake on glioma survival is not well understood. The current study examines the association between antioxidant intake and survival after glioma diagnosis. Methods Adult patients diagnosed with malignant glioma during 1991-1994 and 1997-2001 were enrolled in a population-based study. Diagnosis was confirmed by review of pathology specimens. A modified food-frequency questionnaire interview was completed by each glioma patient or a designated proxy. Intake of each food item was converted to grams consumed/day. From this nutrient database, 16 antioxidants, calcium, a total antioxidant index and 3 macronutrients were available for survival analysis. Cox regression estimated mortality hazard ratios associated with each nutrient and the antioxidant index adjusting for potential confounders. Nutrient values were categorized into tertiles. Models were stratified by histology (Grades II, III, and IV and conducted for all (including proxy subjects and for a subset of self-reported subjects. Results Geometric mean values for 11 fat-soluble and 6 water-soluble individual antioxidants, antioxidant index and 3 macronutrients were virtually the same when comparing all cases (n = 748 to self-reported cases only (n = 450. For patients diagnosed with Grade II and Grade III histology, moderate (915.8-2118.3 mcg intake of fat-soluble lycopene was associated with poorer survival when compared to low intake (0.0-914.8 mcg, for self-reported cases only. High intake of vitamin E and moderate/high intake of secoisolariciresinol among Grade III patients indicated greater survival for all cases. In Grade IV patients, moderate/high intake of cryptoxanthin and high intake of secoisolariciresinol were associated with poorer survival among all cases. Among Grade II patients, moderate intake of water-soluble folate was associated with greater survival for all cases; high intake of vitamin C and genistein and the highest level of the antioxidant index were associated with poorer survival for all cases. Conclusions The associations observed in our study suggest that the influence of some antioxidants on survival following a diagnosis of malignant glioma are inconsistent and vary by histology group. Further research in a large sample of glioma patients is needed to confirm/refute our results.

  4. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

    Dan-Jie Guo

    2015-01-01

    Full Text Available Background: Pulmonary embolism (PE can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old. The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results: Ninety-six cases (28.6% were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3% were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05 in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746 and 0.655 (95% CI: 0.584-0.722, respectively (P = 0.389. The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  5. Clinical management of dying patients.

    Gavrin, J; Chapman, C.R.

    1995-01-01

    Dying is universal, and death should be a peaceful time. Myriad comfort measures are available in the last weeks before life ends. Discussions about end-of-life issues often suffer from lack of informed opinion. Palliative care experts have identified specific somatic and psychological sources of distress for dying patients and their loved ones. Pain, shortness of breath, nausea and vomiting, and fear of abandonment contribute substantially to both physical and psychological discomfort toward...

  6. Anemia in elderly hospitalized patients: prevalence and clinical impact.

    Migone De Amicis, Margherita; Poggiali, Erika; Motta, Irene; Minonzio, Francesca; Fabio, Giovanna; Hu, Cinzia; Cappellini, Maria Domenica

    2015-08-01

    Anemia is a common finding in elderly individuals. Several studies have shown a strong relationship between anemia, morbidity and mortality, suggesting anemia as a significant independent predictor of adverse outcome in elderly hospitalized patients. The pathophisiology of anemia in the elderly is not yet completely understood. Several mechanisms are involved. We investigated the prevalence of anemia in a cohort of 193 elderly patients admitted to the Internal Medicine Ward of Ca'Granda Policlinico Hospital along 6 months, and its relationship to comorbidities and to the length of hospitalization. Anemia was classified according to the WHO criteria. The majority of patients (48 %) had a mildmoderate, normocytic anemia; severe anemia was found in 8 out of 92 anemic patients. In a subgroup of patients erythropoietin was tested and resulted statistically higher if compared to non-anemic controls (p = 0.003). Considering the most common cause of anemia, nutritional deficiency, chronic renal disease and anemia of chronic disease were found respectively in 36, 15 and 25 % of cases. Unexplained anemia was diagnosed in 24 % of patients, according to the literature. Anemia was independently associated with increased length of hospital stay. Our study confirmed a high prevalence of anemia in elderly patients, and its association with a higher number of comorbidities and a longer stay. A correct clinical approach to anemia in elderly hospitalized patients is essential, considering its negative impact on patients' quality of life, and its social burden in term of healthcare needs and costs. PMID:25633233

  7. Severe myoclonic epilepsy of infancy (Dravet syndrome): Clinical and genetic features of nine Turkish patients

    Meral Özmen; Cengiz Dilber; Burak Tatli; Nur Aydinli; Mine Çaliskan; Baris Ekici

    2011-01-01

    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...

  8. A clinical score to reduce unnecessary antibiotic use in patients with sore throat

    McIsaac, W. J.; White, D; Tannenbaum, D.; Low, D E

    1998-01-01

    OBJECTIVE: To validate a score based on clinical symptoms and signs for the identification of group A Streptococcus (GAS) infection in general practice patients with score throat. DESIGN: A single throat swab was used as the gold standard for diagnosing GAS infection. Clinical information was recorded by experienced family physicians on standardized encounter forms. Score criteria were identified by means of logistic regression modelling of data from patients enrolled in the first half of the...

  9. Introducing Optometry Students to Clinical Patient Care.

    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)

  10. Clinical Practice Guidelines for Critical Patients Nutrition.

    Marta Patricia Casanova Gonzlez

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Critical Patients Nutrition. This document includes a review and update of aspects related with nutritional assessment of patients in critical condition; indications, contraindications and procedures for enteral and parenteral nutrition and its follow up. It includes assessment guidelines focused on the most important aspects to be accomplished.

  11. Retrospective Analysis of Discrepancies between Clinical and Histopathological Diagnoses in Head and Neck Lesions: An Institutional Study with 10 Years Database

    Ketki P Kalele

    2016-01-01

    Full Text Available Introduction: Oral and maxillofacial lesions present a wide spectrum of clinical manifestations ranging from an asympto - matic small lesion to a large destructive one. Several lesions mimic each other in their clinical presentation posing a diag - nostic dilemma. Due to interoperator subjectivity and lack of defined objective diagnostic criteria, histopathological investi - gation, most of the times, plays a vital role in final diagnosis. Many studies have reported the concordance rates among the clinical and histopathological diagnoses of oral lesions, however, there are very few studies which have highlighted the discrepancies in them that have led to drastic changes in the lines of diagnoses and treatment. This institutional retro - spective descriptive study intended to highlight this lacuna by going through histopathological registry to study such cases with discrepancies in clinical and histopathological diagnoses in last 10 years. The aim of this study was to systematically analyze the discrepancies in clinical and histopathological diagnoses of various oral lesions with an emphasis on malig - nant and nonmalignant groups so as to stress the importance of histopathological examination to ultimately minimize the risk of inadvertent inappropriate treatment. Materials and methods: A total of 1570 cases that were reported to our institute over a period of 10 years were evaluated from the histopathology registry. Out of these, 1300 cases met our inclusion criteria. Discrepancies were charted as major and minor discrepancies and discrepancy indices were calculated. Lesions were divided into malignan t and nonmalignant groups and were subjected to d i agnostic-screening test evaluation to assess the discrepancies. Results: Total discrepancy value (discrepancy index obtained was 12.9%, out of which 9.23% showed major discrepancies and 3.69% showed minor discrepancies. Ninety-five percent confidence interval (CI was calculated, and was found in the range of 11.18 to 14.83. Sensitivity and specificity values for the study group of malignant and nonmalignant lesions were 90.09% and 98.35% respectively. Positive predictive value of 91.39%, negative predictive value of 98.08% and Cohens kappa value of 0.8895 was obtained. Diagnostic accuracy was 97% and bias index of 0.002308 was also calculated. Conclusion: To summarize, our results indicate that the discre- pancy between clinical diagnosis and the histopathological interpretation of the various oral lesions studied is not very high. However, a thorough clinicopathological protocol can be designed to overcome this small but significant discrepancy, so as to avoid any inadvertent, inappropriate treatment to the patient

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

    Gülay Taşdemir

    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.

  13. Correlation between bone scan findings and serum PSA level in prostate cancer patients in Bangladesh: both newly diagnosed and hormonally treated cases

    Full text: The objective of the current study was to determine whether pre- treatment serum prostate specific antigen (PSA) levels can identify a group with low probability of osseous metastases and safely eliminate the need for bone scan as a routine part of the staging evaluation in Bangladeshi patients with newly diagnosed prostate carcinoma. Also, to find out a cut off value for serum PSA level for predicting positive bone scan in newly diagnosed Bangladeshi prostate cancer patients and to assess the role of PSA level in hormonally treated cases. Prostate cancer most commonly metastasizes to the bone. Bone scintigraphy is one of the best methods in detecting bone metastases, assessing the progression of the disease and response to therapy. For more than 30 yrs it has been known that bone scintigraphy is more sensitive than radiographic, clinical evaluation or chemical markers such as alkaline phosphatase or acid phosphatase in detection of early osseous metastatic prostate cancer. The introduction of PSA has dramatically changed the management of prostate cancer. Serum PSA level has proven to be a useful serum marker for detection of metastatic prostate cancer and it provides the best overall correlation. It also has considerable impact on bone scanning. Of special significance is the fact that patients who have a low PSA level in previously untreated carcinoma of prostate are extremely unlikely to have positive findings on a bone scan for metastases. The picture is different in patients who has received and responded to hormonal therapy. Bone scintigraphy appears to be extremely useful in patients whose PSA level begins to rise after surgical procedure. Patients, who were on anti- androgen therapy, even though they had visible metastatic disease on bone scans, had normal level of PSA Patients and methods: A total of 390 cases were studied. Some (n=242) were newly diagnosed without having any specific treatment other than surgery. Others (n=148) were old cases who received treatment for their prostate cancer. All patients underwent a bone scan and serum PSA measurement. Results: Only 6% of 242 patients with newly diagnosed prostate cancer had positive bone scan on initial evaluation. Scans were positive in 0 of 112 with PSA level below 10 ng/ml, 5 of 76 with PSA level between 10 to 20 ng/ml and 09 of 54 with PSA level above 30 ng/ml. In newly diagnosed cases the sensitivity of PSA in predicting bony mets was found to be appreciably high and did not decrease notably with the increase of cut off value from 10ng/ml to 30ng/ml. From this study it was evident that PSA level between 10-30ng/ml has optimum sensitivity and specificity in newly diagnosed cases. In case of patients on hormone therapy bone scan was positive in 49 cases at PSA level 20ng/ml. PSA alone would have failed to detect a significant number of patients in hormonally treated cases indicating a low sensitivity in this group. Conclusion: Patients with newly diagnosed and untreated prostate cancer should undergo bone scintigraphy if there is bone pain. Recent reports discourage the routine use of a bone scan when serum PSA is <20ng/ml. In newly diagnosed cases, the incidence of bone metastasis increased with the increasing level of serum PSA. The likelihood of bone metastasis is low in newly diagnosed cases when PSA level is low. In hormonally treated cases bone scan was positive even when the PSA level was low. PSA is a major predictor for positive bone scan. About two third of the patients analyzed were in the low risk group and elimination of a bone scan in these patients would result in considerable economic saving. Serum PSA level may remain low even in presence of metastases in hormonally treated cases. For assessment of hormonally treated cases bone scan should be done. (author)

  14. Estimation of the true incidence of lactic acidosis within the Lighthouse Clinic cohort, and the likely magnitude of missed diagnoses in the region

    Colin Speight

    2014-11-01

    Full Text Available Introduction: Lactic acidosis is one of the most serious side effects associated with ART, most commonly associated with stavudine. Clinical features are non-specific and specialist laboratory capabilities are essential to confirm the diagnosis, making under-diagnosis likely in resource-constrained settings. Lighthouse Trust is a tertiary referral ART centre with over 23,500 patients on ART. The adjacent University of North Carolina Project laboratory, also serving Kamuzu Central Hospital, has been the only site processing lactate tests in Central Zone for many years. Our objective was to quantify the true incidence within our cohort, and estimate the likely degree of historical missed diagnoses from less central ART clinics. Methods: All high lactate results between June 2010 and June 2013 were treated as cases, and cross referenced with the Lighthouse database. Patients transferring in to Lighthouse within one month prior to diagnosis were assumed to have been referred due to their lactic acidosis, and moved to the Central Zone cohort to avoid referral bias. Routinely collected quarterly ART cohort data for both Lighthouse and the entire Central Zone were analyzed. Results: Over the three-year period, from within the Lighthouse cohort, there were 138 cases: 74% were female, median duration on ART was 14 months (IQR 1026, and 98.5% were attributable to stavudine (only two cases to zidovudine. Over this period, the average number of patients taking stavudine at Lighthouse was 10,960 (3,600 on zidovudine. For the whole Central Zone (minus Lighthouse patients there were 61,000 on stavudine (4,830 on zidovudine, yet only 124 cases of lactic acidosis were apparently diagnosed from within this cohort. Conclusions: Although cases may, of course, also have been missed at Lighthouse, as a tertiary referral centre the rate observed is likely to be closer to the true incidence. Over the three years, with 138 cases from the 10,960 patients taking stavudine at Lighthouse, it is likely that somewhere in the region of 700 additional cases occurred amongst the 61,000 patients elsewhere in the Central Zone. This equates to somewhere in the region of 550 missed diagnoses or 80% of all cases. Given that the clinical sequelae of undiagnosed lactic acidosis are either death or at best ART default, this provides further vindication for the decision to phase out stavudine in Malawi.

  15. Retrivability in The Danish National Hospital Registry of HIV and hepatitis B and C coinfection diagnoses of patients managed in HIV centers 1995–2004

    Sørensen Henrik T

    2008-04-01

    Full Text Available Abstract Background Hospital-based discharge registries are used increasingly for longitudinal epidemiological studies of HIV. We examined completeness of registration of HIV infections and of chronic hepatitis B (HBV and hepatitis C (HCV coinfections in the Danish National Hospital Registry (DNHR covering all Danish hospitals. Methods The Danish HIV Cohort Study (DHCS encompasses all HIV-infected patients treated in Danish HIV clinics since 1 January 1995. All 2,033 Danish patients in DHCS diagnosed with HIV-1 during the 10-year period from 1 January 1995 to 31 December 2004 were included in the current analysis. We used the DHCS as a reference to examine the completeness of HIV and of HBV and HCV coinfections recorded in DNHR. Cox regression analysis was used to estimate hazard ratios of time to diagnosis of HIV in DNHR compared to DHCS. Results Of the 2,033 HIV patients in DHCS, a total of 2,006 (99% were registered with HIV in DNHR. Of these, 1,888 (93% were registered in DNHR within one year of their first positive HIV test. A CD4 = 100,000 copies/ml and being diagnosed after 1 January 2000, were associated with earlier registration in DNHR, both in crude and adjusted analyses. Thirty (23% HIV patients registered with chronic HBV (n = 129 in DHCS and 126 (48% of HIV patients with HCV (n = 264 in DHCS were registered with these diagnoses in the DNHR. Further 17 and 8 patients were registered with HBV and HCV respectively in DNHR, but not in DHCS. The positive predictive values of being registered with HBV and HCV in DHCS were thereby estimated to 0.88 and 0.97 and in DNHR to 0.32 and 0.54. Conclusion The study demonstrates that secondary data from national hospital databases may be reliable for identification of patients diagnosed with HIV infection. However, the predictive value of co-morbidity data may be low.

  16. Incidentally diagnosed simultaneous second primary tumor of the sphenoid sinus in a patient with lung cancer

    Yigit, Ozgur; Taskin, Umit; Demir, Ahmet; Behzatoglu, Kemal

    2009-01-01

    Synchronous tumors are described as multiple primary malignancies presenting within 6 months of diagnosis of index tumors. Synchronous tumors of the lung and the head and neck region is frequently seen. However, isolated sphenoid sinus and lung cancers are not reported yet. Here, we reported an...... incidentally diagnosed simultaneous second primary sphenoid sinus tumor in a patient with lung cancer. Radiological evaluation results demonstrated a significant contrast-enhanced mass in the sphenoid sinus extending through the nasopharynx because of the destruction of the sphenoid sinus. The decision was...... made to proceed with chemotherapy and radiotherapy treatment regimens for the sphenoid sinus lesion, and right lobectomy was performed for the lung lesion. Asymptomatic simultaneous, synchronous, or metastatic tumors must always be kept in mind, and histopathologic diagnosis should be done for both...

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

    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.

  18. Treatment pathways of extrapulmonary patients diagnosed at a tertiary care hospital in Delhi, India

    Manoj Grover

    2014-01-01

    Full Text Available Background: In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment. Materials and Methods: In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi. Results: Factors associated with longer paths included reason for going to first health facility (nearness and known provider, availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks. Conclusions: Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.

  19. Effects of potassium iodide (KI) protective dose on the course of thyroid diseases diagnosed at the Outpatient Endocrinologic Clinic in Lodz, 1986, before Chernobyl accident

    2521 patients of the Lodz Outpatient Endocrinologic Clinic (2290 females, 231 males; inhabitants of the central region of Poland were included in the study. The obtained results indicate that: 1) KI administration neither increased the number of exacerbations of hyperthyroidism nor affected the onset of new cases of that disease in 1986. 2) The same can be said about the cases of thyroiditis and hypothyroidism. 3) No increase of ATMA or ATG antibodies ''prevalence, as well as no elevation of those antibodies'' titres after KI prophylactic dose were observed in the patients with Grave's disease and chronic thyroiditis, when compared to persons who did not take Lugol's iodine. 4) The course of the majority of diseases diagnosed in 1986, evaluated with use of the, so called, test for analysis of trends, became unchanged. 5) There were adverse side effects noted after KI in 32 patients out of all the examined 774 patients (i.e., in 4.13%); five of the affected patients required medical care. 6) After iodine tincture; side effects occurred in three patients in the group of 35 patients included in the examination, i.e., in 8.57%; none of the affected patients required medical care. 7) Our results, comprising the four year observation period after Chernobyl accident, do not indicate any increased incidence of malignant neoplasms of the thyroid gland, what confirms the apparent theoretical data; much longer observation time is necessary to reveal phenomena of scholastic type (10-15 years). (author). 30 refs, 11 figs, 14 tabs

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

    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

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

    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 (χ2 = 3.27, p = 0.07, non significant. This study revealed that there is non significant difference association between hypercalcemia and tuberculosis.

  2. Difficult ("heartsink" patients and clinical communication difficulties

    Faustino R Pérez-López

    2010-12-01

    Full Text Available Faustino R Pérez-LópezDepartment of Obstetrics and Gynecology, Hospital Clínico de Zaragoza, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, SpainAbstract: Managing the difficult patient requires a set of skills or strategies oriented at improving the physician–patient relationship and avoiding conflictive situations. There are different types of difficult patients who should be precisely identified for their management. These patients seek appropriate medical care which is not always provided. However, some may have unrecognized pathological illnesses, especially personality or psychiatry disorders. Clinical communications may be altered by professional and situational factors. In some circumstances, clinical symptoms are medically unexplainable or poorly defined as part of a disease or syndrome. Organic disease should be ruled out before patients are classified as having a somatoform disorder. Diagnosis may be delayed when symptoms are not properly evaluated therefore causing serious health consequences. Clinical competence, empathy, and high quality communication is required to succeed in difficult clinical encounters.Keywords: physician–patient communication, barriers to communication, expert patient

  3. Effects of Age on Arterial Stiffness and Blood Pressure Variables in Patients with Newly Diagnosed Untreated Hypertension

    Cho, Soo Kyung; Cho, Sang Ki; KIM, KYE HUN; Cho, Jae Yeong; YOON, HYUN JU; Yoon, Nam Sik; Hong, Young Joon; Park, Hyung Wook; Kim*, Ju Han; AHN, YOUNGKEUN; Jeong, Myung Ho; CHO, JEONG GWAN; Park, Jong Chun

    2015-01-01

    Background and Objectives To investigate the impact of age on arterial stiffness and blood pressure (BP) variables in newly diagnosed untreated hypertension (HT). Subjects and Methods A total of 144 patients with newly diagnosed untreated HT were divided into two groups: young group (age ≤50 years, n=71), and old group (age >50 years, n=73). BP variables were measured on office or 24 hours ambulatory BP monitoring (ABPM). Parameters of arterial stiffness were measured on pulse wave velocity (...

  4. [Prenatal cerebrovascular accidents diagnosed in the early infant stage: a series of 10 patients].

    Pina-Jover, María; Martinez-Del Villar, María; Lillo-Laguna, Lucía; Jadraque-Rodriguez, Rocío; Martinez-Pastor, Pedro; Jover-Cerda, Jenaro; Gomez-Gosalvez, Francisco

    2013-07-01

    INTRODUCTION. A foetal or prenatal cerebrovascular accident (CVA) is defined as an ischaemic, thrombotic or arterial or venous haemorrhagic event that occurs between the 14th week of gestation and the onset of labour. PATIENTS AND METHODS. We report a retrospective study of a series of 10 patients suffering from a, presumably foetal, stroke that went unnoticed during the pregnancy and was diagnosed in the early infant stage. The symptoms and the age at which they were identified are highlighted. RESULTS. None of the 10 patients studied presented any relevant events in the mothers' medical history, but there were four threats of a preterm birth that were solved using the usual means and without the occurrence of any alterations that later affected the foetus. The studies that led to the diagnosis were carried out between the sixth and ninth months of life, and the reason for visiting was reported by the family as being a lower degree of mobility on one side of the body with respect to the other. Two patients presented thrombophilia. With a mean follow-up time of six years, all the patients have an associated infantile cerebral palsy, a third of them have epilepsy and 75% have learning difficulties or intellectual disability. CONCLUSIONS. When CVA are not detected in the prenatal period, it is important in primary care to look for and detect the warning signs of the psychomotor development of the infant at an early stage in order to begin a study of the case and to undertake rehabilitation as early as possible. PMID:23799595

  5. Survival analysis in patients with newly diagnosed glioblastoma using pre- and postradiotherapy MR spectroscopic imaging†

    Li, Yan; Lupo, Janine M.; Parvataneni, Rupa; Lamborn, Kathleen R.; Cha, Soonmee; Chang, Susan M.; Nelson, Sarah J.

    2013-01-01

    Background The objective of this study was to examine the predictive value of parameters of 3D 1H magnetic resonance spectroscopic imaging (MRSI) prior to treatment with radiation/chemotherapy (baseline) and at a postradiation 2-month follow-up (F2mo) in relationship to 6-month progression-free survival (PFS6) and overall survival (OS). Methods Sixty-four patients with newly diagnosed glioblastoma multiforme (GBM) being treated with radiation and concurrent chemotherapy were involved in this study. Evaluated were metabolite indices and metabolite ratios. Logistic linear regression and Cox proportional hazards models were utilized to evaluate PFS6 and OS, respectively. These analyses were adjusted by age and MR scanner field strength (1.5 T or 3 T). Stepwise regression was performed to determine a subset of the most relevant variables. Results Associated with shorter PFS6 were a decrease in the ratio of N-acetyl aspartate to choline-containing compounds (NAA/Cho) in the region with a Cho-to-NAA index (CNI) >3 at baseline and an increase of the CNI within elevated CNI regions (>2) at F2mo. Patients with higher normalized lipid and lactate at either time point had significantly worse OS. Patients who had larger volumes with abnormal CNI at F2mo had worse PFS6 and OS. Conclusions Our study found more 3D MRSI parameters that predicted PFS6 and OS for patients with GBM than did anatomic, diffusion, or perfusion imaging, which were previously evaluated in the same population of patients. PMID:23393206

  6. Bortezomib and thalidomide, a steroid free regimen in newly diagnosed patients with multiple myeloma

    Ghosh, Nilanjan; Ye, Xiaobu; Ferguson, Anna; Huff, Carol Ann; Borrello, Ivan

    2011-01-01

    Despite their efficacy in myeloma, corticosteroids have acute and chronic toxicities. Newer agents with significant anti-myeloma activity permit the development of steroid-free regimens. We designed a Phase II clinical trial to study the toxicity and efficacy of a steroid-free combination of bortezomib and thalidomide as a first-line treatment in patients with symptomatic myeloma. Patients received bortezomib 1·3 mg/m2 on days 1, 4, 8 and 11 every 21 d and thalidomide 150 mg/d for a maximum o...

  7. Doses of ionising radiation received by patients diagnosed at the Nuclear Medicine Department in Warsaw from 1985 to 1999

    In order to evaluate the radiological risk incurred by patients diagnosed at the Department of Nuclear Medicine (DNM), Central Clinical Hospital of the Military University Medical School in Warsaw, the collective committed effective dose equivalents (CCEDE) and the mean personal effective dose equivalents (MPEDE) were calculated for the subsequent years of the period from 1985 to 1999 and compared to the respective values obtained for the mid-1970s. The results indicate that although the number of patients and the total radioactivities used in the diagnostic assays at the DNM increased more than 2.5-fold in the second half of the 1980s and in the 1990s, as compared to the years 1975-1976, the MPEDEs calculated for the periods from 1985 to 1989 and from 1990 to 1994 were similar to and two-fold lower, respectively, than those obtained for the years 1975-1976. However, in the second half of the 1990s, these doses rose again and in 1999 they were almost three times as high as in the mid-1970s. This latter observation results from the increased contribution to CCEDE of the doses from the diagnostic use of I-131 which equalled to 88% in 1975, dropped to 20% in 1994, and again rose to 90% of the total dose in 1999. In fact, beginning from 1995, a new whole-body I-131-based screening procedure was introduced for the detection of thyroid cancer metastases. (author)

  8. The science of clinical practice: disease diagnosis or patient prognosis? Evidence about "what is likely to happen" should shape clinical practice

    Croft, P.; Altman, DG; Deeks, JJ; Dunn, KM; Hay, AD; HEMINGWAY, H.; LeResche, L; Peat, G.; Perel, P; Petersen, SE; Riley, RD; Roberts, I.; Sharpe, M; Stevens, RJ; van der Windt, DA

    2015-01-01

    BACKGROUND: Diagnosis is the traditional basis for decision-making in clinical practice. Evidence is often lacking about future benefits and harms of these decisions for patients diagnosed with and without disease. We propose that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. DISCUSSION: Disease diagnosis can provide crucial information for clinical decisions that influence outcome in serious acute illness. Howev...

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

    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.

  10. A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus

    H K Gill

    2014-01-01

    Full Text Available Background: Diabetic peripheral neuropathy (DPN predisposes to foot ulceration and gangrene. It has been reported that DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetes mellitus (T2DM are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosed T2DM. Materials and Methods: We prospectively studied 195 consecutive patients over age 30 with a duration of diabetes ≤6 months. All underwent a clinical and biochemical evaluation and were screened for DPN using Neuropathy Symptom Score (NSS and Neuropathy Disability Score (NDS as well as the vibration perception threshold using a biothesiometer. We compared the prevalence of peripheral neuropathy (PN in 75 age- and sex-matched healthy controls. Results: The cases had a mean age of 47.6 ± 10.2 years (59% males and duration of symptoms of 5.9 ± 8.2 months prior to presentation. The overall prevalence of DPN was 29.2% [95% CI 22.8-35.7]. PN among matched control was 10.7% (95% CI 3.5-17.8. The prevalence of DPN showed an increasing trend with age (trend chi-square 11.8, P = 0.001. Abnormal vibration perception threshold was present in 43.3% (95% CI 36.3-50.3 of cases and had a significant correlation with NDS (P = 0.000. Abnormal monofilament testing was present in 6.1% of cases (95% CI 2.7- 9.5. A logistic regression analysis showed that DPN was independently associated with age (P = 0.002 and duration of diabetes prior to presentation (P = 0.02 but not with body mass index, plasma glucose, or HbA1c. Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with T2DM, which was independently associated with age and duration of symptoms of diabetes prior to the diagnosis. Screening for DPN at diagnosis of diabetes is warranted, especially among older subjects.

  11. Effects of acupuncture versus ultrasound for patients with impingement syndrome : Randomized clinical trial

    Johansson, Kajsa; Adolfsson, Lars; Foldevi, Mats

    2005-01-01

    Background and Purpose. There is no definitive evidence for the efficacy of the physical therapy interventions used for patients with impingement syndrome. The purpose of this study was to compare manual acupuncture and continuous ultrasound, both applied in addition to home exercises, for patients diagnosed with impingement syndrome. Subjects and Methods. Eighty-five patients with clinical signs of impingement syndrome were randomly assigned to either a group that received acupuncture (n=44)...

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

    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.

  13. ASSOCIATION OF VISCERAL FAT WITH DETERIORATED PULMONARY FUNCTION IN NEWLY DIAGNOSED HYPOTHYROID PATIENTS

    Sudhir Modala, Usha Dhar, K V Thimmaraju, B J Pradeep Kumar, Bandi Hari Krishna

    2015-07-01

    Full Text Available Objectives: To assess the pulmonary function and its association with visceral fat in newly diagnosed hypothyroid patients. Materials & methods: The study group subjects were 37 females and the control group subjects (n=37 were age and gender matched healthy volunteers. Pulmonary functions were assessed by computerized spirometer. The readings for Forced vital capacity (FVC, Forced expiratory volume in the first second (FEV1, Forced expiratory volume percent (FEV1 /FVC% and Peak expiratory flow (PEF were noted for participants in both the groups. Body fat assessment was done with Omron HBF 375, a body fat analyzer. Results: The baseline parameters like mean age and height for each group are comparable and there was a significant difference in weight and BMI between the groups (p = 0.000. The pulmonary function test parameters were significantly less in hypothyroid patients when compared to controls (p = 0.000. Further, association between visceral fat pulmonary function test parameters showed negative correlation for (FVC (L: r = – 0.888; p = 0.000, (FEV1 (L: – 0.811; p = 0.000 and (FEV1/FVC (%: r = 0.430; p = 0.008. Conclusion: It is concluded that deteriorated pulmonary function in hypothyroidism is associated with increased visceral fat. Therapeutic interventions like diet, exercise, yoga to reduce visceral fat should be incorporated as part of treatment to improve the pulmonary function.

  14. Evaluation of patient care cascade for HIV-positive patients diagnosed in La Romana, Dominican Republic in 2011: a retrospective cohort study.

    Bowman, Alex S; Lerebours, Leonel; Amesty, Silvia; de la Rosa, Milagros; Gil, Elizabeth; Halpern, Mina; Nicholas, Stephen; Lamb, Matthew R

    2016-04-01

    The Caribbean has the highest adult HIV prevalence in the world after sub-Saharan Africa (2011). One sub-population in the Dominican Republic is the migratory Batey community primarily comprised of Haitian immigrants with limited access to healthcare and HIV prevalence rates of between 3.0% and 9.0%, compared to 0.7% nationally. This retrospective cohort study describes the cumulative retention from diagnosis to virological suppression for newly-diagnosed HIV-infected adults presenting to the Clínica de Familia and its Batey programme in La Romana, during 2011. Of the patients diagnosed with HIV, 65% entered into care, 59% completed immunologic testing, 53% were eligible for antiretroviral therapy (ART) initiation, 36% initiated ART within three months of eligibility and 27% were retained in care. Seventeen per cent of those retained on ART with a 12-month viral load measure had undetectable viral load. Attrition primarily occurred before ART initiation. The Batey programme had a first step lost-to-follow-up of 88% compared to 20% at the clinic (p < 0.001). This retrospective study details the continuum of care and indicates where structural changes must occur to increase continuity between steps. The manuscript results are important to help implement programmes to enhance engagement and retention in HIV primary care. PMID:25941055

  15. Intelligent Virtual Patients for Training Clinical Skills

    Rizzo, Albert; Kenny, Patrick; Parsons, Thomas D.

    2009-01-01

    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...

  16. Efficacy and safety of garenoxacin tablets on clinically diagnosed atypical pneumonia: postmarketing surveillance in Japan.

    Izumikawa, Koichi; Watanabe, Akira; Miyashita, Naoyuki; Ishida, Tadashi; Hosono, Hiroaki; Kushimoto, Satoru; Kohno, Shigeru

    2014-09-01

    We performed a postmarketing surveillance study to determine the efficacy and safety of the oral quinolone antibacterial agent garenoxacin (Geninax() Tablets 200 mg) against atypical pneumonia. Between October 2009 and July 2011, patients with community-acquired pneumonia visited 26 facilities in Japan; we collected survey forms from 105 of these patients who were suspected of having atypical pneumonia based on the Japanese Respiratory Society Guidelines for the Management of Community-Acquired Pneumonia in Adults. We examined the safety in 105 patients and the efficacy in 71 patients. 1. The efficacy rates among patients suspected of having atypical pneumonia and those with a confirmed diagnosis of atypical pneumonia were 94.8% (55/58 patients) and 92.3% (12/13 patients), respectively. The efficacy rate was 4/4 for patients in whom Chlamydophila pneumoniae was detected (including 1 patient with a polymicrobial infection with another bacterial strain) and 90% (9/10 patients) for patients in whom Mycoplasma pneumoniae was detected (garenoxacin was ineffective in 1 of 2 patients with a polymicrobial infection with another bacterial strain). 2. The incidence of adverse drug reactions (including abnormal laboratory tests) was 4.8% (5/105 patients). Among the adverse drug reactions, gastrointestinal disorders, infection and infestation, nervous system disorder, and skin and subcutaneous tissue disorder were observed in 2.9% of patients (3/105), 1.0% (1/105), 1.0% (1/105), and 1.0% (1/105), respectively. In conclusion, garenoxacin showed an efficacy rate of greater than 90% for suspected atypical pneumonia and confirmed atypical pneumonia. Garenoxacin is considered to be useful in daily practice. PMID:24934886

  17. European clinical network: autism spectrum disorder assessments and patient characterisation.

    Ashwood, Karen L; Buitelaar, Jan; Murphy, Declan; Spooren, Will; Charman, Tony

    2015-08-01

    The United Nations and World Health Organisation have identified autism spectrum disorder (ASD) as an important public health issue across global mental health services. Although a range of tools exist to identify and quantify ASD symptoms, there is a lack of information about which ASD measures are used in different services worldwide. This paper presents data from a large survey of measures used for patient characterisation in major ASD research and clinical centres across Europe collected between June 2013 and January 2014. The objective was to map the use of different instruments used to characterise ASD, comorbid psychopathology and cognitive and adaptive ability for patient diagnostic and characterisation purposes across Europe. Sixty-six clinical research sites diagnosing 14,844 patients per year contributed data. The majority of sites use the well-established Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview (ADI) instruments, though the proportion of sites in Western Europe using the ADI was almost double the rate in Eastern Europe. Approximately half the sites also used the Social Communication Questionnaire (SCQ) and Social Responsiveness Scale (SRS), although use of the SRS was over three times higher in Western Europe compared with Eastern Europe. The use of free/open access measures was lower than commercially available tools across all regions. There are clinical and scientific benefits in encouraging further convergence of clinical characterisation measures across ASD research and clinical centres in Europe to facilitate large-scale data sharing and collaboration, including clinical trials of novel medications and psychological interventions. PMID:25471824

  18. MRI follow-up in a case of clinically diagnosed Creutzfeld-Jakob disease

    Hutzelmann, A.; Biederer, J. [Department of Radiology, Christian-Albrechts-Univ., Kiel (Germany)

    1998-03-27

    We report the case of a 75-year-old woman suffering from Creutzfeld-Jakob disease (CJD). As brain biopsy was refused, diagnosis had to be based on clinical examination, EEC and findings on cranial MRI. Over a 4-month period MRI examinations demonstrated progressive cortical atrophy and bilateral enhanced signal intensity on T2-weighted images of caudate nuclei and putamina indicating development of spongioform degeneration. As clinical course and the characteristic pattern of brain lesions corresponded to cases of neuropathologically confirmed CJD, we suggest that MRI should be considered a valuable diagnostic tool in clinical diagnosis of the disease. (orig.) With 2 figs., 10 refs.

  19. The lived experience in patients with screening-diagnosed Abdominal Aortic Aneurysm (AAA). : A qualitative interview study

    Torbjrnsson, Eva; Kollberg, Sandra

    2012-01-01

    Kollberg, S. Torbjrnsson, E. (2012). The lived experience in patients with screening-diagnosed abdominal aortic aneurysm (AAA). ABSTRACT The aim of this study was to describe the patients experiences of living with the knowledge of having an abdominal aortic aneurysm (AAA) that was found during screening. Eleven patients from two different screening centers, with initially measured aneurysms of 40-46 mm, were invited to participate in the interview study. Three of the men declined to pa...

  20. Psychiatric diagnoses in patients with burning mouth syndrome and atypical odontalgia referred from psychiatric to dental facilities

    Miho Takenoshita

    2010-10-01

    Full Text Available Miho Takenoshita1, Tomoko Sato1, Yuichi Kato1, Ayano Katagiri1, Tatsuya Yoshikawa1, Yusuke Sato2, Eisuke Matsushima3, Yoshiyuki Sasaki4, Akira Toyofuku11Psychosomatic Dentistry, 2Complete Denture Prosthodontics, 3Liaison Psychiatry and Palliative Medicine, 4Center for Education and Research in Oral Health Care, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanBackground: Burning mouth syndrome (BMS and atypical odontalgia (AO are two conditions involving chronic oral pain in the absence of any organic cause. Psychiatrically they can both be considered as somatoform disorder. From the dental point of view, however, the two disorders are quite distinct. BMS is a burning or stinging sensation in the mouth in association with a normal mucosa whereas AO is most frequently associated with a continuous pain in the teeth or in a tooth socket after extraction in the absence of any identifiable cause. Because of the absence of organic causes, BMS and AO are often regarded as psychogenic conditions, although the relationship between oral pain and psychologic factors is still unclear. Some studies have analyzed the psychiatric diagnoses of patients with chronic oral pain who have been referred from dental facilities to psychiatric facilities. No study to date has investigated patients referred from psychiatric facilities to dental facilities.Objective: To analyze the psychiatric diagnoses of chronic oral pain patients, diagnosed with BMS and AO, and referred from psychiatric facilities to dental facilities.Study design: Psychiatric diagnoses and disease conditions of BMS or AO were investigated in 162 patients by reviewing patients medical records and referral forms. Psychiatric diagnoses were categorized according to the International Statistical Classification of Disease and Related Health Problems, Tenth Revision.Results: The proportion of F4 classification (neurotic, stress-related, and somatoform disorders in AO patients was significantly higher than in BMS patients. BMS patients were more frequently given a F3 classification (mood/affective disorders. However, 50.8% of BMS patients and 33.3% of AO patients had no specific psychiatric diagnoses.Conclusion: Although BMS and AO are both chronic pain disorders occurring in the absence of any organic cause, the psychiatric diagnoses of patients with BMS and AO differ substantially.Keywords: glossodynia, stomatodynia, ICD-10, somatoform disorder

  1. Clinical service desires of medical cannabis patients

    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...

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

    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.

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

    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.

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

    Chanda Pascalina; Castillo-Riquelme Marianela; Masiye Felix

    2009-01-01

    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 Ra...

  5. Williams-Beuren syndrome: cardiovascular abnormalities in 20 patients diagnosed with fluorescence in situ hybridization

    Sofia Mizuho Miura Sugayama

    2003-11-01

    Full Text Available OBJECTIVE: To evaluate the cardiovascular findings and clinical follow-up of patients with Williams-Beuren syndrome. METHODS: We studied 20 patients (11 males, mean age at diagnosis: 5.9 years old, assessed for cardiovascular abnormalities with electrocardiography and Doppler echocardiography. Fluorescence in situ hybridization (FISH was used to confirm the diagnosis of the syndrome. RESULTS: Elastin gene locus microdeletion was detected in 17 patients (85% (positive FISH, and in 3 patients deletion was not detected (negative FISH. Sixteen patients with a positive FISH (94% had congenital cardiovascular disease (mean age at diagnosis: 2,3 years old. We observed isolated (2/16 supravalvular aortic stenosis and supravalvular aortic stenosis associated (11/16 with pulmonary artery stenosis (4/11; mitral valve prolapse (3/11; bicuspid aortic valve (3/11; aortic coarctation (2/11, thickened pulmonary valve (2/11; pulmonary valvular stenosis (1/11; supravalvular pulmonary stenosis (1/11; valvular aortic stenosis (1/11; fixed subaortic stenosis (1/11; pulmonary artery stenosis (2/16 associated with pulmonary valvar stenosis (1/2 and with mitral valve prolapse (1/2; and isolated mitral valve prolapse (1/16. Four patients with severe supravalvular aortic stenosis underwent surgery (mean age: 5.7 years old, and 2 patients had normal pressure gradients (mean follow-up: 8.4 years. CONCLUSION: A detailed cardiac evaluation must be performed in all patients with Williams-Beuren syndrome due to the high frequency of cardiovascular abnormalities.

  6. Williams-Beuren syndrome: cardiovascular abnormalities in 20 patients diagnosed with fluorescence in situ hybridization

    Sofia Mizuho Miura, Sugayama; Regina Lcia, Moiss; Jaqueline, Wagnfur; Nana Miura, Ikari; Kikue Terada, Abe; Cludio, Leone; Clvis Artur Almeida da, Silva; Maria de Lourdes Lopes Ferrari, Chauffaille; Ae Kim, Chong.

    2003-11-01

    Full Text Available OBJECTIVE: To evaluate the cardiovascular findings and clinical follow-up of patients with Williams-Beuren syndrome. METHODS: We studied 20 patients (11 males, mean age at diagnosis: 5.9 years old), assessed for cardiovascular abnormalities with electrocardiography and Doppler echocardiography. Fluo [...] rescence in situ hybridization (FISH) was used to confirm the diagnosis of the syndrome. RESULTS: Elastin gene locus microdeletion was detected in 17 patients (85%) (positive FISH), and in 3 patients deletion was not detected (negative FISH). Sixteen patients with a positive FISH (94%) had congenital cardiovascular disease (mean age at diagnosis: 2,3 years old). We observed isolated (2/16) supravalvular aortic stenosis and supravalvular aortic stenosis associated (11/16) with pulmonary artery stenosis (4/11); mitral valve prolapse (3/11); bicuspid aortic valve (3/11); aortic coarctation (2/11), thickened pulmonary valve (2/11); pulmonary valvular stenosis (1/11); supravalvular pulmonary stenosis (1/11); valvular aortic stenosis (1/11); fixed subaortic stenosis (1/11); pulmonary artery stenosis (2/16) associated with pulmonary valvar stenosis (1/2) and with mitral valve prolapse (1/2); and isolated mitral valve prolapse (1/16). Four patients with severe supravalvular aortic stenosis underwent surgery (mean age: 5.7 years old), and 2 patients had normal pressure gradients (mean follow-up: 8.4 years). CONCLUSION: A detailed cardiac evaluation must be performed in all patients with Williams-Beuren syndrome due to the high frequency of cardiovascular abnormalities.

  7. Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry

    Pedersen, Line Merete Blak; Klarlund, Mette; Jacobsen, Sren; Svendsen, Anders Jrgen; Frisch, Morten

    2004-01-01

    for RA), a rheumatologist assessed the proportion of RA diagnoses recorded in the NPR that could be confirmed by scrutiny of the original medical records. The completeness of RA diagnoses in the NPR was estimated by a two-sample capture-recapture method. Overall, 59% of the 217 RA diagnoses in the NPR......; however, our findings prompt general carefulness when using non-audited registries for research in RA....

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

    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. The clinical analysis of 469 pulmonary carcinomatous cases diagnosed by bronchoscopy under the age of 40

    Min SONG

    2008-06-01

    Full Text Available Background and objective In recent years, more and more young patients have been suffering from lung cancer, and these young patients do not always have good prognosis. This article wants to study the relationship between the histopathology with gender, location and the sign of fibrobronchoscopy in lung cancer patients under the age of 40. Methods The article analyzed retrospectively the fibrobronchoscopy data of 469 young lung cancer patients under the age of 40. Results In the 469 patients, the male/female ratio was 2.42/1. The most common histopathology was squamous cell carcinoma (33.0%, followed by adenocarcinoma (26.% and small cell carcinoma (20.5%. The ratio of squamous cell carcinoma in male (40.7% was more than in female (14.6%, and ratio of adenocarcinoma in female (43.1% was more than in male (19.0%, it is obviously different on the distribution of cancer histopathology between male and female patients (P >0.05. The location of lung carcinoma was more likely in the bilateral upper lobars and in the right lung, 81.4% had direct signs. Conclusions Lung cancer patients under the age of 40, squamous cell carcinoma is significantly more in male group, but adenocarcinoma is significantly more in female group. This study suggests fibrobrochoscopy is an indispensable approach in the diagnosis of young lung cancer. Paying more attention to the lung cancer of young patients and examining with fibrobronchoscopy will be found much helpful to early diagnosis.

  10. 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

    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

  11. How Many Samples and How Many Culture Media To Diagnose a Prosthetic Joint Infection: a Clinical and Microbiological Prospective Multicenter Study.

    Bémer, Pascale; Léger, Julie; Tandé, Didier; Plouzeau, Chloé; Valentin, Anne Sophie; Jolivet-Gougeon, Anne; Lemarié, Carole; Kempf, Marie; Héry-Arnaud, Geneviève; Bret, Laurent; Juvin, Marie Emmanuelle; Giraudeau, Bruno; Corvec, Stéphane; Burucoa, Christophe

    2016-02-01

    Although numerous perioperative samples and culture media are required to diagnose prosthetic joint infection (PJI), their exact number and types have not yet been definitely determined with a high level of proof. We conducted a prospective multicenter study to determine the minimal number of samples and culture media required for accurate diagnosis of PJI. Over a 2-year period, consecutive patients with clinical signs suggesting PJI were included, with five perioperative samples per patient. The bacteriological and PJI diagnosis criteria were assessed using a random selection of two, three, or four samples and compared with those obtained using the recommended five samples (references guidelines). The results obtained with two or three culture media were then compared with those obtained with five culture media for both criteria. The times-to-positivity of the different culture media were calculated. PJI was confirmed in 215/264 suspected cases, with a bacteriological criterion in 192 (89%). The PJI was monomicrobial (85%) or polymicrobial (15%). Percentages of agreement of 98.1% and 99.7%, respectively, for the bacteriological criterion and confirmed PJI diagnosis were obtained when four perioperative samples were considered. The highest percentages of agreement were obtained with the association of three culture media, a blood culture bottle, a chocolate agar plate, and Schaedler broth, incubated for 5, 7, and 14 days, respectively. This new procedure leads to significant cost saving. Our prospective multicenter study showed that four samples seeded on three culture media are sufficient for diagnosing PJI. PMID:26637380

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

    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)

  13. Clinical management of arrhythmias in elderly patients

    Chen, Jian; Hocini, Mlze; Larsen, Torben Bjerregaard; Proclemer, Alessandro; Sciaraffia, Elena; Blomstrm-Lundqvist, Carina

    2015-01-01

    The purpose of this survey was to assess clinical practice in management of cardiac arrhythmias in elderly patients (age ?75 years) in the European countries. The data are based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network members. Responses were...

  14. Clinical Service Desires of Medical Cannabis Patients

    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 pat...

  15. Clinical diagnosis of hyposalivation in hospitalized patients

    Soraya de Azambuja, Berti-Couto; Paulo Henrique, Couto-Souza; Reinhilde, Jacobs; Olivia, Nackaerts; Izabel Regina Fischer, Rubira-Bullen; Fernando Henrique, Westphalen; Samuel Jorge, Moyss; Srgio Aparecido, Igncio; Mait Barroso da, Costa; Ana Lcia, Tolazzi.

    2012-04-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examin [...] ed, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p

  16. Clinical evaluation of 413 Thalassemic patients

    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.

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

    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.)

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

    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.

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

    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. Utility of functional diffusion maps to monitor a patient diagnosed with gliomatosis cerebri.

    Ellingson, Benjamin M; Rand, Scott D; Malkin, Mark G; Schmainda, Kathleen M

    2010-05-01

    Diffusion-weighted magnetic resonance imaging (DWI) is a sensitive imaging biomarker for tumor cellularity. Functional diffusion maps (fDMs), which examine voxel-by-voxel changes in the apparent diffusion coefficient (ADC) calculated from serial DWIs, have previously been applied to regions of contrast-enhancement; however, application of fDMs to non-enhancing brain tumors has not been pursued. In this case study we demonstrate the utility of applying fDMs to regions of abnormal FLAIR signal intensity in a patient diagnosed with gliomatosis cerebri: a relatively rare, infiltrative, non-enhancing brain tumor. The absolute volume of hypercellularity extracted from fDMs was useful in tracking tumor growth, which correlated in time with a progressive decline in neurological status despite no change in traditional magnetic resonance images. Results of this study demonstrate the value of fDMs, applied to regions of FLAIR abnormal signal intensity, for localizing regions of hypercellularity and for monitoring overall tumor status. PMID:19813078

  1. Seasonal distribution and evolving forms of multiple sclerosis patients diagnosed from April 2004 to November 2007 Distribución estacional y formas evolutivas de esclerosis múltiple en pacientes diagnosticados entre Abril del 2004 y Noviembre del 2007

    Hermes Fundora-Hernández; Alberto J Dorta-Contreras; Maray Socias-López; Silvana Fraga-Santana; Silvia Nicté Villatoro-Rodríguez; Bárbara Padilla-Docal; Elena Noris-García; Raisa Bu-Coifiu-Fanego; Marlén González-Hernández

    2009-01-01

    BACKGROUND: Multiple sclerosis (MS) was first reported in Cuba in 1965. The most frequent appearance is observed in the first six months of the year. OBJECTIVE: To determine the seasonal distribution and evolving forms of MS patients diagnosed with the disease between April 2004 and November 2007. METHOD: Twenty-one patients with suspected MS and 42 outbreaks were studied. Patients were classified according to Lublin and Revingold's criteria for clinical forms and according to McDonald. RESUL...

  2. Genital Shedding of Resistant Human Immunodeficiency Virus-1 Among Women Diagnosed With Treatment Failure by Clinical and Immunologic Monitoring

    Graham, Susan M.; Chohan, Vrasha; Ronen, Keshet; Deya, Ruth W.; Masese, Linnet N.; Mandaliya, Kishor N.; Peshu, Norbert M.; Lehman, Dara A.; McClelland, R. Scott; Overbaugh, Julie

    2016-01-01

    Background. The accumulation of human immunodeficiency virus (HIV) resistance mutations can compromise treatment outcomes and promote transmission of drug-resistant virus. We conducted a study to determine the duration and evolution of genotypic drug resistance in the female genital tract among HIV-1-infected women failing first-line therapy. Methods. Treatment failure was diagnosed based on World Health Organization (WHO) clinical or immunologic criteria, and second-line therapy was initiated. Stored plasma and genital samples were tested to determine the presence and timing of virologic failure and emergence of drug resistance. The median duration of genital shedding of genotypically resistant virus prior to regimen switch was estimated. Results. Nineteen of 184 women were diagnosed with treatment failure, of whom 12 (63.2%) had confirmed virologic failure at the switch date. All 12 women with virologic failure (viral load, 5855–1 086 500 copies/mL) had dual-class resistance in plasma. Seven of the 12 (58.3%) had genital HIV-1 RNA levels high enough to amplify (673–116 494 copies/swab), all with dual-class resistance. The median time from detection of resistance in stored samples to regimen switch was 895 days (95% confidence interval [CI], 130–1414 days) for plasma and 629 days (95% CI, 341–984 days) for genital tract secretions. Conclusions. Among women diagnosed with treatment failure using WHO clinical or immunologic criteria, over half had virologic failure confirmed in stored samples. Resistant HIV-1 RNA was shed in the genital tract at detectable levels for ≈1.7 years before failure diagnosis, with steady accumulation of mutations. These findings add urgency to the ongoing scale-up of viral load testing in resource-limited settings. PMID:26966695

  3. The prevalence and risk factors of decreased bone mineral density in firstly diagnosed ulcerative colitis patients in the eastern region of Turkey.

    Ediz, Levent; Dülger, Ahmet Cumhur; Toprak, Murat; Ceylan, Mehmet Fethi; Kemik, Ozgür

    2011-01-01

    The prevalance of osteoporosis or osteopenia in Turkish population with ulcerative colitis (UC) at the diagnosis time has not been evaluated so far. Therefore we aimed to determine the prevelance and risk factors of decreased bone mineral density (BMD) in UC patients at the diagnosis time in Turkey. We retrospectively evaluated dexa results, demographic and clinical characteristics, and some biochemical markers of bone turnover of the UC patients at the diagnosis time between June 2005 and February 2010 from the gastroenterology clinic records of the university hospital. The study population consisted of firstly diagnosed 63 UC patients (male: female = 27: 36; mean age 41.8 years). 38.1% at lumbar spine and 44.4% at femoral neck of the Turkish UC patients patients had low BMD at the diagnosis time. The occurrence of osteoporosis among Turkish UC patients at the diagnosis time were 8% at lumbar spine and 11% at femoral neck. 30.1% at lumbar spine and 33.3% at femoral neck of the patients had osteopenia at the diagnosis time. Pearson's coefficient of correlation showed significant correlations between low BMD and pancolitis (pmenopause, and symptom duration before the diagnosis (pWestern and Eastern societies. Pancolitis, age, duration of symptoms, and menopause are predictive factors for low bone density in these patients. PMID:21686139

  4. CLINICAL ACTIVITY OF SEQUENTIAL FLAVOPIRIDOL, CYTOSINE ARABINOSIDE, AND MITOXANTRONE FOR ADULTS WITH NEWLY DIAGNOSED, POOR RISK ACUTE MYELOGENOUS LEUKEMIA

    Judith E Karp; Blackford, Amanda; Smith, B. Douglas; Alino, Katrina; Seung, Amy Hatfield; Bolaos-Meade, Javier; Greer, Jacqueline M; Carraway, Hetty E; GORE, STEVEN D.; Jones, Richard J.; Levis, Mark J.; McDevitt, Michael A; Doyle, L. Austin; John J. Wright

    2009-01-01

    Flavopiridol, a cyclin-dependent kinase inhibitor, is cytotoxic to leukemic blasts. In a Phase II study, flavopiridol 50 mg/m2 was given by 1-hour infusion daily 3 beginning Day 1 followed by 2 gm/m2/72 hr ara-C beginning Day 6 and 40 mg/m2 mitoxantrone on Day 9 (FLAM) to 45 adults with newly diagnosed acute myelogenous leukemia (AML) with multiple poor risk features. Thirty patients (67%) achieved complete remission (CR) and 4 (9%) died. Twelve (40%) received myeloablative allogeneic bone ...

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

    Ciet, Pierluigi; Wielopolski, Piotr; Manniesing, Rashindra; Lever, Sandra; de Bruijne, Marleen; Morana, Giovanni; Muzzio, Pier Carlo; Lequin, Maarten H.; Tiddens, Harm A.W.M.

    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...

  6. Validity of ankylosing spondylitis and undifferentiated spondyloarthritis diagnoses in the Swedish National Patient Register

    Lindström, U; Exarchou, S; Sigurdardottir, V; Sundström, B; Askling, J; Eriksson, J K; Forsblad-d'Elia, H; Turesson, C; Kristensen, L E; Jacobsson, L

    2015-01-01

    OBJECTIVES: Epidemiological studies of spondyloarthritis (SpA), using ICD codes from the Swedish National Patient Register (NPR), offer unique possibilities but hinge upon an understanding of the validity of the codes. The aim of this study was to validate the ICD codes for ankylosing spondylitis...... (AS) and undifferentiated SpA (uSpA) in the NPR against the established classification criteria [modified New York (mNY), Assessment of SpondyloArthritis international Society (ASAS), Amor, and European Spondyloarthropathy Study Group (ESSG) criteria]. METHOD: All patients with an ICD-8/9/10 code of...... diagnosis of AS or uSpA in 2007-2009 were selected. Based on a structured review of clinical records, positive predictive values (PPVs) for fulfilling the criteria sets were calculated. RESULTS: For those having received an ICD code for AS, the PPVs for fulfilling the mNY criteria or any set of SpA criteria...

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

    Winther, Simon; Schmidt, Samuel Emil; Holm, Niels Ramsing; Toft, Egon; Struijk, Johannes Jan; Bøtker, Hans Erik; Bøttcher, Morten

    2016-02-01

    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. PMID:26335368

  8. Usual Interstitial Pneumonia Preceding Collagen Vascular Disease: A Retrospective Case Control Study of Patients Initially Diagnosed with Idiopathic Pulmonary Fibrosis

    Kono, Masato; Nakamura, Yutaro; Enomoto, Noriyuki; Hashimoto, Dai; Fujisawa, Tomoyuki; Inui, Naoki; Maekawa, Masato; Suda, Takafumi; Colby, Thomas V.; Chida, Kingo

    2014-01-01

    Background The aim of this study was to evaluate the cumulative incidence and the predictive factors for collagen vascular disease (CVD) in patients initially diagnosed with idiopathic pulmonary fibrosis (IPF), and to examine the features of patients who then developed CVD. Methods This was a retrospective review of 111 consecutive patients with IPF diagnosed at our institution. None of the patients fulfilled any of the CVD criteria from the American College of Rheumatology (ACR) within 6 months or more after the diagnosis of IPF. Results Ten patients (9.0%) developed CVD during the follow-up period: four had rheumatoid arthritis (RA); four had microscopic polyangiitis (MPA); one had systemic sclerosis (SSc); and one had SSc and Sjogrens syndrome (SjS). The mean time until CVD diagnosis was 3.9 years. The cumulative incidences of CVD at 1, 5, and 10 years were 0.91%, 9.85%, and 15.5%, respectively. Patients who developed CVD were significantly younger, more likely to be women and had a better prognosis than those with IPF. Cox proportional hazards regression analysis showed that female sex and the presence of lymphoid aggregates with germinal centers were significantly associated with the occurrence of CVD in patients initially diagnosed with IPF. Conclusions CVD is an important underlying condition in IPF, and shows better prognosis. The possibility of the development of CVD should remain a consideration in the follow-up of IPF. PMID:24736601

  9. Mandibular lesion differential diagnoses in a patient with a previous history of locally advanced head and neck carcinoma

    Eighteen months after completion of a radio chemotherapy treatment for a T4 tonsil cancer, a patient presented with a piece of bone coming out through a submandibular fistula and increasing pain. A CT scan, a bone scintigraphy and an 18-fluorodeoxyglucose positron-emission tomography were performed. Both diagnoses of osteoradionecrosis and tumor recurrence were suspected and then confirmed after mandibulectomy. (authors)

  10. Techniques for risk stratification of newly diagnosed patients with chronic myeloid leukemia.

    Mitchell, Birgitta; Deininger, Michael

    2011-02-01

    Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm caused by BCR-ABL, a constitutively active tyrosine kinase generated as a result of the t(9;22)(q34;q11). The natural history of CML is progression from a relatively benign chronic phase to an acute leukemia termed blast crisis. Imatinib, an inhibitor of BCR-ABL tyrosine kinase activity, has a dramatic effect on the natural history of the disease. Despite the favorable outcomes with imatinib, a subset of patients have primary refractory disease, or experience relapse after an initial response. Recently identified molecular predictors of drug response might help predict outcome with tyrosine kinase inhibitor therapy more accurately than clinical prognostication scores, but have not yet been introduced into clinical routine. These techniques include analysis of drug transport proteins, in vitro drug assays, measurement of imatinib plasma levels, BCR-ABL activity monitoring, and gene expression profiling. In this article we review the current status of these technologies, which may ultimately allow us to tailor therapy to a specific patient. PMID:21299455

  11. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

    Mikhailova Е.V.

    2013-09-01

    Full Text Available Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definition of a serological ELISA method and RPHA immunoglobulins to influenza, rubella, and enterovirus, immunological study of blood, cerebrospinal fluid PCR, electromyography of the affected limbs. Results. 77 patients (49% with the disease associated with the violation of the musculoskeletal system were registered. In the other cases revealed polyneuropathy was not of poliovirus etiology. Etiological nature of the disease could be explained by 54% of patients. In 37 (46% patients the diagnosis was formulated in accordance with the severity of paralysis. One child was diagnosed with a vaccine-associated poliomyelitis. Conclusion. The diagnosis of «acute flaccid paralysis» used as administered requires a detailed interpretation in a hospital.

  12. Clinical diagnosis of hyposalivation in hospitalized patients

    Soraya de Azambuja Berti-Couto

    2012-04-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients. MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years. Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom, chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheecks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination. RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9% presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05. Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05. CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.

  13. Clinical aspects of patients with nasal polyposis

    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.

  14. Comparison of clinical and laboratory methods to diagnose the early pregnancy in pigs

    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)

  15. Clinical phenotypes in adult patients with bronchiectasis.

    Aliberti, Stefano; Lonni, Sara; Dore, Simone; McDonnell, Melissa J; Goeminne, Pieter C; Dimakou, Katerina; Fardon, Thomas C; Rutherford, Robert; Pesci, Alberto; Restrepo, Marcos I; Sotgiu, Giovanni; Chalmers, James D

    2016-04-01

    Bronchiectasis is a heterogeneous disease. This study aimed at identifying discrete groups of patients with different clinical and biological characteristics and long-term outcomes.This was a secondary analysis of five European databases of prospectively enrolled adult outpatients with bronchiectasis. Principal component and cluster analyses were performed using demographics, comorbidities, and clinical, radiological, functional and microbiological variables collected during the stable state. Exacerbations, hospitalisations and mortality during a 3-year follow-up were recorded. Clusters were externally validated in an independent cohort of patients with bronchiectasis, also investigating inflammatory markers in sputum.Among 1145 patients (median age 66 years; 40% male), four clusters were identified driven by the presence of chronic infection withPseudomonas aeruginosaor other pathogens and daily sputum: "Pseudomonas" (16%), "Other chronic infection" (24%), "Daily sputum" (33%) and "Dry bronchiectasis" (27%). Patients in the four clusters showed significant differences in terms of quality of life, exacerbations, hospitalisations and mortality during follow-up. In the validation cohort, free neutrophil elastase activity, myeloperoxidase activity and interleukin-1β levels in sputum were significantly different among the clusters.Identification of four clinical phenotypes in bronchiectasis could favour focused treatments in future interventional studies designed to alter the natural history of the disease. PMID:26846833

  16. Essential trace metals and heavy metals in newly diagnosed schizophrenic patients and those on anti-psychotic medication

    Arinola, Ganiyu; Idonije, Blessing; Akinlade, Kehinde; Ihenyen, Olubisi

    2010-01-01

    BACKGROUND: Nutritional deprivation in the early stage of life increases the risk of developing schizophrenia. Oxidative stress, disturbed thinking and irrational behavior which are common to schizophrenic patients may be a result of changes in the levels of certain trace metals. METHODS: Twenty (20) healthy volunteers and a total of thirty-five (35) schizophrenic patients consisting of 20 on antipsychotic drugs for at least 2 weeks and 15 newly diagnosed but not taking antipsychotic drugs we...

  17. [Prevalence of human papillomavirus (HPV) in Belém, Pará State, Brazil, in the oral cavity of individuals without clinically diagnosable injuries].

    Araújo, Marizeli Viana de Aragão; Pinheiro, Helder Henrique Costa; Pinheiro, João de Jesus Viana; Quaresma, Juarez Antônio Simões; Fuzii, Hellen Thais; Medeiros, Rita Catarina

    2014-05-01

    This cross-sectional study aimed to determine HPV prevalence in the oral cavity of individuals without clinically diagnosable lesions and to identify the respective HPV types. A total of 166 samples were analyzed from patients 18 years or older in the State of Pará, Brazil. Samples were collected by sterile brush scraping in the oral cavity. HPV detection used polymerase chain reaction (PCR). Infected samples were typed as HPV 6, 11, 16, 18, 31, 33, 35, 52, and 58. HPV was present in 40 samples (24.1%). Three samples (7.5%) were positive for HPV 6, five (12.5%) for HPV 18, and one (2.5%) for HPV 58. PMID:24936827

  18. Patient representatives' views on patient information in clinical cancer trials

    Dellson, Pia; Nilbert, Mef; Carlsson, Christina

    2016-01-01

    BACKGROUND: Patient enrolment into clinical trials is based on oral information and informed consent, which includes an information sheet and a consent certificate. The written information should be complete, but at the same time risks being so complex that it may be questioned if a fully informe...

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

    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

  20. Clinical Features and Outcomes of Patients With Genotype 3 Hepatitis C Virus Infection in Korea

    Cha, Ra Ri; Lee, Sang Soo; Lee, Chang Min; Ji, Sung Bok; Jung, Hee Cheul; Cho, Hyun Chin; Kim, Jin Joo; LEE, JAE MIN; Kim, Hong Jun; Ha, Chang Yoon; Kim, Hyun Jin; Kim, Tae-Hyo; Jung, Woon Tae; Lee, Ok-Jae

    2016-01-01

    Abstract Hepatitis C virus (HCV) genotype 3 infection is very rare in high-income Asia Pacific. The aim of our retrospective observational study was to evaluate the incidence, clinical features, and treatment outcomes of patients with a genotype 3 HCV infection in the Gyeongnam Province of Korea. Ninety-eight consecutive patients diagnosed with a genotype 3 HCV infection at Gyeongsang National University Hospital, between January 2005 and December 2014, were enrolled into the study. Relevant ...

  1. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

    Hikmat N Abdel-Razeq; Mansour, Asem H; Ismael, Yousef M

    2011-01-01

    Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE) in asymptomatic cancer patients. The significance and clinical outcome of such inc...

  2. A rare clinical case of subdural hemorrhage in a patient with scrub typhus

    Aradhna Sharma; Tarun Sharma(Department of Theoretical Physics, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba-400005, India); Anuradha Sood

    2016-01-01

    Scrub typhus is a common infectious disease with a self-limiting course but may potentially cause a fatal outcome in some cases. We here present a case report of a patient diagnosed with scrub typhus and was given effective antibiotic therapy. Initially, the patient improved significantly but had sudden clinical deterioration on day five and presented with subdural hemorrhage. Orientia tsutsugamushi the causative agent of scrub typhus may be considered as a causal or provoking factor for cere...

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

    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; Jackson, Mandy; Tucker, Stephen J; Nmeth, Andrea H

    2015-07-01

    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

  4. Comparison Between Clinical and Echocardiographic Findings in Infants and Children Diagnosed with Hypertrophic Cardiomyopathy

    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.

  5. Pacientes con Giardia lamblia diagnosticada por frotis duodenal / Patients with Giardia lamblia diagnosed through duodenal smear

    Hidelisa, Herrero Aguirre; Jess, Fernndez Duharte; Suleidy, Vega Sam; Jos Antonio, Candel Herrero.

    2014-12-01

    Full Text Available Se efectu un estudio descriptivo y transversal de 105 pacientes mayores de 15 aos con infeccin por Giardia lamblia, diagnosticada por frotis duodenal mediante endoscopia en el Servicio de Gastroenterologa del Policlnico de Especialidades del Hospital Provincial Docente Clinicoquirrgico "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, sntomas digestivos referidos, positividad del frotis e imagen endoscpica. Se utiliz el porcentaje como medida de resumen. Predominaron el sexo femenino (58,0 %), el grupo etario de 29-39 aos (38,0 %), la epigastralgia como sntoma principal (66,6 %) y las imgenes endoscpicas grados I y II como las ms frecuentes (68,4 y 41,3 %, respectivamente). El ndice 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

  6. Predicting reoffense in pedophilic child molesters by clinical diagnoses and risk assessment.

    Eher, Reinhard; Olver, Mark E; Heurix, Isabelle; Schilling, Frank; Rettenberger, Martin

    2015-12-01

    A Diagnostic and Statistical Manual of Mental Disorders (DSM)-based diagnosis of pedophilia has so far failed to predict sexual reoffense in convicted child molesters, probably because of its broad and unspecific conceptualization. In this study, therefore, we investigated the prognostic value of the subtype exclusive pedophilia and a series of customary risk assessment instruments (SSPI, Static-99, Stable-2007, VRS:SO) and the PCL-R in a sample of prison released pedophilic sexual offenders. First, we examined the convergent validity of risk assessment instruments (N = 261). Then, we calculated the predictive accuracy of the measures and diagnosis for sexual recidivism by ROC analyses and subsequent Cox regression (N = 189). Also, predictive values with more clinical immediacy were calculated (sensitivity, specificity, PPV and NPV). The VRS:SO, the SSPI, and the Static-99 significantly predicted sexual recidivism, as did a diagnosis of exclusive pedophilia. Also, the VRS:SO predicted sexual reoffense significantly better than the Stable-2007, the Static-99/Stable-2007 combined score, and the PCL-R. When used combined, only the VRS:SO and a diagnosis of exclusive pedophilia added incremental validity to each other. Our findings support that the clinical diagnosis of an exclusive pedophilia based on DSM criteria and VRS:SO defined risk factors can reliably discriminate higher from lower risk offenders, even within the select subgroup of pedophilic child molesters. PMID:26146817

  7. Phase II Evaluation of Gefitinib in Patients With Newly Diagnosed Grade 4 Astrocytoma: Mayo/North Central Cancer Treatment Group Study N0074

    Purpose: Amplification of the epidermal growth factor receptor (EGFR) gene represents one of the most frequent gene alterations in glioblastoma (GBM). In the current study, we evaluated gefitinib, a potent EGFR inhibitor, in the treatment of adults with newly diagnosed GBM. Methods and Materials: Ninety-eight patients (96 evaluable) were accrued between May 18, 2001, and August 2, 2002. All were newly diagnosed GBM patients who were clinically and radiographically stable/improved after radiation treatment (enrollment within 5 weeks of radiation completion). No prior chemotherapy was permitted. EGFR amplification/mutation, as assessed by fluorescence in situ hybridization and immunohistochemistry, was not required for treatment with gefitinib but was studied when tissues were available. Gefitinib was administered at 500 mg each day; for patients receiving dexamethasone or enzyme-inducing (CYP3A4) agents, dose was escalated to a maximum of 1,000 mg QD. Treatment cycles were repeated at 4-week intervals with brain magnetic resonance imaging at 8-week intervals. Results: Overall survival (OS; calculated from time of initial surgery) at 1 year (primary end point) with gefitinib was 54.2%, which was not statistically different compared with that of historical control population (48.9%, data from three previous Phase III North Central Cancer Treatment Group studies of newly diagnosed GBM patients). Progression-free survival (PFS) at 1 year post-RT (16.7%) was also not significantly different to that of historical controls (30.3%). Clinical outcome was not affected by EGFR status (amplification or vIII mutation). Fatigue (41%), rash (62%), and loose stools (58%) constituted the most frequent adverse events, the majority of these being limited to Grade 1/2. Of note, the occurrence of drug-related adverse effects, such as loose stools was associated with improved OS. Conclusions: In our evaluation of nearly 100 patients with newly diagnosed GBM, treatment with adjuvant gefitinib post-radiation was not associated with significant improvement in OS or PFS. However, patients who experienced gefitinib-associated adverse effects (rash/diarrhea) did demonstrate improved OS.

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

    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 ...

  9. [Clinical Handling of Patients with Dissociative Disorders].

    Okano, Kenichiro

    2015-01-01

    This paper discusses the way informed psychiatrists are expected to handle dissociative patients in clinical situations, with a specific focus on dissociative identity disorders and dissociative fugue. On the initial interview with dissociative patients, information on their history of trauma and any nascent dissociative symptoms in their childhood should be carefully obtained. Their level of stress in their current life should also be assessed in order to understand their symptomatology, as well as to predict their future clinical course. A psychoeducational approach is crucial; it might be helpful to give information on dissociative disorder to these patients as well as their family members in order to promote their adherence to treatment. Regarding the symptomatology of dissociative disorders, detailed symptoms and the general clinical course are presented. It was stressed that dissociative identity disorder and dissociative fugue, the most high-profile dissociative disorders, are essentially different in their etiology and clinical presentation. Dissociative disorders are often confused with and misdiagnosed as psychotic disorders, such as schizophrenia. Other conditions considered in terms of the differential diagnosis include borderline personality disorder as well as temporal lobe epilepsy. Lastly, the therapeutic approach to dissociative identity disorder is discussed. Each dissociative identity should be understood as potentially representing some traumatically stressful event in the past. The therapist should be careful not to excessively promote the creation or elaboration of any dissociative identities. Three stages are proposed in the individual psychotherapeutic process. In the initial stage, a secure environment and stabilization of symptoms should be sought. The second stage consists of aiding the "host" personality to make use of other more adaptive coping skills in their life. The third stage involves coaching as well as continuous awareness of their comorbid psychiatric conditions. Lastly, factors preventing the patients' smooth recovery process are mentioned. They include their contact with past and current aggressors, chronic and ongoing stress within the family, including abuse and violence, and comorbid conditions such as depression and chronic medical conditions. PMID:26524866

  10. A note on clinical presentations of amebic liver abscess: an overview from 62 Thai patients

    Wiwanitkit Viroj

    2002-07-01

    Full Text Available Abstract Background Amebic liver abscess is a tropical disease with a wide spectrum of clinical presentations. Given the often nonspecific nature of the complaints related to amebic abscess, a retrospective review of patients with confirmed disease to recognize the most common patterns of presentation is useful. Here, we study the clinical presentations of 62 Thai patients with amebic liver abscess. We also compare the clinical presentations of Anti HIV seronegative and Anti HIV seropositive patients. Methods A retrospective case review was carried out for 62 Thai patients who had been diagnosed with amebic liver abscess. Clinical information was collected, including symptoms and signs, location and number of abscesses. The Anti HIV serology laboratory investigation was also reviewed. Results According to our study, the common clinical symptoms and signs are abdominal pain (85.5 %, fever and chills (74.2 %, and abdominal tenderness (69.4 %. The location of the abscess was predominantly in the right lobe (74.2 %, and most of patients had a single abscess (77.4 %. Similar trends in clinical presentations were observed in both Anti HIV seropositive and Anti HIV seronegative subjects. Conclusions In conclusion, the clinical presentations of our amebic liver abscess patients were similar to those in previous reports. A similarity to those in the pyogenic liver abscess patients can be observed. Nevertheless, we could not detect important significant differences in the clinical presentations between Anti HIV seropositive and Anti HIV seronegative groups of patients.

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

    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

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

    Denti, Paolo; Jeremiah, Kidola; 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

  13. Differential Diagnoses of Overgrowth Syndromes: The Most Important Clinical and Radiological Disease Manifestations

    Overgrowth syndromes comprise a heterogeneous group of diseases that are characterized by excessive tissue development. Some of these syndromes may be associated with dysfunction in the receptor tyrosine kinase (RTK)/PI3K/AKT pathway, which results in an increased expression of the insulin receptor. In the current review, four overgrowth syndromes were characterized (Proteus syndrome, Klippel-Trenaunay-Weber syndrome, Made lungs disease, and neurofibromatosis type I) and illustrated using cases from our institution. Because these syndromes have overlapping clinical manifestations and have no established genetic tests for their diagnosis, radiological methods are important contributors to the diagnosis of many of these syndromes. The correlation of genetic discoveries and molecular pathways that may contribute to the phenotypic expression is also of interest, as this may lead to potential therapeutic interventions

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

    Mor, Anil; Thomsen, Reimar W.; Rungby, Jørgen; Ulrichsen, Sinna Pilgaard; Nielsen, Jens Steen; Stidsen, Jacob; Friborg, Søren; Brandslund, Ivan; Christiansen6, Jens Sandahl; Beck-Nielsen, Henning; Sørensen, Henrik Toft

    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...... similar between groups. Patients in the highest ALAT quartile had more alcohol overuse (10.4% vs. 2.2% with >14/21 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...

  15. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome a comprehensive cancer center experience

    Hikmat N Abdel-Razeq

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (SD was 57.7 (12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension, and sudden death.Keywords: pulmonary embolism, incidental, cancer, chemotherapy

  16. A retrospective classification of diagnoses in terms of DSM-5 for patients included in randomized controlled trials of Ginkgo biloba extract EGb 761(®).

    Hoerr, Robert; Zaudig, Michael

    2016-04-01

    When the early trials of Ginkgo biloba extract EGb 761(®) were conducted, different terms were used to denote ageing-associated neurocognitive disorders. With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a taxonomy covering dementia and pre-dementia stages of such disorders became available. DSM-5 diagnostic criteria for neurocognitive disorders (NCDs) were applied to patients with any type of ageing-associated cognitive impairment, including dementia, enrolled in randomized controlled clinical trials of EGb 761(®), taking into account the reported inclusion and exclusion criteria and patient characteristics at baseline. For 23 of 31 trials (74 %), the inclusion diagnoses could be classified as NCD in accordance with DSM-5. Thirteen trials enrolled patients with major NCD, four trials enrolled patients with mild NCD and six trials enrolled patients with NCD, who could not be classified unambiguously as having mild or major NCD. Although various terms were formerly used for neurocognitive disorders, the patients enrolled in the majority of clinical trials with EGb 761(®) could be classified retrospectively using modern DSM-5 diagnostic criteria. PMID:26267422

  17. The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis

    Kadriye Yasar

    2012-01-01

    Full Text Available Objective: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD was aimed. Materials and Methods: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. Results: Of 55 cases aged ranging between 25 to 79, 33 (59% were female. The cases with tuberculous SD (TBSD, brucellar SD (BSD and pyogenic SD (PSD were found in 24 (43%, 12 (21% and in 19 (34% patients.Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%, 22 (39% and 8 (14% cases. The number of the cases with history of previous surgery or trauma was 14 (25%. Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25% had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively. Conclusion: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation.

  18. The role of the Oregon State University Endophyte Service Laboratory in diagnosing clinical cases of endophyte toxicoses.

    Craig, A Morrie; Blythe, Linda L; Duringer, Jennifer M

    2014-07-30

    The Oregon State University Colleges of Veterinary Medicine and Agricultural Sciences instituted the Endophyte Service Laboratory to aid in diagnosing toxicity problems associated with cool-season grasses in livestock. The endophyte (Neotyphodium coenophalum) present in tall fescue (Festuca arundinacea) produces ergopeptine alkaloids, of which ergovaline is the molecule used to determine exposure and toxicity thresholds for the vasoconstrictive conditions "fescue foot" and "summer slump". Another vasoconstrictive syndrome, "ergotism," is caused by a parasitic fungus, Claviceps purpurea, and its primary toxin, ergotamine. "Ryegrass staggers" is a neurological condition that affects livestock consuming endophyte (Neotyphodium lolii)-infected perennial ryegrass (Lolium perenne) with high levels of lolitrem B. HPLC-fluorescent analytical methods for these mycotoxins are described and were used to determine threshold levels of toxicity for ergovaline and lolitrem B in cattle, sheep, horses, and camels. In addition, six clinical cases in cattle are presented to illustrate diagnosis of these three diseases. PMID:25017309

  19. Perigastric appendagitis: CT and clinical features in eight patients

    Aim: To describe perigastric appendagitis (PA) on CT as a new and distinct clinical entity to enable recognition and prevent additional unnecessary investigation or intervention. Materials and methods: Institutional review board approval was obtained and informed consent was waived. Retrospective review of the clinical data and CT findings in eight patients with PA encountered over 10 years at one institution was performed. The English literature was reviewed and summarized. Two experienced abdominal radiologists reviewed the CT images by consensus. Results: Seven of eight patients had moderate to severe epigastric pain for 1–7 days. All eight patients (four men, four women; mean age 44 years, range 33–81 years) had no fever or leukocytosis. All underwent abdominal CT which showed ovoid fat inflammation along the course of the perigastric ligaments (gastrohepatic, gastrosplenic, and falciform). Two had gastric wall thickening. Although the inflammation was correctly described, the specific diagnosis was not made on initial interpretation in five patients. Subsequently, they underwent further diagnostic testing [an upper gastrointestinal examination and hepatobiliary iminodiacetic acid (HIDA) cholescintigraphy, an upper endoscopy and MRI examination, HIDA cholescintigraphy, another CT, and an MRI examination, respectively]. The HIDA cholescintigraphy, upper GI examination, and upper endoscopy examinations were normal. No repeated examination was performed on the other three patients. Pain resolved spontaneously in all within two days. Conclusion: Perigastric appendagitis can present with an acute abdomen, which is safely managed conservatively if diagnosed correctly. Radiologists should be aware of the entity to avoid unnecessary intervention, and recognize the CT findings of ovoid fat inflammation in the distribution of the perigastric ligaments. - Highlights: • Normal perigastric ligaments can have fatty appendages. • Torsion of these appendages causes moderate to severe abdominal pain. • Appearance on CT scan is similar to epiploic appendagitis and omental infarction. • Radiologists should be aware of this unknown and under-reported entity. • Treatment is conservative. Lack of knowledge may prompt unnecessary intervention

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

    Nghiemphu, Phioanh Leia, E-mail: leian@ucla.edu [University of California, Los Angeles, CA (United States); Wen, Patrick Y. [Dana -Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Lamborn, Kathleen R. [University of California, San Francisco, CA (United States); Drappatz, Jan [Dana -Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Robins, H. Ian [University of Wisconsin, Madison, WI (United States); Fink, Karen [University of Texas, Southwestern, Dallas, TX (United States); Malkin, Mark G. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lieberman, Frank S. [University of Pittsburgh, Pittsburgh, PA (United States); DeAngelis, Lisa M. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Torres-Trejo, Alejandro [University of Pittsburgh, Pittsburgh, PA (United States); Chang, Susan M. [University of California, San Francisco, CA (United States); Abrey, Lauren [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Fine, Howard A. [Neuro-Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, MD (United States); Demopoulos, Alexis; Lassman, Andrew B. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kesari, Santosh [Dana -Farber/Brigham and Women' s Cancer Center, Boston, MA (United States); Mehta, Minesh P. [University of Wisconsin, Madison, WI (United States); Prados, Michael D. [University of California, San Francisco, CA (United States); Cloughesy, Timothy F. [University of California, Los Angeles, CA (United States)

    2011-12-01

    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.

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

    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.

  2. Clinical service desires of medical cannabis patients

    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.

  3. Validity of Commonly Used Clinical Tests to Diagnose and Screen for Spinal Pain in Adolescents

    Aartun, Ellen; Hartvigsen, Jan; Hestbaek, Lise

    2016-01-01

    were collected at the age of 11 to 13 (n = 1224) and 2 years later (n = 963). Spinal pain (neck pain, mid back pain, and low back pain) was assessed by an electronic survey completed during school time, and reference standard was defined as both lifetime prevalence and frequent pain as a proxy of......OBJECTIVE: The overall aim of this study was to determine the ability of 2 selected clinical tests to detect or predict neck pain, mid back pain, and low back pain in a school-based cohort of Danish 11- to 15-year-olds. METHODS: A school-based 2-year prospective cohort study was conducted. Data...... under the receiver operating characteristic curve was calculated for evaluation of all tests combined. RESULTS: The sensitivity was low, and specificity was high for all tests at both baseline (age, 11-13 years) and follow-up (age, 13-15 years). When all tests were evaluated collectively in 1 model, the...

  4. Monitoring patient rights--a clinical seminar.

    Shalev, Carmel; Freiman, Efrat

    2002-01-01

    Israel enacted the Patient Rights Law in 1996. The Law embodies a movement from paternalism to autonomy in doctor-patient relations. The following year, law students at the Israeli Centre for Academic Studies participated in a clinical seminar designed to measure internalisation ofthe Law, through personal interviews with hospitalized patients. The seminar can be adapted for medical students. The methodology is taken from human rights field work. The objective is to use patient rights as indicators of quality of care in medical settings. Students studied the text and principles of the Law in light of personal testimonies taken from relatives and friends. They developed an open-structured questionnaire, and were trained in interviewing with due respect for the patients' dignity and privacy, and the need to obtain their free and informed consent to the interview. The interviews were conducted in Hadassah Hospital, Jerusalem, after receiving approval of the Helsinki Committee. The findings, though in no way statistically valid, are nonetheless interesting. Students received training in listening and advocacy skills. The approach is conciliatory rather than adversarial. The thesis is that respect for patient rights is an efficient tool for quality control, risk management, conflict resolution and prevention of litigation. PMID:12437201